IV drug abuse blamed for rising HIV infection rate in parts of India

CHENNAI, INDIA–David, 37, injects heroin daily–a schedule that has never varied for the past 15 years. Despite perpetually running short on cash to buy his fix, he has never been desperate enough, he says, to share needles.

Audio slideshow: A drug addict injects despite HIV fears

“I know how HIV goes from one body to another,” David says. “I’ve seen many friends get sick and die like that.”

Still, David admits that when he finally faces the dire choice between buying a new needle or heroin, his addiction will overcome his fear of HIV.

David remains HIV negative but his dependence on heroin puts him at an enormous risk. A study released in November by UNAIDS and the World Health Organization notes that intravenous drug use is the main risk factor for HIV infection in north-east India, and now plays a growing role in major cities like Chennai, Mumbai and New Delhi.

The study shows that efforts to help drug users tend to be at best “inconsistent, too small and infrequent” to make a dent. If an urgent effort is not made to expand programs that help addicts, the study found, there is a strong possibility that intravenous drug use combined with paid sex could make the HIV epidemic in India far worse.

Needle exchange programs, which have proven to reduce the rate of infection among addicts in Europe and the United States, are almost non-existent in India. The Indian government notes that such programs are “frowned upon in India because of ethical and moral implications” of appearing to condone drug abuse.

That political attitude leaves David with few choices. He depends on his 68-year-old father’s meager pension to survive, and as his father’s health dwindles so do the days of not sharing needles.

Elderly mothers bear AIDS burden

In countries with a high prevalence of AIDS, the epidemic decimates the young to middle-aged adult population—the backbone of the labor that supports both the national economy and the family.

Slideshow: Elderly Mother Bears AIDS Burden

In the absence of men and women of working-age, older relatives often resume the burden of being breadwinners and caretakers. More often than not, this task falls on elderly women.

A study published in 2002 by HelpAge International, a U.K.-based non-profit that champions older people worldwide, noted the following:

One outcome in countries with high HIV/AIDS prevalence is an increase in the number of chronically poor households headed by older women, with a large number of dependents. Older women generally suffer most from chronic poverty and lack of resources. They are often in need of care themselves, but face, sometimes unaided, the costs and emotional stress of nursing terminally ill relatives, paying for burials and the financial and practical difficulties of bringing up orphans - including payment of school fees.

While the study was published four years ago, the effects described are still the reality. During the summer of 2005, Srinivas and I often noticed elderly mothers at hospitals and care centers unwilling to abandon their sons or daughters to the epidemic.

A friendship with Narasimha

Slideshow: Time spent with Narasimha

While I first met many of those profiled on Lives in Focus for the first time last year, Srinivas has been visiting them since 2001. His relationship in many ways extends beyond that of a photographer and subject.

Srinivas watched in 2002 as AIDS took the life of one sister but spared the other. On this past trip, Srinivas was sincerely moved when he saw how well the surviving sister had fared despite losing her entire family.

When I accompanied him in 2005, I was struck by how everyone considered Srinivas an old friend. In this series, Srinivas talks about his friendship with one patient:

I met Narasimha in 2002 when I was visiting Freedom Foundation AIDS Shelter for the third time. At that time he was quite ill from the effects of HIV. There were days when he just lay in bed and other times he was quite active, helping around the clinic, tending to the garden and helping bathe the really sick patients.

During my time there he kept asking me to take a full-length photo of him so that when he died his mother could put that up on the wall.

One thing that struck me about him was how positive he was about life even as he lay in bed not knowing whether he would make it to tomorrow.Since 2004 Narasimha has been on anti-retroviral medication and his health has greatly improved.

As of now, he gets his medication free from the government hospital. The situation will change as he becomes immune to the first line of treatment and has to switch to the more expensive second and hence third line of treatment.

Click on the audio slide show above to hear Srinivas discuss his friendship.

Related Previous Posting: Narasimha, a 30-year-old HIV+ auto-rickshaw driver, wonders about his future (Video Interview).

Illustrating how to prevent the spread of HIV

In an earlier post, Lives in Focus featured a prevention program called ASHA (”Hope”), which provides education to young women who are considered at risk because they have little or no education and are likely to be married at a young age.

Slideshow: Illustrating how to prevent the spread of HIV

The program stresses the need for peer counselors to visit people in their own communities rather than bringing them to an office. Another component to this outreach is the use of educational material that requires no literacy skills.

In an age of menu-driven DVD tutorials, simple, culturally recognizable illustrations are effective and inexpensive instructional tools. This series features several scans of the educational material that show how HIV spreads, how to protect oneself, and what adjustments one can make to remain healthy despite being HIV+.

Related Previous Posting: Prevention v. Treatment

A mother’s love

Slideshow: A mother’s love

Fatima, 35, worries that one day her six-year-old granddaughter will have to look upon her as a mother instead. Fortunately, the child’s own HIV+ mother—Shabana–has remained healthy on an anti-retroviral treatment. As much as Fatima praises God for keeping Shabana alive, she knows that medicines also play a vital role and she is prepared to sacrifice to keep her daughter healthy.

“We will eat whatever we find so we can still buy the medicine,” says Fatima. “God will find a way—we have at least that much faith.”

