Tackling AIDS In India
The Vulnerability of Women and Girls

Sitting on the concrete floor of a YWCA community center in Najafgarh, a low income neighborhood in West Delhi , 14 year-old Chandini is concentrating on getting her petticoat sewn straight. "If I do this right, hopefully I can sell this piece and make some money." Chandini is enrolled in a year-long cutting and tailoring course offered at the center. Her friend Hamida has already started up a small business. She sews petticoats for 15 rupees each.

For Chandini and Hamida, this course could save their lives. Both girls come from a community of migrant rag pickers where young girls roam the streets alone at night, often falling prey to sexual abuse. Others are married off very young to men who have multiple partners. Desperate to feed their families and survive, the girls sometimes turn to prostitution. The growing prevalence of HIV/AIDS in their migrant community is setting off warning bells with health care workers.

Working to Stem the Epidemic
HIV is spreading at an alarming rate in India . An estimated 5.1 million people are infected with the virus. December 1st marked World AIDS Day, a time to remember the 20 million people worldwide who have died from the disease. The day raises awareness about prevention and care efforts, and encourages people to take part in the battle against the deadly disease. This year's theme focuses on the vulnerability of women and girls. In India , AIDS was once confined mostly to men. However, prevalence rates for women are growing faster than ever before. Young girls are often the most vulnerable because social norms and poverty prevent them from learning how to protect themselves.

The United States Agency for International Development (USAID), along with public and private partners, is working to tackle India 's epidemic. In 2004 alone, USAID India provided $15.5 million to non-governmental organizations (NGOs) and the Indian government to support HIV/AIDS prevention, treatment and care programs. Sexual contact is the main method of transmission. However, there is very little public awareness of how HIV is spread. "Part of our struggle is to get the face of AIDS out there and make people respond to it," says Robert Clay, director of health programs for USAID India.

One such project is the YWCA community center in Delhi , which empowers girls like Chandini and Hamida by giving them realistic alternatives to being on the street or marrying at very young ages. Girls come to the center every day and take life skills classes that teach them how to take care of their bodies and protect themselves from sexually transmitted diseases. AIDS is discussed openly and peer leaders perform street plays in their communities to spread the message.

In HIV/AIDS "hot spot" states, like Maharashtra and Tamil Nadu, another USAID-supported program, Operation Lighthouse, takes a different approach to prevention by targeting high-risk groups in port communities patronized by truckers, migrant workers and day laborers. Through Population Services International, USAID supports free HIV counseling and testing centers, and professionally staffed telephone "help" lines to answer questions quickly and anonymously. A key way to stop spread of the virus is to help individuals face their HIV status, so they can take steps to stop transmitting it. The highly successful public education campaign has reached 373,000 people. From these and other local, grassroots efforts, behavioral surveys show a decrease in the percentage of truckers who report practicing risky sexual behaviors - from 48 percent to 26 percent.

Caring for the Affected
Sadly, over 90 percent of people in India living with HIV do not know that they are infected. The stigma attached to HIV/AIDS is one of the greatest obstacles to eradicating it. USAID reaches out to affected individuals through counseling, care and treatment programs. In Tamil Nadu, where the first HIV case was reported in 1986, the Community Health Education Society (CHES), dispels myths about the disease, with USAID support.

Mr. and Mrs. Krishna are both HIV positive. They have an eight-year-old daughter who is not infected with the virus. Out of fear of being ostracized in their community, they had not disclosed their status to anyone, including their young child. But with their health deteriorating, both felt they needed to take action. At a CHES community center, they met with a counselor to discuss how to disclose their HIV positive status to their daughter. With help from CHES, they decided to name Mr. Krishna's sister as a foster parent to their daughter. Mr. Krishna feels relieved now. "Even if I die, I know there will be someone to take care of my daughter."

In Tirunelveli, a small farming community in Tamil Nadu, migrant laborers move to Mumbai to find work. Away from home, many end up frequenting the city's red light districts. When they return to their villages, many bring back more than just money. They carry HIV and infect their wives with the virus. A Family Health International (FHI) effort helps these women - who are uncomfortable discussing sex and HIV with their husbands - get and share information about the disease. Counselors meet with the wives in places where they regularly gather to teach the women about prevention, and how to care for AIDS patients. Women in the village can then train each other to care for ill family members, and dispel myths about HIV/AIDS.

Garnering Support from the Private Sector
Although HIV/AIDS is still largely concentrated in high risk populations, the newest surveillance data suggest that the epidemic may be moving beyond these groups into the general population. Unfortunately, the epidemic in India is yet to be seen as a widespread threat by most Indians. USAID is working to raise awareness in diverse settings, including the private sector.

USAID reaches out to the Indian business community to address the social and economic costs of HIV/AIDS through its bilateral efforts - "Avert," in Maharashtra and the AIDS Prevention and Control Program, APAC, in Tamil Nadu. India 's business leaders such as Bharat Petroleum and the Confederation of Indian Industries have adopted "Workplace Intervention for HIV/AIDS" policies formulated by USAID and its partners. Partners work with industry management to plan and implement AIDS policies at offices and in factories. Their aim is to change employee attitudes and boost safe behavior.

Acknowledging the needs of its workplace, the U.S. Embassy recently unveiled a policy to educate its 1,800 employees about HIV/AIDS and provide care options. USAID championed the policy as a model for India 's private sector.

If unchecked, HIV/AIDS will ravage India , severely affecting its productivity and promising future. Says Ambassador David C. Mulford: "Protecting women and girls, like the fight against HIV/AIDS generally, is an effort in which everyone has a part to play. The American people are privileged to join the people of India as we work together to turn the tide again HIV/AIDS.