Written by: Hayley Trinh, Communications and Development Intern, Education for Equality International
Since the first known case of HIV in India was diagnosed in 1986, the number of people infected with the virus has continued to grow. According the most recent UNAIDS Gap Report, India has the third-highest number of people living with HIV in the world, with 2.1 million Indians accounting for four of every 10 people infected in Asia.
Rajasthan, where EEI’s girls’ education and empowerment efforts are currently focused, is considered a low prevalence state by National AIDS Control Organization (NACO), but the population is considered highly vulnerable because of its high percentage of migrant labor. People from Rajasthan migrate to high prevalence states like Maharashtra and Gujarat and return with the disease. Rajasthan also accounts for 19% of all mines in India, employing over 500,000 workers, many of them are from other states. The situation in the state has become critical due to increase of traffic on national highways, tourists, and laborers coming in search for jobs. Due to its large population of over 74 million, even a small increase in HIV/AIDS prevalence would translate into a large number of cases. These factors strongly suggest that Rajasthan is indeed a highly vulnerable, high-priority state.
Young girls and women in Rajasthan, especially in rural areas, constitute a particularly vulnerable group with high risk of contracting HIV and face many obstacles in making informed sexual and reproductive health decisions. The deeply-rooted custom of child marriage is a huge contributor to this. Rajasthan has some of the highest rates of early marriage in India, with 65% of girls married before their 18th birthday. Exposure to regular, unprotected sex within marriage means these girls are faced with an elevated risk of infection that would not occur in the absence of early marriage.
Gender norms and power imbalances also play a considerable role in increasing the vulnerability of adolescent and young women in Rajasthan. Double standards that condone and even encourage premarital relations for males but not for females are widespread. These norms increase the likelihood that many men already have a STI or are HIV-positive prior to marriage. Since the Indian society grants more freedom to men, many often indulge in extramarital sex, putting young girls and women at risk if their husbands return home having become HIV-positive. Gender norms also associate masculinity with toughness and dominance, and femininity with submissiveness, limiting women’s ability to deny sex or negotiate condom use with their partners.
Low female literacy rate (52.1% compared to 79.2% in males) also indicates the lack of power on the part of girls and women. Despite having increased significantly in recent decades, Rajasthan’s female literacy rate remains the lowest in the country, contributing to inferior access to economic opportunities and resources for women. Such economic dependency makes it less likely that young girls and women will succeed in negotiating protection during sexual activities, making them even more vulnerable to HIV and other STI.
Because of the culture of silence that surrounds sex, it is difficult for adolescent and young women to be informed about safe sex practices and risk reduction. Accessing treatment and services for STI can be highly stigmatizing for them. Given such taboos and stigmas, it is not surprising that studies by NACO show little awareness and knowledge of HIV in rural areas and among women. A survey of 30,000 married women in 13 states (including the high HIV prevalence states) showed that only one in six women had heard of HIV/AIDS, and even then with very poor knowledge of its transmission and prevention. The study reported numerous misconceptions, including that HIV can be transmitted by mosquito bites, living in the same room, shaking hands, and sharing food. When EEI led a sexual health education training in Rajasthan in 2015, none of the participating girls (all aged 15-20) knew what HIV/AIDS or STI were.
It is clear that young girls and women in India in general and in Rajasthan in particular are a high-risk subgroup that require special attention from the government and NGOs. Child brides are more vulnerable to HIV, and India needs measures that delay marriage or at least enforce existing laws on the minimum age for marriage in a more committed way. Efforts should be made to increase awareness and understanding of HIV/AIDS and encourage behavioral change among the population. Most importantly, HIV/AIDS prevention programs must focus on economic and social aspects of society, not just on the virus as a public health threat. The status and empowerment of women are important variables in combating the disease. Literacy, education, exposure to the media, awareness of HIV/AIDS, labor market participation, and economic independence are important considerations in improving the status of women in India. Policymakers need to focus on gender inequality and other underlying socioeconomic factors to effectively combat the pandemic.
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Girls’ Globe is present at the 2016 International AIDS Conference in Durban, South Africa (17-22nd of July). Follow our team on social media @GirlsGlobe, @FHI360 & @JNJGlobalHealth and by using the hashtag #EndHIV4Her for inspiring blog posts, interviews and updates! To sign up for the daily In Focus Newsletter visit crowd360.org/aids2016/.
Cover photo credit: Fonda Sanchez, Founder of EEI.