Introduction

HIV/AIDS has rapidly emerged as one of the greatest threats to human health in the 21st century.
Over 25 million people have died since the beginning of the AIDS epidemic. Currently, over 7,500
people die from AIDS each day—about five people every minute (UNAIDS, 2006).

World Scenario

It is estimated that there were 33.4 million people living with HIV/AIDS worldwide at the end of 2008.
Approximately 2.7 million people were newly infected with HIV (the AIDS virus) in 2008 . UNAIDS
estimates that HIV/AIDS took the lives of more than 2 million people in 2008. Women account for
approximately 50% of people infected with HIV. In most regions of the world, HIV is affecting women
and girls in increasing numbers. In 2008, around 430,000 children were born with HIV, bringing to 2.1
million the total number of children under 15 living with HIV. Young people account for around 40% of
all new adult (15+) HIV infections worldwide. Sub-Saharan Africa is the region most affected and is
home to 67% of all people living with HIV worldwide and 91% of all new infections among children. In
sub-Saharan Africa the epidemic has orphaned more than 14 million children. The percentage of HIV-
positive pregnant women who received treatment to prevent transmission of the virus to their child
increased from 33% in 2007 to 45% in 2008. Latest data indicate that fewer than 40% of young people
have basic information about HIV and less than 40% of people living with HIV know their status. The
number of new HIV infections continues to outstrip the numbers on treatment—for every two
people starting treatment, a further five become infected with the virus.

"The number of HIV-positive people receiving antiretroviral drugs [ARVs] for their infections jumped
by more than a quarter in 2009, growing from 4 million to 5.2 million, the World Health Organization
said Monday at the International AIDS Conference in Vienna," the Los Angeles Times reports (7/19).

"Between 2003 and 2010, the number of patients receiving lifesaving antiretroviral treatment
increased twelve-fold, according to the Geneva-based body," the Associated Press notes (Oleksyn,
7/19).

"This is the largest increase in people accessing treatment in a single year. It is an extremely
encouraging development," Hiroki Nakatani, WHO assistant director-general for HIV, tuberculosis,
malaria and neglected tropical diseases, said in a statement issued by the WHO (7/19).
In the last 2 decades, there have been significant advances in the control and treatment of HIV/AIDS,
but still no cure. Prevention thus remains a critically important strategy for reducing the impact of
this global pandemic. Science has shown that HIV is transmitted from person to person by a known
set of risk behaviors and transmission routes, including unprotected sex with an infected partner,
the sharing of equipment used to inject both illegal and legal drugs, and mother-to child
transmission. In the charged debates about HIV/AIDS, HIV risk behaviors are often described in
simplistic terms as a matter of “human choice,” with little attention paid to the complex social,
environmental, cultural, and economic factors impacting these choices. It is critically important to
understand not only the science of this disease but also the behavioral and sociocultural influences
that both facilitate and prevent the spread of HIV.

Indian Scenario

India is one of the largest and most populated countries in the world, with over one billion
inhabitants. Of this number, it's estimated that around 2.27 million people are currently living with
HIV.1

HIV emerged later in India than it did in many other countries. Infection rates soared throughout the
1990s, and today the epidemic affects all sectors of Indian society, not just the groups – such as sex
workers and truck drivers – with which it was originally associated.

In a country where poverty, illiteracy and poor health are rife, the spread of HIV presents a daunting
challenge.

The History of HIV/AIDS in India

At the beginning of 1986, despite over 20,000 reported AIDS cases worldwide, 2 India had no
reported cases of HIV or AIDS.3 There was recognition, though, that this would not be the case for
long, and concerns were raised about how India would cope once HIV and AIDS cases started to
emerge. One report, published in a medical journal in January 1986, stated:

“Unlike developed countries, India lacks the scientific laboratories, research facilities, equipment,
and medical personnel to deal with an AIDS epidemic. In addition, factors such as cultural taboos
against discussion of sexual practices, poor coordination between local health authorities and their
communities, widespread poverty and malnutrition, and a lack of capacity to test and store blood
would severely hinder the ability of the Government to control AIDS if the disease did become
widespread.”4

Later in the year, India’s first cases of HIV were diagnosed among sex workers in Chennai, Tamil
Nadu.5 It was noted that contact with foreign visitors had played a role in initial infections among sex
workers, and as HIV screening centres were set up across the country there were calls for visitors to
be screened for HIV. Gradually, these calls subsided as more attention was paid to ensuring that HIV
screening was carried out in blood banks.6 7

In 1987 a National AIDS Control Programme was launched to co-ordinate national responses. Its
activities covered surveillance, blood screening, and health education. 8 By the end of 1987, out of
52,907 who had been tested, around 135 people were found to be HIV positive and 14 had AIDS. 9
Most of these initial cases had occurred through heterosexual sex, but at the end of the 1980s a
rapid spread of HIV was observed among injecting drug users (IDUs) in Manipur, Mizoram and
Nagaland - three north-eastern states of India bordering Myanmar (Burma). 10

