Introduction:
HIV stands for “Human Immunodeficiency Virus”, a virus which has the ability to attack and destroy the immune system. The HIV-infected person shows no symptoms for months, usually years. Symptoms arise due to a breakdown in the immune system. When the immune system, the body’s defence force-beings to fail, the body is no longer able to protect itself. Once this happens a person in vulnerable to attacks from infections and cancers that a person with a healthy immune system would be able to resist. These are called opportunistic infections because they take advantage of the body’s weakened defences. AIDS stands for “Acquired Immuno Deficiency Syndrome”. People don’t catch AIDS. What people Catch is HIV/AIDS is the name of the medical condition which develops among people infected by HIV. We Heard that Someone “Died of AIDS”. This is not entirely accurate, since it is the opportunistic infections that cause death.
The Church’s response in India towards addressing HIV and AIDS took a historical step forward when the then commission on life of the National Council of Churches in India (NCCI) took the initiative to involve individual churches and institutions in India to critically review the work done thus far and to formulate a policy on HIV and AIDS with a view to presenting it at the XXVI Quadrennial Assembly of the NCCI at Shillong from 30th April – 5th may 2008.
Origin of HIV & AIDS:
The first recognised cases of the AIDS were detected among the homosexual (Gay community) in San Francisco in America in the year 1981. It was identified in the heroin drug abuser’s community in W. Jersey in 1982. However it was only in 1984, two scientists in France found it was the Human Immunodeficiency Virus which caused the disease. The internationally accepted term for the virus is HIV. More recently a new variant has been isolated in patients with West African connection/HIV II/LAV II HIV People travelling from country have quickly transmitted HIV to Indian soil. In India the first case of AIDS was detected in 1986. In July 1847 a recipient of blood transfusion developed AIDS and died. It was discovered that the victim had contracted the disease from the infected blood during transfusion. In 1989, 53 HIV positive males among the promiscuous men were detected; since, the number has been growing at a very fast rate. Till January 1991 there were 60 recorded AIDS cases in India which reached 102 by December the same year. By September 1992 the figure has shot 238. And with all the number of cases hushed up and cases unreported the number could be much more. A recent article in India Today (Nov. 10, 1992) warned: Although only 11,000 confirmed AIDS cases are in the country the Bombay-based Centre for AIDS Research and Control (CARE) estimates that there will be atleast 50,000 full-blown cases by 1995. By then the HIV infection would have affected an enormous one million citizens throughout the Country.
Most individuals infected with AIDS have no Symptoms and feel well. Some develop Symptoms which include tiredness, fever, loss of appetite and weight, diarrhoea, night sweats and swollen glands (Iymphnodes usually in the neck, armpits, or groin). If these symptoms continue for more than two weeks, the person should approach the doctor.
Stages of HIV & AIDS:
Stage I: During the first stage when the HIV virus gets into the body it might go unnoticed. But a few patients may develop transient measles like fever two or three weeks after the virus has entered the human body. A rash may appear all over the body accompanied by fever, chills, sweats and persistent cough and exhaustion. After 2-4 weeks the fever may disappear and the infection forgotten. The infected person may also have profuse watery stools and may get dehydrated. There may be swelling of the lymph glands in the neck, armpit and groins. Within a few weeks these may vanish.
Stage II: The infected person may be normal, attending to his routine. But he is infective and he could easily transmit the infection to others at this stage.
Stage III: After a period of 1-10 years (which varies from person to person) the HIV infected people may have swellings of all lymph glands of the body. It may not cause pain, but it is visible on the infected person’s neek, armpits and the groin.
Stage IV: in the Fourth and final stage which is the end stage of infection, varieties of virus, bacteria, fungi and parasites infect all parts of body. The body yields itself to various peculiar opportunistic infections and cancers.
Many factors can lead to AIDS discrimination and stigma:
• HIV is a deadly disease that many people fear.
