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HIV Fact Sheet Andhra Pradesh |
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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 Andhra
Pradesh, 96 percent of adults have heard
of the disease, with high awareness in both
urban and rural areas. Television is the
most likely source of HIV/AIDS knowledge,
followed by friends or relatives. Only 2.9
percent of ever-married women received
information on the disease from a health
worker.
Where Do Women Hear about HIV/AIDS?
Sources of Knowledge in Andhra Pradesh
(percent)
Television
74.3
Friend/relative
40.6
Radio
33.7
Print media
15.9
Cinema
14.7
Other
7.7
Hoarding 6.8
Health worker 2.9
Teacher 0.9
Adult education 0.3
Awareness of the use of the condom as a
means to prevent HIV/AIDS is far from
universal. In the rural areas, about one-
third of men and nearly half of women were
not aware of its role in disease prevention.
Percent Knowing that Consistent Condom Use
Can Prevent HIV/AIDS, Andhra Pradesh, 2001
68.3
59.2
76.4
62.3
Urban
Rural
60.1
56.0
Personal experience with the disease is
widespread. Overall, 31.2 percent of BSS
respondents knew of someone who had
died of AIDS, 26.6 percent in urban areas
and 32.8 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, Andhra Pradesh, 2001
Both sexes
16.5
11.4
A small proportion felt it was possible to be
tested confidentially for the disease but
only 16.5 percent in urban areas and 11.4
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
13.0
10.8
9.7
22.2
Urban
Rural
Andhra Pradesh 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 Andhra Pradesh 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.
Andhra Pradesh
HIV/AIDS in India
The Hard-hit States
Adilabad
Karimnagar
Nizamabad
CHHATTISGARH
Srikakulam
Medak
Warangal
Rangareddi Hyderabad
Khammam
Visakhapatnam
East
Godavari
Nalgonda
Mahbubnagar
Guntur
West
Godavari
Krishna
Yaman
(PONDICHERRY)
Kurnool
Prakasam
Anantapur
Cuddapah
Nellore
Chittoor
TA M I L
NADU
Andhra Pradesh was one of the first states in
India to be considered high HIV/AIDS
prevalence and is currently one of the six
“hard-hit” states. Through mid-2003, eight
percent of the country’s reported cases of
AIDS was in Andhra Pradesh and the number
of cases is rising rapidly. The state has the
highest proportion of those with sexually
transmitted diseases (STDs) who have tested
positive for HIV/AIDS. People suffering from
STDs are far more vulnerable to HIV infection.
But HIV/AIDS is no longer confined to those
with risky sexual behaviour. It has now
moved into the general population, signified
by the number of women in antenatal clinics
who also test positive for the disease.
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
Reported Cases of AIDS,
Andhra Pradesh 1986 - 2003
4,339
2,350
1,316
612
through through through through
March 2001 March 2002 Dec. 2002 Aug. 2003
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 HIV/AIDS epidemic.
However, the rise in reported cases from
612 in March 2001 to 4,339 through
August 2003 shows that the disease is
quickly gaining ground. Of those 4,339
cases, 1,989 were added in the first eight
months of 2003 alone.
Percent Testing Positive for HIV at Sentinel
Sites, Andhra Pradesh, 2002
30.4
Over one percent of
pregnant women now test
positive. HIV is no longer
limited to high-risk groups.
It now affects everyone.
Sexually transmitted
disease patients
1.3
Women in
antenatal
clinics
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
Of the 49 high prevalence HIV/AIDS
districts in India, seven are in
Andhra Pradesh...
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 while
low-risk groups are women treated in
antenatal clinics (ANCs).
The National AIDS Control Organisation
(NACO) classifies the HIV/AIDS epidemic
in Andhra Pradesh as high prevalence,
with five percent or more of high-risk
groups and one percent or more of women
in antenatal clinics testing positive. Rates
for women in some clinics have now risen
as high as four percent. That is a very high
rate for women in the general population,
who typically do not engage in risky sexual
behaviour and whose chance of
contracting HIV is considered low.
Percent of Pregnant Women and STD Patients
Testing Positive for HIV, Andhra Pradesh, 2002
ANC Clinics
Gandhi MC Hospital, 1.5
Hyderabad
Rangaraya MC Hospital, 3.0
Kakinada
Medical College,
4.0
Guntur
STD Clinics
Civil Hospital,
Ongole
Medical College,
Vishakhapatnam
SV Medical College,
Tirupati
12.8
35.6
39.2
The sentinel site data show that the
epidemic has now spread from high-risk
groups to the general population. In
Andhra Pradesh, the HIV/AIDS outbreak
is a genuine epidemic.
A true AIDS epidemic is not a future
possibility for Andhra Pradesh.
It is a present reality...
Andhra Pradesh 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. Tragically,
pregnant women can pass the infection to
their unborn child or, after birth, by
breastfeeding, an otherwise recommended
practice.
Andhra Pradesh recorded the highest
frequency of sex with non-regular partners
in the country. Among men, 19.2 percent
said they had had sex with a non-regular
partner in the previous year, as did 7.4
percent of women.
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 Adults Having Sex with a
Non-regular Partner in the Past Year,
India and Andhra Pradesh, 2001
6.6
India
2.0
11.8
Both sexes
Male
Female
Andhra Pradesh
13.3
19.2
7.4
Added Risk with STDs
Sexually transmitted diseases (STDs)
increase vulnerability to HIV infection. The
Behavioural Surveillance Survey (BSS)
2001, conducted by NACO, showed that
Andhra Pradesh had one of the highest
levels of STD prevalence in India. More
than 20 percent of STD patients in urban
areas and 30 percent in rural areas tested
positive for HIV. This is a serious public
health issue as rural populations have less
access to diagnosis and treatment.
Percent of STD Patients Testing Positive for
HIV in Urban and Rural Areas by Sex,
Andhra Pradesh, 2001
31.6
24.9
32.4
24.2
30.6
26.2
Urban
Rural
Both sexes
Male
Female
The higher rate in rural areas requires
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 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 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.
People from the business class have the
highest prevalence of the STD patients
tested in Andhra Pradesh. The
unemployed form the second largest group
in HIV infection. This group is often without
work after migrating to larger towns and
cities and becomes vulnerable to HIV.
Truck drivers who travel distances to many
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, Andhra Pradesh, 2001
Business
Unemployed
Driver
Agriculture/
unskilled
Housewife
Hotel staff
Factory worker
Service class
Student 2.4
37.0
35.2
32.0
30.7
28.7
26.3
23.8
15.9
The best defence against HIV/AIDS
is a single, uninfected partner…
A telling statistic is the high prevalence of
HIV discovered among housewives at 28.7
percent. This high rate of infection is yet
another signal of the expansion of HIV into
the general public.
Reported Frequency of Condom Use by Clients
of Sex Workers, Andhra Pradesh, 2001
(percent)
79.7
57.8
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, only 8.5 percent of clients of
female sex workers in Peddappuram and
25.9 percent in Kakinada always use a
condom. These are very low levels since
even relatively high use of the condom is
not enough. HIV will spread steadily with
anything short of 100 percent use.
25.9
Peddappuram
Kakinada
8.5
Some-
times
All
times
7.8 9.6
Most
times
3.3 1.8
Rarely
0.7 4.2 0 0.6
Never No
response
Only 100 percent use of the condom
with commercial sex workers can
prevent the spread of HIV/AIDS.
Andhra Pradesh is far short of this
goal…