HIV-positive women face violence of various kinds such as denial of information, discrimination, and lack of security, but this gets little attention. Ranjita Biswas reports on a workshop in Kolkata, ‘Understanding Violence against Women and its Implications for our Struggle against HIV/AIDS’, that discussed this problem based on the findings of a six-month study

“I was married off to a man who was HIV-positive. My in-laws never revealed his condition before our marriage. After five years of marriage and a child, I found my husband was sick all the time. His condition deteriorated gradually, but I just didn’t know what was wrong with him. I couldn’t go to his doctor to ask; they are borolok(big people). But I collected money from here and there for his treatment.”

“I wanted to know from my husband about his ailment; he was suffering so much. But he said ‘What’s the point of telling you? You won’t understand.”

According to the National Family Health Survey 3 (2005-2006) more than 40% of women in India have not heard of AIDS. More than 38% of those living with HIV in India are women; most of them contracted the virus in monogamous relationships, through partners who were infected during paid sex. According to the 2006 AIDS epidemic update compiled by UNAIDS and WHO, unprotected heterosexual intercourse is the cause for the bulk of HIV infections in India. With an estimated 2.5 million people infected with the virus, India has the second largest number of HIV-positive people in the world.

Denial of information, discrimination, lack of security, being blamed for bringing in the “curse”, and being evicted from their homes after the death of the husband are regular occurrences for HIV-positive women in India. This violence gets less attention than other forms of violence. A recent workshop ‘Understanding Violence against Women and its Implications for Our Struggle against HIV/AIDS’ held in Kolkata in April-May 2007, discussed this problem based on a study undertaken by the School of Women’s Studies, Jadavpur University, and ActionAid India over a period of six months.

The study used qualitative methods to analyse the interconnection between violence against women and the increasing incidence of HIV among women, “considering violence as a contributing factor and consequence of HIV.”

The researchers interviewed 60 positive women from low income and lower middle class backgrounds in and around Kolkata and Siliguri in north Bengal.

The main point that comes out from the study is that HIV/AIDS and violence against women - seen as a denial of her rights - are interrelated with the problem of gender discrimination prevalent in society and women’s status as a whole. Ignoring women’s health needs is also related to this gender bias.

The study started with the premise that there is a synergistic relationship between violence against women and HIV: a woman subjected to violence can be at an increased risk of HIV infection, and women with HIV may also be subjected to violence because of their positive status.

The research was divided into three parts:

• Recording oral narratives of HIV-positive women to examine how their experience of violence could have contributed to their contraction of the disease, and how violence continues to define their lives through discrimination and stigmatisation.
• A review of laws and policies related to violence against women and those related to HIV/AIDS, to assess the intersection between violence against women and HIV/AIDS.
• Interviews with policy makers and health officials (doctors and counsellors).

From the narratives it becomes clear that in a patriarchal society, the already inferior status of women becomes worse if she becomes HIV-positive. She may even be blamed for her husband’s infection. “My in-laws blamed me for my husband’s illness saying that because I couldn’t satisfy him, he went to other women and developed the disease,” said one woman quoted in the survey.

Problems in access and treatment

For a village woman diagnosed with HIV, access to medicine is the first hurdle she faces. The sub-centre located in the village, is the lowest rung of the healthcare structure and provides a dismal quality of health care. Consequently women have to travel to distant towns for treatment.

“Had the medicine been available to us in the village, we would not have to go to the town. Why don’t they look into it?” said one woman who has to travel to the big town for antiretroviral treatment (ART). This is not easy as she has to attend to her domestic chores, often she has no money of her own for transportation, and her in-laws and even her husband may refuse to part with the fare. The delay can also lead to opportunistic infections like tuberculosis.

Dr S K Guha, in-charge, ART Centre, Calcutta School of Tropical Medicine, says, “Delay in starting treatment can aggravate not only TB but other opportunistic infections like fungal infections. ART should be given at the right time.” He explains that if the TB bacilli are lying dormant in a patient, they can be re-activated due to HIV infection. ”Delay in treatment leads to this re-activation as the immunity level is low. In the last few years we have noticed a considerable increase in the number of women and children coming for treatment. More than 90% are from rural areas and almost all of them are housewives.”

At the Calcutta School of Tropical Medicine, the number of HIV patients in the institute’s patient load who are suffering from extra-pulmonary TB has gone up sharply. Extra-pulmonary TB is often more difficult to diagnose. The study cites the case of a woman who died within six months of the detection due to lack of treatment which she could not access.

There are other reasons for delayed treatment. Lack of information is one. Says one HIV-positive woman, “I went to many doctors but nobody told me exactly what was wrong with me. I didn’t know where to go and at last reached a medical college where I came to know about this disease.” The long distances, the feeling that it has been a waste of time and money, all these lead to the woman’s reluctance or inability to avail of timely medicine.

In West Bengal, there are only four public health care centres for ART, and two CD4 detecting machines, one located in the South 24 Parganas district and another in the North 24 Parganas. Doctors say a vast majority of cases remain undetected or untreated.

