Introduction

HIV/AIDS has rapidly emerged as one of the greatest threats to human health in the 21st century. Over 25 million people have died since the beginning of the AIDS epidemic. Currently, over 7,500 people die from AIDS each day about five people every minute (UNAIDS, 2006).

World Scenario It is estimated that there were 33.4 million people living with HIV/AIDS worldwide at the end of 2008. Approximately 2.7 million people were newly infected with HIV (the AIDS virus) in 2008 . UNAIDS estimates that HIV/AIDS took the lives of more than 2 million people in 2008. Women account for approximately 50% of people infected with HIV. In most regions of the world, HIV is affecting women and girls in increasing numbers. In 2008, around 430,000 children were born with HIV, bringing to 2.1 million the total number of children under 15 living with HIV. Young people account for around 40% of all new adult (15+) HIV infections worldwide. Sub-Saharan Africa is the region most affected and is home to 67% of all people living with HIV worldwide and 91% of all new infections among children. In sub-Saharan Africa the epidemic has orphaned more than 14 million children. The percentage of HIVpositive pregnant women who received treatment to prevent transmission of the virus to their child increased from 33% in 2007 to 45% in 2008. Latest data indicate that fewer than 40% of young people have basic information about HIV and less than 40% of people living with HIV know their status. The number of new HIV infections continues to outstrip the numbers on treatment for every two people starting treatment, a further five become infected with the virus.

"The number of HIV-positive people receiving antiretroviral drugs [ARVs] for their infections jumped by more than a quarter in 2009, growing from 4 million to 5.2 million, the World Health Organization said Monday at the International AIDS Conference in Vienna," the Los Angeles Times reports (7/19). "Between 2003 and 2010, the number of patients receiving lifesaving antiretroviral treatment increased twelve-fold, according to the Geneva-based body," the Associated Press notes (Oleksyn, 7/19). "This is the largest increase in people accessing treatment in a single year. It is an extremely encouraging development," Hiroki Nakatani, WHO assistant director-general for HIV, tuberculosis, malaria and neglected tropical diseases, said in a statement issued by the WHO (7/19).

In the last 2 decades, there have been significant advances in the control and treatment of HIV/AIDS, but still no cure. Prevention thus remains a critically important strategy for reducing the impact of this global pandemic. Science has shown that HIV is transmitted from person to person by a known set of risk behaviors and transmission routes, including unprotected sex with an infected partner, the sharing of equipment used to inject both illegal and legal drugs, and mother-to child transmission. In the charged debates about HIV/AIDS, HIV risk behaviors are often described in simplistic terms as a matter of human choice, with little attention paid to the complex social, environmental, cultural, and economic factors impacting these choices. It is critically important to understand not only the science of this disease but also the behavioral and sociocultural influences that both facilitate and prevent the spread of HIV.

Indian Scenario India is one of the largest and most populated countries in the world, with over one billion inhabitants. Of this number, it's estimated that around 2.27 million people are currently living with HIV.1 HIV emerged later in India than it did in many other countries. Infection rates soared throughout the 1990s, and today the epidemic affects all sectors of Indian society, not just the groups workers and truck drivers with which it was originally associated. In a country where poverty, illiteracy and poor health are rife, the spread of HIV presents a daunting challenge. The History of HIV/AIDS in India At the beginning of 1986, despite over 20,000 reported AIDS cases worldwide,2 India had no reported cases of HIV or AIDS.3 There was recognition, though, that this would not be the case for long, and concerns were raised about how India would cope once HIV and AIDS cases started to emerge. One report, published in a medical journal in January 1986, stated: Unlike developed countries, India lacks the scientific laboratories, research facilities, equipment, and medical personnel to deal with an AIDS epidemic. In addition, factors such as cultural taboos against discussion of sexual practices, poor coordination between local health authorities and their communities, widespread poverty and malnutrition, and a lack of capacity to test and store blood such as sex

