As AIDS Spreads, India Is Still Struggling for a Workable Strategy
November 14, 2002
Tamil Nadu has among India's highest rates of HIV infections -- nearly doubling to 1,151 cases last month from 613 in October 2001 -- and by far the country's highest number of AIDS cases -- from March 31 to August 31, cases rose from 16,677 to 22,826. But the southern state of 62 million has also led in prevention efforts. After a decade of focusing on high-risk populations like truck drivers and sex workers, the state's rate of antenatal infection appears to be stabilizing or even dropping. But without similar efforts at prevention in other states, many experts fear the worst.Adapted from:
The Tamil Nadu State AIDS Control Society and the AIDS Prevention and Control Project (APAC), which was financed by the US Agency for International Development, have concentrated on high-risk groups. Spending about $6 million a year, they used peer educators, advertising and other methods to promote prevention. The proportion of commercial sex workers using condoms increased to 88 percent in 2001 from 56 percent in 1996, according to APAC, and among truck drivers and their helpers to 78 percent from 44 percent.
Reaching into deeply conservative, diffuse villages, teaching infected men to start using condoms and their wives to demand that they do so, is another matter. Right now, said APAC Project Director Bimal Charles, "someone who goes to buy [condoms] is a marked person," in a culture where AIDS stigma is intense. At least a third of new HIV patients at the state's Hospital for Thoracic Medicine are women, most of them monogamous housewives; of new cases, 72 percent are from rural areas. In 1996, the hospital had 10 cases of children with HIV; now it has 250.
Many private doctors and hospitals -- even many government hospitals -- either refuse or are unable to treat HIV/AIDS patients. In the future, Charles says, more care will be "home-based," intended to give a "dignified end" to the terminal illness. Activists like Rama Pandian see that as shirking responsibility for developing a public health system that can deal with AIDS. It allows doctors and hospitals to continue to avoid treating AIDS patients, Pandian said.
New York Times
11.11.02; Amy Waldman
This article was provided by CDC National Prevention Information Network. It is a part of the publication CDC HIV/Hepatitis/STD/TB Prevention News Update.