When asked what is a better way to deliver ART to this section of people, Prof (Dr) Santanu K Triparthi, Head, Department of Pharmacology, Nil Ratan Sarkar Medical College and Hospital, Kolkata, said: “We should look at ways of providing the medicine at easily accessible locations rather than expect people to travel all the way. Irregular taking of medication has the possibility of drug-resistance developing. The government should take the initiative to clearly identify up to what level it can provide ART and then formulate a public-private partnership strategy aimed at achievable goals. Awareness campaigns should not be for awareness alone but for provision of medicines; awareness is important but it is useless if we cannot provide the medicine.”

Another problem an HIV-positive woman faces is during pregnancy. Despite years of training and workshops to allay misconceptions, care-givers in many hospitals refuse to help an HIV-infected woman during delivery. “At the government hospital they refused to help me even though my labour pain had started. It went on for a long time. The baby was born all right but it died soon after,” one young mother told the researchers.

Integrating laws

The study made an interesting attempt to relate clauses in the Domestic Violence Act, to HIV/AIDS in the presentation ‘Mapping between Domestic Violence Act and HIV and AIDS’.

The landmark Act that came into force in 2006 broadens the definition of systematic violence against women. The researchers suggest that the provisions under the law can be applied to HIV-positive women. For example, clause 3 (iii) relating to verbal and mental abuse which includes a) insults, ridicule, humiliation, degrading or name calling…, or b) repeated threats to cause physical pain to any person in whom the person aggrieved is interested. It is quite obvious that an HIV-positive woman is frequently a victim of this abuse.

Then there is clause 17 which refers to the right to reside in a shared household. “After my husband’s death (due to AIDS) my in-laws said I couldn’t occupy his room and was asked to shift to the kitchen,” one woman testified. According to the international human rights organisation, Breakthrough, “nearly 90 % of Positive women are thrown out of their homes after their husbands die of AIDS.” There is often a violation of the custody law when a child, even a minor, is taken away from a mother if she is found to be HIV-positive.

Asked to comment on the study’s attempt to link violence against women with HIV/AIDS, Prof Santanu K Triparthi said: “A campaign on violence against women is always welcome but trying to link it to an HIV/AIDS campaign is a little far-fetched. Women might be discriminated against at the domestic level, which is understandable considering our patriarchal set-up, but to make it a cause-effect scenario in case of the disease is a little difficult to agree on. If we look at the case studies, we find it is as true of the male patients.

“Considering the logistical problems, and the woman’s economic status, it is almost impossible for the poor woman from a rural area to come to the city to get medicine regularly, that’s true; but it’s true of the male patients as well.”

What women want

From speaking to HIV-positive women, the study lists what the women perceive as absolutely essential for their survival:

• To live with dignity and receive proper healthcare
• Financial independence
• Protection against sexual abuse
• The ability to negotiate safe sex without the threat of violence
• Non-discriminatory nutritional, health and educational support for their children
• Prevention of child marriage which is detrimental to women’s negotiating power within the family
• Decentralisation and accessibility of comprehensive health care system
• Greater access to drugs for opportunistic infections
• Sensitisation of the local panchayats to the problems of affected women
• Access to integrated legal and health services/information
• Sex workers’ demand for located district based sex work without the control of brothel keepers and pimps, etc.

Researcher on the study Sreerupa Sengupta says that violence against women is usually seen from a sexual or physical angle and “ignores these subtle forms of violence. The study attempts to focus on these less focused areas while formulating a campaign to bring an understanding of these issues to the public domain.”

Recommendations

The study has made certain recommendations based on its findings:

• Integration of different legislations addressing issues of violence against women and HIV & AIDS (The Protection of Women from Domestic Violence Act 2005; Rape Laws; HIV/AIDS Bill 2004; and the Immoral Traffic [Prevention] Act 1956).
• Need to use the Domestic Violence Act to address economic violence such as issues of eviction and marital rape; for example, did marital rape lead to their becoming positive? The women were rather vague about the concept of marital rape because of the social strata they come from. But they told researchers they were “forced” (jor kore) to have sex, even after they protested, perhaps uneasy about it, or having heard gossip because instances of getting ‘sick’ have been observed in villages with migrant labourers. Sometimes, of course, they do not know the implication of the effect of having unprotected sex with an HIV-positive partner.
• Greater interaction between doctors and counsellors for more integrated and effective service.
• Need to go beyond medical counselling to address the issue of social and economic violence.
• Focus should shift from individual violence to an exploration of the root causes of women’s vulnerability, economic debility and systematic violence.
• Disseminating awareness of property laws among positive women.

These suggestions would be forwarded to concerned authorities for evaluation, the researchers said. But the ultimate target is a sustained campaign to bring the violence against women vis-a vis HIV/AIDS into greater focus and to give a voice to the muted demands of hundreds of women who suffer in the backwaters.

(Ranjita Biswas is a journalist based in Kolkata writing mainly on women and gender issues, HIV/AIDS and environment. She is also Editor of Trans World Features)

Infochange News & Features, February 2008