Posts Tagged With: HIV

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The HIV Problem

Let’s talk about it – we need to.

HIV/AIDS is causing untold human suffering and, in many countries, is reversing decades of developmental progress. Since the late 1970s, more than 23 million people have lost their lives to the disease and by 2010, the cumulative toll is expected to rise to 45 million. After more than 30 years of the earliest-known cases, many people around the world still remain uniformed. In many countries, indigenous traditions and cultures are not conducive to facing up to the taboo surrounding sex and sexuality.  Čítať ďalej

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The Price of Not Knowing

In India, ignorance remains a key challenge in the battle against AIDS

In the battle against AIDS, ignorance remains one of the most crucial challenges, an unstuck cog that will not let the wheel turn smoothly no matter how much we push. Globally, more than 40 per cent of respondents do not understand that AIDS is always fatal. A few months ago, a global study by M·A·C AIDS Fund found that, shockingly, AIDS is still underestimated as a global killer. In India, where rates of HIV are rising, 59% believe that HIV is a curable disease. In a collusion of opinion and fact, this first-ever perception audit also found that 86 per cent of adults in the United States, U.K., France, Russia, China, India, Brazil, Mexico and South Africa believe stigma and shame to be a contributor to the spread of HIV. Seventy-six per cent report lack of access to treatment to be a problem as well.

Some astonishing fallacies about access to treatment seem to be in circulation as well. According to the survey, many people mistakenly believe there is currently a cure for HIV. People also believe treatment is more widely available than it is. According to the study, “nearly half of all respondents believe that most people diagnosed with HIV are receiving treatment, when in fact only one in five people who needed treatment received it in 2006.”

The survey also suggests an continuing stigma surrounding HIV. Nearly half of the people surveyed reported being uncomfortable working with those who are HIV positive, while slightly more than half of the respondents did not want to live in the same home as someone infected with HIV.

Despite public health campaigns and sustained efforts by various non-governmental and non-profit organisations working in the sphere, myths about AIDS are both widespread and persistent. Many are ignorant about how the disease spreads or what can be done to prevent it. A major part of the problem is that personal prejudices have kept the stigma and shame about HIV alive. Also, taboos related to sexuality have kept discussion about AIDS out of the places where they most need to be taking place—the home and the classroom. Cultural taboos forbid speaking to children or teenagers about such matters and health becomes a distant lower priority as compared to “morality”. Disturbingly, sex education is still not part of the curriculum in India’s schools. Of course, culture is an important parameter to keep in mind while communicating. But this should not hinder honesty when it comes to important, potentially life-and-death impacting factors. Besides public awareness campaigns, mainstreaming HIV/AIDS awareness into education is imperative because it will enable us to prevent the next generation from facing the scourge that has devastated so many in this one.

Social mores that prevent women from exercising control or agency in their own lives exacerbates the problem. There are approximately 2.5 million cases of HIV in India, with 60% of these occurring amongst the rural population. Married women of childbearing age are considered to be at high risk of HIV because of their husbands’ pre-marital and extra-marital sexual activity but another recent study revealed that levels of HIV testing amongst pregnant women in rural India are very low, and even women who have symptoms of sexually transmitted infections or tuberculosis are not being referred for HIV voluntary counselling or testing.

Formal institutions have been unable or unwilling to address the problem of ignorance with adequate seriousness. All of this points to the growing responsibility that development workers have—to fill this lacunae and educate people in families and communities about AIDS, as often and as comprehensively as possible.

Sources:

1. Global Study at M·A·C AIDS Fund; Retrieved online from http://www.macaidsfund.org/news/pr_rl_global_study.html
2. ‘How the World Thinks About AIDS’, TIME Magazine; Retrieved online from http://www.time.com/time/health/article/0,8599,1684462,00.html
3. ‘Very low levels of HIV testing amongst women in rural India’, January 28, 2008, Aidsmap News (http://www.aidsmap.com)
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A Dangerous Marriage? Women and HIV/AIDS

The United Nation states that in many parts of the world women are most likely to be exposed to HIV infection in their marriage beds. Women’s fertility and her relationship to her husband are often the source of an Indian woman’s social identity. Besides biological influences, the HIV/ AIDS epidemic in India is inextricably tied to the cultural and social values and economic relationships between men and women and within communities. While social inequalities facilitate its spread in India, the HIV virus, in turn, reflects and reinforces these inequalities.

