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HIV Fact Sheet Nagaland |
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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
Nagaland, the most likely source of HIV/
AIDS knowledge is from a friend or
relative. The percentage obtaining
information from media such as television
and radio is far lower than in other states,
pointing to the difficulty of reaching people
in this area of the country. Only 3.1 percent
of ever-married women had heard of the
disease from a health worker.
Further, while one’s becoming aware of
HIV is a useful and desirable first step,
interpersonal communication is vital for
understanding the nature of the illness.
Such education is woefully lacking, with
82.6 percent of residents having had no
such counseling in five Northeastern
states, including Nagaland.
Where Do Women Hear about HIV/AIDS?
Sources of Knowledge in Nagaland
Friend/
relative
Television
72.3
40.0
Radio
39.8
Hoarding
Print
media
Other
Health
worker
3.1
Cinema 1.2
27.1
25.8
23.4
Teacher 1.0
Adult
education
1.0
National Family Health Survey, 1998-99
(survey of ever-married women, ages 15-49)
Accurate knowledge, testing and
counseling are three main weapons in
the struggle against HIV/AIDS…
Awareness of the use of the condom as a
means to prevent HIV/AIDS was far from
universal. In the rural areas, only 57.6
percent of men and 41.5 percent of
women were aware of its value.
Percent Knowing that Consistent Condom
Use Can Prevent HIV/AIDS, Five
Northeastern States*, 2001
70.6
49.5
79.5
57.6
Urban
Rural
61.8
41.5
Overall, in these states, 28 percent of
survey respondents said that they believed
testing for HIV infection was possible in
their area. However, the percentage who
knew of a place to be tested was a
shocking zero percent – no respondent
could identify a testing place. Testing for
HIV is not only in the individual’s own self-
interest, but would act as a strong
deterrent to its spread.
Both sexes
Male
Behavioural Surveillance Survey 2001
National AIDS Control Organisation
*Arunachal Pradesh, Meghalaya, Mizoram,
Nagaland and Tripura
Female
Nagaland 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.
It is also important to reach drug users and their partners.
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 Nagaland 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.
Nagaland
HIV/AIDS in India
The Hard-hit States
Mokokchung
Mon
Dimapur
Kohima
Wokha
Zunheboto
Tuensang
Phek
High prevalence districts
Map not to scale
Nagaland detected its first AIDS case in 1994.
It is now one of the states with the highest
HIV/AIDS prevalence in India. Although the
prevalence of infection among intravenous
drug users has been a major concern, the
disease has now spread to the general
population. Rising numbers of pregnant
women, whose sexual behaviour is not
believed to be risky, are testing positive for
HIV. But this spread of HIV can be prevented.
Reaching drug users who share needles with
accurate information on how to avoid the
disease is a major concern in the state.
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.
Reported Cases of AIDS, Nagaland
343
298
235
103
through through through through
March 2001 March 2002 Dec. 2002 Aug. 2003
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How Far Has AIDS Spread?
Officially reported cases of AIDS from
hospitals and clinics across the state are
only a small fraction of the total. However,
their rise from 103 in 2001 to 343 through
August 2003 shows that the disease is
rapidly gaining ground. Of those 343
cases, 45 were added in the first eight
months of 2003 alone.
Among adults, males are infected 3:1
compared to females, but the number of
infected females is rising. About 90 percent
of the total reported AIDS cases are in the
age group 15-44.
Percent Testing Positive for HIV at
Sentinel Sites, Nagaland, 2002
10.3
Over one percent of
pregnant women now test
positive. HIV is no longer
limited to high-risk groups.
It now affects everyone.
Intravenous
drug users
2.4
Sexually
transmitted
disease
patients
1.3
Women in
antenatal
clinics
Of the 49 high prevalence HIV/
AIDS districts in India, three are
in Nagaland...
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
intravenous drug user (IDU) clinics and
patients at sexually transmitted disease
(STD) clinics. Women treated in antenatal
clinics (ANCs) are the low-risk group.
