InterPress News Service (IPS) - Sunday, November 30, 1997.
Analysis - By Laxmi Murthy

The HIV virus that causes the deadly disease is spreading in previously "untouched" populations, the National AIDS Control Organisation (NACO) acknowledges. Epidemiological observations, it reports, indicate that the virus is moving from urban to rural areas, and from "high-risk group" to the general population.

Sero-positivity is a high 18.6 per 1000, and most cases of HIV infection have been detected in men and women between the ages of 20 and 45, which would mean the untimely loss of a large number of adults in the prime of their economic life in India.

Data from antenatal clinics indicate rising HIV prevalence among pregnant women, resulting in a consequent rise in HIV among children. In India, the predominant mode of transmission is through heterosexual contact (76.8 percent), followed by intravenous drug use (9 percent) and infected blood products (7.4 percent).

Monday (Dec 1), is the day the world observes internationally the threat posed by AIDS. Currently, 90 percent of all people living with HIV are in the developing world and the Asia-Pacific region is expected to have the largest cumulative number of people with the HIV infection.

The United Nations Development Programme (UNDP) places issues of gender and poverty at the core of the problem of transmission of HIV. The lack of autonomy of women makes them more vulnerable to the risk of infection.

In a report that was released earlier this week, UNAIDS, the joint U.N agency for HIV/AIDS, said 46 percent of the estimated 2.3 million people worldwide who died of AIDS this year, were women.

In India too labour mobility and the changes in values and traditional structures associated with the processes of modernisation are also underlying contributory factors to the rapid spread of the virus. The absence of economic, social and political rights for the majority has also been found to be crucial to the spread of HIV.

"Behaviour is often conditioned by factors beyond one's control. The disadvantaged do not have options. For instance, women are usually not in a position to enforce condom use of only one partner," points out Geeta Sethi, senior projects operations officer of the UNDP Regional Project on HIV and Development.

The approach to tackling the AIDS pandemic has shifted from a focus on individual behaviour to tackling the pandemic as a development problem with social implications. The governance approach being advocated by the UNDP involves adopting strategies which strengthen government, civil society and private sector institutions so as to create and implement effective responses to the HIV epidemic.

NACO, India's pivotal body in dealing with HIV/AIDS prevention was established in 1992, but has not proved itself equal to the mammoth task of reducing the impact of the AIDS pandemic in India. While NACO officials aver that they have adopted a multi-sectoral approach, the fact that they are based in the Ministry of Health and Family Welfare proves otherwise. Although as much as 45.15 percent of the 84 million dollars World Bank loan has gone into Information, Education and Communication, results do not seem to be proportionately high.

An official at the NACO claimed, "We view the problem as a social one, and therefore do not target individuals. We have endorsed the WHO guidelines against compulsory testing for HIV, and also respect the confidentiality of persons who test positive." Despite these assertions, the NACO cannot shrug off its involvement in the infamous forcible testing of women in prostitution in Calcutta in 1994.

In 1989, the government tried to push through a draconian AIDS (prevention) Bill, which would have further victimised and isolated the HIV positive, but was forced to retreat by protests and active lobbying by the Delhi-based AIDS Anti-Discrimination Movement.

According to Doris D'cruz-Grote of UNAIDS, the fact that the HIV infection is an invisible one, as well as the existence of traditional taboos on discussing sexual behaviour have a direct bearing on effective programme strategies.

More importantly, lack of advocacy, awareness, and absence of accurate data on infection rates, coupled with a lack of political will to tackle the problems are factors affecting a streamlined response to the epidemic in India.

Severe budgetary cuts in the welfare sector, the result of changes in overall policy dictated by conditionalities of the World Bank and International Monetary Fund (IMF) loans, are additional problems. Ironically, the very forces contributing to deepening impoverishment and marginalisation in the developing world through structural adjustment programmes have now come together in UNAIDS to point out that poverty, gender and labour migration are key factors in tackling the AIDS pandemic.

Unless there is a drastic restructuring of priorities, the AIDS pandemic is very likely to erupt in the not-too distant future. (END/IPS/ap-he-02/lm/an/97)

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