At the beginning of the 1990s, as infection rates continued to rise, responses were strengthened. In
1992 the government set up NACO (the National AIDS Control Organisation), to oversee the
formulation of policies, prevention work and control programmes relating to HIV and AIDS. 11 In the
same year, the government launched a Strategic Plan, the National AIDS Control Programme (NACP)
for HIV prevention. This plan established the administrative and technical basis for programme
management and also set up State AIDS Control Societies (SACS) in 25 states and 7 union territories.
It was able to make a number of important improvements in HIV prevention such as improving blood
safety.

By this stage, cases of HIV infection had been reported in every state of the country. 12 Throughout
the 1990s, it was clear that although individual states and cities had separate epidemics, HIV had
spread to the general population. Increasingly, cases of infection were observed among people that
had previously been seen as ‘low-risk’, such as housewives and richer members of society. 13 In 1998,
one author wrote:

“HIV infection is now common in India; exactly what the prevalence is, is not really known, but it can
be stated without any fear of being wrong that infection is widespread… it is spreading rapidly into
those segments that society in India does not recognise as being at risk. AIDS is coming out of the
closet.”14
In 1999, the second phase of the National AIDS Control Programme (NACP II) came into effect with
the stated aim of reducing the spread of HIV through promoting behaviour change. During this time,
the prevention of mother-to-child transmission (PMTCT) programme and the provision of free
antiretroviral treatment were implemented for the first time. 15 In 2001, the government adopted the
National AIDS Prevention and Control Policy and former Prime Minister Atal Bihari Vajpayee referred
to HIV/AIDS as one of the most serious health challenges facing the country when he addressed
parliament. Vajpayee also met the chief ministers of the six high-prevalence states to plan the
implementation of strategies for HIV/AIDS prevention. 16

The third phase (NACP III) began in 2007, with the highest priority to reach 80 percent of high-risk
groups including sex workers, men who have sex with men, and injecting drug users with targeted
interventions.17 Targeted interventions are generally carried out by civil society or community
organisations in partnership with the State AIDS Control Societies. They include outreach
programmes focused on behaviour change through peer education, distribution of condoms and
other risk reduction materials, treatment of sexually transmitted diseases, linkages to health
services, as well as advocacy and training of local groups. The NACP III also seeks to decentralise the
HIV effort to the most local level, i.e. districts, and engage more non governmental organisations in
providing welfare services to those living with HIV/AIDS. 18

Current estimates

In 2006 UNAIDS estimated that there were 5.6 million people living with HIV in India, which indicated
that there were more people with HIV in India than in any other country in the world. 19 In 2007,
following the first survey of HIV among the general population, UNAIDS and NACO agreed on a new
estimate – between 2 million and 3.1 million people living with HIV. 20

In 2008 the figure was confirmed to be 2.31 million, 21 which equates to a prevalence of 0.3%. While
this may seem a low rate, because India's population is so large, it is third in the world in terms of
greatest number of people living with HIV. With a population of around a billion, a mere 0.1% increase
in HIV prevalence would increase the estimated number of people living with HIV by over half a
million.

The national HIV prevalence rose dramatically in the early years of the epidemic, but a study released
at the beginning of 2006 suggests that the HIV infection rate has recently fallen in southern India,
the region that has been hit hardest by AIDS. 22 In addition, NACO released figures in 2008 suggesting
that the number of people living with HIV has declined from 2.73 million in 2002 to 2.27 million in
2008.23

Some AIDS activists are doubtful that the situation is improving:

“It is the reverse. All the NGOs I know have recorded increases in the number of people accepting
help because of HIV. I am really worried that we are just burying our head in the sand over
this.”Anjali Gopalan, the Naz Foundation, Delhi24

Peter Piot, Executive Director of UNAIDS, stresses:

“the statement that India has the AIDS problem under control is not true. There is a decline in
prevalence in some of the Southern states… In the rest of the county, there are no arguments to
demonstrate that AIDS is under control”25

What Is HIV?

To understand what HIV is, let’s break it down:

H – Human – This particular virus can only infect human beings.

I – Immunodeficiency – HIV weakens your immune system by destroying important cells that fight
disease and infection. A "deficient" immune system can't protect you.

V – Virus – A virus can only reproduce itself by taking over a cell in the body of its host.

Human Immunodeficiency Virus is a lot like other viruses, including those that cause the "flu" or the
common cold. But there is an important difference – over time, your immune system can clear most
viruses out of your body. That isn't the case with HIV – the human immune system can't seem to get
rid of it. Scientists are still trying to figure out why.

