ABSTRACT
Stigma and discrimination have been "bed fellows" of HIV and AIDS in India. Perpetuated by lack of awareness, deep-rooted traditional beliefs, adherence to harmful practices, and a moralistic tag associated with a condition connected with sex (in India the method of HIV transmission being largely heterosexual in nature) and high-risk individuals such as sex workers, it made it difficult for the country to fight an epidemic that was hard to track, estimate, diagnose, and treat. Various interventions under India's National AIDS Control Program (NACP) have targeted stigma and discrimination among different groups. The program has been fairly successful in its outreach programs, bringing about a reduction in adult HIV prevalence and new infections. As the country transitions from NACP Phase III (2007-2012) to IV (2012-2017), making treatment and longevity its top priority, stigma is no longer such a terrifying word. This review discusses the social and cultural context of HIV/AIDS-related stigma in general and highlights various policies and intervention programs that have led India's campaign against HIV/AIDS-driven stigma into the testing, care, support, and treatment ambit.
Subject(s)
HIV Infections/psychology , Health Services Accessibility , Prejudice , Social Stigma , Acquired Immunodeficiency Syndrome/prevention & control , Acquired Immunodeficiency Syndrome/psychology , HIV Infections/prevention & control , Health Knowledge, Attitudes, Practice , Humans , India , National Health Programs/organization & administrationABSTRACT
BACKGROUND: In Geographical Information Systems issues of scale are of an increasing interest in storing health data and using these in policy support. National and international policies on treating HIV (Human Immunodeficiency Virus) positive women in India are based on case counts at Voluntary Counseling and Testing Centers (VCTCs). In this study, carried out in the Indian state of Andhra Pradesh, these centers are located in subdistricts called mandals, serving for both registration and health facility policies. This study hypothesizes that people may move to a mandal different than their place of residence for being tested for reasons of stigma. Counts of a single mandal therefore may include cases from inside and outside a mandal. HIV counts were analyzed on the presence of outside cases and the most likely explanations for movement. Counts of women being tested on a practitioners' referral (REFs) and those directly walking-in at testing centers (DWs) were compared and with counts of pregnant women. RESULTS: At the mandal level incidence among REFs is on the average higher than among DWs. For both groups incidence is higher in the South-Eastern coastal zones, being an area with a dense highway network and active port business. A pattern on the incidence maps was statistically confirmed by a cluster analysis. A spatial regression analysis to explain the differences in incidence among pregnant women and REFs shows a negative relation with the number of facilities and a positive relation with the number of roads in a mandal. Differences in incidence among pregnant women and DWs are explained by the same variables, and by a negative relation with the number of neighboring mandals. Based on the assumption that pregnant women are tested in their home mandal, this provides a clear indication that women move for testing as well as clues for explanations why. CONCLUSIONS: The spatial analysis shows that women in India move towards a different mandal for getting tested on HIV. Given the scale of study and different types of movements involved, it is difficult to say where they move to and what the precise effect is on HIV registration. Better recording the addresses of tested women may help to relate HIV incidence to population present within a mandal. This in turn may lead to a better incidence count and therefore add to more reliable policy making, e.g. for locating or expanding health facilities.
Subject(s)
HIV Infections/diagnosis , HIV Infections/epidemiology , Serologic Tests/methods , Social Isolation , Adult , Ambulatory Care/standards , Ambulatory Care/trends , Communicable Disease Control , Demography , Developing Countries , Disease Transmission, Infectious , Female , HIV Infections/psychology , HIV Seropositivity , Hospitals/statistics & numerical data , Humans , Incidence , India/epidemiology , Pregnancy , Young AdultABSTRACT
GIS (Geographic Information System) is a useful tool that aids and assists in health research, health education, planning, monitoring and evaluation of health programmes that are meant to control and eradicate certain life threatening diseases and epidemics. HIV/AIDS is one such epidemic that poses a serious challenge and threatens the overall human welfare. This communication is an attempt to link and understand the health scenario in a GIS context with emphasis on HIV/AIDS. Various GIS based functionalities for health studies and their scope in analyzing and controlling epidemiological diseases are explored. Overall scenario of the spread of HIV/AIDS around the world is presented along with the Indian perspective. Finally, we conclude with the general management problems, issues and challenges related to HIV/AIDS prevailing in India.