“There are many social precursors for the rapid spread of HIV in the country, including the inability to talk openly and learn about sex and sexuality, pressures from family to give birth to an heir and an implicit threat to the marriage when a woman is unable to become a mother, the high prevalence and acceptability of domestic violence against women, the moral double standard imposed on men and women, and the lower status of women in general. The pressure to be a mother is so intense that when a woman has to choose between being HIV-seronegative but without children and possible conception with possible HIV infection, she often chooses the latter.” (S.Solomon and A.K.Ganesh, 21)

For a majority of people in India, it is still hard to believe that heterosexual transmission accounts for 80 percent of all infections. Generally speaking – 39 percent of PLWHA (people living with HIV and AIDS) in India are women. Data indicates that 7 of 10 women affected by HIV are from poor rural and poor urban communities. Yet, at least 70 percent of women in rural areas have not heard of the virus. The only sexual contact 75 percent of HIV positive women have had is with their husbands.

Why are women in India more likely to be exposed to HIV infection than men? Let’s look at the major factors:

  1. Male-to-female HIV transmission occurs more easily. Young girls and women are more susceptible to HIV than boys and men. In numbers, it means that they are 2.5 times more likely to be HIV-infected as their male counterparts.
  2. Women are more likely to be sexually exploited. Statistics show that 1 of 3 women around the world is raped, beaten, coerced into sex, or otherwise abused in her lifetime. A strong link was established between unwanted sex and marital violence.
  3. Women are generally less educated. According to the International Women’s Health Coalition in India, if HIV and AIDS education is even offered in schools, it is to young people 15 years and older. Yet 42 percent of boys and 69 percent of girls (15-17) are not in school. Even the so-called educated women are not aware of HIV and AIDS. There are myths prevalent about sexually transmitted diseases (STD) such as having sex with a ‘virgin’ can cure a man suffering from STD and many believe that certain symptoms of STD such as white discharge is the effect of body heat or overwork and do not go for check-ups.
  4. Women have fewer rights. The general standard of life of Indian women is lower than that of men. Often, a HIV positive woman is subjected to greater levels of hostility and stigma than their male counterparts.
  5. Women have less economic independence. The economic vulnerability of women makes it more likely that they will exchange sex for money or favors and less likely that they will succeed in negotiating protection.
  6. Some traditions are harmful to women. In many rural areas, there are traditional forms of sex work. One such example is the tradition of the devadasi, in which young women are “married” to a temple or deity and then provide sexual services to patrons and priests. In India, 27 percent of male clients of male sex workers are married or living with a female partner.
  7. Men determine sexual behaviour. Indian society praises patriarchy and male sexuality. There is an absence of choice at the individual and systemic levels for women. It is difficult for women to be informed about risk reduction.

Inequalities Abound

Prevention of HIV transmission is hindered by gaps in knowledge and by cultural, legal, and medical factors. In 2004, only an estimated four percent of all pregnant women received HIV counseling and testing, and only about two percent of HIV positive pregnant women received antiretroviral prophylaxis. This tendency is supported by the fact that many deliveries are not attended by medical personnel.

The most common method of contraception in India, particularly in the south, has historically been the sterilisation of women, typically done before they turn 30. In Andhra Pradesh, female sterilisation is used for family planning by 62.9 percent of married women and condoms by only 0.5 percent. Advocating the use of condoms has been viewed as promoting promiscuity. The acceptance, availability, and use of condoms are increasing, but primarily among sex workers and outside of marriage.

Mortality and morbidity data indicate that women in India remain providers rather than receivers of health care. Shalini Bharat of the Tata Institute of Social Sciences (TISS), Mumbai, revealed in a 2001 study that while the majority of those who shared their HIV status with their families were looked after by family members, it was largely men who received such care.

Women with HIV are often subjected to various forms of violence and discrimination based on gender. Usually they are those ones considered responsible for a husband’s HIV diagnosis. They are often refused a share of household property, denied access to treatment and care or even physically abused. Deaths due to injury and sexual violence of women with HIV are on the increase. A study by K. Sathiamoorthy and Suniti Solomon showed 48.7 percent of women living with HIV experienced violence in their home.

In the last few years, prevention experts have shifted from looking at the HIV and AIDS epidemic solely as a health issue to focusing on other factors. Focus on social inequalities and empowerment is important in dealing with HIV and AIDS.

Empowerment is the key

Health officials in India recognize the need to frame strategies to address women’s health care, including HIV vulnerabilities, in the context of rights. Generally there is a need to deal with a virus which is more dangerous than HIV. It is the virus which is affecting people’s minds and cultures and makes us look at women as inferior to men.

Besides the importance of safer practices, abstinence and voluntary testing, empowerment of women is essential. There is a need to design policies to empower women in India. Decreasing the gender gap in education, improving women’s access to economic resources, increasing women’s political participation, and protecting women from violence are key.

