HIV/AIDS in India: What women know about it and what is the impact in rural areas

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HIV/AIDS in IndiaWhat women know about it and
what is the impact in rural areas
HIV/AIDS in IndiaWhat women know about it and
what is the impact in rural areas
HIV/AIDS in IndiaWhat women know about it and
what is the impact in rural areas

• Saseendran Pallikadavath
• R William Stones
• Opportunities and Choices Programme
• Centre for AIDS Research

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In 2021, undoubtedly, there will still be an
AIDS epidemic ..The next 20 years can be
different, but only if we act now (Robert and
Jeffrey, N Engl J Med, 2001) Structure of
presentation An overview of HIV/AIDS in India
Womens knowledge about HIV Impact of AIDS in
rural areas Research needs Conclusion
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• Our research
• Secondary data
• Pallikdavath S and Stones RW, Womens
  reproductive health security and HIV/AIDS in
  India, EPW, Vol 38, 2003
• Pallikdavath S and Stones RW, Dissemination of
  AIDS knowledge through Indian Family Planning
  programme prospects and limitations, AIDS, Vol.
  17, 2003
• Pallikdavath S, Snneh A, McWhirter and Stones RW,
  Rural womens knowledge of AIDS in the higher
  prevalence states, Health Promotion International
  (under review)
• Pallikdavath S, Jaychandran and Stones RW,
  Womens reproductive health, socio-cultural
  context and AIDS knowledge in northern India,
  Journal of Health Management (under review)
• Pallikdavath S, Sreedharan C and Stones RW,
  Sources of AIDS knowledge in India, AIDS care
  (submitted)
• Primary data
• 6. Pallikadavath S, Garda L Apte, Freedman J, and
  Stones RW, HIV/AIDS in Rural India context and
  health care needs, Journal of Biosocial Sciences
  (under review)

Womens reproductive health in the context of
HIV
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An overview of HIV/AIDS in India
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Projections 30 million HIV by 2010 Dr Soloman
(March 30 2004, talk in California) 12 million
HIV by 2015 according to UN (Economist, April 15,
2004) 9 million HIV by 2010 according to NACO
(Economist, April 15, 2004)
HIV in India First HIV case in 1986,Tamil
Nadu HIV cases in 2002 3.82 - 4.58 million
(15-49) 2002 estimate based on 384 sentinel
sites 166 STD 200 Antenatal
(proxy for general) 13
IDU 3 MSM 2 CSW 0.8
prevalence 10 global burden
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AIDS cases in India 68,809 as on March 31, 2004
(others estimate 600,000)

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More men
Proportion of women increased
21
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MTCT
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HIV prevalence () among antenatal attendees,
Northern region-India, 1998-2002
15.3 million married women 15-44
7.8 Million
23.4 Million
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HIV prevalence () among antenatal attendees,
Southern region-India, 1998-2002
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HIV prevalence () among antenatal attendees,
North-eastern region-India, 1998-2002
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(No Transcript)
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Implications
An increase of HIV prevalence in low prevalence
states (Northern) A decline of HIV in high
prevalence states (Southern and some NE States).
North-South differentials can mask the reality
Significant variations exists across
states Low HIV prevalence in some states can
neglect localised epidemics
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Implications Even a decline in new HIV cases in
future would lead to a large number of AIDS cases
due to the momentum created in the
past Provision of continued care to AIDS
patients would remain a major task ART
started in April, 2004 as 3 by 5 initiative by
WHO/UNAIDS. India plans to treat 100,000 PLWA
with possibility of further increase
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Womens knowledge about HIV
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Rural womens knowledge about AIDS
2001 Behavioural surveillance survey (BSS)
(National) Survey conduced by the National AIDS
Control Organisation 84,182 men and women 15-49
years
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Increase in HIV
1.1
1.3
2.6
3.3
Decrease in HIV
6.1
13.9
10.8
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Womens knowledge about AIDS in low and high
prevalence states
Uttar Pradesh and Madhya Pradesh
LOW Maharashtra and Tamil Nadu HIGH 1999-2000
National Family Health Survey a sample survey of
90,303 ever married women in the age group 15-49
years

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Womens knowledge about HIV in Uttar Pradesh and
Madhya Pradesh, 1998-2000


Heard of HIV Uttar Pradesh 20.2 India
40.3 Madhya Pradesh 22.7 106 million
married women in the age 15-49 no Aware
that HIV can be avoided AIDS knowledge Uttar
Pradesh 59.2 Madhya Pradesh 56.4 Having
correct knowledge Uttar Pradesh 45.7 Madhya
Pradesh 47.5
Only 5 married women have correct knowledge
in UP
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Vulnerable women groups in North Older Poor
Less educated Not having access to TV Non-users
of FP Lack of integration of FP with HIV
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Womens knowledge about HIV in rural Maharashtra
and Tamil Nadu, 1998-2000

24 married women in rural MHA have correct
knowledge

Heard of HIV Maharashtra 40.1 Tamil Nadu
84.0 Aware that HIV can be
avoided Maharashtra 55.4 Tamil Nadu 85.5
Having correct knowledge Maharashtra
59.3 Tamil Nadu 43.2
31 married women in rural TN have correct
knowledge
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Vulnerable women groups in the South Less
educated Not working Not having access to TV Not
visited by a FP worker Never users of FP No
access to modern electronic media
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Where do women obtain AIDS knowledge from?