three north-eastern states of India bordering Myanmar (Burma).907 who had been tested. but at the end of the 1980s a rapid spread of HIV was observed among injecting drug users (IDUs) in Manipur. and as HIV screening centres were set up across the country there were calls for visitors to be screened for HIV. Its activities covered surveillance. AIDS is coming out of the closet. Mizoram and Nagaland . and health education. India s first cases of HIV were diagnosed among sex workers in Chennai. It was able to make a number of important improvements in HIV prevention such as improving blood safety. cases of HIV infection had been reported in every state of the country.10 At the beginning of the 1990s. Tamil Nadu. By this stage. .8 By the end of 1987. HIV had spread to the general population. but it can be stated without any fear of being wrong that infection is widespread 14 it is spreading rapidly into those segments that society in India does not recognise as being at risk. blood screening.13 In 1998.11 In the same year. This plan established the administrative and technical basis for programme management and also set up State AIDS Control Societies (SACS) in 25 states and 7 union territories. 4 Later in the year.12 Throughout the 1990s. such as housewives and richer members of society.6 7 In 1987 a National AIDS Control Programme was launched to co-ordinate national responses. prevention work and control programmes relating to HIV and AIDS. responses were strengthened. around 135 people were found to be HIV positive and 14 had AIDS. it was clear that although individual states and cities had separate epidemics. exactly what the prevalence is. these calls subsided as more attention was paid to ensuring that HIV screening was carried out in blood banks.5 It was noted that contact with foreign visitors had played a role in initial infections among sex workers.would severely hinder the ability of the Government to control AIDS if the disease did become widespread.9 Most of these initial cases had occurred through heterosexual sex. cases of infection were observed among people that had previously been seen as low-risk . In 1992 the government set up NACO (the National AIDS Control Organisation). to oversee the formulation of policies. as infection rates continued to rise. is not really known. the National AIDS Control Programme (NACP) for HIV prevention. Increasingly. out of 52. the government launched a Strategic Plan. Gradually. one author wrote: HIV infection is now common in India.

They include outreach programmes focused on behaviour change through peer education. linkages to health services. as well as advocacy and training of local groups. i. the prevention of mother-to-child transmission (PMTCT) programme and the provision of free antiretroviral treatment were implemented for the first time. During this time.In 1999. which indicated that there were more people with HIV in India than in any other country in the world. men who have sex with men. UNAIDS and NACO agreed on a new estimate between 2 million and 3. The NACP III also seeks to decentralise the HIV effort to the most local level. and injecting drug users with targeted interventions.15 In 2001.16 The third phase (NACP III) began in 2007.31 million. Vajpayee also met the chief ministers of the six high-prevalence states to plan the implementation of strategies for HIV/AIDS prevention.3%. The national HIV prevalence rose dramatically in the early years of the epidemic. distribution of condoms and other risk reduction materials. a mere 0.21 which equates to a prevalence of 0. the second phase of the National AIDS Control Programme (NACP II) came into effect with the stated aim of reducing the spread of HIV through promoting behaviour change.1% increase in HIV prevalence would increase the estimated number of people living with HIV by over half a million. the region that has been hit hardest by AIDS.1 million people living with HIV. following the first survey of HIV among the general population.17 Targeted interventions are generally carried out by civil society or community organisations in partnership with the State AIDS Control Societies.22 In addition. because India's population is so large. but a study released at the beginning of 2006 suggests that the HIV infection rate has recently fallen in southern India. treatment of sexually transmitted diseases. While this may seem a low rate.18 Current estimates In 2006 UNAIDS estimated that there were 5. With a population of around a billion.19 In 2007. NACO released figures in 2008 suggesting . and engage more non governmental organisations in providing welfare services to those living with HIV/AIDS. the government adopted the National AIDS Prevention and Control Policy and former Prime Minister Atal Bihari Vajpayee referred to HIV/AIDS as one of the most serious health challenges facing the country when he addressed parliament.20 In 2008 the figure was confirmed to be 2. with the highest priority to reach 80 percent of high-risk groups including sex workers. it is third in the world in terms of greatest number of people living with HIV.e.6 million people living with HIV in India. districts.

There is a decline in prevalence in some of the Southern states demonstrate that AIDS is under control What Is HIV? To understand what HIV is. there are no arguments to disease and infection. I Immunodeficiency HIV weakens your immune system by destroying important cells that fight 25 In the rest of the county.23 Some AIDS activists are doubtful that the situation is improving: It is the reverse. HIV can destroy so many of your CD4 cells that your body can't fight infections and diseases anymore. Human Immunodeficiency Virus is a lot like other viruses.27 million in 2008. Executive Director of UNAIDS. That isn't the case with HIV the human immune system can't seem to get rid of it. But there is an important difference over time. . stresses: the statement that India has the AIDS problem under control is not true. A "deficient" immune system can't protect you. Anjali Gopalan. I am really worried that we are just burying our head in the sand over this.that the number of people living with HIV has declined from 2. Over time. but HIV invades them. Your body has to have these cells to fight infections and disease. HIV infection can lead to AIDS. let s break it down: H Human This particular virus can only infect human beings. uses them to reproduce itself. the Naz Foundation. V Virus A virus can only reproduce itself by taking over a cell in the body of its host. When that happens. your immune system can clear most viruses out of your body. and then destroys them. Scientists are still trying to figure out why. All the NGOs I know have recorded increases in the number of people accepting help because of HIV. We know that HIV can hide for long periods of time in the cells of your body and that it attacks a key part of your immune system your T-cells or CD4 cells. Delhi24 Peter Piot.73 million in 2002 to 2. including those that cause the "flu" or the common cold.

