Dallying with death: the impending crisis in India.
- PubMed: 12345637
More than one million Indians are already infected with HIV and an epidemiologist at the AIDS Control and Prevention Project's regional office in Bangkok predicts that India will have the largest HIV-positive population in the world by 1995. Sexual networking in which people have sexual relations with two or more partners, either serially or concurrently, is the principal mode by which HIV is disseminated through large populations with a multiplier effect. Since physical symptoms of HIV infection typically are not manifest for many years after initial infection, however, infected individuals and their partners generally do not know that one or both are infected with HIV. Many people do not believe that HIV exists and that they may be at risk of infection. As such, it is very difficult to convince them to protect themselves against exposure. The picture of HIV and AIDS in 1994 is not one of infection exclusively among prostitutes, drug users, and homosexuals, but one of a shift from homosexual to heterosexual transmission in many areas and rapidly rising rates of infection among housewives and other women outside commercial sex activities. Studies in Thailand have documented the high incidence of sexual intercourse among Thai men with prostitutes, wives, and girlfriends. A World Health Organization study in Madras, India, found that while monogamy and sex within marriage are stressed in public, almost 4600 men visit prostitutes daily in the city. Generally visiting commercial sex establishments together and sharing one woman, friends drink heavily before having sex and tend to not use condoms. So many men have sex with prostitutes in Madras because of the segregation of the sexes in Tamil society, the late marriage age among men (26-30 years old), the large number and steady inflow to the city of single young men searching for work, the cultural perception of the mother as sacred, the male desire to lose one's virginity before an arranged marriage, and the anonymity of the urban setting. Complete condom coverage in Madras would require at least 9200 condoms per day. The author recommends instead abstinence and limiting sex to people known to be uninfected as the most effective strategy for avoiding HIV infection.