Dipika Gaur
Fellowship Location: Punjab, India
Himachal Pradesh State Aids Control Society
I have spent a lot of time this past week in New Delhi, India’s capital city, having conversations with physicians who work at both private and public hospitals about a variety of topics. Mainly, we’ve discussed why very few, if any, patients are willing to talk to someone who isn’t a doctor (me) and whether NACO and its branches are effective at reducing incidence and providing affordable care to those infected.
I spent two days with physicians from Medanta, one of India’s premiere hospitals, located in Gurgaon, that provides multi-specialty care. Having spent most of my past few weeks in villages and public government hospitals, the grandeur and the environment Medanta provides is of course notable. I met a physician (unnamed to respect his wishes) who spoke very strongly about the importance of eliminating stigma within big cities and small villages alike. “It’s the perception that these people are somehow less than every other person.” I conversed with some HIV+ individuals in Punjab and they talked a lot about how being instantaneously shunned by friends, family, and even some health professionals impacted their willingness to go seek care. One woman, a 35 year old mother of two, explained how her husband, her in-laws, and many of her neighbors held her responsible for poor choices when she was most certainly infected by her husband (who apparently refused to be tested). The loss of her social structure and their perception of her as guilty led to her own loss of self-esteem and respect. In my eyes, it’s a vicious cycle of defamation.
A friend of mine who lives in Delhi said to me, “People are Punjab are way too backward to even have conversations about this. They will not want to talk to you. Most of the people there are uneducated, so it’s better to try a place like Delhi or Mumbai.” But the socio-economic aspects to HIV transmission in Punjab are not similar to those of Delhi and Mumbai. The difference between drug use and heterosexual transmission in comparison to the high numbers of MSM transmission is important. In addition, the education that was being referred to might not be as clear cut as “people in big cities are educated and small villages are full of illiterates” Chandigarh is one of Northern India’s biggest cities and the majority of its HIV+ population are rickshaw drivers and migrants from other states who live in poverty. In Delhi and Mumbai, many hijras are infected and their status as, more or less, second-class citizens is related to their diagnosis.
In this way, my time in India so far has asked me to seriously question what it means to be educated about HIV/AIDS? Are those who know of the virus and disease but still have misconceptions about transmission educated enough? How has social status played into whether one is considered educated about AIDS or not? And how has the government made an effort to target misconceptions in both general knowledge and transmission specifics?