InterPress News Service (IPS); Wednesday, 24 September 1997.
Laxmi Murthy

No longer a disease afflicting only sex workers, truck drivers and homosexuals, AIDS has become a very real possibility for housewives and new-born infants.

Across India, as many as 1.6 percent women attending ante- natal clinics are HIV positive. In Bombay, the figure is as high as 2.8 percent.

With 2,346 cases, Maharashtra is the state with the highest number of AIDS cases -- almost 50 percent of the country's total tally. Sangli, in the south of the state, has been identified by the state government as the most vulnerable district as regards the spread of HIV.

The powerful sugar lobby that controls the economy of rural Maharashtra has its roots in this town on the banks of the River Krishna. Located on the border of Karnataka state, Sangli district is the first entry point of trafficking routes. Further, the devadasi system (dedicating girls to the goddess Yellamma), a form of temple prostitution given a fair amount of social sanction, flourishes in the region despite legal provisions banning the practice.

SANGRAM, a Sangli-based NGO has been working for the last five years in the area of HIV/AIDS prevention among women in prostitution. During the course of their work, several issues emerged which pointed to the need for a more broad-based strategy for HIV/AIDS prevention.

Although sex workers in the region have formed themselves into Veshya AIDS Muqabla Parishads (VAMP) or prostitute collectives, and are able to enforce condom use, they found that rural clients are the most reluctant users of condoms.

Moreover, some women who solicit sex at the weekly bazaars are found to be from private homes which double up as brothels, necessitating a broader definition of ''women at risk''.

The alarming rise in HIV positive cases among pregnant women, as well as the fact that even remote areas of the district have reported cases of HIV/AIDS, made it imperative to intervene at the grass-roots level.

SANGRAM has currently initiated a district level programme, covering all 711 villages with a total population of about 230,000. One of the main objectives is to combat the widespread prevalence of myths and prejudices about HIV/AIDS with the provision of accurate information.

Formal and informal groups in both urban and rural areas at the sub-district level are being encouraged to form concerned citizens forums at the sub-district level for information dissemination. Promotion of safe sex practices and ensuring easy availability of condoms will be carried out by health workers in co-ordination with the government Primary Health Centres.

Emphasis is placed on home-based care as well as community- based care strategies of people with AIDS. Since AIDS is not a medical care problem alone, the social dimension is being stressed. Says Meena Seshu of SANGRAM, ''It is crucial to create an atmosphere of positive living and reduce discriminatory attitudes towards affected persons and their families.''

The implications of HIV/AIDS on women being multifold, a women-centred perspective is woven into the approach. Says Nagdevi Shinge, coordinator with SANGRAM, ''Women are badly affected whether as an infected partner or as the surviving partner. They are also the major care-givers to HIV infected persons in the family. In all these situations, women need support and sensitivity from those around them.''

Special efforts are being made to reach out to women isolated within the family, who are the most vulnerable and also the most ill-informed about AIDS.

With heterosexual transmission of HIV accounting for about 75 percent of all sources of infection, there is a crying need to break the stony silence around matters relating to sexual behaviour. ''No more can the middle class behave as though sex does not exist. AIDS has forced the issue right into the drawing room,'' points out Shehnaaz, a community worker with SANGRAM.

However, given the strong taboos about talking about sex, raising awareness about AIDS is an uphill task. That the government is hard put to make any headway is all too apparent. India is expected to have the highest incidence of AIDS in the world by 2000 AD, ironically declared the year by which 'Health for All' is to be achieved.

Projections put the figure as 5 to 8 million cases of AIDS by the turn of the century. The National AIDS Control Organisation (NACO) reports a sero-positivity rate of 20.82 per 1000. The NACO itself is a classic case of mismanagement and lacklustre programmes completely devoid of innovativeness or even sincerity.

Lack of funds can by no means be cited as justification for effective interventions, since even four years after the allocation of the World Bank 85-million dollar loan, NACO has managed to spend only 55 million dollars, and that too without much success.

With the AIDS pandemic already on the doorstep, local level efforts must be supported along with wide-ranging policy guidelines. Initiatives like the one in Sangli which build community participation and other essential components for any successful health programme must be encouraged and replicated. (End/IPS/lm/an/97)

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