you can become infected with HIV. Humans probably came in contact with HIV when they hunted and ate infected animals. D Deficiency You get AIDS when your immune system is "deficient. AIDS is a syndrome. Acquired Immunodeficiency Syndrome is the final stage of HIV infection. You acquire AIDS after birth. Where Did HIV Come From? Scientists believe HIV came from a particular kind of chimpanzee in Western Africa. you will need medical intervention and treatment to prevent death. certain cancers. because it is a complex illness with a wide range of complications and symptoms. or a very low number of CD4 cells.What Is AIDS? To understand what AIDS is. which put them at risk for opportunistic infections. You will be diagnosed with AIDS if you have one or more specific infections. If any of those fluids enter your body. ." or isn't working the way it should. If you have AIDS. rather than a single disease. let s break it down: A Acquired AIDS is not something you inherit from your parents. Recent studies indicate that HIV may have jumped from monkeys to humans as far back as the late 1800s How Do You Get HIV? HIV is found in specific human body fluids. I Immuno Your body's immune system includes all the organs and cells that work to fight off infection or disease. People at this stage of HIV disease have badly damaged immune systems. S Syndrome A syndrome is a collection of symptoms and signs of disease.

which means that people can more easily transmit the virus to others. This is called acute retroviral syndrome (ARS). During primary HIV infection. nasal fluid. We know that the following fluids can contain high levels of HIV: y y y y y y Blood Semen (cum) Pre-seminal fluid (pre-cum) Breast milk Vaginal fluids Rectal (anal) mucous Other body fluids and waste products-like feces. often described as the worst flu ever. or respiratory or gastrointestinal infections. unless they have blood mixed in them and you have significant and direct contact with them HIV-Positive without Symptoms Many people who are HIV-positive do not have symptoms of HIV infection. Early Stages of HIV: Signs and Symptoms As early as 2-4 weeks after exposure to HIV (but up to 3 months later). tears. Sometimes people living with HIV go through periods of being sick and then feel fine. or primary HIV infection. people can experience an acute illness. It is important to remember that some symptoms of HIV infection are similar to symptoms of many other common illnesses. and it s the body s natural response to HIV infection. . While the virus itself can sometimes cause people to feel sick. or vomit-don t contain enough HIV to infect you. there are higher levels of virus circulating in the blood. most of the severe symptoms and illnesses of HIV disease come from the opportunistic infections that attack a damaged immune system. Often people only begin to feel sick when they progress toward AIDS (Acquired Immunodeficiency Syndrome). saliva. sweat. urine.Which Body Fluids Contain HIV? HIV lives and reproduces in blood and other body fluids. such as the flu.

AIDS: Signs and Symptoms When HIV infection progresses to AIDS. fever. the virus becomes less active in the body. oral. . and even wasting syndrome at late stages. diarrhea. nausea. Many of the signs and symptoms of AIDS come from opportunistic infections which occur in patients with a damaged immune system. or vaginal) with a partner who is HIV-positive. Unprotected means without a condom or other barrier to protect you from infected body fluids. many people begin to suffer from fatigue. chills. although it is still present. Safer Sex Most people who get HIV get it by having unprotected sex (anal. however. night sweats. Chronic Phase or Latency: Signs and Symptoms After the initial infection and seroconversion. This period can last up to 10 years sometimes longer. that not everyone gets ARS when they become infected with HIV. vomiting. many people do not have any symptoms of HIV infection.Symptoms can include: y y y y y y y y y Fever Chills Rash Night sweats Muscle aches Sore throat Fatigue Swollen lymph nodes Ulcers in the mouth It is important to remember. This period is called the chronic or latency phase. During this period.

