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HIV Fact Sheet Maharashtra |
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People Need HIV/AIDS Information
For people to take steps to avoid HIV/
AIDS, they must first hear of it. In
Maharashtra, 82 percent of adults have
heard of the disease. Television is the most
likely source of HIV/AIDS knowledge,
followed by friends or relatives and print
media. Only 6.5 percent of ever-married
women had heard of the disease from a
health worker.
Personal experience with the disease is
becoming more widespread, according to
the Behavioural Surveillance Survey (BSS)
2001. Overall, 20.8 percent of BSS
respondents knew of someone who had
died of AIDS, 30.6 percent in urban areas
and 14.6 percent in rural areas.
Percent Knowing that Consistent Condom Use
Can Prevent HIV/AIDS, Maharashtra, 2001
Awareness of the use of the condom as a
means to prevent HIV/AIDS was far from
universal. In the rural areas, two-thirds of
women and one-third of men were not
aware of its role in disease prevention.
Accurate knowledge, testing and
counseling are three main weapons in
the struggle against HIV/AIDS…
A majority felt it was possible to be tested
confidentially for the disease (58.6
percent), but only 20 percent in urban
areas and five percent in rural areas knew
where to go for testing. Testing for HIV is
not only in the individual’s own self-interest,
but would act as a strong deterrent to its
spread.
Maharashtra HIV/AIDS in India The Hard-hit States
What must be done?
G The stigma associated with people living with HIV/AIDS must be ended. Women
and orphans are cast from families, children from their school and workers from
their workplace. Ignorance breeds needless fear.
G Confidential testing centres must be made operational in every district. HIV/AIDS
must be fought at the grass-roots level.
G Women are a vital target for information and testing, lest they be left defenceless.
G HIV/AIDS information — and counseling — must be universal. Everyone should
know the truth about HIV/AIDS.
G People must learn that a single, uninfected partner is the best defence.
G Those who do engage in risky behaviour must learn the value of a high quality
condom and how to obtain one.
G Treatment for people living with HIV/AIDS, including antiretroviral drugs, should be
provided free of charge, given that the expense is beyond the reach of many.
G The importance of quickly educating youth is a key element in the campaign.
All the danger signs are there. Knowledge of the disease itself is low, the knowledge
of preventive measures is far short of what is necessary and counseling is
unavailable to many. HIV/AIDS has come to Maharashtra and is now a genuine
epidemic.
This series of factsheets on the six hard-hit HIV/AID states (Andhra Pradesh, Karnataka,
Maharashtra, Manipur, Nagaland and Tamil Nadu) are available in English and the
respective state language and are free of charge to individuals and organisations. For
additional copies, please contact the Population Foundation of India at the address below.
Factsheet prepared by:
Population Foundation of India
B-28, Qutab Institutional Area, Tara Crescent, New Delhi 110 016
Telephone: 91-11-2686 7080 Fax: 91-11-2685 2766 e-mail: popfound@sify.com
www.popfound.org
and
Population Reference Bureau
1875 Connecticut Ave., NW, Suite 520, Washington, DC 20009
Telephone: (202) 483-1100 Fax: (202) 328-3937 e-mail: popref@prb.org
www.prb.org
Funding was provided through the generosity of the Bill & Melinda Gates Foundation.
Printed in India at Ajanta Offset & Packagings Ltd., Delhi. November 2003.
Maharashtra
HIV/AIDS in India
The Hard-hit States
M
A
Nandurbar
DH YA
PRADES H
Dhule
Jalgaon
Amravati
Akola
Buldana
Nagpur
Wardha
Gondia
Bhandara
Thane
Mumbai
Raigarh
Nashik
Aurangabad
Washim
Yavatmal
Chandrapur
Pune
Ahmadnagar
Jalna
Hingoli
Parbhani
Bid
Nanded
Osmanabad
Latur
PRADESH
Gadchiroli
Satara
Solapur
Ratnagiri
Sangli
A
ATAK
Kolhapur N
Sindhudurg
GOA
Maharashtra was one of the earliest states to
be affected by HIV/AIDS in India and one of
the first to be considered high prevalence.
The first AIDS case in the state was detected
in Mumbai in May 1986. Through mid-2003,
21 percent of the country’s reported cases of
AIDS was in Maharashtra. The epidemic
began among groups with a high risk of
infection, such as sex workers and their
clients. But it has now spread to the general
population. This is the way HIV/AIDS spread
in Africa. Maharashtra is now on the same
path. But HIV can be prevented by
intensifying the current HIV control
programme. Accurate information on how to
avoid the always-fatal disease — and the
elimination of the stigma against its
victims — can help the state stem the tide of
the epidemic.
High prevalence districts
Map not to scale
Maharashtra's Share of India's
Reported AIDS Cases,
1986 - 2003
Maharashtra
21%
Other States
79%
National AIDS Control Organisation
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How Far Has AIDS Spread?
