UN Secretary General Kofi Annan has said in a message in connection with World AIDS Day, "...the epidemic continues its lethal march around the world, with few signs of slowing down. In the course of the past year, every minute of every day, some 10 people were infected. In the hardest-hit regions, life expectancy is plummeting. HIV/AIDS is spreading at an alarming rate among women, who now account for half of those infected worldwide."
In India, entrenched gender norms add new dimensions to a problem spiraling out of control.
Says Dr.Suniti Solomon, who documented the first HIV+ case in India in 1986, and has been involved in pioneering research under the aegis of her institution, YRG Care, "The average Indian home is very happy if a boy is born. Women are discriminated against from birth so you can imagine how vulnerable victims of HIV/AIDS can be. How many women will tell their abusive families to get lost and walk out? During our counselling sessions we find that women get blamed for everything - for being childless, for delivering a girl child and so on. If an antenatal check up reveals that the woman is HIV+, the family labels her a bad woman of immoral character. She is considered the source of the infection, regardless of whether she is a victim herself."
Also see: Undone by HIV/AIDS
Says Rakhi Sarkar, programme officer of Voluntary Services Overseas, an international development agency that works through volunteers, "Strategically, women must be the centre of the response to HIV and AIDS. By failing to place gender concerns at the heart of the response to HIV and AIDS, some interventions may actually be exacerbating the impact of HIV and AIDS on women." Poverty and deep-rooted beliefs about female and male sexuality underlie the spread and impact of HIV and AIDS.
Says a representative from Jagruti, an organization working with sex workers in India, "If a woman cant feed herself, why would she worry about a disease that might kill her in ten years time? If a client offers to pay twice as much for sex without a condom, the need for money may overtake everything she knows about HIV and AIDS."
Sex work in India mainly takes place in brothels or on the street. Dalit women (from the lowest caste) are among the most vulnerable to being forced into sex work.
The National AIDS Control Organization (NACO) says 25% of the 3.97 million people living with HIV/AIDS in India are women. UNAIDS figures state that 0.8% of the total adult population (15-49) in India is living with HIV or AIDS, of which 1.5 million are women in the 15-24 age group. However, the VSO study says that many organizations and individuals disputed these figures, suggesting that insufficient surveillance sites have been set up to portray the real picture. The stigma surrounding HIV/AIDS is so extreme that the true figures may be much higher.
Says Sarkar, "Cultural norms of sexual ignorance and purity for women block their access to prevention information. Due to lack of awareness, many women in India generally have little ability to discuss or negotiate the use of condoms or their partners previous or concurrent sexual contacts."
The subordinate economic and social position of women within a patriarchal structure can be traced to ancient India, where some documented writings by authors like Manu and Valmiki called for absolute subservience of women to their husbands. According to some texts, the husband retains absolute control over the wifes mind and body and has, "the right to use physical corrective methods over his erring wife." Information from this period suggests that wife-beating was considered a part of everyday life. These norms have been perpetuated by inheritance, property, and divorce laws that favour men.
Also, there is very little sex education in Indian schools. As a result, most Indian schoolchildren do not know what HIV is and children, particularly girls who dropout in larger numbers in rural and underprivileged communities, are very unlikely to be able to access prevention information.
Says Dr.Prasanna Poornachandra, of the International Centre for Prevention of Crime and Victim Care, that runs a secret shelter for victims of domestic violence, "Women are extremely vulnerable even within marriages. Because they have nowhere else to go, they even put up with prolonged periods of abuse in return for promises of everything will be all right now. Where is the question of negotiating condom use when she cannot even protect herself from physical abuse?"
Unequal rights to property mean that women may be forced out of their homes when widowed or diagnosed with HIV. Most women in India are landless. They are seldom given a share in parental property or able to own other assets. The Hindu Succession Act 1956 recognized the right of women to inherit the property of their father, and an amendment of the Act to confer these property rights in a joint family is under consideration. However, this Act does not apply to women belonging to non-Hindu religious communities, and is rarely implemented even in the case of Hindu women.
The burden of caring for the sick falls predominantly on women, compounding their domestic responsibilities and reinforcing stereotypes about gender roles.
Different ministries do not prioritize HIV/AIDS because it is seen as a health issue, and coordination across ministries leaves much to be desired. Donor agencies have focussed more on the south of the country, where services, though not of a desirable standard, are better than in the rest of the country.
The Tambaram Sanitarium in Chennai, the largest facility in Asia for tuberculosis treatment, has become a de facto centre for HIV/AIDS treatment thanks to an exclusive ward devoted to PLWHA. Nevertheless, corruption is rampant and it is not uncommon to find patients sharing the premises with pigs and rodents. An activist says, "Cleanups and whitewashing is engineered before some dignitary, particularly a foreign one, arrives on inspection. Otherwise, patients sometimes have to sleep on the floor and bribe everyone from the ward boy to the pharmacist to get medicines which are supposed to be available free."
In Chennais outlying suburb of Pallavaram, Zonta International, an NGO, began a rehabilitation home for sex workers close to nine years back. Every woman in the floating population of twenty seven odd inmates here is AIDS positive. The need for an organization willing to accept these forsaken women was felt when the government "rescued" them but they still had nowhere to go. Here lives Kamla (name changed) - the malnourished result of years of neglect, sold by her family to a potential employer who turned out to be a pimp, sexually abused and physically battered, looking forty-five though she is not yet thirty. Dying faster now than she was before, Kamla is also a terminal victim of fully developed AIDS. When she cries, as she is often wont to, it is unclear what causes her greater grief - whether it is because visitors sometimes refuse the tea she makes for them or the fact that all three of her letters to her "found" family have gone unanswered.