women. Some research focuses on behaviors and social factors that increase the risk of HIV infection: y y y y y y y Unprotected sexual contact (oral. Both male condoms and female condoms are effective in preventing HIV infection. including HIV. anal.Prevention Before and During Sex Here s what you can do to protect yourself and others if you are sexually active: y y y Know your own HIV status and your partner s too Use condoms. Prevention Research Researchers are looking at many different ways to prevent the spread of HIV. and that of your sex partner(s). men who have sex with men) at a higher risk of getting HIV. is the best way to protect each of you from STIs. . Condoms Keep You Safer Condoms offer excellent protection against HIV if you use them correctly. or vaginal) Injection drug use Poverty Lack of access to medical care Language barriers Cultural expectations Threat of partner violence These factors may place specific groups of people (people of color. The goal of this type of research is to develop prevention programs or approaches that will stop the spread of HIV. correctly and consistently Limit your number of sexual partners Knowledge Is Power Have you been tested for HIV and other sexually transmitted infections (STIs)? Has your partner? Knowing your health status.

or vaginal sex with a partner whose HIV status is unknown? . oral. not HIV itself.Other research examines biomedical methods of preventing HIV transmission. In June 2008. If you answer "Yes" to any of the following questions. but there are other kinds of HIV tests that use urine or a swab of fluids from your mouth instead. To date. Since HIV was first identified in 1984. director of NIAID. Antibodies to HIV appear in your blood. When you get tested for HIV. The goals of vaccine research are both preventative and therapeutic. Your body makes different antibodies to fight different threats so the test looks specifically for HIV antibodies to see if you are infected with HIV. researchers have been working to develop an HIV vaccine. Dr. and oral fluid as your immune system begins trying to fight the virus. What Is An HIV Test? An HIV test looks for signs of HIV in your body. the search for an effective HIV vaccine has not been successful. you will usually give a sample of blood. Should I Be Tested? HIV is spread through risky behaviors. These include male circumcision and microbicides. How Does An HIV Test Work? Most HIV tests look for antibodies to the virus. works) with others? y Have you had unprotected anal. urine. you should get an HIV test: y Have you injected drugs or steroids or shared equipment (such as needles. explained that NIAID canceled the trial because scientists need a better understanding of how HIV vaccines and the immune system interact before they will be able to develop a successful vaccine. but rapid HIV tests can give results in about 20 minutes. the National Institute for Allergy and Infectious Diseases (NIAID) canceled large-scale HIV vaccine trials after the failure of a similar privately funded vaccine trial in 2007. Anthony Fauci. syringes. Some tests take a few days for results.

you can also take steps to protect your sex or drug-using partners from becoming infected. y If you are pregnant. When Should I Be Tested? On average. or a sexually transmitted infection (STI)? y Have you had unprotected sex with someone who could answer "Yes" to any of the above questions? y y Are you pregnant or planning to become pregnant? Have you been sexually assaulted? If you continue to engage in high-risk behaviors. you can get into early treatment. tuberculosis (TB). you can make informed decisions about your sexual behaviors and how to stay safe. and possibly more often. it can take your body a while to start making HIV .y y Have you exchanged sex for drugs or money? Have you been diagnosed with. Why Should I Be Tested? Getting tested can give you some important information and can help keep you For example: y and others safe. or treated for. This increases your chances of staying healthy. Knowing your own HIV status can give you peace of mind and testing is the only way you can know for sure. y If you find out you are HIV-positive. That's because. knowing your status can help protect your baby from being infected. y If you know you are HIV-positive. y When you and your partner know each other's HIV status. Talk with your healthcare provider about a testing schedule that is right for you. or planning to get pregnant. hepatitis. you may need to wait 1-3 months from the time of possible exposure to get an accurate test result. if you are infected. it is recommended that you get an HIV test at least once a year.

If you are tested earlier than 3 months after exposure. your test result may not be accurate. the testing center will give you another test to make sure the first test result was correct. That's why most healthcare providers encourage you to have a follow-up test 3 months later. . The test only tells you what your HIV status is when you took it so if you were exposed to HIV after you took the test. while you are waiting to take your test. it means the test didn't find any evidence of HIV antibodies in your body. If you took an HIV test within the first 3 months after possible exposure. it is still possible that you might have HIV. the results may not show your current HIV status.) What Does A "Negative" Result Mean? If your test comes back negative. or get your results: y y Don't inject drugs or always use clean equipment and don't share needles or works Don't have sex or always use protection (condom or dental dam) if you do What Does a "Positive" Result Mean? If your test comes back positive. To get an accurate result. you should consider getting another test 3 months later to confirm your results. the tests may not pick up the presence of HIV antibodies. (Before then.antibodies. This time between when you are exposed to HIV and the time you could test positive for HIV antibodies is called the window period. the test may miss any HIV in your body fluids. Depending on when you were exposed. or between your first test and a follow-up test. If you engage in risky behaviors between the time you take the test and get your results. it means that it found evidence of HIV antibodies in your blood. How Accurate Are My HIV Test Results And What Do They Mean? HIV tests are over 99% accurate if you take one 3 months after a possible exposure. But a negative result only means that the test couldn't find HIV. If you have a positive HIV test.

