On the eve of World AIDS Day, December 1, Rema Nanda, public health-HIV/AIDS program director of the American India Foundation, said reaching out to women was an essential step to combat AIDS in India.
If the woman, who is also responsible for the care of the children and the elderly in the household, falls sick, the entire family gets disintegrated, she said. Nanda, who was speaking at the Asia Society in New York recently, suggested targeted interventions, like the Gates Foundation's model for sex workers, for women.
'Most of the sex workers that have been reached are making tremendous efforts to ensure that their children don't end up there, so the multiplier impact is tremendous,' she said. 'Could we take the same approach of targeted intervention, which at its heart involves self-help groups, and bring it to mainstream communities?'
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There may be programs for sex workers in India, but there are hardly any that target the clients, who may infect their wives and their children. Nanda suggested full disclosure -- reaching out to women and telling them what the disease is. Another of her suggestions was to weave AIDS into a public health approach. 'AIDS becomes one dimension, for instance, of addressing reproductive health,' she said, pointing that there exists a very high prevalence of sexually transmitted infections and diseases in India. She also sought an integrated approach -- asking government or private campaigns to talk about AIDS while reaching women for, say, pulse polio or diarrhea control.
The discussion, titled 'AIDS in Asia: Changing Dynamics in China, India and Iran,' also included Professor Kaveh Khoshnood of the Yale School of Public Health and Jia Ping, chief executive director and founder of Global Fund Watch (China initiative), who spoke over the phone. Joelle Tanguy, senior vice president for global programs and partnerships of the Global Business Coalition on HIV/AIDS, Tuberculosis and Malaria, moderated the discussion. While AIDS has become an epidemic in sub-Saharan Africa, the panel aimed to examine another characteristic, its emergence in emerging economies where it is still a 'contained epidemic,' Tanguy said.
Nanda, who spent the last six months in India meeting communities that live beyond the metro cities, also spoke about repercussions of the revised HIV figures in India that dropped from 5.7 million to 6.8 million infections in 2006 to between 2.3 million and 3.1 million that summer. India, which was supposed to have overtaken South Africa in the number of HIV/AIDS cases by the summer of 2006, is now number 3 on the list of countries with the highest number of infections, after South Africa and Nigeria.
'The new data shows that the epidemic continues to be concentrated in certain high-risk communities: sex workers, truck drivers, injecting drug users, and -- now the government is acknowledging and able to say this -- men having sex with men,' she said.
While any country would be thrilled to learn that it was not having a massive explosion of AIDS, Nanda said people like her who work in public health aren't raising their hopes. Numbers don't matter, she said. The people who have the disease are sexually active, and often don't even know they have the infection. 'Against this backdrop and the fact that we are 1.1 billion people, 70 percent of whom are at the bottom end of this pyramid, you can imagine that from a public health perspective where the goal is to promote and protect good health, this number has tremendous impact.'
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