Officially reported AIDS cases from
hospitals and clinics are only a small
fraction of the total. However, their rise
from 4,459 in March 2001 to 11,829
through August 2003 shows that the
disease is quickly gaining ground. Of those
11,829 cases, 1,160 were added in the first
eight months of 2003 alone. Mumbai
accounted for 2,595 of all reported cases.
Percent Testing Positive for HIV at Sentinel
Sites, Maharashtra, 2002
One percent of pregnant
women now test positive.
HIV is no longer limited to
high-risk groups. It now
affects everyone.
Among adults, males are infected 3:1
compared to females, but the number of
females with HIV/AIDS is rising. About 90
percent of the total reported AIDS cases
are in the age group 15-44.
Measuring the Spread
In order to measure the extent of HIV
infection, testing is conducted at “sentinel
sites” among high and low-risk groups.
High-risk groups are patients at sexually
transmitted disease (STD) clinics,
commercial sex workers (CSWs), patients
at intravenous drug user (IDU) clinics and
men who have sex with men (MSM).
Women treated in antenatal clinics (ANCs)
form the low-risk group.
The National AIDS Control Organisation
(NACO) classifies the HIV/AIDS epidemic
in Maharashtra as high prevalence, with
five percent or more of high-risk groups
testing positive and one percent or more of
women in antenatal clinics testing positive.
In Mumbai, rates for ANC women as high
as three percent were recorded in 2002.
This is a very high rate for women in the
general population, who typically do not
engage in risky sexual behaviour and
whose risk is considered low.
Of the 49 high prevalence HIV/
AIDS districts in India, 14 are in
Maharashtra...
3.3
2.5
0.8
0.8
Kurla Bhabha
Hospital
MW Desai
Hospital
The sentinel site data show that the
epidemic has now spread to the general
population. In Maharashtra, the HIV/AIDS
outbreak is a genuine epidemic.
A true AIDS epidemic is not
a future possibility for Maharashtra.
It is a present reality...
Maharashtra HIV/AIDS in India The Hard-hit States
Bridge Groups
The high rate of HIV infection among
women in antenatal clinics indicates that
the disease is being carried to the general
population by a “bridge” group. It is unlikely
that these women contracted the disease
through their own behaviour, but through
that of their husbands.
“Bridge” groups, such as husbands
who use the services of sex workers,
infect their wives with HIV who then
pass the disease to their babies. The
epidemic is complete…
Tragically, pregnant women can pass the
infection to their unborn child or, after birth,
by breastfeeding, an otherwise
recommended practice.
The high rates of infection for those with
less education show the importance of
educating women and their partners about
the dangers of HIV/AIDS.
Added Risk with STDs
Sexually transmitted diseases (STDs)
increase vulnerability to HIV infection.
Contrary to the notion that AIDS primarily
affects urban areas, high levels of HIV
have been found among rural STD patients
as well. This raises a serious public health
issue as rural populations have less
access to medical diagnosis and
treatment, including STD services.
Percent of STD Patients Testing Positive for
HIV in Urban and Rural Areas by
Sex, Maharashtra, 2001
The high rates in rural areas require
greatly increased efforts for HIV education
outside cities and towns. Reaching down to
village panchayat leaders to convince them
of the need to overcome the stigma
associated with AIDS and the discussion of
it has become a critical need. People fear
the stigma from even being tested,
knowing they are likely to be ejected from
their household, village or school.
Stigma: An Ally of AIDS
The fight against AIDS will fail if its
stigma cannot be overcome. The fear
of stigma for simply being tested for
the infection allows HIV/AIDS to
spread undetected from person to
person...
HIV Moves through Society
The occupation of STD patients who tested
positive for HIV paints a clear picture of
how the disease spreads, especially in the
initial stages. Those with frequent contact
with many customers or clients are more
likely to contract the disease and then
spread it to others.
Percent Testing Positive for HIV at STD Sites
by Occupation, Maharashtra, 2001
Workers in the hotel and tourist industry
have the highest prevalence of the groups
tested in Maharashtra, followed by drivers
and the unemployed. Truck drivers who
travel distances to many locations bring
the infection with them, often to areas
where the disease has not yet begun.
Migrants in search of employment come to
Maharashtra already infected or contract
the disease after arriving. This group is
often without work for some time and
vulnerable to HIV.
The best defence against HIV/AIDS
is a single, uninfected partner…
A telling statistic is the high prevalence of
HIV discovered among housewives at 7.6
percent. This high rate of infection is yet
another signal of the expansion of HIV into
the general public.
Pune and Sangli
Condom Use Short of Goal
The best defence against HIV is a single,
uninfected partner. When one’s behaviour
is risky, the primary defence is a high
quality condom. Although condom use has
increased, one-third of clients of non-
brothel-based female sex workers (FSWs)
do not use a condom. One-fourth of those
utilizing the services of brothel-based
FSWs also fail to use a condom. This is a
critical issue in that relatively high use of
the condom is not enough. HIV will spread
steadily with anything short of 100 percent
use.
Pune and Sangli
Only 100 percent use of the condom
with commercial sex workers can
prevent the spread of HIV/AIDS.
Maharashtra is far short of this goal…