We know that HIV can hide for long periods of time in the cells of your body and that it attacks a key
part of your immune system – your T-cells or CD4 cells. Your body has to have these cells to fight
infections and disease, but HIV invades them, uses them to reproduce itself, and then destroys them.

Over time, HIV can destroy so many of your CD4 cells that your body can't fight infections and
diseases anymore. When that happens, HIV infection can lead to AIDS.
What Is AIDS?

To understand what AIDS is, let’s break it down:

A – Acquired – AIDS is not something you inherit from your parents. You acquire AIDS after birth.

I – Immuno – Your body's immune system includes all the organs and cells that work to fight off
infection or disease.

D – Deficiency – You get AIDS when your immune system is "deficient," or isn't working the way it
should.

S – Syndrome – A syndrome is a collection of symptoms and signs of disease. AIDS is a syndrome,

rather than a single disease, because it is a complex illness with a wide range of complications and
symptoms.

Acquired Immunodeficiency Syndrome is the final stage of HIV infection. People at this stage of HIV
disease have badly damaged immune systems, which put them at risk for opportunistic infections.

You will be diagnosed with AIDS if you have one or more specific infections, certain cancers, or a very
low number of CD4 cells. If you have AIDS, you will need medical intervention and treatment to
prevent death.

Where Did HIV Come From?

Scientists believe HIV came from a particular kind of chimpanzee in Western Africa. Humans probably
came in contact with HIV when they hunted and ate infected animals. Recent studies indicate that
HIV may have jumped from monkeys to humans as far back as the late 1800s

How Do You Get HIV?

HIV is found in specific human body fluids. If any of those fluids enter your body, you can become
infected with HIV.
Which Body Fluids Contain HIV?

HIV lives and reproduces in blood and other body fluids. We know that the following fluids can
contain high levels of HIV:

 Blood

 Semen (cum)

 Pre-seminal fluid (pre-cum)

 Breast milk

 Vaginal fluids

 Rectal (anal) mucous

Other body fluids and waste products-like feces, nasal fluid, saliva, sweat, tears, urine, or vomit-don’t
contain enough HIV to infect you, unless they have blood mixed in them and you have significant and
direct contact with them

HIV-Positive without Symptoms

Many people who are HIV-positive do not have symptoms of HIV infection. Often people only begin
to feel sick when they progress toward AIDS (Acquired Immunodeficiency Syndrome). Sometimes
people living with HIV go through periods of being sick and then feel fine.

While the virus itself can sometimes cause people to feel sick, most of the severe symptoms and
illnesses of HIV disease come from the opportunistic infections that attack a damaged immune
system. It is important to remember that some symptoms of HIV infection are similar to symptoms of
many other common illnesses, such as the flu, or respiratory or gastrointestinal infections.

Early Stages of HIV: Signs and Symptoms

As early as 2-4 weeks after exposure to HIV (but up to 3 months later), people can experience an
acute illness, often described as “the worst flu ever.” This is called acute retroviral syndrome (ARS),
or primary HIV infection, and it’s the body’s natural response to HIV infection. During primary HIV
infection, there are higher levels of virus circulating in the blood, which means that people can more
easily transmit the virus to others.
Symptoms can include:

 Fever

 Chills

 Rash

 Night sweats

 Muscle aches

 Sore throat

 Fatigue

 Swollen lymph nodes

 Ulcers in the mouth

It is important to remember, however, that not everyone gets ARS when they become infected with
HIV.

Chronic Phase or Latency: Signs and Symptoms

After the initial infection and seroconversion, the virus becomes less active in the body, although it is
still present. During this period, many people do not have any symptoms of HIV infection. This
period is called the “chronic” or “latency” phase. This period can last up to 10 years—sometimes
longer.

AIDS: Signs and Symptoms

When HIV infection progresses to AIDS, many people begin to suffer from fatigue, diarrhea, nausea,
vomiting, fever, chills, night sweats, and even wasting syndrome at late stages. Many of the signs and
symptoms of AIDS come from opportunistic infections which occur in patients with a damaged
immune system.

Safer Sex

Most people who get HIV get it by having unprotected sex (anal, oral, or vaginal) with a partner who
is HIV-positive. “Unprotected” means without a condom or other barrier to protect you from
infected body fluids.
Prevention Before and During Sex

Here’s what you can do to protect yourself and others if you are sexually active:

 Know your own HIV status and your partner’s too

 Use condoms, correctly and consistently

 Limit your number of sexual partners

Knowledge Is Power

Have you been tested for HIV and other sexually transmitted infections (STIs)? Has your partner?
Knowing your health status, and that of your sex partner(s), is the best way to protect each of you
from STIs, including HIV.

