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HIV Fact Sheet Tamil Nadu |
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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 Tamil
Nadu, 89 percent of adults have heard of
the disease. In the rural areas, however,
16 percent of women are unaware of its
existence. For those who have heard of
the disease, television accounted for
most of that knowledge, followed by radio
and friends or relatives. Only 3.4 percent
of ever-married women had heard of the
disease from a health worker.
Where Do Women Hear about HIV/AIDS?
Sources of Knowledge in Tamil Nadu
(percent)
Television
Radio
Friend/relative
Print media
19.2
75.1
52.4
50.9
Hoarding
Cinema
Other
14.3
11.8
8.9
Health worker 3.4
Teacher 0.9
Adult education 0.4
While one’s becoming aware of HIV
through media is a useful and desirable
first step, interpersonal communication is
vital for understanding the nature of the
illness. Such education is woefully lacking
in the state, with nine out of ten residents
having had no such counselling,
according to the Behavioural Surveillance
Survey (BSS) 2001.
Percent Knowing that Consistent Condom Use
Can Prevent HIV/AIDS, Tamil Nadu, 2001
77.0
66.3
70.2
55.7
55.7
Urban
Rural
41.1
The BSS also revealed that awareness of
the use of the condom as a means to
prevent HIV/AIDS was far from universal.
In the rural areas, about 30 percent of men
and 60 percent of women were not aware
of its role in disease prevention.
Personal experience with the disease is
becoming more widespread. Overall, 18.4
percent of BSS respondents knew of
someone who had died of AIDS, 19.4
percent in urban areas and 17.9 percent
in rural areas.
Both sexes
Male
Female
Accurate knowledge, testing and
counseling are three main weapons in
the struggle against HIV/AIDS…
Percent Knowing a Place Where They Could Be
Tested for HIV/AIDS, Tamil Nadu, 2001
31.4
Both sexes
12.2
A majority felt it was possible to be tested
confidentially for the disease (65.9
percent), but only 31.4 percent in urban
areas and 12.2 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.
Male
Female
10.5
13.9
37.9
Urban
Rural
24.8
Tamil Nadu 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 Tamil Nadu 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.
Tamil Nadu
HIV/AIDS in India
The Hard-hit States
ANDHRA
PRADESH
Thiruvallur
Chennai
A
K
A
T
A
N
R
A
K
Dharmapuri
Salem
Vellore
Kancheepuram
Tiruvanamalai
Viluppuram
PONDICHERRY
The Nilgiris
Erode
Coimbatore
Cuddalore
Namakkal
Perambalur
Ariyalur Nagapattinam
Tiruchirappalli
Karur
ThanjavurThiruvarur
Karaikal
(PONDICHERRY)
Nagapattinam
Dindigul
Pudukkottai
Madurai
Theni
Sivaganga
Virudhunagar
Ramanathapuram
Toothukkudi
Tirunelveli
High prevalence districts
Map not to scale
Kanniyakumari
Tamil Nadu detected the first case of AIDS
in India in Chennai in May of 1986. Through
mid-2003, 45 percent of the country’s
reported cases of AIDS was in Tamil Nadu,
although it has only six percent of the
country’s population. 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.
Tamil Nadu is now on the same path.
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.
Tamil Nadu's Share of India's
Reported AIDS Cases
1986 - 2003
Tamil Nadu
45%
Other states
55%
National AIDS Control Organisation
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How Far Has AIDS Spread?
Officially reported AIDS cases from hospitals
and clinics across the state are only a small
fraction of the total. However, their rise from
9,714 in March 2001 to 24,667 through
August 2003 shows that the disease is
rapidly gaining ground. Of those 24,667
cases, 6,391 were added in the first eight
months of 2003 alone.
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.
Percent Testing Positive for HIV at
Sentinel Sites, Tamil Nadu, 2002
34
One percent of pregnant
women now test positive.
HIV is no longer limited to
high-risk groups. It now
affects everyone.
15
Intravenous
drug users
Sexually
transmitted
disease
patients
2
Men who
have sex
with men
1
Women in
antenatal
clinics
Measuring the Spread
Of the 49 high prevalence HIV/AIDS
districts in India, seven are in
Tamil Nadu...
