Public Health
Facts & Stats
India is at high risk of a full-blown AIDS epidemic because:
- Considerable portions of the Indian population live in poverty (over 35% of Indians earn less than $1 per day)
- Large numbers of vulnerable groups, including women, sex workers, truck drivers, and intravenous drug users.
- Low levels of literacy (48% of women, 73% of men)
- Significant rural to urban and intrastate migration of male populations
- Culture based stigma related to sex and sexuality, and severe discrimination against HIV+
- Visible commercial sex workers and rising rates of casual sex outside of marriage
- Resistance to condom use
- Widespread prevalence of sexually transmitted diseases (STDs)
- Low status of women and their inability to negotiate safe sex
The focus needs to be on scaling up programs that are working, expanding reach to the general population where the virus has spread, and shoring up the public health system, all of which requires the appropriate level of resources and political leadership. At this moment, the crisis in India is surmountable provided there is significantly stronger, high visibility national level public health response that makes HIV/AIDS prevention everybody’s business.
A National AIDS Control Program was launched in 1987 with the program activities covering surveillance, screening blood and blood products and health education. In 1992 the National AIDS Control Organization (NACO) was established.5 NACO carries out India's National AIDS Program, which includes the formulation of policy, prevention and control programs. With the second phase of the National AIDS Control Program (1999-2004), NACO has expanded its program. NACO provides funds to state AIDS control societies for targeted interventions, blood safety, youth campaigns, VCT, care and support and social mobilization. The second phase of the program aims to promote cooperation among public, private and voluntary sectors.
The Indian government is also criticized for clinging to the idea that the epidemic is limited to "high risk groups", such as sex workers, drug users and truck drivers, and that targeting them is the best strategy to contain the epidemic further. But this approach no longer reflects the reality of at least some Indian states, where the epidemic is in the general population.
In these states women who only have sex with their husbands may be the group at highest risk of HIV transmission, and although in Indian society men can experiment with sex outside of marriage, women do not have the status to demand condom use of their husbands.