Dipika Gaur

Dipika Gaur
Fellowship Location: Punjab, India
Himachal Pradesh State Aids Control Society

Last week, I spent a day at Chandigarh State AIDS Control Society’s Community Care Center. In conversation with one of the supervisors (specifics left out to respect his/her wishes), we began discussing how to tackle HIV incidence amongst Punjabis and Indians in general. The supervisor said she thought one way to reduce incidence is to mandate HIV testing among couples before they get their marriage certification. With this, marriage partners would be aware of one another’s HIV status and able to make educated decisions about their sexual behavior. I was amazed because I never thought how linking marriage to preventative measures could be used to target incidence. I’ve spent some time developing my own opinion about any type of health care mandates… and I guess the time is fitting seeing that the US Supreme Court has just upheld the Affordable Care Act.

Instead of sharing how I feel, I’ll share some of my thoughts about one proposed HIV/AIDS mandate. Since the 1980’s, Argentina, Uganda, and the United States have proposed and/or implemented mandates meant to curb national HIV/AIDS incidence and prevalence. Uganda, specifically, had proposed a bill that included mandatory HIV testing and criminalization of the intentional spread of HIV amongst other points. From a public health perspective, this seems on par with the most effective ways to reduce transmission. I remember conversations with friends in NYC and we talked a lot about partners never telling each other about their status out of fear, thus intentionally putting the other person at risk. Uganda’s policies make sense then: establish rules that don’t allow one person to put others in society at risk. This proposed bill (the HIV and AIDS Prevention and Control Bill) was turned down by many Ugandan and international health entities, mainly citing human rights concerns. Similarly with the Affordable Care Act, many opponents are troubled by mandating insurance amongst all Americans. Mandating HIV/AIDS testing and the criminalization of a method of transmission became human rights issues.

So do public health interests and human rights contradict each other more than working hand in hand? I’m looking into this more. I’ll be spending some time once I get home finding various examples that work for both sides… Let me know if you have any ideas/examples.

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?

Dipika Gaur
Fellowship Location: Punjab, India
Himachal Pradesh State Aids Control Society

Hey there,
Internet has been hard to come by because the power is usually out for at least a few hours each day. Coincidentally, I end up being at home only when the power is out. It has been an eye-opening few weeks in India, and hopefully, I can familiarize you with my experiences through this blog. I am a rising third-year student at Gallatin, concentrating in Global Health Equity with a Focus on HIV/AIDS. I’m also a Public Health and Policy minor within Steinhardt. I am in India trying to better understand perceptions of HIV/AIDS etiology and epidemiology within the state of Punjab.

I had originally planned to work with the Punjab State AIDS Control Society (PSACS), but once I got settled in here, I realized that patient contact through a government organization was nearly impossible. Although I’m still interning, I have been splitting my time amongst PSACS and CSACS (Chandigarh SACS) centers. Chandigarh is the capital of two states (Punjab and Haryana) so it qualifies as a union territory and has its own SACS. The specifics of my work with the SACS will follow in another post, but I hope this provides a little bit of background with which to follow.

One of the most resonating aspects of my trip so far have been the reactions that friends, family, acquaintances, and random strangers send my way when they learn that I am passionately committed to working on HIV/AIDS issues. The strongest response was, “you couldn’t find something more acceptable/respectable?” (The best translation I can offer). I want to say I didn’t feel offended because the person was someone who I met two days prior and barely knew. Yet, most certainly, I was offended. Before arriving here, I didn’t think I would have to explain why HIV/AIDS was so important to me. I spent most of my time thinking about how others would share their stories. My trip here has led me to reflect upon why this matters to me.

Whenever asked why I’m “doing this”, I say that I believe everyone has a right to a life of dignity regardless of their socioeconomic or medical history. The human right to express themselves freely and live without fear of persecution or hate. I can’t say that these rights are respected all the time here, and I can’t say social stigma doesn’t impact care… but I’ve come to realize that one must within themselves identify their rights and stand by them. There is a loss of self-respect in many of the HIV/AIDS cases here and grasping this has become one of my main priorities.