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,
sexually transmitted disease (STD) clinics,
and men who have sex with men (MSMs).
Women treated in antenatal clinics (ANCs)
form the low risk group.
Percent of Pregnant Women Testing
Positive for HIV, Tamil Nadu, 2002
4.0
The National AIDS Control Organisation
(NACO) classifies the HIV/AIDS epidemic
in Tamil Nadu 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 the state, rates for women in many ANC
clinics have now risen above one percent.
These are very high rates for women in the
general population, who typically do not
engage in risky sexual behaviour and
whose chance of contracting HIV is
considered low.
1.5
1.3
1.0
1.0
0.8
Community
Health
Centre,
Namakkal
Medical Tirunelveli Medical
College, MC Hospital, College,
Salem Tirunelveli Madurai
Govt.
Hospital,
Vellore
Govt.
Hospital,
Dindigul
The sentinel site data show that the
epidemic has now spread to the general
population. In Tamil Nadu, the HIV/AIDS
outbreak is a genuine epidemic.
A true AIDS epidemic is not
a future possibility for Tamil Nadu.
It is a present reality...
Tamil Nadu 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 HIV through
their own behaviour, but through that of
their husbands.
Among these women, the high rates of
infection for those with little or no
education show the difficulty of reaching
these groups with AIDS information.
Tragically, pregnant women can pass the
infection to their unborn child or, after birth,
by breastfeeding, an otherwise
recommended practice.
“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, Tamil Nadu, 2001
0.7
Total
1.8
1.0
Illiterate
2.3
Literate/
Primary
Secondary
and higher
0.5
0.7
Urban
1.6
Rural
1.5
Added Risk with STDs
Sexually transmitted diseases (STDs)
increase vulnerability to HIV infection.
The level of HIV among patients in STD
clinics in Tamil Nadu has now risen to an
alarming degree, one of the highest in
India. Infection rates are higher in rural
areas than in urban areas, a serious
public health issue as rural populations
have less access to medical diagnosis
and treatment.
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.
Percent of STD Patients Testing Positive for HIV in
Urban and Rural Areas by Sex, Tamil Nadu, 2001
11.5
10.0
11.8
11.4
10.9
8.8
Urban
Rural
Both sexes
Male
Female
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 HIV/
AIDS to spread undetected from
person to person...
HIV Moves through Society
The occupation of STD patients 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.
Workers in the hotel and tourist industry
have the highest prevalence of the STD
groups tested in Tamil Nadu. Truck drivers
are the second group. Drivers often travel
distances to many different locations,
bringing the infection with them, often to
areas where the disease has not yet
begun. The unemployed form the third
largest group in HIV infection with 12.5
percent in Tamil Nadu. This group is often
without work for some time after migrating
to larger towns and cities and becomes
vulnerable to HIV.
Percent Testing Positive for HIV at STD Sites
by Occupation, Tamil Nadu, 2001
Hotel staff
Driver
40.0
17.9
Unemployed
Housewife
12.5
11.4
Business
Factory worker
10.9
10.1
Service class
Agriculture/
unskilled
Student
9.4
9.2
5.3
The best defence against HIV/AIDS
is a single, uninfected partner…
A telling statistic is the high prevalence of
HIV discovered among housewives at 11.4
percent. This high rate of infection is
another signal of the general expansion
of HIV.
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 become more widespread, nine
percent of clients of female sex workers
(FSWs) still do not use a condom. A
dramatic increase in condom use has
been observed among clients of FSWs
during 1996-2000. Condom use among
truckers and helpers was found to have
increased from 44 percent to 70 percent
during the same period. But even high use
of the condom is not enough. HIV will
spread steadily with anything short of
100 percent use.
Condom Used During Last Sex with a
Non-regular Partner, Tamil Nadu
Male factory
workers
Truckers and
helpers
17
25
28
50
48
44
51
1996
1997
1998
1999
2000
66
67
70
Clients of
commercial
sex workers
56
74
80
88
91
APAC-VHS, Chennai and Tamil Nadu State AIDS Control Society
Only 100 percent use of the condom
with commercial sex workers can
prevent the spread of HIV/AIDS.
Tamil Nadu is far short of this
goal…