Condoms Keep You Safer

Condoms offer excellent protection against HIV if you use them correctly. Both male condoms and
female condoms are effective in preventing HIV infection.

Prevention Research

Researchers are looking at many different ways to prevent the spread of HIV. Some research focuses
on behaviors and social factors that increase the risk of HIV infection:

 Unprotected sexual contact (oral, anal, or vaginal)

 Injection drug use

 Poverty

 Lack of access to medical care

 Language barriers

 Cultural expectations

 Threat of partner violence

These factors may place specific groups of people (people of color, women, men who have sex with
men) at a higher risk of getting HIV. The goal of this type of research is to develop prevention
programs or approaches that will stop the spread of HIV.
Other research examines biomedical methods of preventing HIV transmission. These include male
circumcision and microbicides.

Since HIV was first identified in 1984, researchers have been working to develop an HIV vaccine. The
goals of vaccine research are both preventative and therapeutic.

To date, the search for an effective HIV vaccine has not been successful. In June 2008, the National
Institute for Allergy and Infectious Diseases (NIAID) canceled large-scale HIV vaccine trials after the
failure of a similar privately funded vaccine trial in 2007. Dr. Anthony Fauci, director of NIAID,
explained that NIAID canceled the trial because scientists need a better understanding of how HIV
vaccines and the immune system interact before they will be able to develop a successful vaccine.

What Is An HIV Test?

An HIV test looks for signs of HIV in your body. When you get tested for HIV, you will usually give a
sample of blood, but there are other kinds of HIV tests that use urine or a swab of fluids from your
mouth instead. Some tests take a few days for results, but rapid HIV tests can give results in about 20
minutes.

How Does An HIV Test Work?

Most HIV tests look for antibodies to the virus, not HIV itself. Antibodies to HIV appear in your blood,
urine, and oral fluid as your immune system begins trying to fight the virus. Your body makes
different antibodies to fight different threats—so the test looks specifically for HIV antibodies to see
if you are infected with HIV.

Should I Be Tested?

HIV is spread through risky behaviors. If you answer "Yes" to any of the following questions, you
should get an HIV test:

 Have you injected drugs or steroids or shared equipment (such as needles, syringes,
works) with others?

 Have you had unprotected anal, oral, or vaginal sex with a partner whose HIV status is
unknown?
  Have you exchanged sex for drugs or money?

 Have you been diagnosed with, or treated for, hepatitis, tuberculosis (TB), or a sexually
transmitted infection (STI)?

 Have you had unprotected sex with someone who could answer "Yes" to any of the
above questions?

 Are you pregnant or planning to become pregnant?

 Have you been sexually assaulted?

If you continue to engage in high-risk behaviors, it is recommended that you get an HIV test at least
once a year, and possibly more often. Talk with your healthcare provider about a testing schedule
that is right for you.

Why Should I Be Tested?

Getting tested can give you some important information and can help keep you—and others—safe.
For example:

 Knowing your own HIV status can give you peace of mind—and testing is the only way
you can know for sure.

 When you and your partner know each other's HIV status, you can make informed
decisions about your sexual behaviors and how to stay safe.

 If you are pregnant, or planning to get pregnant, knowing your status can help protect
your baby from being infected.

 If you find out you are HIV-positive, you can get into early treatment. This increases your
chances of staying healthy.

 If you know you are HIV-positive, you can also take steps to protect your sex or drug-using
partners from becoming infected.

When Should I Be Tested?

On average, you may need to wait 1-3 months from the time of possible exposure to get an accurate
test result. That's because, if you are infected, it can take your body a while to start making HIV
antibodies. This time between when you are exposed to HIV and the time you could test positive for
HIV antibodies is called the window period.

If you took an HIV test within the first 3 months after possible exposure, you should consider getting
another test 3 months later to confirm your results.

How Accurate Are My HIV Test Results And What Do They Mean?

HIV tests are over 99% accurate if you take one 3 months after a possible exposure. (Before then, the
tests may not pick up the presence of HIV antibodies.)

What Does A "Negative" Result Mean?

If your test comes back negative, it means the test didn't find any evidence of HIV antibodies in your
body. But a negative result only means that the test couldn't find HIV. Depending on when you were
exposed, it is still possible that you might have HIV. If you are tested earlier than 3 months after
exposure, the test may miss any HIV in your body fluids. That's why most healthcare providers
encourage you to have a follow-up test 3 months later.

If you engage in risky behaviors between the time you take the test and get your results, or between
your first test and a follow-up test, your test result may not be accurate. The test only tells you what
your HIV status is when you took it—so if you were exposed to HIV after you took the test, the
results may not show your current HIV status.

To get an accurate result, while you are waiting to take your test, or get your results:

 Don't inject drugs—or always use clean equipment and don't share needles or works

 Don't have sex—or always use protection (condom or dental dam) if you do

What Does a "Positive" Result Mean?

