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.)

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 years are living with HIV/AIDS Over 50% of all new infections occurring among young people aged below ,000 AIDS orphan children and 160,000 AIDS children living in the country Who Are Now the People Infected & Affected by HIV/AIDS in India?

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 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 who Have Heard of HIV/AIDS MICS-2000

Percent Women aged who Know all Three Modes of Vertical Transmission of HIV MICS-2000

Women & Violence Violence inside and outside the family 74% increase in crimes against women (rape, molestation and torture showing the highest rate of growth) Children account for 30% of total rape 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 Correct knowledge about benefits of condom use to prevent STI/HIV Used condom during last intercourse Source: FHAC Coverage Evaluation AIIMS/INCLEN/USAID

Proportion of 15-19yr olds willing to share food with a HIV positive person: Rural All India Assam West Bengal Jharkhand Chatisgarth Karnataka Orissa Bihar Sikkim Gujarat NE (ex sikkim & Manipur) J&K UP MP Rajasthan Maharashtra Urraranchal Haryana Himachal Pradesh AP Delhi Tamil Nadu Punjab Kerala Manipur

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-To- Child Transmission of HIV in India 27 million pregnancies per year 108,000 infected pregnancies Annual Cohort of 32,000 infected newborns 0.4% prevalence 30% transmission 25,000 - NACO50,000 - 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

Some Lessons Learnt: Reduced transmission of HIV from mother to infant

1985 Focus on HIV as a health problem Prevention Care Recognition of Multi-Sectoral Response Care Prevention in general populations Targeted interventions 1995 Multi-Sectoral Strengthening Response 2005 Prevention Care Strengthening the Response: a Paradigm Shift