INDIA: HIV/AIDS battle spreads to rural areas

NEW DELHI, 6 September 2006 (PlusNews) - India's economic revival has led to surging growth, malls and multiplexes and the creation of vast wealth. But the growth masks the situation in rural areas where millions of illiterate people continue to grind out a living in extreme poverty.

The basics - primary health care, education and clean drinking water - are often missing. It is rurally - where 70 percent of the population lives - that India is facing its greatest challenges in its battle against HIV/AIDS, according to India's National AIDS Control Organisation (NACO).

Urban middle-class India and the English language media largely ignore the existence of this 'other India '. However, villagers unable to eke out a living are leaving for the cities in large numbers, making it difficult to compartmentalise the concerns of urban and rural India.

Migration is now a crucial factor in understanding the dynamics of one of India 's most awesome challenges - the HIV/AIDS epidemic - as it spreads from traditional high-risk groups such as sex workers, drug users and truckers to the general population.

NACO estimates that 59 percent of the HIV-infected population lives in rural India. The Joint United Nations Programme on HIV/AIDS (UNAIDS) estimates that close to 5.7 million Indians are infected with HIV - a figure the government contests.

The rural face of the epidemic in India is reflected in the membership of the self-help groups for HIV-positive people that have sprung up.

More than half of the 50 members of the Network of HIV Positive People in the northern state of Uttaranchal lived in remote villages, Rajinder Dass, who heads the network, said.

"For many of our members, the nearest health facility is 15 to 20 kms away. Transport is one of the biggest problems. Treatment and counselling facilities are invariably in the urban areas. For example, to get one's CD4 cell count [CD4 cell count indicates how strong the immune system] tested, one has to travel all the way to Dehradun, the state capital," Dass said.

Anti-retroviral Therapy (ART) was also only available in cities.

“We urgently need treatment facilities for HIV-positive people at the level of the primary health centre in the villages," Dass said.

For rural women living with the deadly virus, the situation was even worse.

A female member of the HIV Positive Network in Haryana State, who did not wish to be named, said the stigma and discrimination against HIV-positive people was more severe among traditional communities in the countryside than in cities.

"Most HIV-positive women in the villages find it difficult to access the government-run Voluntary Confidential Counselling and Testing Centres because these are located in district headquarters, because they lack privacy and because frequent trips to such places will arouse suspicion in the community. We need counselling facilities in the villages," she said.

But there is good news. In August this year India launched a HIV/AIDS campaign and held a convention for district council chairpersons and mayors.

The convention, which brought together more than 500 representatives from local towns and villages, discussed the rural and urban contexts of HIV/AIDS in India.

The National Aids Control Organisation, the Parliamentarians' Forum on HIV/AIDS and UNAIDS, were also involved.

The gathering was part of an effort to build a countrywide community of elected leaders in rural and urban areas who had the potential to influence the response to the epidemic.

"The challenges that the HIV epidemic poses need to be addressed at the district and community levels. By involving the Zilla Parishad [district council] chairpersons we are working towards tackling the epidemic at the level where it touches individual lives," Sujatha Rao, NACO's director general, said.

Noble Thalari, a UNAIDS India communications officer, said it was "absolutely necessary" to decentralise the response to the epidemic.

"The solutions to the problems faced by HIV-positive people have to be topical and locally relevant," Thalari said.