• Some adults in the U.S. still wrongly believe that they can catch HIV through casual contact, such as sharing a drinking glass or touching a toilet seat. This greatly increases their fear about being near people who are infected.
• Many people connect HIV and AIDS with behaviours that are already stigmatized, such as sex between men or injecting drugs.
• Some people believe that having HIV or AIDS is the person's own fault. For example, they might think it's the result of moral weakness and deserves to be punished.
Unfortunately, AIDS discrimination and stigma also fuel the epidemic. They prevent people from talking about their HIV status with sex partners or people with whom they share needles. Fear of rejection and worries about confidentiality also prevent many from getting tested for HIV. This means they may spread HIV to others without knowing it.
Examples of AIDS Discrimination:
What exactly is AIDS discrimination?
It means you are treated differently than other people simply because you are infected with HIV.
For example:
• A person denies you access to medical care at a hospital, medical or dental office, skilled nursing facility, or drug treatment centre.
• A person denies you child custody or visitation, or the right to adopt or become a foster parent.
• An employer asks unlawful questions on a job application or harasses, fires, or transfers you to a lesser job position.
• A person of authority reveals your HIV status at school, at work, or within a health care institution.
• You are evicted from a rental property.
HIV & AIDS Discrimination in Church response:
Stigma kills more than HIV itself. Prevailing stigma is responsible for people, infected and affected to hesitate to accessing counselling, testing and treatment services and be denied these facilities, thus forcing them to withdraw from church and society. They are sent out of their families, separated from their own children, and made to feel worthless. By its silence and its failure to stand up against such stigma, the church has perpetuated this stigma and discrimination.
The Church as the Body of Christ is challenged to confess its brokenness and vulnerability when it denies the image of God in the other.
a. We acknowledge that stigma creates and perpetuates gross inequities, wounding (Physically, socially, economically, psychologically and spiritually) both the infected and the effected thus leading to discrimination. We therefore condemn all forms of stigma and discrimination.
b. We recognise that we are called to be the salt and the light of the earth, proactively identifying, preventing and breaking down all forms of stigmatising barriers and working towards realising kingdom values.
c. We recognise that eternal life is a wholesome reality as mentioned in Jn 3:15, which cuts across all forms of manmade barriers of stigma and discrimination. We call upon the church to be a wholesome community open for dialogue and nurture each other in an interdependent manner.
d. We acknowledge that all of us are part of the same Body of Christ that He sees as equal and that we are equal partners in the scared ceremonies and daily life of the church. We will uphold healing which brings together those stigmatised due to HIV and AIDS and the community at large. We recognise that AIDS is like any other ailment which requires love, care and concern where both the PLHA and the community as a whole are equal partakers of hope and healing.
e. By our teaching, our practice, and by exerting our collective and individual influence, we will actively advocate with society in general and the government in particular
• Against all forms of stigma, taking strength from the diverse ministries of the church, including education, social service and health, that reach every part of society.
• For access at ART and other medical support relevant to HIV and AIDS.
• For Access to correct information through Awareness and capacity building programmes.
HIV/ AIDS Discrimination in India:
In India, as elsewhere, AIDS is perceived as a disease of "others" - of people living on the margins of society, whose lifestyles are considered 'perverted' and 'sinful'. Discrimination, stigmatisation and denial are the outcomes of such values, affecting life in families, communities, workplaces, schools and health care settings. Because of HIV/AIDS related discrimination, appropriate policies and models of good practice remain underdeveloped. People living with HIV and AIDS continue to be burdened by poor care and inadequate services, whilst those with the power to help do little to make the situation better.
In India the social reactions to people with AIDS have been overwhelmingly negative. For example, in one study 36% of people felt it would be better if infected people killed themselves, the same percentage believed that infected people deserved their fate. Also, 34% said they would not associate with people with AIDS, and one fifth stated that AIDS was a punishment from God.
