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INDIA: Towards an AIDS-Free Society, But at What Price?

Analysis by Neeta Lal

NEW DELHI, Dec 1 2009 (IPS) - As the global community observes World AIDS Day today, India is caught in a rancorous debate about a government scheme which mandates that all pregnant women in the country be tested for HIV so that its 1.2 billion people can have “an AIDS-free generation”.

The controversial scheme was initiated in October by the ‘Parliamentary Forum on HIV and AIDS’, instituted in 2000 to help the government formulate public health policies. According to the Forum, “(p)assing the disease to a newborn is a human rights violation. This should stop … The newborn should not suffer lifelong without committing any sin as this is a human rights violation.” Predictably, the scheme has stirred up a hornet’s nest with activists raging that mandatory testing of any person is a blatant human rights violation.

Moreover, when the move targets women alone, it has a domino effect on further societal discrimination for them, which is often responsible for higher HIV cases among them in the first place. This also leads to a phenomenon experts call the “feminisation of the epidemic” or an upward spiral in the number of females reporting a particular disease.

In India, women account for nearly half the approximately 2.5 million infected with HIV/AIDS. Their heightened vulnerability to the disease can be traced primarily to socio-economic reasons—early marriage, violence and sexual abuse. Add to it women’s natural biological propensity for the disease, and you have a deadly cocktail indeed.

“What makes things worse is that in the Indian scenario, abstinence and condom use are rarely an option for women,” Raman Chawla, advocacy officer of Lawyers’ Collective, a pan-India non-governmental organisation on legal advocacy, told IPS.

She added that “social norms don’t encourage” women to be sexually knowledgeable. “So females have little negotiating power in their sexual relationships, including marriage. Our organisation is therefore totally opposed to the mandatory testing of pregnant women as it violates their right to bodily integrity too.”

Compulsory HIV testing for women, in other words, will further perpetuate the inequities of ossified social practices. In any case, health workers said, HIV/AIDS initiatives meet with limited success in countries which flout respect for human rights.

“Women who are forced to be tested will not necessarily seek out treatment. So even if you forcibly test them, they can’t be coerced into being treated for the disease or take special precautions against transmitting the disease during pregnancy to the fetus,” Preeti Hasija, a community health worker with an NGO, told IPS.

According to Dr Umesh Chawla, programme manager of India HIV-AIDS Alliance, an international NGO, the parliamentary scheme highlights the dichotomy inherent in many of the Indian government’s earlier health measures—professing to do public good while simultaneously violating human rights.

“It is a pregnant woman’s right to get herself tested for HIV,” opined Dr Chawla. “However, the testing has to be a voluntary decision, taken after consulting the family/spouse so that it amounts to an informed choice. If the family is not kept in the loop,” said the doctor, “that too can have serious social implications.”

Dr Chawla recounted the case of a pregnant villager who was dumped by her husband when she was found to be HIV-positive. Such cases raise larger questions about the ethics of public health programmes, he said.

“For instance, mandatory testing is unnecessary in cases where the pregnant woman doesn’t belong to a high-risk category. By forcing all women to undergo this test, it amounts to the worst case of gender disparity.”

The scheme also spotlights other valid concerns—such as the social fate of Indian women who test positive for HIV and are then rejected by their fiancés. This prompts one to ask: Won’t the mandatory testing policy then create a new stigmatised demographic? Also, how will the policy protect women who are infected post-marriage by promiscuous husbands?

Then, how will HIV testing impact the well-entrenched Indian tradition of arranged marriages where brides and grooms often do not even date each other, forget about being frank enough to ask for an HIV test?

Perhaps the weakest link in the chain will be the scheme’s implementation. The initiative will be supervised by the health ministry’s Janani Suraksha Yojana, a safe motherhood intervention under the National Rural Health Mission, which aims to reduce maternal and neo-natal mortality by promoting institutional delivery among the poor.

This means that at the local level, the programme will be controlled by the ‘panchayats’ or local village councils, which are dominated by men. This, fear health workers, will ratchet up possibilities for coercion and corruption.

Already, India is noted for its abysmal public health system, which fails to provide basic care for women. Every year, about 78,000 mothers die during childbirth and from pregnancy-related complications in India, according to the United Nations Children’s Fund (UNICEF).

India’s maternal mortality rate—at 450 per 100,000 live births—is way behind its Millennium Development Goals, which call for a reduction to 109 by 2015. UNICEF’s ‘State of the World’s Children 2009′ report states that high maternal mortality rates in India are a result of growing social inequalities and shortages in primary healthcare facilities.

Millions of births are not attended by doctors, nurses or trained midwives despite India’s booming economy, which has been growing at a healthy clip of about eight percent for the past three years, adds the report.

However, despite strong public disenchantment against the initiative, the case of AIDS rights crusaders is weakened considerably by the non-passage of the HIV/AIDS bill, which has been pending clearance since 2006.

The legislation was drafted to protect the rights of people living with the disease and to prevent and control the spread of the infection following intensive discussions with different stakeholders. If passed, the bill can ensure equitable human rights and access to prevention, treatment, care and support to all HIV-affected people.

Be that as it may, the Indian government’s concern for an “AIDS-affected future generation” can hardly be faulted. According to the National AIDS Control Organization, the government’s premier body for AIDS prevention and control, India has approximately 100,000 children below 18 who are HIV-infected.

Also, about 70,000 children below 15 are infected every year through parent-to-child transmission. Thousands of Indian babies are also born with an HIV-positive status as they acquire the virus in their mother’s womb.

This has resulted in AIDS creating a corollary human rights crisis—the orphaning of children on a massive scale. Currently, there are almost two million AIDS orphans in India, a figure that is likely to double within five years. Many of these ‘invisible’ children—so called because they lack a sense of belonging—are trafficked into prostitution or child labor.

“Orphaning,” said the Joint United Nations Programme on HIV/AIDS, “remains the most visible, extensive, and measurable impact of AIDS on children.”