World AIDS Day: HIV Infection Rates Plunging In India, But Many Have No Access To Anti-Retroviral Drugs

Marriage and weddings are among the most fundamental aspects of Indian culture and society. But for the sub-continent’s HIV-infected population, finding a suitable life partner can be difficult, if not impossible, due largely to the stigma associated with the disease.

However, some lonely-hearts have found salvation from an unusual (and free) Indian matrimonial website called PositiveSaathi.com, which unites men and women who are both carrying the virus. ("Saathi" means "friend" or "companion" in both the Hindi and Bengali languages). BBC reported on an HIV-positive 42-year-old Indian woman called "Nisha" (not her real name) whose first husband divorced her after she became infected with the virus (by her spouse) and gave birth to an infected baby son. She later found an HIV-positive husband through the Saathi website and the happy couple now look after her son, who is now 11.

"The [website] came as a ray of hope in my darkest hour," she told BBC. The PositiveSaathi website, which was founded by a government worker named Anil Valiv seven years ago, now boasts more than 5,000 registered HIV-positive clients, including about 250 Indians who live abroad. Remarkably, about two-thirds of the people registered originate in India’s rural regions, where Internet penetration remains marginal.

Valiv, who is employed in the transport ministry, was inspired to launch the website after hearing from a physician about an HIV-infected man who was yearning to get married. "[The HIV-infected man] told the doctor that if he didn't find an HIV-positive match soon, he would marry a healthy woman without revealing his HIV status,” Laviv said. “The doctor was in a dilemma. That made me realize how difficult it was for such people to find a spouse."

Valiv also experienced the disease up close -- a friend died from AIDS in utter isolation. "He [the AIDS victims] was shunned by his own family,” Valiv told BBC. “I cannot forget the longing in his eyes for a family and children. Such is the stigma attached to the infection that when he died in 2006, his father refused to light his pyre at his sparsely attended funeral."

In deeply conservative and tradition-based Indian society, people carrying the deadly virus are often ostracized and mistreated. "If their emotional and physical needs are unmet, they can end up spreading the infection," Valiv added. Interestingly, caste still plays a dominant role in those who are infected seeking life-partners. "The caste consideration is strong also because many of them do not reveal their HIV status to their families, who keep putting pressure on them to get married," Valiv explained.

Valiv cannot estimate how many people have actually become married through his website but he said that almost two dozen couples who tied the knot as a result of his service have produced healthy children.

On a broader scale, in India -- a country where sex is rarely discussed openly -- the battle against AIDS appears to be making tremendous progress. According to AIDS Alliance, about 2.4 million people in the country are HIV-positive, a tiny percentage of India’s vast population of 1.2 billion. (Consider that in South Africa, a nation of about 52 million people, some 5 million are infected with the virus.)

Of the estimated Indian data on HIV, almost two-thirds (61 percent) are male and 39 percent are female. In contrast, in sub-Saharan Africa, the gender profile is reverse, with females accounting for about 60 percent of the HIV-positive population, according to the World Health Organization (WHO). But similar to other countries, in India, the highest-risk groups comprise intravenous drug addicts, homosexuals and female sex workers, and those segments of the population are up to 30 times more likely to contract AIDS than the general public.

The Joint United Nations Program on HIV and AIDS (UNAIDS) Report for 2013 revealed more good news for India -- since 2001, the rate of new infections have plunged by an astounding 57 percent since 2001. (In contrast, the rate of virus infection in neighboring Pakistan has skyrocketed eight-fold over that same period, while Bangladesh and Sri Lanka each saw a 25 percent increase in infections.)

A report in HealthIndia.com attributed the dramatic reduction in India’s virus infections to a concerted effort by the central government to “tackle the ailment head on through information dissemination, education and communication.” Moreover, despite Indian society’s squeamishness about sex, there has never been “AIDS denialism” in India like there was in other epidemic countries which prevented the disease from spreading far and wide, the report added.

Of course, one of the principal factors behind the decrease in infection has to do with the availability of anti-retroviral therapy (ART), a drug cocktail which helps HIV-positive people manage their condition and prevents the virus from developing into full-blown AIDS. However, according to UNAIDS data from 2010, less than 425,000 people in the country were regularly receiving ARTs, suggesting other factors may be just as important in keeping a lid on the virus, including increased abstinence from promiscuous sex and illegal drugs. Meanwhile, ARTs remain out of reach for many HIV-infected people in India for a variety of reasons.

The Press Trust of India reported that more than 1 million people in India stricken with HIV and AIDS have no access to ARTs. Part of the problem is that some virus-carriers feel too stigmatized to approach medical facilities, but a larger issue is cost. The Deccan Chronicle reported that ART drug costs start at a minimum of 3,000 Rupees ($48), a trifle for Westerners, but a significant amount of money for most Indians.

Given the strong evidence that early diagnosis of HIV and provision of ART when need is clinically indicated can dramatically reduce HIV transmission, the importance of widespread testing and available ART cannot be understated, Dr. Anita Raj, Professor in the Division of Global Public Health, Department of Medicine at the University of California in San Diego, told International Business Times.

But she added that broad, generalized HIV testing to support early diagnosis has not been achieved in India, and ART provision and adherence for those who are HIV infected and ART eligible is not as high as it should be. “Studies from hospitals indicate that falling out of care to be pretty common,” she said. “First-line drugs have dropped in price substantially due to the availability of generics, but for those who have exhausted the first and second line drugs, medications are more expensive because of patents.”

The Hindustan Times reported that some people are eligible to receive ART from the government free of charge -- it remains unclear why many do not access such drugs. For example, to illustrate the government’s dedication to fighting the disease, all pregnant women who deliver babies at a hospital or a clinic are tested for HIV; if they test positive, they are provided with a drug called Nevirapine that cuts the rate of transmission from mother to child by more than half.

Still, India has made impressive progress against HIV transmission. “The pace of progress needs to be redoubled to sustain past achievements, drive results and meet global AIDS targets,” Steven Kraus, an official with UNAIDS said, according to the Hindustan Times. Kraus and UNAIDS particularly praised the New Delhi government for spreading awareness and prevention techniques before the disease turned into a plague. “The detection of India’s first HIV in 1987 led to the establishment of a national strategy working group,” UNAIDS stated. “Since the early 1990s, India’s political leaders have provided consistent support for large scale-prevention for key populations.”

However, many HIV-infected people in India face continued stigmatization and discrimination with respect to jobs and housing. The DNA news agency of India reported that HIV activists are urging government leaders to pass a pending bill that will protect rights of those carrying the virus and eliminate all discrimination against them. "Statistics don't bleed, but people bleed,” said Jayakumar Christian, national director of World Vision India. “In our work with around 40,000 children affected by HIV and AIDS across the country, we have seen their families have been denied the right to dignified life and treatment because of the stigma attached to the disease. A legal protection would go a long way in ensuring these children are able to access their rights."

The so-called "HIV/AIDS" bill has been pending with the national government for the past five years. "When we first started talking about the HIV/AIDS bill, we were talking about how our children needed to be taken care of,” said Daisy David, an HIV-positive activist. “Today, those children are adults waiting to be married, and have a different set of problems, but there is no law yet." She told Today’s Christian Woman: "After I was diagnosed, I faced extreme discrimination from relatives, family, church, neighbors and friends. It was shocking for me to accept it."

David was the first woman in India to advocate for the free distribution of ARTs in the country.