The health care sector has generally been the most conspicuous context for HIV/AIDS related discrimination, stigma and denial. Negative attitudes from health care staff have generated anxiety and fear among many people living with HIV and AIDS. As a result, many keep their status secret, fearing still worse treatment from others. It is not surprising that among a majority of HIV positive people, AIDS-related fear and anxiety, and at times denial of their HIV status, can be traced to traumatic experiences in health care settings.
"There is an almost hysterical kind of fear at all levels, starting from the humblest, the sweeper or the ward boy, up to the heads of departments, which make them pathologically scared of having to deal with an HIV positive patient. Wherever they have an HIV patient, the responses are shameful."
Other examples of discrimination are children of HIV-positive parents, whether positive or negative themselves, being denied the right to go to school or being separated from other children. Whilst women are often blamed by their parents and in-laws for infecting their husbands, or for not controlling their partners' urges to have sex with other women. People in marginalized groups (female sex workers, hijras (transgendered) and gay men) are often stigmatised on the grounds not only of their HIV status but also being members of socially excluded groups.
Stigma is also affecting prevention efforts, with the harassment of AIDS outreach workers and peer - educators being reported in 2002. Although the Indian government encourages NGOs to provide condoms and AIDS education to high-risk groups such as sex workers and men who have sex with men, it seemingly allows law enforcement agencies to harass outreach workers who provide those services.
Care and support of people living with HIV/AIDS:
Since the launch of the second phase of the National AIDS Control Program in 1999, the Indian government has established 25 community HIV/AIDS care centres across the country. But the standard of care that NACO supports is limited to the provision of drugs for the treatment of opportunistic infections. And the distribution of these drugs is limited to those institutions that qualify through a NACO state-level selection process. Many people living with HIV only have access to centres not selected to receive drugs, so cannot have access to treatment for most opportunistic infections. Just as importantly, a major obstacle to the provision of care for HIV positive people, is the stigma surrounding the disease as described earlier.
With regard to antiretroviral drugs, India is a major producer of cheap generic copies of many HIV/AIDS drugs that are being sold to many countries all over the world. Despite that antiretroviral drugs are affordable to a tiny fraction of people in need of treatment in India.
"It is a sad irony that India is one of the biggest producers of the drugs that have transformed the lives of people with AIDS in wealthy countries. But for millions of Indians, access to these medicines is a distant dream" Joanne Csete, Director of the HIV/AIDS programme at Human Rights Watch.
In December 2003, the Indian Health Minister Sushma Swaraj announced that more than $40 million would be allocated from April 2004 to provide antiretroviral drugs in government run hospitals. The first projects will be in the worst-affected states: Karnataka, Maharashtra, Tamil Nadu, Manipur and Nagaland.
In early 2003 the Indian Health Minister Sushma Swaraj told the press that the country's AIDS program had to focus on sexual abstinence and faith rather than just condoms. But according to Peter Piot of UNAIDS:
"In order to prevent the spread of HIV, a combination approach is required. We need to promote abstinence, delay of sex, faithfulness and the use of condoms. No single approach will work." Peter Piot
Many people have been disappointed with the allocation of only $38.8 million of the government's own funds over the period of 1999-2004. The government has also been criticised of poor ability in implementing HIV/AIDS programs and inadequate efforts with injecting drug users and men who have sex with men.
The Indian government is also criticized for clinging to the idea that the epidemic is limited to "high risk groups", such as sex workers, drug users and truck drivers, and that targeting them is the best strategy to contain the epidemic further. But this approach no longer reflects the reality of at least some Indian states, where the epidemic is in the general population. In these states women who only have sex with their husbands may be the group at highest risk of HIV transmission, and although in Indian society men can experiment with sex outside of marriage, women do not have the status to demand condom use of their husbands.
Voluntary testing and counselling (VCT)
NACO has developed a VCT policy that states that "no individual should be made to undergo mandatory testing for HIV" and that "no mandatory testing should be imposed as a precondition for employment or for provision of health care facilities during employment" (India's armed forces are exempt from this condition). NACO has also developed guidelines for VCT centres, which deal with consent and confidentiality issues.
