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HIV Around the World - India

More HIV Cases than Anywhere in the World

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Updated February 10, 2007

This feature is the first in a series of articles reviewing the state of HIV around the world. While HIV strikes people and populations all over the world, how it impacts each area, each population, and each culture can be very different. This article takes a look at a part of the world hit very hard by the HIV epidemic. A country of more than a billion people with millions living with HIV. HIV Around the World takes us to India.

India – Demographics

Here are some facts about India:
  • located in South Asia

  • seventh largest country geographically, and the second most populous country in the world

  • approximately 1.1 billion people

  • four major religions – Hinduism, Buddhism, Jainism, and Sikhism

  • while India has the fourth-largest and the second-fastest growing economy in the world, the country still has very high levels of poverty, environmental pollution, disease, and malnutrition.

In some of the urban and more populous areas, there are some primary health care centers that offer quality health care and research. However, the population growth of India has outpaced the growth of the health care industry, resulting in shortages of health care facilities and qualified health care professionals, especially in rural areas. India’s health care system is overseen by the Ministry of Health and Family Welfare.

The Status of HIV and HIV Care in India

Here are some facts about HIV in India:
  • HIV emerged as a problem in India almost a decade later than the rest of the world.

  • HIV rates skyrocketed in the 1990’s and continues today. In fact, India has the highest population of people living with HIV anywhere in the world.

  • At first, HIV was isolated to high-risk populations such as sex workers and the country’s huge truck driver force. Today, all sectors of India’s population is affected.

  • It is estimated that in 1990 there were approximately 200,000 people infected with HIV in India. By 2003 that number had climbed to 5.1 million. Currently, it’s estimated that between 5.2 and 5.7 million people are living with HIV in the country.

  • HIV prevalence estimates vary depending on who you talk to. The World Health Organization (WHO) reports that India's HIV prevalence is on the rise with 5.7 million people living with HIV, while India's National AIDS Prevention and Control Policy (NACO) says the spread of HIV is 5.2 million and slowing down.

Who's Infected?

As was stated earlier, HIV has progressed from a disease found in only the highest-risk population to one found in all segments of the Indian population, be it men, women, rich, poor, urban or rural. Populations thought at one time to be low risk are now being infected, as are high-risk groups. Some groups are being infected at a higher rate than others, however. For instance, women are being infected by way of heterosexual transmission at an alarming rate. Women now make up about 39 percent of those people living with HIV. Most are being infected by husbands or boyfriends who have multiple sexual partners, many of whom are HIV infected and do not know it. Here are some facts about those populations considered to have the highest risk of acquiring HIV.

  • Sex Workers – Because of widespread poverty throughout India, women often resort to prostitution as a means of making money for their families. Others are forced into sex work due to an underground of violence and disrespect toward women. Finally, women involved in marital break-ups will often begin prostituting themselves as a means of surviving financially after being left with children to feed and a household to support. In some areas of India, it’s estimated that one in every two sex workers are HIV infected, many not knowing it.

  • IV Drug Use (IVDU) – The recreational use of drugs often overlaps with the sex trade. While IVDU seems to be worse in the northeastern parts of India, it is common throughout the country. Many attribute the widespread problem of IVDU and HIV to government policies that do not support HIV prevention and risk reduction among IV drug users. Because IVDU is a crime and is consistently enforced and prosecuted, getting prevention messages to users is very difficult. There have been instances of prevention workers themselves being arrested while trying to help and educate IV drug users. Official estimates actually report the HIV prevalence among IV drug users to have gone down from 13 percent in 2003 to 10 percent in 2005.

  • Truck Drivers – India’s economy depends a great deal on its very large trucking network across the country. While truckers help move goods and services throughout India, they also contribute a great deal to the huge HIV population and the spread of HIV from one area of India to another. Truckers will pick-up sex workers along their route, engage in unprotected sex activity and then drop off the sex worker at the trucker’s next stop along the route. This has contributed to the spread of HIV from urban areas into the rural towns and villages. The most damaging fact about truckers and their use of sex workers is that neither party knows they are infected.

  • Men Having Sex with Men – There is a high degree of stigma associated with homosexuality in India. In fact, homosexuality has been criminalized, making HIV education and surveillance very difficult. Outreach workers are often harassed and even arrested for “promoting homosexuality.” It’s estimated that 42 percent of all men who have sex with men are also married, fueling the increasing HIV infection rate among women of India.

  • Migrant Workers – As is the case in the United States, migrant workers in India are very transient and mobile, moving from town to town wherever the work takes them. Unfortunately, they take their risky behavior along with them, fueling the spread of HIV throughout India. While there are attempts at HIV education, the variety of languages, dialects, and cultures makes HIV education very difficult.

Continue to Page 2 to see what is being done about the HIV epidemic in India.

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