In this audio podcast, Fatima talks about how her heart pounded when she first learned of Shabana’s illness and how her faith keeps her strong. (Click the photograph above for an audio slide show or here for audio only.)

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Related Previous Posting: Shabana’s hopes (Video Interview)

High-risk behaviors

Slideshow: High-Risk Behavior

For the grant application mentioned in the previous post, we compiled a series of photographs that depict the lives of people who often engage in high-risk behaviors in India [Note: A comment on the use of "high-risk behavior" v. "high-risk groups"]. Compared to our previous images, these are all in black-and-white and shot with film rather than a digital camera. The photos are of prostitutes, dancers, truckers and hijras, or eunuchs, who are commercial sex workers.

Posting delay

We wanted to explain why we haven’t posted anything since Dec. 21, 2005. We are applying for a grant for the next phase of the project and that work is consuming most of our energy. The deadline is Jan. 31.

The next few items we are considering include:

1. Shabana’s mother’s thoughts and feelings about her daughter’s situation;

2. An expert speaking about the infrastructure required to get treatment to those who need it;

3. And the photographer’s reflection on his long friendship with someone surviving because of anti-retroviral drugs.

We apologize for this delay and we will begin posting as soon as the application material is postmarked.

Lambadis: A people on the outer edge of life in the margins

Slideshow: A people on the outer edge of life in the margins

The first day of December is recognized globally as World AIDS Day—a day to bring to light the issues, struggles and successes in confronting this disease. Lives in Focus looks at the Lambadi, a people who receive little coverage.

India’s Lambadis, who are said to be closely related to European Gypsies, traditionally live in isolation from the surrounding dominant Indian culture. But the AIDS epidemic is drawing them out from their isolation. Statistics on impact of the HIV/AIDS on the Lambadis population is basically non-existent. Ironically, the Lambadi women were known as healers for their skill in caring for women during labor and the child after birth.

This series of photographs portrays a Lambadi mother-in-law caring of her dead son’s HIV+ wife. They traveled overnight by bus hoping to find a cure for what was slowly extinguishing the young woman’s life.

An artist’s impressions

Slideshow: Seven Lives Worth Living

Over the past few months, Lives in Focus has posted photographs and video of people living with HIV/AIDS in India. Srinivas Kuruganti’s photographs capture scenes with only available light and the videos depict people without any special effects.

The series of images here present an artist’s impressions of people affected by the epidemic. The artist Anna Bhushan writes about the work:

I have been traveling to India every year for the last 10 years to visit my family in Hyderabad but until 2003 when I met Srinivas, I, like so many others both in India and abroad, had no idea of the scale
of the HIV epidemic in India.

On my first visit to Freedom Foundation, I spent the afternoon playing with the children there, it was a deeply moving experience and I was so touched by their trust and need for affection, even from a total stranger.

When I returned to London I made a series of portraits based on Srinivas’s photos and my memories of visits to the clinic, which I later turned into, “Seven Lives Worth Living” which was shown at the Royal College of Art summer show in 2004.

The monologues are translated and edited (but not changed) interviews conducted by Srinivas with patients at the clinic and their words, although deeply personal, bring attention to some general social issues associated with the disease.

For instance, Tajunisa’s tragic description of her attempt to kill herself with her three sons and her
belief that her suffering is “God’s wish”, relates to the findings of a 2001 UNAIDS survey in which “36 percent of people felt it would be better if infected people killed themselves and that infected people deserved their fate…34% said they would not associate with people with AIDS, and one fifth stated that AIDS was a punishment from God.” (from avert.org).

Other voices touch on issues of shame, concealment as well as alienation and maltreatment from family and society.

The words and illustrations in this audio slideshow are from “Seven Lives Worth Living.” For more work by Bhushan, please visit her Website: rawmango.com.

How can you help?

Many of the readers of this blog have asked: How can we help the people in the orphanages and centers profiled on Lives in Focus. It is obvious but what they need most is money to provide the treatment, the care and the activities to keep the children healthy. Others need funds to help pay for representation in the courts.

Lives in Focus has compiled a list of places you might send a check. Remember the exchange rate between the dollar and the Indian Rupee turns even $5 dollars into a windfall for these places. The centers below are also international tax-deductible charities. Please do mention that you heard about them through Lives in Focus:

• Network of HIV Positive People (Family Counseling Center)
  ATTN: M. Swapna
  H.No. 8-3-167/30, Venkateswara Housing Society, Erragadda
  Hyderabad-38, India
• Lawyers Collective HIV/AIDS Unit
  Programme Management Unit (PMU)
  ATTN: Anand Grover
  Jalaram Kripa, Ground Floor
  No. 61, Janmabhoomi Marg, Fort
  Mumbai 400001 , Indiaemail: aidslaw@lawyerscollective.org
  website: www.lawyerscollective.org
• Freedom Foundation Bangalore
  ATTN: Ashok Rau
  Office - 180, Hennur Cross,
  Bangalore - 560 043. India
• Freedom Foundation Hyderabad
  ATTN: Dr. Troy Cunningham
  21 Cariappa Road, Bolarum
  Secundrabad 500 010, India
  Telephone: 011 91 40 2786 2148 or 011 91 40 2786 5530