However, many Indians are tested for HIV without their consent or knowledge. It has been reported that over 95% of patients listed for surgical procedures are involuntary tested for HIV; for those who test positive, their treatment/surgery is cancelled. Another issue for anyone undergoing an HIV test is that his or her test will in most instances be neither anonymous nor confidential. Some Government officials (inc. legislators in Goa and Andhra Pradesh) have even voiced their support of mandatory premarital testing for HIV and are proposing related legislation.
Major Problems Faced by HIV & AIDS Orphans:
Along with numerous problems of orphans in general, (lack of family support, loss of proper care, education, food, and other basic amenities, dependency for financial, material needs, psycho-social, spiritual support, inability/ restrictions to express feelings by children, control, misuse, vulnerabilities such as trafficking, drugs, exploitation by others, loss of hope for their future, restrictions in taking their decisions, lack of consultative process etc), the AIDS orphans also suffer from stigma, discrimination and judgemental attitudes. The AIDS orphans are left unattended due to the lack of social commitments and social securities from governmental and Church authorities. They have difficulty in finding foster care and homes when both parents are lost due to AIDS, as well due to their own infection status as CLHAs (Children Living with HIV/AIDS).
These children grow with questions about their future and their survival. Many of them love their faith in God, due to their difficult circumstances. As they grow, they struggle with education, settlement for life, marriage, sustainability etc.. Poor access and availability of padiatric anti-Retroviral Treatment (ARTs), nutrition and psycho-social support to maintain immunity of the CLHAs, are common, many times they are left alone to look after themselves.
World AIDS Orphan Day:
India biggest home for AIDS Orphans
• AIDS orphans are shunned by communities.
• They are denied inheritance rights by near relatives.
• They face EVERYDAY exploitation in every form of fundamental rights such as denial of education and food and health
• They live on rock of contracting sexually Transmitted Diseases (STDs), face sexual and physical abuse
• They live with the trauma of having lost their parents, face stigma and discrimination of worst kind
• They normally end up on street: take to prostitution and crime to survive
• Large gap between Government policy and its implementation for AIDS Orphans; community at large not concerned
Combating Health Care Discrimination in India:
• Reducing HIV stigma and discrimination in health care settings requires not only addressing the attitudes and practices of health care workers but also meeting their needs for information, training and supplies to prevent occupational exposure to HIV.
• Policies and programmes to reduce stigma and discrimination must be directed at all hospital employees—from the cleaning staff to hospital superintendents—since everyone has a role to play.
• Outside groups wishing to work in health care settings to reduce stigma and discrimination need to position themselves as true partners rather than as critics or whistle blowers if their goal is to improve the health care environment for people living with HIV.
• With tools such as a “PLHA-friendly” checklist, hospital managers reviewed facility-specific information on stigma and discrimination and devised their own solutions. The stigma-reduction efforts were not imposed by the project. Hospital managers appreciated this approach
Conclusion:
The level of discrimination can be assessed by asking people whether they are aware of or have seen incidents during which a person living with HIV or AIDS experienced. Isolation is including physical and social exclusion. People are excluding from the social gathering, some are abandoned by partner. Abandoned by family or they are sent away. People are losing their role or identity. They lost respect and standing within the family and by the community. It is our duty to address these type issues to our friends in our circle and society, especially to our congregation if chance permits. That will limit the discrimination which people of society show towards them, and that will surely change the view towards them because ‘change alone won’t change’.
Bibliography
Kingston, shantha. Question of survival AIDS. India: turning point study seires, 1993.
Paterson, Gillian. HIV prevention: A Global Theological conversation. Geneva: Ecumenical Advocacy Alliance, 2009.
Samraj, S., Anita David, Lavanya & Sujay Suneetha. AIDS in India: who cares anyway? The lasting decisions. Bangalore: Centre for Contemporary Christianity, 2011.
Sahu, D.K. Policy on HIV and AIDS. Maharashtra : NCCI, 2009
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