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Last Updated: Friday, 28 November, 2003, 19:31 GMT
India's widening Aids epidemic
By Subhadra Menon
In Delhi

Amrita Deshpande has been living with HIV for almost seven years.


She caught the virus from her husband, who did not tell her he was HIV-positive when they married.

Ms Deshpande - not her real name - suspects she caught the virus from a prostitute, but she does not know.

"My husband thought marriage would give him social acceptability, and succumbing to Aids after being married was somehow a better thought," she told me.

Many young women in India are in similar situations to Deshpande, infected in their own homes by their own husbands.

The trend marks a critical point in the country's battle with HIV. As the virus spreads from high-risk groups such as sex workers and injecting drug users to mainstream society, it becomes harder to control.

The National Aids Control Organisation (NACO), the government body established to combat Aids, says there are clear indications that this shift is taking place.

Growing epidemic

About 4.6 million Indians are infected with HIV, according to government figures.

This is the world's second-highest number of infections in a single country, yet HIV prevalence in India is still low at less than 1%.

Indian truckers
Truck drivers are one of India's high-risk groups
Should the disease really take hold as it has in sub-Saharan Africa, the numbers affected would be vast.

Dr Sunithi Solomon, Director of YRG Care, a voluntary organisation based in Tamil Nadu, and her colleagues spotted the countries' first recorded case of HIV/Aids.

"Not so long ago I would perhaps see one HIV/Aids patient in a week - now it is more like eight a day," she says.

Data fog

Tamil Nadu is one of India's six states with high HIV prevalence, but there is not a single state in India that is free of the virus.

"It is a huge concern that we remain caught up with numbers," says Dr Madhu Bala Nath, regional director for South Asia at the International Planned Parenthood Federation, and also an HIV/Aids and gender expert.

At least people now see HIV/Aids as a problem, and I think the denial phase is beginning to pass
Dr Madhu Bala Nath, International Planned Parenthood Federation

There are patterns that get lost in the data fog - the speedy escalation of HIV among injecting drug users, the rising infection rates among young, monogamous women, and the growing risk faced by men who have sex with men.

Sex workers and truck drivers are also considered particularly vulnerable.

Stigma remains a key issue: "The strong notion of contagion is still very much there, of fear of the disease and of the stigma and discrimination that it can cause", says Lester F. Coutinho, country programme adviser for the Packard Foundation, an international donor agency.

Health battle

India's large population has meant HIV/Aids is an enormous public health challenge for the country.

Antiretroviral drugs
NACO has established an Aids control policy and a blood safety programme.

The central government too has built a variety of prevention programmes.

It is also involved in a partnership with the International Aids Vaccine Initiative, a New York-based non-profit scientific organisation, to develop and test a preventive vaccine for the strain of the virus most common in India.

Efforts have been fuelled by a vibrant and active community of non-governmental organisations. International pressure has helped too.

Long-term view

There is also now very strong pressure on the government to craft a policy to provide access to antiretroviral drugs, which were at one time completely unaffordable to most Indians.

HIV/Aids work still needs greater integration into India's main health programmes, however, as action has tended to be localised.

Dr Nath believes India should look beyond the six high-prevalence states, address nationwide concerns and build long-term systems which will last.

But meanwhile, she says: "At least people now see HIV/Aids as a problem, and I think the denial phase is beginning to pass."

On the streets of Imphal, the quiet capital of Manipur up in the north-eastern corner of India, as you walk past an HIV/Aids clinic and see some 10 patients waiting outside, unabashed, open, you may just believe her.

Subhadra Menon is a project director at the International Aids Vaccine Initiative in India.

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