When India signed the Declaration of Commitment on HIV/AIDS in the UN General Assembly Special Session (UGASS) in June 2001, it promised to achieve the millennium development goal of halting and reversing the epidemic by 2015. Although the number of people living with HIV in India has reduced to 2.47 million from the earlier estimate of 5.2 million, according to the latest survey by the National AIDS Control Organisation (NACO), government responses to violations of women's reproductive and sexual health rights, a driver of this pandemic, remain woefully inadequate.
Women account for 39 per cent of total infections and the rate of infection among them is steadily increasing. One of the reasons for this could be that the government continued to lag behind on several of its UNGASS commitments on improving the reproductive and sexual health rights of women.
A recent study conducted by the Mumbai-based Tata Institute of Social Sciences (TISS), reveals that one of the biggest violation of women's rights is the government's reluctance to pay equal attention to the health of the mother in a bid to reduce mother-to-child transmission of HIV. Findings of this study will be released as part of a global AIDS Week of Action - May 18-24 - to coincide with the presentations made by various countries at the United Nations on the progress they have made to meet their commitments on HIV and AIDS.
The study, which was commissioned by Action Plus, a conglomerate of 15 Indian non-governmental organisations (NGOs) working on reproductive health, sexuality, gender issues and HIV/AIDs, was carried out to monitor the government's progress on its UNGASS promises. It is part of a larger project to monitor UNGASS commitments coordinated by Gestos, a Brazil based NGO and a member of the UNAIDS Steering Committee on UNGASS/AIDS. It covered six states including Maharashtra, Tamil Nadu, Karnataka and Delhi.
Conducted during the period August to December 2007, the findings indicate that the policy of giving the HIV+ mother a single drug therapy of nevirapine during labour to prevent the transmission of infection from the mother to the child has had an adverse impact on the mother.
"The problem in this treatment is that women tend to become resistant to nevirapine in the long run, as it stays longer in the blood. In fact, research by the National AIDS Research (NARI) has shown that unless another two drugs were given in addition to nevirapine, the health of the mother was put to risk. So, actually we are compromising the future of the mother," contends Dr Vinay Kulkarni, the medical director of Prayas, and a contributor to the study.
Kulkari says Prayas, a Pune-based NGO working on issues of sexuality and HIV, had found that a better option was available. This entailed a dose of another drug, zidovudine. "This would save not just more lives of children but also of their mothers," he asserts. Only about 45 per cent of HIV+ pregnant women tended to adhere to the regimen or take the single drug during labour, implying that a majority did not adhere to a regimen.
If India followed the World Health Organization (WHO) protocols of testing the pregnant woman in the 28th week of pregnancy and began counselling thereafter, there would be greater chances of women being regular in their treatment, he says.
However, the prevention of mother-to child transmission (PMTCT), which is the only entry point for women in the HIV/AIDS programme, cannot be accessed by all women equally. "We have seen pregnant HIV+ sex workers face maximum discrimination from the health providers in the PMTCT programme. Furthermore, proposed amendments to the Immoral Trafficking Prevention Act (IPTA) seeking to criminalise clients of sex workers will only enhance stigma. How can we expect them to access service in such an environment?" asks Meena Seshu of SANGRAM, a Sangli-based NGO working with sex workers and a member of Action Plus.
The study found a lack of gender sensitivity in most of the government's programmes and that gender imbalances limited women's access to services. "During our focus group discussions with NGOS working in the field, we found that government programmes do not address issues like marriage as a risk factor for women or domestic violence and are limited to targeted interventions. Women's risk is addressed through interventions with husbands. Furthermore, the study also found that there is no known policy for HIV post-exposure prophylaxis for rape. This is simply not acceptable to the groups working with women and HIV/AIDS. They feel that the government cannot talk of upholding women's rights on the one hand and then quote lack of infrastructure or resource crunch as an excuse not to provide the necessary means to do so," says Brinelle Dsousa, assistant professor, TISS, and author of the study.
Health activists are hoping that they will be able to use these findings to persuade NACO that more needs to be done to map the gaps in the existing progammes especially in addressing the reproductive and sexual health rights of HIV+ women. Greater convergence between civil society efforts and government programmes are required if India is to keep its promise, particularly to women and young people, of promoting and protecting all human and fundamental rights including the right to the highest attainable standard of physical and mental health.