Health Wise

When I first met Kaushalya in 1997, she was a young widow coming to terms with her changed life. Her husband had died of AIDS in 1995, just seven months after their marriage.

A beacon of hope for millions

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When I first met Kaushalya in 1997, she was a young widow coming to terms with her changed life. Her husband had died of AIDS in 1995, just seven months after their marriage. She was 19, and tested positive for HIV soon after. Like thousands of other uneducated and economically-dependent women, Kaushalya was blamed for her husband’s death and thrown out of the family home in Namakkal, Tamil Nadu.

Alone and terrified, she nevertheless refused to give up, and started to work for a group involved in AIDS advocacy and prevention, giving support to other HIV positive women. Now 32, Kaushalya heads India’s Positive Women’s Network. When I first met her, she had to be coaxed into telling her story, in Tamil. Now, she speaks about women’s rights and HIV at international fora, in English.

What makes her a hero is that she did not let a social stigma browbeat her into submission. By fighting back, she gave hope to millions of women like her. Just for the record, an estimated 2.5 million people live with HIV in India, of whom 39 per cent are women.

Though infection is lower among women, cultural taboos and the gender bias prevent them from accessing information and services related to HIV-AIDS. India has been providing free antiretroviral therapy (ART) to all those who need it since April 1, 2004 (including second-line ART drugs since last year) but women account for just about one in five people who access treatment.

More worryingly, according to the National Family Health Survey-3 — India’s largest health survey, which covered a nationally representative sample of 124,385 women and 74,369 men from 29 states in 2005-06 — only 57 per cent of Indian women had some knowledge of HIV and its prevention. The good news is that such knowledge was higher among unmarried girls who had never had sex (76 per cent). This is crucial in a country where men have multiple sexual partners and older men marry much younger women, leading to higher HIV rates among young women compared to young men.

What works against women, however, is violence, with NFHS-3 data showing that one in three women in the sexually-active 15 to 49-year-old segment suffer physical abuse, which increases their vulnerability to HIV. Victims of such violence have lower negotiating skills and can’t ask their partners to adopt safe sex practices.

That apart, gender barriers such as economic dependence, child-rearing responsibilities, limited mobility and no decision-making power also hamper access to treatment. Education and economic security will help women make safer sexual decisions, but until that happens, Kaushalya remains an example of a woman who has fought severe odds, and survived.