Virginia Review of Asian Studies Volume 16 (2014): 56-73 Ramdass: India Women AIDS
THE SOCIO-ECONOMIC IMPACT OF HIV/AIDS ON INDIAN WOMEN
SHEKIRA A. RAMDASS
MARY BALDWIN COLLEGE
Abstract:HIV/AIDS has emerged as a serious public health issue across the world, affecting the well-being of many men, women, and children. Diffusing across borders as an infectious killer, it has jeopardized domestic and international stability since the 1970s.Highly prevalent in India, which is the third-largest nation with a high rate of HIV, the virus has had negative social and economic implications for women. Socially, it has caused women to suffer from unethical stigma and discrimination, forcing them to live in isolation and endure brutal violence. Economically, the virus places a financial burden on Indian women due to the high cost of medication and treatment. Furthermore, the spread of HIV/AIDS hinders women’s ability to be caregivers and homemakers — vital economic roles that Indian women value and cherish – and places them in a vulnerable position.Unable to attend school or achieve economic stability, many HIV-infected women are forced to enter prostitution, thereby spreading the disease to clients and, worse, to children through mother-to-child transmission.Though actions have been taken to deter the diffusion of HIV/AIDS in India, more aggressive efforts are essential to improve the social and economic well-being of all Indian women. It is vital that international, national, and local agencies collaborate to achieve advanced solutions to prevent further destruction in society.
The HIV/AIDS epidemic is a persistent transnational issue that hinders both domestic and international development. Highly concentrated in many developing and developed areas, HIV/AIDS continues to diffuse across regions as a result of permeable borders. It is imperative that such a communicable disease is addressed in order to promote worldwide growth.
What is the socio-economic impact of HIV/ AIDS in India, especially in relations to women?
The diffusion of HIV/AIDS continues to have a significant impact on the social and economic wellbeing of women in India. Socially, the virus causes women to suffer from harsh stigma and discrimination, forcing many to live in isolation and endure brutal violence. Economically, HIV/AIDS places a financial burden on women due to the high cost of medication and treatment. In addition, the spread of such a disease hinders women’s ability to be caregivers, which is a vital economic role for Indian women. These devastating effects place women in a vulnerable position, preventing many from receiving an education and forcing some of them to enter prostitution. As a result, society witnesses a higher risk of HIV/AIDS transmission, which
ultimately increases the amount of victims affected by such disease.
The paper begins with a detailed background that provides an overview of the HIV/AIDS epidemic. Following are two specific sections that express both the social and economic impact of the disease on women in India. Lastly, the paper discusses vital initiatives that should be taken in order to reduce the spread of HIV. These initiatives will also explain how they relate to the promotion of women’s empowerment, which is essential for preventing future spread of the disease.
Methodology
Qualitative research was performed to collect data regarding the HIV/AIDS epidemic in India. Several scholarly sources including UNAIDS regional and country reports, WHO publications, and surveys from various international and domestic organizations serve as the primary references for the paper. These sources utilized mechanisms such as participant observation, focus groups, and in-depth interviews to help explain the impact of HIV/AIDS diffusion on women. Furthermore, personal experiences from studying abroad in Madurai, India provided additional insight into the devastating consequences of the virus. My time as a student in the Tamil Nadu region enhanced my understanding of the social norms, gender roles, and socio-economic status of women, which are leading factors that contribute to the spread of HIV/AIDS.
Background:
Good health is a fundamental human right that every person is entitled to. A healthy individual is a valuable being who not only contributes to society, but ensures prosperity in social, economic, and political development. However, one who becomes a victim of an illness can bring fatal consequences to society, which ultimately becomes a major health challenge to the developed and developing world.
Emerging as the first modern pandemic in the mid-1970s, HIV/AIDS has become a serious health challenge in all regions. As the fourth leading cause of death around the world and the first leading cause of death in Africa, HIV/AIDS continues to affect 35.3 million people worldwide, including 2.1 million adolescents, ages 10-19.[1]Diffusing as the leading infectious killer, the World Health Organization (WHO) reports that 36 million victims have died since the first reported cases in 1981. In 2012, 1.6 million people died of HIV/AIDs and 2.3 million individuals were newly infected worldwide.[2]
With respect to understanding the vitalityof such global health issue, a brief clinical analysis of the disease is necessary. The human immunodeficiency virus (HIV), unlike other viruses, is incurable and stays in the body for life. The virus itself harms specific cells of the immune system called CD4 or T cells, which are essential to fighting off infections and diseases. Overtime, HIV can destroy these vital T cells, which ultimately prevents the body from functioning properly. When this destruction takes place, the HIV infection becomes known as the acquired immunodeficiency syndrome (AIDS). People, who arrive at this final stage of the HIV infection, have severely damaged their immune system, which can ultimately lead to death. There are several ways in which an individual can receive the virus. Living in body fluids—semen, blood, breast milk, vaginal fluids, etc.., HIV/AIDS can enter the body during sexual contact, pregnancy, breastfeeding, blood transfusion, and drug injections.