There are two types of HIV tests confidential tests and anonymous tests. or taking illegal drugs can weaken your immune system and allow HIV to increase in your body. Whether anyone can know about your test results or your HIV status depends on what kind of test you take. If the second test has the same outcome. you should do the following things even if you don't feel sick: y Find a healthcare provider who has experience treating HIV. you will be diagnosed as being "HIV-positive. Condoms are very effective in preventing HIV transmission when used correctly and consistently. You get AIDS only after HIV has severely damaged your immune system. because there is a very small chance that the first test was wrong. Will Other People Know My HIV Test Results & Status? Your test results are protected by state and Central privacy laws. This is why it is so important to get treatment as soon as you test positive for HIV early treatment can keep HIV under control and prevent it from developing into AIDS. oral. y Maintain a healthy lifestyle. . drinking too much. these infections can cause serious health problems. Does That Mean I Have AIDS? No. Smoking.Reputable testing centers always do these "confirmatory" tests. Being diagnosed with HIV does NOT mean you have AIDS. If you have HIV. y Practice safer sex. The testing center can usually recommend someone. y Get screened for other STIs and for TB. or vaginal) and don't share needles or syringes with anyone. Acquired Immunodeficiency Syndrome (AIDS) is the final stage of HIV disease. If I Test Positive For HIV. y Tell your partner or partners about your HIV status before you have any type of sexual contact with them (anal." What Do I Do If I Am Diagnosed As Being HIV-Positive? If you are diagnosed with HIV.

your sex or drug-using partners may also be infected. If you take an anonymous HIV test. Some places still offer anonymous HIV tests. You can be charged with a crime in many places if you don't tell even if your partner doesn't become infected. Most states have laws that require you to tell your sexual partners if you are HIV-positive before you have sex (anal.Most HIV tests are confidential tests. All personally identifying information will be stripped out. you will get a special number or code that allows you to get your results. oral. including insurance companies. If you test positive for HIV. It's important that they know they have been exposed so that they can be tested too. . Public health officials do not share this information with anyone else. nothing connects your test results to you. Should I Share My HIV Status with Others? Partners If you test positive for HIV. or vaginal). They will only tell your partners that they have been exposed to HIV and should get tested. If you take a confidential HIV test. no one else has access to your HIV test results unless you tell them. Health departments do not reveal your name to your partners. you can ask your doctor or the local health department to tell them for you. The results will go in your medical record and may be shared with your healthcare providers and your insurance company. your name and other identifying information will be attached to your test results. When you take the test. Many states have moved away from anonymous tests because confidential tests help public health officials do a better job of keeping track of how many people have HIV and which areas of the country have the highest rates of HIV. the testing site will report the results to your state health department . Otherwise. This allows them to get resources to the areas that need them most. your family and friends will not know your test results or HIV status unless you tell them yourself. You can tell them yourself but if you're nervous about doing that. Family/Friends In most cases.

and your immune system can stay healthy. like a surgeon. For those living with HIV/AIDS. and take care of your body. who does procedures where there is a risk of blood or other body fluids being exchanged. Your employer cannot discriminate against you because of your HIV status as long as you can do your job Medications + a Healthy Lifestyle We all know that a healthy lifestyle is important. Most people on ART take a combination of several medications to keep their HIV disease under control. If the medications are successful. there may be exceptions to this. HIV can be a chronic. visit your primary healthcare provider regularly. All 50 states and the District of Columbia will allow you to get tested and treated for sexually transmitted infections (STI) but some states allow your healthcare provider to tell your parent(s) if they think doing so is in your best interest. There are a number of ART medications that work directly on the virus and stop it from replicating itself in your body. But it is possible that your employer could find out if the insurance company provides detailed information to your employer about the benefits it pays or the costs of insurance. your employer will not know your HIV status unless you tell. the amount of HIV in your body goes down significantly. manageable disease if you take your HIV medications consistently. the insurance company cannot legally tell your employer that you have HIV. All of these things help to protect your immune system from HIV. .) If you have health insurance through your employer.If you are under 18. Employers In most cases. (An example might be a healthcare professional. it s vital. Medications & Therapies The most effective form of HIV/AIDS treatment is medication called antiretroviral therapy (ART). But your employer does have a right to ask if you have any health conditions that would affect your ability to do your job or pose a serious risk to others.

