1. Centre for AIDS Research, Udhampur
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
Dr Vikram Gulati
Ms Vishava Raksha
Opportunities and Choices Programme
Centre for AIDS Research, Udhampur

2. Structure of presentation
“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

3. Women’s reproductive health in the context of HIV:
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:

4. An overview of HIV/AIDS in India

5. HIV in India Projections: First HIV case in 1986,Tamil Nadu
30 million HIV by 2010: Dr Soloman (March , 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: 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

6. AIDS cases in India: 68,809 as on March 31, 2004 (others estimate: 600,000)

7. Proportion of women increased
More men
Proportion of women increased
35%
21%
MTCT

8. HIV prevalence (%) among antenatal
attendees, Northern region-India,
15.3 million
married
women
15-44
7.8 Million
23.4
Million

9. HIV prevalence (%) among antenatal
attendees, Southern region-India,

10. HIV prevalence (%) among antenatal
attendees, North-eastern region-India,

12. 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

13. 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]

14. Women’s knowledge about HIV

15. 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 years

16. Increase in HIV
1.1
1.3
2.6
3.3
Decrease in HIV
6.1
13.9
10.8

17. Women’s knowledge about AIDS
in low and high prevalence states
Uttar Pradesh and Madhya Pradesh: LOW
Maharashtra and Tamil Nadu: HIGH
National Family Health Survey; a sample survey of 90,303 ever married women in the age group years

18. Women’s knowledge about HIV in Uttar Pradesh
and Madhya Pradesh,
% Heard of HIV
Uttar Pradesh: India: 40.3
Madhya Pradesh: [106 million married
women in the age no
% Aware that HIV can be avoided AIDS 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

19. Vulnerable women groups in North
Madhya Pradesh
Uttar Pradesh
Variables
Aware
of HIV
Knowledge
that HIV
can be
avoided C
orrect
knowledge
about HIV
transmission
of HIV A
ware that
HIV can
be avoided
Correct
HIV
Age group Y ×
Education
Work
Religion
Caste
Standard of living Index
Place of residence
Watch TV
once a
week
FP worker visited
Discussed FP with partner
Ever
use of F P
Media __ -
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

20. Women’s knowledge about HIV in rural
Maharashtra and Tamil Nadu,
24% married women in
rural MHA have
correct knowledge
% Heard of HIV
Maharashtra: 40.1
Tamil Nadu:
% Aware that HIV can be avoided
Maharashtra: 55.4
Tamil Nadu:
% Having correct knowledge
Maharashtra: 59.3
Tamil Nadu:
31% married
women in rural
TN have
correct knowledge

21. 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

22. Where do women obtain AIDS knowledge from?
National Family Health Survey; a sample survey of 90,303 ever married women in the age group years

23. Proportion heard of AIDS from only one
Source of AIDS knowledge
% women heard
of AIDS from:
Measure of effectiveness
Measure of independent effect
Average number
of sources
Radio
45.8
10.4
4.8
1.7
Television
68.4
26.7
18.3
1.5
Newspaper
20.7
2.7
0.6
2.2
Pamphlet/magazine
9.5
3.8
0.4
2.5
Clinic/health worker
4.4
16.8
0.7
2.1
Church/Mosque
0.2
15.9
0.1
2.3
School/teacher
1.1
10.1
2.9
Community meeting
26.0
0.8
1.8
Friends/relatives
37.3
33.1
12.3
1.6
Work place
3.3
17.7
1.9
Cinema
5.9
2.6
Exhibition
11.1
2.8
Adult education programme
0.5
3.1
Political leaders
18.1
0.0
All --
38.9
3.6
Number of women
19,803 **
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%

24. Measure of independent effect
Source of AIDS knowledge
% women heard
of AIDS
from:
Measure of effectiveness
Measure of independent effect
Average number
of sources
Radio
36.4
2.3
0.8
2.1
Television
91.0
30.4
27.7
1.6
News paper
34.0
0.9
0.3
2.2
Pamphlet/magazine
15.9
2.6
Clinic/health worker
2.8
6.1
0.2
Church/Mosque
0.1
15.0
0.0
4.3
School/teacher
1.0
4.1
3.4
Community meeting
1.5
12.9
2.7
Friends/relatives
23.2
3.7
2.0
Work place
1.8
6.8
3.0
Cinema
10.6
0.7
Exhibition
4.0
Adult education programme
0.5
8.9
Political leaders
4.5
All --
33.6
4.4
Number of women
16,615 **
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:
appropriate time
culturally compatible contents

25. Impact of AIDS in rural areas

26. Impact of AIDS in rural areas:
Field work in Dec Interviews with HIV + men and women and focus group interviews with general population in 4 villages in Pune, Maharashtra

27. Small business trips to urban areas
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]

28. “ I got the infection from my husband ……
“ 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]

29. “people do not invite me…. family members do not treat me well
“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 to my house. They do not touch me. …”
[28 year old HIV positive widow]”

30. 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

31. Research needs and conclusion

32. 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

33. 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

34. 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.

35. Thanks.