Percent of Pregnant Women, STD Patients and
IDUs Testing Positive for HIV, Nagaland, 2002
ANC clinics
Civil Hospital,
Mokokchung 1.3
Civil Hospital,
Dimapur
1.3
Civil Hospital,
Tuensang
8.0
The HIV/AIDS epidemic in Nagaland is
now categorized 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.
STD clinics
Civil Hospital,
Kohima
IDU clinics
Civil Hospital,
Dimapur
2.4
5.8
The risk of HIV through sex with an IDU is
closely related to the frequency of needle
sharing among drug users. Among IDUs,
the prevalence of HIV infection is high, with
rates up to 24.6 percent having been
recorded in 2002. Unlike other states,
many infections in Nagaland result from
infected syringes and needles and through
blood transfusion or blood products.
Civil Hospital,
Tuensang
24.6
A true AIDS epidemic is not
a future possibility for Nagaland.
It is a present reality...
MNahaagraalasnhdtra HHIVI/VA/AIDIDSSininInIdnidaia ThTeheHaHradr-dh-iht iSt tSattaetses
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. Husbands
are a bridge that carries HIV from high-risk
groups, such as sex workers and their
clients, to their spouses.
Tragically, pregnant women can pass the
infection to their unborn child or, after birth,
by breastfeeding, an otherwise
recommended practice.
Among pregnant women, the high rates of
infection for those with higher education
shows that even these groups have been
unable to protect themselves from
infection.
“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…
Percent of Pregnant Women Testing Positive
for HIV, by Education, Nagaland, 2001
Total
Illiterate
Literate/
Primary 0.0
0.5
0.7
Secondary
and higher
1.6
1.5
Urban
Rural
2.0
1.9
2.6
Added Risk with IDUs
Injecting drug users (IDUs) who share
needles pose a particular problem in
Nagaland. Among IDUs, HIV prevalence
rose to over 10 percent in 2002. The drug
users, in turn, transmit HIV to their sex
partners.
HIV infection in Nagaland is a more
significant problem in urban areas,
according to sentinel site data. This
situation suggests that an intensified
campaign in urban areas to spread HIV
awareness and knowledge could greatly
assist the fight against the disease in the
state. Encouraging IDUs to be tested for
infection should be a priority. Many IDUs
are unaware that they have contracted the
disease.
Percent of IDUs Testing Positive for HIV in
Urban and Rural Areas by Age Group,
Nagaland, 2001
15.1
Urban
Rural
7.8
5.2
4.4
0.0
Less than 20
20-29
0.0
30-44
Stigma: An Ally of AIDS
The fight against AIDS will fail if its
stigma cannot be overcome. The fear
of being stigmatized for simply being
tested for the infection allows AIDS to
spread undetected from person to
person...
HIV Moves through Society
The occupation of patients at STD clinics
who tested positive for HIV illustrates 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.
Among those treated at STD clinics,
drivers have the highest prevalence of HIV
in Nagaland. Drivers who travel distances
to many different locations bring the
infection with them, often to areas where
the disease has not yet begun.
Percent Testing Positive for HIV at STD Sites
by Occupation, Nagaland, 2001
Driver
20.0
Business
12.0
Student
10.0
Unemployed
7.1
Service class
4.6
Housewife
3.6
A telling statistic is the high prevalence of
HIV discovered among housewives at 3.6
percent. This high rate of infection is
another signal of the expansion of HIV into
the general public.
The best defence against HIV/AIDS
is a single, uninfected partner…
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. The Behavioural
Surveillance Survey 2001, conducted by
the National AIDS Control Organisation
(NACO), showed that the level of condom
use during risky sexual behaviour is
inadequate in five Northeastern states*. In
urban areas, only 40.7 percent of survey
respondents used a condom consistently
with non-regular sex partners. In the rural
areas, this figure was 31 percent. 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.
*Separate data for Nagaland are not available in the
Behavioural Surveillance Survey 2001.
Consistent Condom Use with Non-regular Sex
Partners, in Five Northeastern States*, 2001
(percent)
During the
last 12
months
40.7
30.9
Urban
Rural
During last
sexual
intercourse
69.3
58.5
Only 100 percent use of the condom
with commercial sex workers can
prevent the spread of HIV/AIDS.
Nagaland is far short of this goal...