although some HIV/AIDS prevention and education can be done at the national level. Messages were also conveyed to young people through schools. as a number of major languages and hundreds of different dialects are spoken within its population. including debates and roleplay. The vast majority of infections occur through heterosexual sex (80%). a voluntary blood donation day and TV spots with a popular Indian film-star. Each of these things helps to boost your immune system and prevent other chronic diseases. was launched in July 2007 and runs until 2012.concerts. men who have sex with men. and injecting drug users as well as truck drivers and migrant workers. Each state has its own AIDS Prevention and Control Society. diabetes. such as heart disease. and students were educated through active learning sessions. plenty of rest. and is concentrated among high risk groups including sex workers. HIV prevention Educating people about HIV/AIDS and how it can be prevented is complicated in India.53 The programme has a budget of around $2. daily exercise. a well-balanced and nutritious diet. Who is affected by HIV and AIDS in India? People living with HIV in India come from incredibly diverse cultures and backgrounds. Various public platforms were used to raise awareness of the epidemic .6 billion. many of the efforts are best carried out at the state and local level. and HIV testing. Teachers and peer educators were trained to teach about the subject. this money will come from . While medications are essential for treating HIV. Under the second stage of the government s National AIDS Control Programme (NACP-II). state AIDS control societies were granted funding for youth campaigns. which carries out local initiatives with guidance from NACO. or high blood pressure. blood safety checks. and staying current with your medical care are all important pieces of successful treatment.Healthy Living Treatment for HIV/AIDS is more than just taking pills every day.54 Aside from the government.52 The third stage of the National AIDS Control Programme (NACP-III). among other things. which finished in March 2006. radio dramas. This means that. two thirds of which is for prevention and one sixth for treatment.

such as the World Bank and the Bill and Melinda Gates Foundation.2 million people with HIV/AIDS education and awareness. the government has also initiated a campaign called Condom Bindas Bol! (Condom-Just say it!). NACO estimates that 3. It aims to break the taboo that currently surrounds condom use in India. the government has supported the installation of over 11.60 According to a mid-year report on the progress of the second round of the Red Ribbon Express. health activists in West Bengal promoted condom use through kite flying.000 condom vending machines in colleges. With support from the United States Agency for International Development (USAID). and international agencies. 55 As part of its focus on prevention. gas stations and hospitals. road-side restaurants. On World AIDS Day 2007 India flagged off its largest national campaign to date. In doing so. public events and celebrity endorsements. members of these risk groups have formed their own organisations to respond to the epidemic. Small-scale campaigns like this are often run or supported by non-governmental organisations.59 Following the success of the campaign. companies. they can make an important impact. which is popular before the state s biggest festival. which involves advertising. In some cases. stations. Durga Puja: "The colourful kites carry the message that using a condom is a simple and instinctive act fly high in the sky and land at distant places where we cannot reach. and to persuade people that they should not be embarrassed to buy them."57 This initiative is an example of how HIV prevention campaigns in India can be tailored to the situations of different states and areas. particularly among high-risk groups.'58A year later the train journey was completed.8 million people were reached in the first six months of the campaign. particularly in rural areas where information is often lacking. which play a vital role in preventing infections throughout India.non-governmental organisations. the 'Red Ribbon Express' took off again in December 2009. and now includes counseling and training services.56 In one unique scheme.61 they can . treatment of sexually transmitted diseases (STDS) as well as HIV/AIDS education and awareness. HIV testing. in the form of a seven-coach train called the 'Red Ribbon Express. The government has however funded a small number of national campaigns to spread awareness about HIV/AIDS to complement the local level initiatives. having travelled to 180 stations in 24 states and reaching around 6.

