Vulnerability of Women & Children to HIV/AIDS

DR. KANUPRIYA CHATURVEDIDR. S.K. CHATURVEDI

What is Vulnerability?

“that may be wounded”

“Susceptible of injury”

“Exposed to damage”

(lit. or fig.)

25% of all HIV infection fall in women, with an accompany increase in vertical transmission and pediatric HIV

Reported median of HIV prevalence among pregnant women exceed 2%in most high prevalence states

Already about 660,000 young women and 345,000 young men aged between 15-24 years are living with HIV/AIDS

Over 50% of all new infections occurring among young people aged below 25

120,000 AIDS orphan children and 160,000 AIDS children living in the country

Who Are Now the People Infected & Affected by HIV/AIDS in India?

Vulnerability Factors of Women

• Overall Status• Illiteracy• Low Control on Reproductive Rights• Low Access to Health Care• Lack of Knowledge• Violence Against Women

Vulnerability Factors of Women

Sex ratio: 933/1000

(~ 25 million missing)

Women & Education Close to 245 million women lack the basic

capability to read and write (over 50% of women in India)

Women’s literacy lower than men Gross school enrolment rate is 65% for boys

and 49% for girls, ages 11-14 Drop out rates: 60% for girls, 54% for boys

(middle school) Gender gap in literacy is increasing in some

states (Rajasthan – girl enrolment 33.3%, boys 83%)

Women & Reproductive Rights

26% married by the age of 15 and 54% by 18

36% of married adolescents between 13 and 16, and 64% between 17and 19, are already mothers or pregnant with first child

52% of women have never used contraception (condom use < 3%)

Little control over fertility and reproductive rights

Women & Access to Health Care

Annual Pregnancies 27 million % ANC Coverage (1/3+) 65.4/38 % Institutional Deliveries 33.6 % Deliveries attended by

Skilled Birth Attendants 42.3 High prevalence of STI/RTI Births is by adolescent mother 1/10 MMR is ~ 500/100,000 live births

Percent Women aged 15-49 who Have Heard of HIV/AIDS

21.6

26.2

65.8

76.1

59.7

84.7

8774.5

87.7

70.6

23.8

27.3

23.9

48.7

32

7441.3

54.3 74

12.7

35.4

43

56.3

88.3

43.4

31.1

59.2

92.8

54.7

41.1

54.8

63.9

Per cent

< 3030 - 4950 - 6970 & above

MICS-2000

Percent Women aged 15-49 who Know all Three Modes of Vertical Transmission of HIV

13.3

13

40.6

34.4

31.4

40.8

36.642.2

46.9

46.8

14

12.8

11.5

30.8

19

37.821.1

39.6 36.1

6.8

17.7

23.4

36.9

58.1

21

15

21.1

50.2

29.9

17.2

26.2

31.1

Per cent

< 2020 - 2930 - 3940 & above

MICS-2000

Women & Violence

Violence inside and outside the family

74% increase in crimes against women 1980-1990 (rape, molestation and torture showing the highest rate of growth)

Children account for 30% of total rape victims

Vulnerability Factors of Adolescents

• Early debut of sexual activity• Lack of Knowledge• Lack of an enabling environment where to acquire this knowledge• Misconceptions

HIV/AIDS Awareness among Adolescents< 20 years - FHAC 2000

0

10

20

30

40

50

60

RuralUrban Slums

Correct knowledge about benefitsof condom use to prevent STI/HIV

Used condomduring last intercourse

Source: FHAC Coverage EvaluationAIIMS/INCLEN/USAID 2000

32

53

3.46.3

Proportion of 15-19 yr olds willing to share

food with a HIV positive person: Rural

0 20 40 60 80 100

All IndiaAssam

West BengalJharkhandChatisgarth

KarnatakaOrissa

BiharSikkim

GujaratNE (ex sikkim & Manipur)

J&KUPMP

RajasthanMaharashtraUrraranchal

HaryanaHimachal Pradesh

APDelhi

Tamil NaduPunjabKerala

Manipur

Vulnerability Factors of Children

• Parent-To-Child Transmission of HIV• Lack of Access to Treatment• Lack of coordinated Efforts for ‘Care & Support’

Rationale for Prevention of Parent-To-Child Transmission of HIV in India

27 million pregnancies per year

108,000 infected pregnancies

Annual Cohort of 32,000 infected newborns

0.4% prevalence

30% transmission

25,000 - NACO 50,000 - NNF

25,000-50,000 deaths within few months to 5 years

Some Lessons Learnt:Increased knowledge of women about how to prevent HIV/AIDS

50.3

35.7

85.1 87.8

0

20

40

60

80

100

Before counselling After counselling

Proportion of women who know how to avoid:

acquiring HIV/AIDS transmitting HIV/AIDS to baby

33

8

0

5

10

15

20

25

30

35

%

No ARV With ARV

who acquired HIV - PCR at 2 monthsProportion of infants of HIV (+) mothers

Some Lessons Learnt:Reduced transmission of HIV from mother to infant

1985

Focus on HIV as ahealth problem

Prevention

Care

Recognition ofMulti-Sectoral Response

Care

Prevention ingeneral

populations

Targetedinterventions

1995

Multi-SectoralStrengthening

Response

2005

Prevention

Care

Strengthening the Response: a Paradigm Shift