HIV/AIDS cases have been reported globally, but 95% of new infections have occurred in low and middle income countries, especially in Sub-Saharan Africa and South and Southeast Asia regions.[3]In regards to India, a nation that has suffered from its diffusion since 1987, the disease has counted among the most deadly public health concerns of the nation.[4] According to AIDS Alliance, roughly 2.4 million people in India are HIV-positive. Although India remains a low prevalence country, compared to HIV/AIDS rates in Thailand and Myanmar, it is the highest ranking nation in South Asia. HIV in India is prevalent all over the nation, though it is more significant in the following states: Andhra Pradesh, Maharashtra, Karnataka, and Tamil Nadu. These states are located primarily in the south of India, and are among the most impoverished cities in the country. In regards to Andhra Pradesh, HIV has infected 500,000 people, and remains the highest of all Indian states. Maharashtra ranks second infecting roughly 420,000 people. Karnataka and Tamil Nadu, respectfully, have250,000 and150, 000infected people.[5]
(Map Source: HIV and AIDS Charity AVERT)[6]
There are several risk factors that put India in danger of rapid diffusion of HIV/AIDS. These risks include, but arenot limited to the following:
Injecting Drug Use(IDU): Individuals who engage in drug injection often use contaminated injecting equipment, which is one of the main high risk factors for HIV infections in Northeast India (Manipur, Mizoram and Nagaland).[7] Such activity, according to the World Health Organization, is also prevalent in major urban cities including: Chennai, Mumbai, New Delhi, and in the state of Punjab.
Unsafe Sex and Low Condom Use: Sexual transmission through the practice of unsafe sex is responsible for roughly 87.4 percent of reported HIV cases in India.[8]This is a result of a high prevalency among commercial sex workers, specifically from rural and low economic areas such as AndhraPradesh andMaharashtra. As a result, the nation witnesses higher rates of the disease among sex workers, mainly females, and their clients. Women who engage in such activity appear to have a larger proportion of the virus due to regular unsafe sexual practices with HIV- infected partners.
Migrant Workers: Migration due to work forces people to be away from families and the community. This increases the likelihood of risky sexual behavior, which contributes to HIV transmission. The mobility of female sex workers and male truck drivers in India, especially in Andrash Predesh and Nagaland, are indeed at a higher risk of contracting the virus.[9]
Men Who Have Sex withMen:Though overt homosexuality is not common in India, it still plays significant role in the diffusion of HIV/AIDS. According to WHO, Chattisgarh (15%), Nagaland (14%), and Maharashtra (13%) have the highest HIV prevalence among men who have sex with men.[10]
HIV/AIDS has truly diffused across borders in India affecting men, women, and children. As the nation remains the third largest carrier after South Africa and Nigeria, respectively, India continues to suffer from the virus’ devastating social and economic effects.[11]Thus far, India has taken valuable steps to assist in reducing the spread of HIV/AIDS. Adopting the Declaration of Commitment on HIV/AIDSin 2001 and the Political Declaration on HIV/AIDS in 2006, India has committed itself to improving its efforts to cease the spread of AIDS. Though actions have been taken, the nation continues to suffer from devastating trends that place Indian citizens, especially women, in vulnerable positions to contract the disease.
Social Impact
The diffusion of HIV/AIDS has negatively contributed to the social and economic stability and prosperity of women in India. In regards to the social impact, Indian women face challenges both in the home and in the community, a direct result of gender inequality and high rates of stigma and discrimination. Women in Indian society already carry an inferior status that requires them to be submissive to male authority. They lack the power to exercise personal autonomy over their lives and, most importantly, their bodies, which places them in a vulnerable position to contract the virus. Limited authority has prevented women from negotiating safe sexual practices with their husband or partner, which is indeed very risky. According to UNAIDS, almost 85% of Indian women get infected with HIV from their spouse or other male sexual partner(s).[12] In India, men are more likely to carry HIV/AIDS, which is a result of extra-marital sexual activity or drug injections. In addition, men playa more dominant role in India, and therefore, are more likely to initiate and control sexual interaction. As a result, women fear to negotiate safe sex, which prevents the use of contraceptives that are vital for preventing the spread of HIV.