If your test comes back positive, it means that it found evidence of HIV antibodies in your blood. If
you have a positive HIV test, the testing center will give you another test to make sure the first test
result was correct.
Reputable testing centers always do these "confirmatory" tests, because there is a very small chance
that the first test was wrong. If the second test has the same outcome, you will be diagnosed as
being "HIV-positive."

What Do I Do If I Am Diagnosed As Being HIV-Positive?

If you are diagnosed with HIV, you should do the following things—even if you don't feel sick:

 Find a healthcare provider who has experience treating HIV. The testing center can usually
recommend someone.

 Get screened for other STIs and for TB. If you have HIV, these infections can cause serious
health problems.

 Maintain a healthy lifestyle. Smoking, drinking too much, or taking illegal drugs can
weaken your immune system and allow HIV to increase in your body.

 Practice safer sex. Condoms are very effective in preventing HIV transmission when used
correctly and consistently.

 Tell your partner or partners about your HIV status before you have any type of sexual
contact with them (anal, oral, or vaginal) and don't share needles or syringes with
anyone.

If I Test Positive For HIV, Does That Mean I Have AIDS?

No. Being diagnosed with HIV does NOT mean you have AIDS. Acquired Immunodeficiency Syndrome
(AIDS) is the final stage of HIV disease. You get AIDS only after HIV has severely damaged your
immune system. This is why it is so important to get treatment as soon as you test positive for HIV—
early treatment can keep HIV under control and prevent it from developing into AIDS.

Will Other People Know My HIV Test Results & Status?

Your test results are protected by state and Central privacy laws.

Whether anyone can know about your test results or your HIV status depends on what kind of test
you take. There are two types of HIV tests—confidential tests and anonymous tests.
Most HIV tests are confidential tests. If you take a confidential HIV test, your name and other
identifying information will be attached to your test results. The results will go in your medical record
and may be shared with your healthcare providers and your insurance company. Otherwise, no one
else has access to your HIV test results unless you tell them.

Some places still offer anonymous HIV tests. If you take an anonymous HIV test, nothing connects
your test results to you. When you take the test, you will get a special number or code that allows
you to get your results.

If you test positive for HIV, the testing site will report the results to your state health department .
All personally identifying information will be stripped out. Public health officials do not share this
information with anyone else, including insurance companies.

Many states have moved away from anonymous tests because confidential tests help public health
officials do a better job of keeping track of how many people have HIV and which areas of the
country have the highest rates of HIV. This allows them to get resources to the areas that need them
most.

Should I Share My HIV Status with Others?

Partners
If you test positive for HIV, your sex or drug-using partners may also be infected. It's important that
they know they have been exposed so that they can be tested too.

You can tell them yourself—but if you're nervous about doing that, you can ask your doctor or the
local health department to tell them for you. Health departments do not reveal your name to your
partners. They will only tell your partners that they have been exposed to HIV and should get tested.

Most states have laws that require you to tell your sexual partners if you are HIV-positive before you
have sex (anal, oral, or vaginal). You can be charged with a crime in many places if you don't tell—
even if your partner doesn't become infected.

Family/Friends
In most cases, your family and friends will not know your test results or HIV status unless you tell
them yourself.
If you are under 18, there may be exceptions to this. All 50 states and the District of Columbia will
allow you to get tested and treated for sexually transmitted infections (STI)—but some states allow
your healthcare provider to tell your parent(s) if they think doing so is in your best interest.

Employers
In most cases, your employer will not know your HIV status unless you tell. But your employer does
have a right to ask if you have any health conditions that would affect your ability to do your job or
pose a serious risk to others. (An example might be a healthcare professional, like a surgeon, who
does procedures where there is a risk of blood or other body fluids being exchanged.)

If you have health insurance through your employer, the insurance company cannot legally tell your
employer that you have HIV. But it is possible that your employer could find out if the insurance
company provides detailed information to your employer about the benefits it pays or the costs of
insurance.

Your employer cannot discriminate against you because of your HIV status as long as you can do your
job

Medications + a Healthy Lifestyle

We all know that a healthy lifestyle is important. For those living with HIV/AIDS, it’s vital. HIV can be a
chronic, manageable disease if you take your HIV medications consistently, visit your primary
healthcare provider regularly, and take care of your body. All of these things help to protect your
immune system from HIV.

Medications & Therapies

The most effective form of HIV/AIDS treatment is medication called antiretroviral therapy (ART).
There are a number of ART medications that work directly on the virus and stop it from replicating
itself in your body.

