By Kishore Kumar Dash; PLHA continues to face Social Stigma
With 2.5 million HIV/AIDS cases ,India, at this level, continues to be the third largest contributor to the global HIV burden after South Africa and Nigeria. It remains one of the most significant problems haunting India over the past decade. The killer disease is more severe in the southern half of the country and the far north-east. As per the recent stastics ,the highest of 479.866 lakhs HIV prevalence rates are found in Andhra Pradesh, followed by 436.679 in Maharashtra and 255.881 in Karnataka in the south; and Manipur and Nagaland in the north-east. The joint report prepared by NIMS, ICMR, NACO and AIIMS in March last year reveals the urgent attention of the policy and programme managers in view of increasing epidemic trend in seven States including Orissa. Orissa was among seven low prevalence States, where increasing epidemic trend was noticed by various agencies during the five-year period. The reports of five folds increase in terms of HIV prevalence among adults in the State between 2002 and 2006 is a matter of serious concern. More importantly number of people living with HIV/AIDS (PLHA) in all ages had seen a dramatic increase in Orissa. As per the study, there was a rise of nearly five folds among numbers of PLHA from 2002 to 2006. Estimates said 8,248 people living with HIV were detected in 2002 in the State that went up to 9,717 in 2006 in the State. Further, this number went up to 16,082 by the end of January,2010.
According to the Health & Family Welfare Department sources of Government of Orissa, Ganjam district tops the lists of both HIV positive cases and AIDS death cases, followed by Cuttack and Koraput. With the number of people living with HIV/AIDS stands at 921 by February 2010, Koraput stands second in the state. This apart, a total of 133 deaths have been reported in Koraput during the same period. In fact, Ganjam district happened to be the major hub of this killer virus.Ganjam again topped the list having 5920 in the category. Cuttack follows it with 2083 persons affected by HIV positive.Though Orissa is not one of the high risk states, Ganjam is one of the high risk districts in the country. While 3,359 HIV positive cases were reported last year in the district, this year the number has reached at 3,635 till November last year. According to latest figures released by the Orissa State AIDS Control Society (OSACS), OSACS on the occasion of World AIDS Day,December 2009, as many as 1,083 persons were so far died due to AIDS in the State while Ganjam suffered highest number of casualties with 349 deaths, followed by Koraput with 145 deaths. The deaths on account of AIDS are rising in the State where 714 people lost their lives this year compared to 133 last year and 28 in 2006. This years death roll is estimated to be the highest during the past seven years. Situation is slowly becoming grim in other districts of Orissa like Puri, Kendrapara, Angul, Bargarh, Rayagada and Jajpur.
The report published in the Indian Journal of Medical Research revealed that an increasing epidemic trend has been noticed in seven of the low-prevalence States such as Pudduchery, Jammu and Kashmir, Jharkhand, Bihar, Orissa, Rajasthan and West Bengal. The assessment showed that HIV prevalence among the adults was 0.36 per cent while the rate in high prevalence States stood at an alarming 0.8 per cent. In the low and moderate epidemic states like Orissa, the rate of infection stood at 0.2 per cent. As per the data, Odishas adult HIV prevalence rate has seen a rise from the 0.06 per cent level in 2002 to 0.22 per cent in 2006. This also explains why the number of people living with HIV/AIDS (PLHA) has increased over the same time--from 9,717 to 48,248 a 400 per cent growth. The report further points out that Tamil Nadu is one among the high-prevalence States to have recorded a decline in the rate, while it remained stable in Andhra Pradesh and Karnataka.
Social Stigma Makes HIV/AIDS People Ostracized:
Ostracism, humiliation and mistreatment at the hands of family members, community and the medical fraternity are increasing in Orissa.Stigma remains the single most important barrier to public action. It is a main reason why too many people are afraid to see a doctor to determine whether they have the disease, or to seek treatment if so. It helps make AIDS the silent killer, because people fear the social disgrace of speaking about it, or taking easily available precautions. Stigma is a chief reason why the AIDS epidemic continues to devastate society across the state. Fear of contagion coupled with negative, value-based assumptions about people who are infected leads to high levels of stigma surrounding HIV and AIDS. The epidemic of fear, stigmatization and discrimination has undermined the ability of individuals, families and societies to protect themselves and provide support and reassurance to those affected. This hinders, in no small way, efforts at stemming the epidemic. It complicates decisions about testing, disclosure of status, and ability to negotiate prevention behaviours, including use of family planning services.
Latest report reveals, that more than 40% of people living with HIV in India, particularly Orissa 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. The case of one Madhab of Padmavati village under Purushottampur block in Orissa's Ganjam district best illustrates the story.
Two years ago, dreaming of a better future he had left for Mumbai. Son of a daily labour, the twenty seven year old Madhab hadn't had the luxury of education. Soon after his arrival, he could get to work as a daily labour. I felt I was lucky. I was very happy, he says. However, his happiness didn't last long as ill fate struck him a bad blow. Back in home since over six months, Madhab is fighting for life and against social stigma as he has been detected with HIV positive.
Madhab is not an isolated case. Hundreds like him from Ganjam district are unsure about their life. Their dreams have turned into nightmares. And they have forced their near and dear ones to undergo the tragedy. In rural Ganjam stories like this are not difficult to find. It's a sad story. The situation is grim. Unless care is taken, it will go out of hand, said a health department official. I wish I had died immediately after testing positive for HIV/AIDS rather than have to undergo such disgrace, pain and trauma. This is much worse than death, weeps Malati , recalling her ordeal at the hands of her family and community members.
When 33-year-old Malati, who lives in a village near Aska in the Ganjam district of Orissa, tested HIV-positive she was driven out of the house, locked up in the family goatshed, denied adequate food and basic amenities. She was finally rescued by a local NGO working with HIV/AIDS. By then, she was delirious, and infested with ticks and worms.
HIV infection is on rise now in Orissa; 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 the state. Sadly though, the emerging face of the HIV epidemic is increasingly turning younger, rural and feminine. Prevailing gender stereotypes and early marriage ensure that women remain ignorant and unable to protect themselves, making them especially vulnerable to infection from husbands. One of the most debilitating impacts of this epidemic is the stigma and discrimination resulting from disclosure of status. And AIDS widows, in particular, bear the brunt of inhuman social ostracism. Their situation exacerbates due to loss of the earlier social support system and source of earnings, dependent children and denial of healthcare.
[The author is a Orissa(India) based freelance journalist and can be reached at firstname.lastname@example.org]