000 adults (aged 15 and above) were receiving free ARVs by April 2010. Another reason why coverage is so limited is the eligibility requirements imposed on second line ARVs. In 2008. the large scale of India s epidemic. which can significantly delay the progression from HIV to AIDS have been available in developed countries since 1996. as in many resource-poor areas. second-line treatment in India is far more expensive than first-line treatment. and the country s lack of finances and resources continue to present barriers to India s antitretroviral treatment programme. by November 2009 there were 266 reported sites providing antiretroviral therapy. . are not produced on a large scale in India due to patent issues that control drug pricing and can be more than 10 times more expensive than first line ARVs. second line ARV drugs.71 While the coverage of treatment remains unacceptably low. the diversity of its spread. unlike first line ARVs. When HIV becomes resistant to the ARVs the treatment regimen needs to be changed to 'second-line' ARVs. However. improvements are being made. widows and children' and those who have received first-line ARVs from a government centre for at least two years are eligible. Treatment for people living with HIV Antiretroviral drugs (ARVs). Unfortunately. about 970 were receiving it as of January 2010. As with many other parts of the world.73 74 One reason for this is expense.70 This represents less than half of the adults estimated to be in need of antiretroviral treatment in India.000 who need to be on second line treatment.75 Ironically. Of the 3. The government has started to expand access to ARVs in a number of areas.According to NACO the 'response has been overwhelming'. an estimated 300. only those 'living below the poverty line. NACO began to roll out government funded second-line antiretroviral treatment in two centres in Mumbai and Chennai. with queues of people waiting to access the services a common sight. India is a major provider of cheap generic copies of ARVs to countries all over the world. By 2009 second-line therapy was available in a total of eight states but treatment remains very limited. and follow up surveys indicating that knowledge of transmission routes of HIV and prevention methods have increased significantly in the areas visited by the train.72 Increasing access to ARVs also means that an increasing number of people living with HIV in India are developing drug resistance. access to this treatment is limited in India.

denied the last rites before they die. it is difficult to educate people about how they can avoid infection.80 People in marginalized groups . AIDS is often seen as someone else s problem as something that affects people living on the margins of society.. Wherever they have an HIV patient. While such strong reactions to HIV and AIDS exist. can be traced to traumatic experiences in health care settings. with 74% of employees not disclosing their status to their employees for fear of discrimination.are often stigmatised not only because of their HIV status. many keep their status secret. "There is an almost hysterical kind of fear . been refused medical treatment. starting from the humblest. this discrimination is hindering efforts to prevent new infections. at all levels. Chennai78 Discrimination is also alarmingly common in the health care sector. Of the 26% who did disclose their status. hijras (transgender) and gay men . teachers sometimes face negative reactions from the parents of children that they teach about AIDS: When I discussed with my mother about having an AIDS education program. and even. spouses and communities. Even as it moves into the general population. People living with HIV have faced violent attacks.76 As well as adding to the suffering of people living with HIV. the sweeper or the ward boy. in some reported cases."79 A 2006 study found that 25% of people living with HIV in India had been refused medical treatment on the basis of their HIV-positive status.. It is not surprising that for many HIV positive people. 10% reported having faced prejudice as a result.81 . It also found strong evidence of stigma in the workplace. she said. as elsewhere. they will kick you . been rejected by families. As a result. She feels that we should not talk about it.77 and in schools. you learn and come home and talk about it in the neighbourhood.female sex workers. the responses are shameful. the HIV epidemic is still misunderstood among the Indian public. up to the heads of departments. Negative attitudes from health care staff have generated anxiety and fear among many people living with HIV and AIDS. AIDS outreach workers and peer-educators have reported harassment. Female student. AIDS-related fear and anxiety. whose lifestyles are considered immoral.Stigma and discrimination in India In India. which make them pathologically scared of having to deal with an HIV positive patient. and at times denial of their HIV status. but also because they belong to socially excluded groups.

more than any other country in the world. Mumbai. the World Bank has warned that India will have to scale up prevention efforts in order to avoid spending more of its health budget in the future.8% of people believed HIV could be transmitted by sharing food with someone. recent surveys do suggest that national HIV prevalence has probably fallen slightly in recent years. India spends about 5% of its health budget on HIV and AIDS.Stigma is made worse by a lack of knowledge about AIDS. the real challenge lies with ignorance about how HIV is transmitted . This trend is mainly due to a drop in infections in southern states. For instance. and there has been a lot of dispute about the accuracy of these estimates. Sujatha Rao. Moreover.for example the majority of men and women in rural areas believe that AIDS can be transmitted by mosquito bites. and accused those who cited them of spreading panic.91 Currently.93 This would put further strain on a struggling health sector which. there are many areas in the northern states where HIV is increasing. Director General of NACO 88 HIV spending increased steadily in India from 2003 to 2007 but has since fallen.83 In 2009.84 The future of HIV and AIDS in India Various groups have made predictions about the effect that AIDS will have on India and the rest of Asia in the future. on top of HIV and AIDS. by 2020 India will have to spend 7% of its health budget on AIDS if the rising tide of the AIDS epidemic in New Delhi. which represented an increase of 28% from the previous year. the north and the north east is not halted. 82 However. NACO carried a population based survey in Nagaland. faces a growing multitude of health . 87 Indeed. particularly among injecting drug users. the dual HIV epidemic driven by unsafe sex and injecting drug use is highly concerning. In the north-east. which showed that 72. although it claims to acknowledge the seriousness of the crisis. in other areas there has been no significant decline.89 90 In 2006-2007 $171 million was spent to contain and prevent the growth of HIV.86 The government has also disputed predictions that India s epidemic is on an African trajectory.85 India's government responded by calling these figures completely inaccurate. According to the World Bank s report. Although a high percentage of people have heard about HIV and AIDS in urban areas (94% of men and 83% of women) this is much lower in rural areas where only 77% of men and 50% of women have heard of HIV and AIDS.92 However. a 2002 report by the CIA's National Intelligence Council predicted 20 million to 25 million AIDS cases in India by 2010 .

