InterPress News Service (IPS); Wednesday, 14 August 1996.
Meena Menon

In her twenties, Malati's world was shattered a few months ago. Her husband succumbed to AIDS, leaving her to look after their three children, the youngest of whom is two years old.

Malati belongs to the dhobi community, which is fiercely resisting her attempts to seek work outside. So she makes ends meet ironing a few clothes everyday. Her youngest child is unwell and she has an alcoholic brother to support. In addition, she has tested HIV positive and is going through a period of denial.

Contrary to the prevalent belief that gays and sex workers are in the high risk group as far as AIDS is concerned, recent developments have pointed to the number of female homemakers who are at risk including neo-natal women.

In India, in 95 percent of the cases, the virus is transmitted through heterosexual contact. A Sentinel surveillance study conducted by the state government at J.J. Hospital here last year found that 3.5 percent of ante-natal women below 20 who visited the hospital were HIV positive while 2.5 percent over 20 were also infected. Their children stand a 30 to 40 percent chance of being infected by the virus, according to doctors.

At Mumbai's (previously Bombay) Wadia Maternity Hospital, every Friday, Dr Rashid Merchant conducts what is referred to as the "HIV OPD". Under the safe Motherhood Project, in the last three years, about 3,800 female homemakers have been screened for the virus, one percent of whom have tested HIV positive.

About 35 percent of these women pass on the infection to their children. Already, evidence of the disease is seen in some of the one-year-old infants brought to the clinic by anxious parents, either one or both of whom are HIV positive.

"We not only test the infants but also have a follow up programme where we keep track till the child is at least 15 months old. If the mothers can afford it, we put them on a drug called AZT which is very expensive (Rs 8,000 for a course for the mother and child)," Dr Merchant explains.

Mamta has recently come to the city to join her husband. She was admitted to a private hospital for a skin ailment. However, as soon her blood tests confirmed she was HIV positive, she was asked to leave. Now in a public hospital, she is being treated for a skin disease, a result of her weakening immune system.

Dr J.K. Maniar who heads the AIDS management unit at the city's G.T Hospital, said he treated over 1,300 couples of whom 75 percent were both HIV positive.

There is a rising trend of women who are infected by their husbands and later widowed. According to social worker Jyotsna Karkare who works at Wadia Hospital, "Most of the women who come here are semi-literate and not very expressive. There is anger and resentment but few articulate their feelings. They cannot walk out of the marriage and fend for themselves."

In fact, researchers point out that it is the women to have to tend to their husbands and there is no corresponding concern for their health and needs.

Studies in AIDS Update, a publication of the Maharashtra state government and Aids Research and Control Centre, women are one of the fastest growing populations being infected with the AIDS virus and the number of cases is doubling every one to two years.

They are also more vulnerable because they are not in a position to insist on contraception due to various cultural prejudices and social factors -- poverty either forces them to sell sex or be at the receiving end of their husband's desires.

Social workers agree empowering women is the only way. But now it is difficult to prevent HIV positive women from having children as the risk is 30 to 40 percent. There are also other pressures involved.

From a conservative trading community, Usha's first husband died in an accident. She remarried innocent of the fact she was HIV positive, infected with the virus by her late husband. After her second marriage, she started falling repeatedly ill and tests revealed she and her child were HIV positive.

Pregnant by now, she had also transmitted the disease to her second husband. However, her husband was keen she should have a child. Usha, suffering from TB as well, was not keen on a second child as she was afraid of the child being HIV positive. Her husband was not convinced and it was only after repeated counselling when he was asked to consider her feelings, her health and the risk factor that he consented to an abortion.

For Usha, who belongs to a middle-class family, where abortion is taboo, it was a difficult choice to make.

Commercial sex workers have long borne the stigma that they are in the high-risk category. The Comprehensive Health Care Unit in Kamathipura, run by the Mumbai municipal corporation's ASHA project dealing with AIDS, attracts nearly 50 to 60 women daily who come for treatment of various types.

One of the patients, Meera has a pain in the abdomen which needs to be treated. She has heard of AIDS and knows clients must use condoms but she cannot insist on it. Now health experts working in the city's red light districts feel it is important to target the general health of the women instead of concentrating only on HIV and AIDS awareness.

(All the names of those infected by HIV have been changed to protect their identity) (End/IPS/MM/AN/96)

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