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HIV/AIDS in India: What women know about it and what is the impact in rural areas. HIV/AIDS in India What women know about it and what is the impact in rural areas. HIV/AIDS in India: What women know about it and what is the impact in rural areas. Saseendran Pallikadavath R William Stones

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Hiv aids in india what women know about it and what is the impact in rural areas l.jpg

HIV/AIDS in India:What 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 India:What 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

Women’s 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, Women’s 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 women’s knowledge of AIDS in the higher prevalence states, Health Promotion International (under review)

  • Pallikdavath S, Jaychandran and Stones RW, Women’s 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)

Women’s 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

35%

21%

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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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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Women’s knowledge about HIV


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Rural women’s 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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Women’s 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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Women’s knowledge about HIV in Uttar Pradesh

and Madhya Pradesh, 1998-2000

% Heard of HIV

Uttar Pradesh: 20.2India: 40.3

Madhya Pradesh: 22.7[106 million married

women in the age 15-49 no

% Aware that HIV can be avoidedAIDS 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

Variables

Madhya Pradesh

Uttar Pradesh

Aware

Knowledge

C

orrect

Aware

A

ware that

Correct

of HIV

that HIV

knowledge

of HIV

HIV can

knowledge

can be

avoided

about HIV

be avoided

HIV

transmission

transmission

Age group

Y

Y

Y

Y

×

Y

Education

Y

Y

×

Y

Y

×

Work

Y

Y

×

Y

×

×

Religion

Y

×

×

Y

Y

×

Caste

Y

×

Y

Y

×

×

Standard of living Index

Y

Y

Y

Y

×

×

Place of residence

Y

×

×

Y

×

Y

Watch TV

once a

week

Y

Y

Y

Y

Y

×

FP worker visited

×

×

Y

×

×

×

Discussed FP with partner

Y

Y

×

Y

Y

×

Ever

use of F P

Y

Y

×

Y

Y

Y

Media

__

Y

×

-

Y

Y


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Women’s 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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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 950/9073*100=10.4%

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

IE=950/1903*100=4.8%


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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:

appropriatetime

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 tomy 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 HUSBAND’S 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.


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