References:
http://www.yrgcare.org/downloads/HIV_in_India.pdf
http://news.bbc.co.uk/2/hi/south_asia/4260314.stm
http://www.breakthrough.tv/teach_detail.asp?TeachId=9
http://www.iwhc.org/resources/hivaidsfactsheet.cfm
http://www.commed.uchc.edu/cichs/research/womensrisk.htm
http://content.nejm.org/cgi/content/full/356/11/1089
http://gateway.nlm.nih.gov/MeetingAbstracts/ma?f=102250393.html
http://www.prb.org/Articles/2003/WithoutMyConsentWomenandHIVRelatedStigmainIndia.aspx
http://www.un.org/womenwatch/daw/csw/hivaids/Gupta.html
Happonen O. Hannu, Opportunity in crisis. Basic Lessons on HIV and AIDS.
Maria Cimperman, When Gods people have HIV and AIDS. An approach to ethics. New York, 2006
Suniti Solomon, MD, and Aylur Kailasam Ganesh, ACA, Special Contribution – HIV in India. Volume 10 Issue 3 July/August, 2002
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Training People on HIV/AIDS

Mainstreaming of HIV and AIDS is an important component of FIDA´s projects in India so providing adequate training along with supplementary material on HIV/AIDS is an integral part of our work. In the course of working with communities, we have realized that many trainings conducted by NGOs, though well-intentioned, tend to be complicated. They burden the participants with too many charts and statistics and leave them confused. One of our goals was to develop a training package that would be easy to understand as well as practical, i.e. people could take it with them and use it in their community immediately.

Our HIV/AIDS training is targeted at project managers and people who are actively involved in community work. The aim is to train these selected people using contextualized material (flip-charts which are part of the new teaching package) and train them on how to use this to teach other people. In other words, we focus on creating trainers of trainers (TOTs).

We have developed a three-day module on HIV/AIDS for the TOTs. During the first two days, we concentrate on introducing the issue. To do this, we use visual flip charts with full color pictures on one side for the audience and help text for the trainer on the other side. The pictures are especially designed to fit into the Indian context. On the first day, we deal with HIV prevention and myths and facts surrounding it. We explain what HIV and AIDS mean, symptoms of AIDS, and the difference between the two. We also address the three main modes of HIV transmission: sex, blood and mother (parent) to child and we provide practical tips for HIV prevention in all three areas. An important part of training is clarification of how HIV does not spread as this is often connected with false beliefs (e.g. HIV is spread by mosquitoes, touch etc).

The second day is focused on care and support of people living with HIV/AIDS and their families. We cover topics like anti-retroviral treatment, health and nutrition, and positive, balanced living. We also look at children and HIV, as well as other crucial issues like stigma and discrimination.

Besides providing comprehensive information, our goal is to encourage people to talk in their communities about HIV and AIDS because by sharing adequate information they may save many lives. Sharing information within the community also breaks down barriers of fear and prejudice connected with HIV/AIDS.

During the training sessions, we observed great reluctance on the part of the community to say words like condom, sex or even breast-feeding out loud. So we decided to make it easier for them by splitting the group into pairs of the same gender. They can then discuss the issues in a relatively safe environment. This participatory approach has helped them to become more familiar with problematic topics. They are able to speak about things and this helps them remember more. It also prepares them for the second, practical part of training, which is educating the community.

After two days of listening and practicing in pairs, the participants go out and practice what they have learned in their communities. Our goal is to give trainers a chance to present materials by themselves, see what they have learned and provide guidance and direction on what they can do further. This process also allows us to observe how effective the training has been – how much they have absorbed and possible areas of weakness.

Each training is influenced by context and demographical and geographical aspects such as the location of the state, city or village as well as the education levels, age and experience of participants. For example, Mumbai has a high prevalence of HIV positive people and we have been making a lot of effort to develop TOT communities there. This August, we conducted training sessions for workers across FIDA´s slum projects in Bandra and Andheri. Participants liked the material we took for them and were open to studying the topic. The practical part of the training worked especially well because the participants became more comfortable with talking about HIV and AIDS. We visited a slum community in Andheri where the room was bursting with women and more people were standing at the door and on the street. The trainers handled the large numbers and managed to reach out to people individually. It was heartening to see that many of the women knew quite a bit about HIV/AIDS. They had more precise information than some trainers in other areas of India where we did our training. The women told us they had received awareness and training from a hospital. Most of the men were working in the afternoon, which explains why the crowd comprised mostly women. However, it’s important that we reach the men as well because most HIV infections occur through male-to-female transmission so we will need to conduct more sessions at a different time when the men are available.

In each place, we try to assess the particularities of the situation and modify our sessions accordingly.

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