Reproductive Health and HIV/AIDS
There is a growing need for inregrared and synergistic approach ro
reproducrive healrh and HIV/AIDS strategies and programmes. Reproduc-
tive healrh is a state of complete physical, mental and social well being in all
matters relaring ro rhe reproductive system and ro its functions and processes.
Reproductive health strategies and programmes should encompass a life-cycle
approach covering infants; childten; adolescents; women and men in the
reproductive age group as well as in post-reproductive period. fu women bear the
burden of giving birth and rearing of the children, reproductive health programmes
are generally focused on women. Male involvement, of course, has ro be part and
parcel of every strategy. With HIV/AIDS spreading like an epidemic in the country,
rhere is a need ro integrate reproductive healrh with HIV/AIDS.
Prevalence of HIV in India has increased over the last four years having rhe
highest number ofHN infections in the world. Maximum number of cases reported
are in the sexually active and economically productive age group of 18-40 years and all
reproductive health programmes are focussed on age group 15-45. Over 50 per cent
of all new infections take place among young adults below 25 years. So, there is a
need ro frame specific strategy and programmes to address young adolescents (J 0-19
years) in order ro make them understand the linkage between HIV/AIDS and healthy
sexuality. If the issues are addressed ar their prime age, integrared programmes on
reproductive health and HIV/AIDS could achieve better results.
In rhe states of Andhra Pradesh, Tamil Nadu, Karnataka, Maharashtra,
Manipur, Mizoram and Nagaland, H1V prevalence has reached around 2 pet cent
among women attending antenatal clinics. The epidemic contin ues ro shift rowards
women and young people, 25 per cent of HIV infections are estimated ro be among
women with the female:male rario of infection increasing sharply.
Women are more vulnerable ro HN infection due ro socio-cultural, biological and
economic factors that include early marriage; no say in the marital union and matters
relared ro sex and protecting themselves from infection. Women also have poor access to
health education and care. Very often women are found ro be HN posirive only when
their husbands or children are found ro be posirive. The women are often blamed for
bringing AIDS in ro the family, though very often they are the victims rather than the
cause. Women suffering from STIs are at least 4 times more vulnerable to infection.
Providing information, building awareness and strengthening knowledge on the
linkage between RTI/STD-HNIAIDS to young married women, speciallyat the time of
registration of first pregnancy and ante-natal check-ups are the issuesto be addressed while
we are advocating reproductive and child health programmes or providing RCH services.
If the vulnerability of women ro HIV/AIDs is ro be reduced then borh men and
women must work rogerher. Policy makers, communiry leaders, religious leaders
and other people in authority musr recognize rhe seriousness of rhis pandemic even
in the so-called low prevalence areas, with very high fertility and POOtstatus of
reproducrive health.
The inequality between men and women is accelerating the spread of HIVI
AIDS. So ro reduce the incidence and prevalence of HIV/AIDS in women, the
following measures could be implemented:
• Developing appropriate educational programmes that target both men and women.
• Supporting educarion on sex and HIV/AIDS for young adolescents in schoolsl
out-of-school ro increase rheir understanding of human sexuality.
• Reducing unnecessary blood transfusions by improving women's nutrition,
preventing anemia, treating infections, preventing the loss of blood due ro
complications in pregnancy and using blood substitutes wherever possible.
• Encouraging voluntary and confidential testing, supported by counseling services.
• Ensuring that prevention, treatment, care and support services are accessible and
affordable ro all.
• Promoting condoms (including female condoms) as a strategy of dual
protection against unwanted pregnancy and STI-HIV/AIDS.
• Sensitizing policy makers, legislarors and corporates on mulri-secroral approach
ro HIV/AIDS programmes.
The non-government organizations and community based organizarions along with
related development secrors should work on reproductive and child health and other
population-related issues in high fertility regions need to take on the new challenge.
Dr Manmohan Singh suggested thar growth,
• employment and poverty reduction, targets of the Tenth
• Five Year Plan, should be given not only for the Union
• as a whole but also for each State. Central and the state
Governments should submit to their legislature an
annual progress report on poverty reduction, policies in
• place and their effectiveness, and legislature must discuss
these reports.
Highlighting the importance of female literacy, he
said that eight or more years of education is required to
• induce fertility decline and bener care of their children.
• Dr Manmohan Singh suggested that a suitable cess be
levied on all central taXes to mobilize additional
• resources, which are needed to operationalize the
fundamental right of each and every child to free
• elementary education.
Reflecting on the national system of primary health
care, Dr Manmohan Singh said that rural India
• continues to be very poorly served by the health care
system. The current public sector expenditure on health
is less than one per cent ofIndia's Gross Domestic
Product (GDP). The result is that the elite groups are
• becoming increasingly insensitive to the poor quality of
health care provided by the fund starved public sector
• health care system, on which the great majority of the
poor people invariably rely. The nation has to recognize
• that there is a need of a well functioning and publicly
funded primary health care system and a nationwide
system of health insurance against serious illness to
realize the goal of "health for all".
Dr Manmohan Singh said that effective strategies for
sustainable development, poverty reduction, human
• resource development and protection of environment
• must allow for maximum possible decentralisation in
designing and implementing them taking into account
specific resource endowment, constraints and potentiali-
ties of different regions and loealities.
• Decentralisation can be an important means to increase
• both efficiency and accountability of development
programmes. He ended his speech with the concluding
remarks that there is a need to create an effective
: environment for the Panchayats and the Municipalities
• to set their own agenda for local level development and
• implement it effectively. It is only then that
• decentralisation can become a major force for efficient
• and equitable people centred development.
The Oration was followed by a Question-Answer
session on the subject. Mr Hari Shankar Singhania,
• Vice-Chairman, Population Foundation of India
presented a vote of thanks to the Chief Guest and the
august audience.
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Population Environment Development-A Bulletin of Population Foundation of India