1999-2000 National Family Health Survey a
sample survey of 90,303 ever married women in the
age group 15-49 years

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Source of AIDS knowledge women heard of AIDS from Measure of effectiveness Measure of independent effect Average number of sources
Radio 45.8 10.4 4.8 1.7
Television 68.4 26.7 18.3 1.5
Newspaper 20.7 2.7 0.6 2.2
Pamphlet/magazine 9.5 3.8 0.4 2.5
Clinic/health worker 4.4 16.8 0.7 2.1
Church/Mosque 0.2 15.9 0.1 2.3
School/teacher 1.1 10.1 0.1 2.9
Community meeting 2.9 26.0 0.8 1.8
Friends/relatives 37.3 33.1 12.3 1.6
Work place 3.3 17.7 0.6 1.9
Cinema 5.9 2.6 0.2 2.7
Exhibition 0.6 11.1 0.1 2.8
Adult education programme 0.5 16.8 0.1 3.1
Political leaders 0.1 18.1 0.0 2.6
All -- -- 38.9 3.6
Number of women 19,803 19,803 19,803
Proportion heard of AIDS from only one source,
from among women who had heard of AIDS from that
particular source along with other
sources. E.g. 950 women heard from radio
alone, From among 9073 who heard from radio
Along with all other Source 950/907310010.4
Proportion heard of AIDS from only one source in
relation to all women who had heard of AIDS Eg.
950 had heard of AIDS from Radio alone and 19,903
were aware Of AIDS IE950/19031004.8
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Source of AIDS knowledge women heard of AIDS from Measure of effectiveness Measure of independent effect Average number of sources
Radio 36.4 2.3 0.8 2.1
Television 91.0 30.4 27.7 1.6
News paper 34.0 0.9 0.3 2.2
Pamphlet/magazine 15.9 2.1 0.3 2.6
Clinic/health worker 2.8 6.1 0.2 2.8
Church/Mosque 0.1 15.0 0.0 4.3
School/teacher 1.0 4.1 0.0 3.4
Community meeting 1.5 12.9 0.2 2.7
Friends/relatives 23.2 15.9 3.7 2.0
Work place 1.8 6.8 0.1 3.0
Cinema 10.6 0.7 0.1 2.8
Exhibition 0.7 0.0 0.0 4.0
Adult education programme 0.5 8.9 0.0 3.7
Political leaders 0.1 0.0 0.0 4.5
All -- -- 33.6 4.4
Number of women 16,615 16,615 16,615
Electronic media alone may not achieve 100
awareness Media underclass needs special
efforts High-effective media needs special
focus community level, and inter-personal
communication Targeting married women
audience appropriate time culturally
compatible contents
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Impact of AIDS in rural areas
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Impact of AIDS in rural areas
Field work in Dec 2001- Interviews with HIV
men and women and focus group interviews with
general population in 4 villages in Pune,
Maharashtra

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How rural women get HIV?
Truck drivers Small business trips to urban
areas I think I got the disease from sex
workers to whom I used to visit during my trips
to Bangalore. At that time I used to have sex
with whomever was available. I was working as a
truck driver. For about one to one and half years
I used to go there and used to have sex about
three or four times a month 40 year old HIV
positive man

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• I got the infection from my husband . He used
  to go out and that is how he got it.In the
  last days when he was dying he made me sit by him
  and told me that he went out with other women and
  that is why he got this infection. He told me
  that he was sorry
• 23 year old HIV positive widow

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• people do not invite me.family members do not
  treat me well. They do not let me touch anything,
  mix with them, do not let me cook for my son. I
  was admitted for TB. After I came home they asked
  me to stay separate Neighbours when come to know
  about my HIV, asked my family members to keep me
  separate. They do not come to my house. My
  relatives do not come to my house. They do not
  touch me.
• 28 year old HIV positive widow

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Impact in rural areas TYPICAL PATTERN

HUSBAND GET THE INFECTION FIRST USES FAMILY
RESOURCES FOR TREATENT WIFE BECOMES HIV WIDOW
(WITH CHILDREN) DRIVEN OUT OF HUSBANDS
HOUSE TAKE SHELTER AT NATAL HOME BECOME A
DESTITUTE
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Research needs and conclusion
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How to keep the low prevalence levels in
northern India? Cost-effective IEC to reach
hard-to- reach women population
Cost-effective prevention innovative
projects Integrating HIV knowledge with FP
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How to mitigate the impact of HIV on rural
women? Economic projects/schemes targeting
rural women Legal assistance to rural
women Social projects to mitigate
stigma Prioritising ART and health care to
widowed and poor women with children
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Conclusion While basic knowledge about AIDS
needs to be imparted to women, there is an urgent
need to provide health care including ART to
women living with AIDS. Social and economic
interventions focusing on women are required to
mitigate the impact of AIDS in rural areas.
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Thanks.