Vulnerability of Women & Children to HIV/AIDS

DR. KANUPRIYA CHATURVEDI DR. S.K. CHATURVEDI

What is Vulnerability?
“that may be wounded” “Susceptible of injury” “Exposed to damage” (lit. or fig.)

Who Are Now the People Infected & Affected by HIV/AIDS in India?
25% of all HIV infection fall in women, with an accompany increase in vertical transmission and pediatric HIV  Reported median of HIV prevalence among pregnant women exceed 2%in most high prevalence states  Already about 660,000 young women and 345,000 young men aged between 15-24 years are living with HIV/AIDS  Over 50% of all new infections occurring among young people aged below 25  120,000 AIDS orphan children and 160,000 AIDS children living in the country

Vulnerability Factors of Women
• Overall Status • Illiteracy • Low Control on Reproductive Rights • Low Access to Health Care • Lack of Knowledge • Violence Against Women

Vulnerability Factors of Women
Sex

ratio: 933/1000 (~ 25 million missing)

Women & Education
 Close

to 245 million women lack the basic capability to read and write (over 50% of women in India)  Women’s literacy lower than men  Gross school enrolment rate is 65% for boys and 49% for girls, ages 11-14  Drop out rates: 60% for girls, 54% for boys (middle school)  Gender gap in literacy is increasing in some states (Rajasthan – girl enrolment 33.3%, boys 83%)

Women & Reproductive Rights
 26%

married by the age of 15 and 54% by 18  36% of married adolescents between 13 and 16, and 64% between 17and 19, are already mothers or pregnant with first child  52% of women have never used contraception (condom use < 3%)  Little control over fertility and reproductive rights

Women & Access to Health Care
Annual Pregnancies 27 million  % ANC Coverage (1/3+) 65.4/38  % Institutional Deliveries 33.6  % Deliveries attended by Skilled Birth Attendants 42.3  High prevalence of STI/RTI  Births is by adolescent mother 1/10  MMR is ~ 500/100,000 live births

Percent Women aged 15-49 who Have Heard of HIV/AIDS
32 63.9 54.3 74

41.3

74 21.6 59.2 31.1 43.4 12.7 35.4 54.7 41.1

27.3

54.8 92.8

Per cent

23.9

26.2

88.3

< 30 30 - 49 50 - 69 70 & above

48.7 23.8 59.7

43

70.6 84.7 65.8

MICS-2000
87 76.1

56.3 87.7 74.5

Percent Women aged 15-49 who Know all Three Modes of Vertical Transmission of HIV
19 31.1 39.6 36.1 21.1 37.8 13.3 12.8 21 6.8 17.7 11.5 13 29.9 58.1 21.1 15 17.2

26.2 50.2

Per cent

< 20 20 - 29 30 - 39 40 & above

30.8 14 31.4

23.4

46.8 40.8 40.6

MICS-2000
36.6 34.4

36.9 46.9 42.2

Women & Violence
 Violence

inside and outside the family

 74%

increase in crimes against women 1980-1990 (rape, molestation and torture showing the highest rate of growth) account for 30% of total rape

 Children

victims

Vulnerability Factors of Adolescents
• Early debut of sexual

activity • Lack of Knowledge • Lack of an enabling environment where to acquire this knowledge • Misconceptions

HIV/AIDS Awareness among Adolescents < 20 years - FHAC 2000
60 50 40 30 20 10 0
Source: FHAC Coverage Evaluation AIIMS/INCLEN/USAID 2000

53

32 Rural Urban Slums

3.4

6.3

Correct knowledge about benefits f condom use to prevent STI/HIV Used condom during last intercourse

Proportion of 15-19 yr olds willing to share food with a HIV positive person: Rural
Manipur Kerala Punjab Tamil Nadu Delhi AP

Himachal Pradesh

Haryana Urraranchal Maharashtra Rajasthan
MP UP

J&K Gujarat Sikkim Bihar Orissa Karnataka Chatisgarth Jharkhand West Bengal Assam All India

NE (ex sikkim & Manipur)

0

20

40

60

80

100

Vulnerability Factors of Children
• Parent-To-Child
Transmission of HIV • Lack of Access to Treatment • Lack of coordinated Efforts for ‘Care & Support’

Rationale for Prevention of Parent-ToChild Transmission of HIV in India 27 million pregnancies per year 0.4% prevalence 108,000 infected pregnancies 30% transmission Annual Cohort of 32,000 infected newborns
25,000 - NACO 50,000 - NNF

25,000-50,000 deaths within few months to 5 years

Some Lessons Learnt:
Increased knowledge of women about how to prevent HIV/AIDS
Proportion of women who know how to avoid: acquiring HIV/AIDS transmitting HIV/AIDS to baby

100 80 60 40 20 0 50.3 35.7
Before counselling After counselling

85.1

87.8

Some Lessons Learnt:
Reduced transmission of HIV from mother to infant
Proportion of infants of HIV (+) mothers who acquired HIV - PCR at 2 months

35 30 25 20 % 15 10 5 0

33

8
No ARV With ARV

Strengthening the Response: a Paradigm Shift
Recognitio n Response of Multi-Sectoral Strengthening Focus on HIV as a Response Targete Multi-Sectoral health problem interventi d ons

Prevention
Care

Care
Prevention in Prevention genera populati l ons Care

1985

1 995

2005