Most people on ART take a combination of several medications to keep their HIV disease under
control. If the medications are successful, the amount of HIV in your body goes down significantly,
and your immune system can stay healthy.
Healthy Living

Treatment for HIV/AIDS is more than just taking pills every day. While medications are essential for
treating HIV, a well-balanced and nutritious diet, daily exercise, plenty of rest, and staying current
with your medical care are all important pieces of successful treatment. Each of these things helps to
boost your immune system and prevent other chronic diseases, such as heart disease, diabetes, or
high blood pressure.

Who is affected by HIV and AIDS in India?

People living with HIV in India come from incredibly diverse cultures and backgrounds. The vast
majority of infections occur through heterosexual sex (80%), and is concentrated among high risk
groups including sex workers, men who have sex with men, and injecting drug users as well as truck
drivers and migrant workers.

HIV prevention

Educating people about HIV/AIDS and how it can be prevented is complicated in India, as a number
of major languages and hundreds of different dialects are spoken within its population. This means
that, although some HIV/AIDS prevention and education can be done at the national level, many of
the efforts are best carried out at the state and local level.

Each state has its own AIDS Prevention and Control Society, which carries out local initiatives with
guidance from NACO. Under the second stage of the government’s National AIDS Control
Programme (NACP-II), which finished in March 2006, state AIDS control societies were granted
funding for youth campaigns, blood safety checks, and HIV testing, among other things. Various
public platforms were used to raise awareness of the epidemic - concerts, radio dramas, a voluntary
blood donation day and TV spots with a popular Indian film-star. Messages were also conveyed to
young people through schools. Teachers and peer educators were trained to teach about the
subject, and students were educated through active learning sessions, including debates and role-
play.52

The third stage of the National AIDS Control Programme (NACP-III), was launched in July 2007 and
runs until 2012.53 The programme has a budget of around $2.6 billion, two thirds of which is for
prevention and one sixth for treatment. 54 Aside from the government, this money will come from
non-governmental organisations, companies, and international agencies, such as the World Bank and
the Bill and Melinda Gates Foundation. 55

As part of its focus on prevention, the government has supported the installation of over 11,000
condom vending machines in colleges, road-side restaurants, stations, gas stations and hospitals.
With support from the United States Agency for International Development (USAID), the
government has also initiated a campaign called ‘Condom Bindas Bol!’ (Condom-Just say it!), which
involves advertising, public events and celebrity endorsements. It aims to break the taboo that
currently surrounds condom use in India, and to persuade people that they should not be
embarrassed to buy them.56

In one unique scheme, health activists in West Bengal promoted condom use through kite flying,
which is popular before the state’s biggest festival, Durga Puja:

"The colourful kites carry the message that using a condom is a simple and instinctive act… they can
fly high in the sky and land at distant places where we cannot reach." 57

This initiative is an example of how HIV prevention campaigns in India can be tailored to the
situations of different states and areas. In doing so, they can make an important impact, particularly
in rural areas where information is often lacking. Small-scale campaigns like this are often run or
supported by non-governmental organisations, which play a vital role in preventing infections
throughout India, particularly among high-risk groups. In some cases, members of these risk groups
have formed their own organisations to respond to the epidemic.

The government has however funded a small number of national campaigns to spread awareness
about HIV/AIDS to complement the local level initiatives. On World AIDS Day 2007 India flagged off
its largest national campaign to date, in the form of a seven-coach train called the 'Red Ribbon
Express.'58A year later the train journey was completed, having travelled to 180 stations in 24 states
and reaching around 6.2 million people with HIV/AIDS education and awareness. 59 Following the
success of the campaign, the 'Red Ribbon Express' took off again in December 2009, and now
includes counseling and training services, HIV testing, treatment of sexually transmitted diseases
(STDS) as well as HIV/AIDS education and awareness. 60

According to a mid-year report on the progress of the second round of the Red Ribbon Express,
NACO estimates that 3.8 million people were reached in the first six months of the campaign. 61
According to NACO the 'response has been overwhelming', with queues of people waiting to access
the services a common sight, and follow up surveys indicating that knowledge of transmission routes
of HIV and prevention methods have increased significantly in the areas visited by the train.

Treatment for people living with HIV

Antiretroviral drugs (ARVs), which can significantly delay the progression from HIV to AIDS – have
been available in developed countries since 1996. Unfortunately, as in many resource-poor areas,
access to this treatment is limited in India; an estimated 300,000 adults (aged 15 and above) were
receiving free ARVs by April 2010. 70 This represents less than half of the adults estimated to be in
need of antiretroviral treatment in India.71

While the coverage of treatment remains unacceptably low, improvements are being made. The
government has started to expand access to ARVs in a number of areas; by November 2009 there
were 266 reported sites providing antiretroviral therapy. 72 

Increasing access to ARVs also means that an increasing number of people living with HIV in India are
developing drug resistance. When HIV becomes resistant to the ARVs the treatment regimen needs
to be changed to 'second-line' ARVs. As with many other parts of the world, second-line treatment in
India is far more expensive than first-line treatment.