it is important to remember that HIV is transmitted primarily by risky sexual and drug-taking behaviors.94 Even if the country's epidemic does not match the severity of those in southern Africa. and people who live in rural areas.95 Myths Common Myths & Misunderstandings There are many myths about HIV /AIDS. Today. Taking an HIV test is the only way to know for sure whether you or someone else has HIV. The challenges India faces to overcome this epidemic are enormous. Most of these myths are based on incorrect information or lack of knowledge about HIV/AIDS and some are related to the stigma that is often attached to HIV. If you engage in those behaviors. in India. Yet.challenges including malaria. just as in the rest of the world Peter Piot. heart disease and cancer. you are at risk of HIV infection your partner Myth: Some people have been cured of HIV. Myth: Only gay people get HIV/AIDS. former Executive Director of UNAIDS. It is essential that effective action is taken to minimise this impact. without taking protective measures. it is clear that HIV and AIDS will have a devastating effect on the lives of millions of Indians for many years to come. Myth: A person with HIV or AIDS looks sick. regardless of the gender of . ethnic minorities. You can even have HIV and not know it. Truth: When the epidemic began in the early 1980s. diabetes. While the number of new cases is still highest among MSM. the picture of the epidemic looks very different. however. Yet India possesses in ample quantities all the resources needed to achieve universal access to HIV prevention and treatment defeating AIDS will require a significant intensification of our efforts. Many new cases of HIV occur among heterosexual women of color. Truth: People with HIV infection often don t look or feel sick. the first cases of HIV and AIDS were found among urban men who had sex with men (MSM). in 2008-2009 spending on HIV/AIDS fell by 15% to $146 million.

If you are beginning a monogamous relationship. AIDS is diagnosed when certain opportunistic infections are present or when a person s CD4 count drops below a certain value. such as shaking hands. during which the body s immune system has been badly damaged. HIV-positive women are able to have a healthy pregnancy and give birth to babies who are HIV-negative. Living with HIV can be challenging. . Myth: HIV isn t a big deal anymore. Truth: Being HIV-positive and having an AIDS diagnosis are not the same. another 56. Myth: You can t have a baby if you are HIV-positive. AIDS occurs only after a long period of HIV infection. it s important for both partners to be tested for sexually transmitted infections. sharing cups or towels. Truth: HIV is not spread through casual contact. and HIV medications can have serious side effects and cause other health problems. Every year.000 Americans become infected with HIV but it doesn t have to be that way! It s easy to protect yourself and others from HIV if you know the facts. including HIV. Myth: A person can get HIV from touching or kissing someone with HIV. Preventing HIV infection is much better than having to treat it Myth: Being HIV-positive is the same thing as having AIDS.Truth: While there are many treatment options. so it s important to keep the lines of communication open. Myth: I am not at risk because I am in a monogamous relationship. Pregnant women should be tested for HIV to ensure that they receive proper care. Truth: You may not always know if your partner is having sex (or injecting drugs) outside of the relationship. there is currently no cure for HIV. or closed-mouth kissing. hugging. A person can take a pill once a day and be fine Truth: An HIV diagnosis is no longer a death sentence like it was in the early days on the epidemic but it continues to be a big deal. Truth: With proper healthcare and medication.

Jai Hind. Conclusion Having seen all the facts and figures about HIV/AIDS and fully knowing well that AIDS can only be prevented by spreading the awareness and taking preventive measures. or might be exposed to HIV at work. let us hope India will become a AIDS free country.Your risk for getting HIV or transmitting it to others is extremely low if: y y y y You aren t having sex of any kind (anal. injecting drugs. .. oral. or vaginal) You aren t injecting drugs You aren t pregnant You aren t likely to have contact with infected body fluids in your workplace But if you are having sex. pregnant. of volunteers for spreading the awareness and take the message to the nook and corner of our country so that atleast by 2020. We Indians should vow to get rid of this social stigma by increasing the no. here s what you need to know..

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