Transcript Vulnerability of Women & Children to HIV/AIDS DR. KANUPRIYA CHATURVEDI DR. S.K. CHATURVEDI.

Vulnerability of Women &
Children to HIV/AIDS
DR. KANUPRIYA CHATURVEDI
DR. S.K. CHATURVEDI
What is
Vulnerability?
“that may be wounded”
“Susceptible of injury”
“Exposed to damage”
(lit. or fig.)
Who Are Now the People Infected &
Affected by HIV/AIDS in India?
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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
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
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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
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Women & Access to Health Care
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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
32
63.9
54.3
74
41.3
74
41.1
59.2
21.6
27.3
31.1
54.8
43.4
12.7
92.8
35.4
Per cent
< 30
30 - 49
50 - 69
70 & above
54.7
88.3
26.2
23.9
43
48.7
23.8
59.7
70.6
84.7
65.8
56.3
MICS-2000
87.7
74.5
87
76.1
Percent Women aged 15-49 who
Know all Three Modes of Vertical
Transmission of HIV
19
31.1
39.6 36.1
21.1
37.8
17.2
21.1
13.3
12.8
15
26.2
21
6.8
Per cent
29.9
58.1
13
11.5
< 20
20 - 29
30 - 39
40 & above
50.2
17.7
23.4
30.8
14
31.4
46.8
40.8
40.6
36.9
MICS-2000
46.9
42.2
36.6
34.4
Women & Violence
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Violence inside and outside the family
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74% increase in crimes against women
1980-1990 (rape, molestation and torture
showing the highest rate of growth)
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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
60
53
50
40
32
Rural
Urban Slums
30
20
10
3.4
6.3
0
Correct knowledge about benefits
of condom use to prevent STI/HIV
Used condom
during last intercourse
Source: FHAC Coverage Evaluation
AIIMS/INCLEN/USAID 2000
Proportion of 15-19 yr olds willing to share
food with a HIV positive person: Rural
Manipur
Kerala
Punjab
Tamil Nadu
Delhi
Himachal Pradesh
AP
Haryana
Urraranchal
Maharashtra
MP
Rajasthan
UP
NE (ex sikkim & Manipur)
J&K
Gujarat
Sikkim
Bihar
Orissa
Karnataka
Chatisgarth
Jharkhand
West Bengal
Assam
All India 0
20
40
60
80
100
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-ToChild Transmission of HIV in India
27 million pregnancies per year
0.4% prevalence
108,000 infected pregnancies
30% transmission
Annual Cohort of 32,000 infected newborns
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
Proportion of women who know how to avoid:
acquiring HIV/AIDS transmitting HIV/AIDS to baby
100
80
85.1
87.8
60
40
20
0
50.3
35.7
Before counselling
After counselling
Some Lessons Learnt:
Reduced transmission of HIV from mother
to infant
Proportion of infants of HIV (+) mothers
who acquired HIV - PCR at 2 months
35
30
25
20
%
15
10
5
0
33
8
No ARV
With ARV
Strengthening the Response:
a Paradigm Shift
Recognition of
Multi-Sectoral Response
Focus on HIV as a
health problem
Targeted
interventions
Care
Prevention
Care
Strengthening
Multi-Sectoral Response
Prevention
Prevention in
general
populations
Care
1985
1995
2005