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India's Hidden Aids Epidemic

By Maxine Frith

The Independent, UK
19 November 2003

When she was 21, Kousalya Periasamy was forced into marriage with a man she did not like.
She was told she had to marry him because his family owned land that supplied water to her father's factory. What Kousalya wasn't told was that her husband was HIV positive.

"He knew he was positive and his family knew too. I think my father suspected because he knew what my husband was like, but the marriage was all to do with money," Kousalya said.

"I knew nothing. I didn't like my husband but he forced me to have sex with him and his family said it was my duty. I became ill and my husband's family said I should go for tests, and that is when I found out I was HIV positive." Kousalya's story is tragically common in India, and goes to the heart of its burgeoning Aids epidemic.

While the country is becoming increasingly wealthy from foreign investment, and the growth of call centres and its hi-tech industry, the status of women has remained hugely unequal. Women have few rights to property, or control over whom they marry. Rape within marriage is legal, and domestic violence is condoned rather than condemned.

Low-caste women are often forced into prostitution, and even those who are better off can find it difficult to receive health care because they are put under pressure not to leave the house alone.

Campaigners say the inequalities are adding to the rapid spread of HIV and Aids. A report by the British charity Voluntary Service Overseas, to be published this week, will warn that unless women's rights are improved India could face disaster.

The Indian government insists that only 4 million people have HIV or Aids - about 0.4 per cent of the population. But most aid agencies say the real figure is much higher. The Centre for Strategic and International Studies in Washington has estimated India will have 25 million cases by 2010.

While the West has focused on Africa when dealing with the Aids epidemic, India has been largely ignored. But as hospitals struggle to cope with the numbers of sick patients, and the country opens its first Aids orphanages, the Indian government is under increasing pressure to act.

Peter Piot, the head of the UN Aids agency, recently told a conference in Delhi: "India has a king-sized problem. But it is a problem with a solution. We can act now before it is too late." According to the VSO report, Gendering Aids, women's low status and lack of rights have left them vulnerable to infection regardless of their own behaviour. Married men visit prostitutes, putting their wives at risk of infection. Three quarters of HIV-positive women have been infected within marriage. Even if a woman knows her husband is infected, it can be impossible to insist he practises safe sex. If they leave their husbands, women, in effect, forfeit their rights to the marital home and the dowry they brought with them. As increasing numbers of HIV-positive men are dying in India, young widows are finding themselves forced out of their home by their husband's relatives.

While the government has begun to respond to the Aids epidemic, it has done little to improve women's rights. It has also banned discussion of condoms in schools and colleges, despite the fact that many girls are married by the time they are 16. Girls are traditionally not supposed to know anything of sex or contraception before they marry.

Satish Kumar, an education officer who works with the Aids group YRG Care in the southern city of Chennai, said: "We need to be able to give teenagers information about condoms. The government says that it will encourage them to become promiscuous, but that is not true."

African countries such as Uganda have cut HIV rates with a campaign known as ABC: Abstain, be faithful or use condoms. VSO has started recruiting volunteers from Uganda to work on HIV and Aids projects in India. In Africa, drug companies have agreed to supply cheap anti-HIV drugs, but the deal does not extend to India.

K K Abraham, of the Indian Network of Positive People, said: "India has got to go through a phenomenal social and economic change in the way we think before we can deal with the Aids issue and see women as equals."

Attitudes are beginning to change. Kousalya was so outraged at the way she was treated that she set up her own support group, the Positive Women's Network, and became the first woman in India to go public about having the virus.

Three years ago, she was critically ill with HIV-related infections. Thanks to anti-Aids drugs, she is now healthy and will travel to London for the launch of the VSO report. "When I first got ill, I was very angry at my husband. I thought I was going to die because Aids meant death, and life had no meaning," she said. "Now I can look forward to the future. I like to look after my nieces. I want India to change for them."