HIV Incidence and Stigma

HIV in India affects all segments of society and all age groups. Women are most vulnerable. If the husband and wife are both HIV-positive, the blame is put on the wife and she is thrown out of the house. The plight of sex workers is also considerable. They usually do not get much money for themselves even though they fill the cash boxes of the pimps. A pimp generally looks after 13-15 girls and is often HIV positive himself.

Ignorance is bliss. This adage holds true in the context of HIV at various levels. For example, most people are unaware that even a single exposure can put them at risk. The majority of asymptomatic individuals never know their HIV status. They do not think HIV testing is necessary, feel too embarrassed to ask for it, and are not aware of facilities where testing can be done. 

The stigma of HIV infection pervades cultural values and makes it difficult for HIV positive people to seek or receive medical care. Physicians hesitate to identify themselves as HIV specialists. This makes it extremely difficult for people to know who the doctors are that treat patients with HIV. If an Internist were to put up a sign outside of their building calling it an HIV clinic, patients with HIV would not come for fear of being pointed out. HIV-negative patients would not come because they would not like to be seen by a doctor who touches patients with HIV or even wait alongside these patients.

Most doctors in India are not well educated on HIV. A surgeon may ask for routine HIV testing (ELISA and Western Blot as necessary) on all of his surgical cases for his own `safety`. If a patient is detected positive, however, the surgeon may want to find an excuse to send him elsewhere and the patient may eventually be lost to the medical system. If physicians have a patient with an opportunistic infection and suspect that their patient is HIV positive, they may also want to send the patient elsewhere. Even more than the stigma, it is ignorance at play. Most doctors have not had formal education on HIV, as this subject was not taught when they were at medical school. Basic information that U.S. physicians take for granted such as HIV transmission modes and antiretroviral treatment guidelines are unknown. Subsequently, pharmaceutical companies largely dictate continuing medical education for health care personnel. Pharmaceutical companies, however, hesitate to come forward in a big way because they fear it is pointless to educate those who would not use antiretrovirals directly.