In 2008, NACO began to roll out government funded second-line antiretroviral treatment in two
centres in Mumbai and Chennai. By 2009 second-line therapy was available in a total of eight states
but treatment remains very limited. Of the 3,000 who need to be on second line treatment, about
970 were receiving it as of January 2010. 73 74 One reason for this is expense; second line ARV drugs,
unlike first line ARVs, are not produced on a large scale in India due to patent issues that control drug
pricing and can be more than 10 times more expensive than first line ARVs. Another reason why
coverage is so limited is the eligibility requirements imposed on second line ARVs; only those 'living
below the poverty line, widows and children' and those who have received first-line ARVs from a
government centre for at least two years are eligible. 75

Ironically, India is a major provider of cheap generic copies of ARVs to countries all over the world.
However, the large scale of India’s epidemic, the diversity of its spread, and the country’s lack of
finances and resources continue to present barriers to India’s antitretroviral treatment programme.
Stigma and discrimination in India

In India, as elsewhere, AIDS is often seen as “someone else’s problem” – as something that affects
people living on the margins of society, whose lifestyles are considered immoral. Even as it moves
into the general population, the HIV epidemic is still misunderstood among the Indian public. People
living with HIV have faced violent attacks, been rejected by families, spouses and communities, been
refused medical treatment, and even, in some reported cases, denied the last rites before they die. 76

As well as adding to the suffering of people living with HIV, this discrimination is hindering efforts to
prevent new infections. While such strong reactions to HIV and AIDS exist, it is difficult to educate
people about how they can avoid infection. AIDS outreach workers and peer-educators have
reported harassment,77 and in schools, teachers sometimes face negative reactions from the parents
of children that they teach about AIDS:

“When I discussed with my mother about having an AIDS education program, she said, ‘you learn
and come home and talk about it in the neighbourhood, they will kick you’. She feels that we should
not talk about it.”Female student, Chennai78

Discrimination is also alarmingly common in the health care sector. Negative attitudes from health
care staff have generated anxiety and fear among many people living with HIV and AIDS. As a result,
many keep their status secret. It is not surprising that for many HIV positive people, AIDS-related fear
and anxiety, and at times denial of their HIV status, can be traced to traumatic experiences in health
care settings.

"There is an almost hysterical kind of fear ... at all levels, starting from the humblest, the sweeper or
the ward boy, up to the heads of departments, which make them pathologically scared of having to
deal with an HIV positive patient. Wherever they have an HIV patient, the responses are shameful." 79

A 2006 study found that 25% of people living with HIV in India had been refused medical treatment on
the basis of their HIV-positive status. It also found strong evidence of stigma in the workplace, with
74% of employees not disclosing their status to their employees for fear of discrimination. Of the 26%
who did disclose their status, 10% reported having faced prejudice as a result. 80 People in
marginalized groups - female sex workers, hijras (transgender) and gay men - are often stigmatised
not only because of their HIV status, but also because they belong to socially excluded groups. 81
Stigma is made worse by a lack of knowledge about AIDS. Although a high percentage of people
have heard about HIV and AIDS in urban areas (94% of men and 83% of women) this is much lower in
82
rural areas where only 77% of men and 50% of women have heard of HIV and AIDS. However, the
real challenge lies with ignorance about how HIV is transmitted - for example the majority of men
and women in rural areas believe that AIDS can be transmitted by mosquito bites. 83 In 2009, NACO
carried a population based survey in Nagaland, which showed that 72.8% of people believed HIV
could be transmitted by sharing food with someone. 84

The future of HIV and AIDS in India

Various groups have made predictions about the effect that AIDS will have on India and the rest of
Asia in the future, and there has been a lot of dispute about the accuracy of these estimates. For
instance, a 2002 report by the CIA's National Intelligence Council predicted 20 million to 25 million
AIDS cases in India by 2010 - more than any other country in the world. 85 India's government
responded by calling these figures completely inaccurate, and accused those who cited them of
spreading panic.86 The government has also disputed predictions that India’s epidemic is on an
African trajectory, although it claims to acknowledge the seriousness of the crisis. 87

Indeed, recent surveys do suggest that national HIV prevalence has probably fallen slightly in recent
years. This trend is mainly due to a drop in infections in southern states; in other areas there has
been no significant decline.