As a result of their subordinate status in India, women are often victims of violent sexual acts, which further increases their risk of contracting the disease. Rape, especially, gang rapes, which has emerged as a relatively common activity in South India, has prevented women from exercising any control.[13]They are forced to engage in nonconsensual and unprotected sex with men, which is an ideal way of enforcing male supremacy in a society that is predominantly patriarchal. As a result, many Indian female victims contract the disease from men who are often HIV-positive. Powerlessness and inequality have been the fundamental factors in the diffusion of HIV/AIDS among women in India. It has caused women not to have protection over their body, and therefore prevents women from feeling empowered.
Indian women who contract the disease are indeed vulnerable to other social factors, such as stigma and discrimination. According to the United Nations Secretary-General, Ban Ki Moon, “stigma is a chief reason why the AIDS epidemic continues to devastate societies.”[14]Stigma and discrimination are indeed closely associated with women’s inferior status in society, which has placed more of a social burden on their wellbeing. According to the 2013 UNAIDS report, Indian women are more likely to contract the disease from men. However, Indian women who are infected face higher levels of stigma and discrimination than men.[15]This inequality is because in India, females are valued less in society than males. As a result, women are forced to suffer from harsher treatment and brutality, which is indeed a severe social impact.Indian women infected with HIV/AIDS are often rejected by their family and spouse, and are therefore forced to live in isolation. Infected women are also separated from their children, which hinders the development of a close relationship between mother and child. Such action has caused many Indian women to face depression and suicidal attempts due to the shame, dishonor and embarrassment associated with HIV/AIDS.[16]An HIV-infected Indian woman from the state of Manipur mentioned in a recent case study conducted by the United Nations Development Programme,“I was separated from my family without my consent. The worst part of it all is that I can’t live with my children. There is no reason for me to live anymore. I want to die.”[17]Furthermore, positive Indian women have been accused of infecting their husband with the virus, irrespective of whether women contracted the virus from their spouse. The discrimination has prevented women from receiving any form of support from their family, which is vital for an individual suffering from the virus.
HIV/AIDS has also contributed to discrimination in the community, which is another negative social impact on Indian women. The community and neighborsin Indian society have caused many women to endure additional isolation and ostracism. This is indeed horrific because it affects many customs that are important within Indian society. Marriage, for example, is a practice that is expected for all women and men in India. In contemporary Indian society, the average marriage takes place around the ages 18-24 for women, which is a vulnerable age for contracting HIV/AIDS.[18] Due to stigma and discrimination associated with the virus, women who are infected struggle to find a suitable groom for marriage. Sons and their families are less likely to agree on marriage arrangements with a woman who is HIV-positive. The fear of contracting the disease through interaction and the shame affiliated with the virus has discouraged many marriage practices in India. Indian men do not want to be associated with HIV-positive women because it brings dishonor. As a result, many women are forced to remain unmarried, which brings additional shame and discomfort to the women and her families.
Stigma associated with HIV, however, has indeed encouraged the practice of very young and early marriages in rural parts of India. Since HIV-infected parents fear their daughters will not get married, many choose to prepare an early wedding to solidify social and economic stability for their girls.[19] This activity, however, has additional negative impacts on the social wellbeing of Indian girls. Limited educational opportunities and academic advancement, for example, becomes a social sacrifice that Indian girls endure. Girls as young as twelve get engaged and become eventually, a wife.[20] Young marriage prevents them from continuing their education because most of their time is consumed taking care of domestic duties—cooking, cleaning, and raising children, which are traditional expectations. A young Indian wife also faces the possibility of her husband not wanting her to pursue an education, which is another demonstration of female inferior status in India.
In addition to the practice of early marriage, HIV stigma and discrimination has prevented Indian girls from gaining entrance into schoolsand universities. This is due to the misconception that the virus will easily spread to students and teachers in the classroom.[21]As a result, girls are forced to remain at home and thus, not receive an education. The diffusion of HIV/AIDS in India has also forced many girls to drop out of school to care for HIV-infected parents. Indian society values the traditional expectation of women and girls playing an active role in the household. Therefore, when Indian parents are infected with HIV/AIDS, girls are expected to be their primary caregivers. This burden is a hindrance on their education because it forces them to leave school in order to assist their HIV-positive parents. According to the United Nations Population Fund, older females are pulled out of school to care for HIV-infected mothers and fathers. The social impact becomes worse when family members, especially mothers, die from the disease. According to Robert Greener, senior economic adviser at the United Nations Development Programme, girls who lose one or both parents to HIV/AIDS areunlikely to remain in school and finish their education. They fail to complete school because they are required to fulfill more pressing responsibilities in the home. This is indeed a social burden on Indian girls because they become the designated person to take over the tasks of the missing or sick parents infected with HIV/AIDS.