“In the north-east, the dual HIV epidemic driven by unsafe sex and injecting drug use is highly
concerning. Moreover, there are many areas in the northern states where HIV is increasing,
particularly among injecting drug users.” Sujatha Rao, Director General of NACO 88

HIV spending increased steadily in India from 2003 to 2007 but has since fallen. 89 90 In 2006-2007 $171
million was spent to contain and prevent the growth of HIV, which represented an increase of 28%
from the previous year.91 Currently, India spends about 5% of its health budget on HIV and AIDS. 92
However, the World Bank has warned that India will have to scale up prevention efforts in order to
avoid spending more of its health budget in the future. According to the World Bank’s report, by
2020 India will have to spend 7% of its health budget on AIDS if the rising tide of the AIDS epidemic in
New Delhi, Mumbai, the north and the north east is not halted. 93 This would put further strain on a
struggling health sector which, on top of HIV and AIDS, faces a growing multitude of health
challenges including malaria, diabetes, heart disease and cancer. Yet, in 2008-2009 spending on
HIV/AIDS fell by 15% to $146 million.94

Even if the country's epidemic does not match the severity of those in southern Africa, it is clear that
HIV and AIDS will have a devastating effect on the lives of millions of Indians for many years to come.
It is essential that effective action is taken to minimise this impact.

“The challenges India faces to overcome this epidemic are enormous. Yet India possesses in ample
quantities all the resources needed to achieve universal access to HIV prevention and treatment…
defeating AIDS will require a significant intensification of our efforts, in India, just as in the rest of the
world” Peter Piot, former Executive Director of UNAIDS.95

Myths

Common Myths & Misunderstandings

There are many myths about HIV /AIDS. Most of these myths are based on incorrect information or
lack of knowledge about HIV/AIDS—and some are related to the stigma that is often attached to HIV.

Myth: A person with HIV or AIDS looks sick.

Truth: People with HIV infection often don’t look or feel sick. You can even have HIV and not know it.
Taking an HIV test is the only way to know for sure whether you or someone else has HIV.

Myth: Only gay people get HIV/AIDS.

Truth: When the epidemic began in the early 1980s, the first cases of HIV and AIDS were found
among urban men who had sex with men (MSM). Today, however, the picture of the epidemic looks
very different. Many new cases of HIV occur among heterosexual women of color, ethnic minorities,
and people who live in rural areas.

While the number of new cases is still highest among MSM, it is important to remember that HIV is
transmitted primarily by risky sexual and drug-taking behaviors. If you engage in those behaviors,
without taking protective measures, you are at risk of HIV infection—regardless of the gender of
your partner

Myth: Some people have been cured of HIV.

Truth: While there are many treatment options, there is currently no cure for HIV.

Myth: HIV isn’t a big deal anymore. A person can take a pill once a day and be fine

Truth: An HIV diagnosis is no longer a death sentence like it was in the early days on the epidemic—
but it continues to be a “big deal.” Living with HIV can be challenging, and HIV medications can have
serious side effects and cause other health problems. Preventing HIV infection is much better than
having to treat it

Myth: Being HIV-positive is the same thing as having AIDS.

Truth: Being HIV-positive and having an AIDS diagnosis are not the same. AIDS occurs only after a
long period of HIV infection, during which the body’s immune system has been badly damaged. AIDS
is diagnosed when certain opportunistic infections are present or when a person’s CD4 count drops
below a certain value.

Myth: A person can get HIV from touching or kissing someone with HIV.

Truth: HIV is not spread through casual contact, such as shaking hands, hugging, sharing cups or
towels, or closed-mouth kissing.

Myth: I am not at risk because I am in a monogamous relationship.

Truth: You may not always know if your partner is having sex (or injecting drugs) outside of the
relationship, so it’s important to keep the lines of communication open. If you are beginning a
monogamous relationship, it’s important for both partners to be tested for sexually transmitted
infections, including HIV.

Myth: You can’t have a baby if you are HIV-positive.

Truth: With proper healthcare and medication, HIV-positive women are able to have a healthy
pregnancy and give birth to babies who are HIV-negative. Pregnant women should be tested for HIV
to ensure that they receive proper care.

Every year, another 56,000 Americans become infected with HIV—but it doesn’t have to be that
way! It’s easy to protect yourself and others from HIV if you know the facts.
Your risk for getting HIV—or transmitting it to others—is extremely low if:

 You aren’t having sex of any kind (anal, oral, or vaginal)

 You aren’t injecting drugs

 You aren’t pregnant

 You aren’t likely to have contact with infected body fluids in your workplace

But if you are having sex, injecting drugs, pregnant, or might be exposed to HIV at work, here’s what
you need to know...

Conclusion

Having seen all the facts and figures about HIV/AIDS and fully knowing well that AIDS can
only be prevented by spreading the awareness and taking preventive measures, We Indians should
vow to get rid of this social stigma by increasing the no. of volunteers for spreading the awareness
and take the message to the nook and corner of our country so that atleast by 2020, let us hope India
will become a AIDS free country. Jai Hind.