A quarter century after the first HIV cases were detected in India, efforts to halt the spread of the virus are making headway in South Asia. But ignorance and stigma surrounding the disease still remain major stumbling blocks in a region where poverty and illiteracy are widespread.
Outreach program brings about awareness
Thousands of people from villages and towns in Assam, turned up to see what the seven-coach 'Red Ribbon Express' train had to offer, as it chugged across the remote north eastern state earlier this month.
The train, which has counseling and medical services, and a troupe of artists on board, is traveling across India to sensitize people about HIV.
Rakhi Chakraborty is assistant director of the Assam AIDS Control Society. She says exhibits on the train, street plays and other programs demonstrate how the virus is contracted and transmitted, as well as what treatments are available.
"So many people visited and those people, they really took interest. They have seen the whole train. They asked so many questions. There were so many people who came for counseling voluntarily. They came for testing also," Chakraborty said.
Targeted population
For a quarter century after the first HIV cases were diagnosed in India, populous cities such as Delhi, Mumbai and Chennai were the epicenter of the battle against AIDS. Here, prevention programs targeted the most vulnerable groups such as sex workers, truckers and migrant labor.
But, as the virus spreads through the heart of the country, initiatives such as the 'Red Ribbon Express' are trying to end ignorance or overcome stigma attached to AIDS in remote areas and villages.
South Asia has an estimated three million people living with the AIDS virus. A majority of them are in the region's most populous country, India, which has the third largest number of people living with HIV in the world, after South Africa and Nigeria.
After a slow start in tackling HIV, India began making serious efforts to confront the problem in recent years. These efforts have yielded dividends, especially in southern states where prevalence was the highest.
Program Coordinator Asa Andersson, at UNAIDS in New Delhi, says there is a "decreasing trend" in the prevalence of AIDS. "We can say that the epidemic is stabilizing and in certain parts also decreasing. So you see a declining rate of HIV prevalence in the country, so in that sense I think it is positive," he said.
Positive strides apparent, but warning against complacency
However, health workers warn against complacency. They say that, although fears that HIV would spiral out of control have ebbed, serious challenges remain.
Suniti Solomon, has been on the frontlines of the fight against AIDS since 1986, when she helped detect India's first HIV cases in the southern state, Tamil Nadu.
Solomon says the profile of the patients at the center she runs for HIV patients in Chennai has changed. Earlier, a majority of her patients were truckers and sex workers. Now they are injecting drug users and men having sex with men.
India recently scrapped a law outlawing homosexuality. But even now, Solomon says many men prefer not to talk about their sexual preferences.
"In India they won't come and tell you they are gay," Solomon said. "Gay people are getting married and they lead a bisexual life. So to get a history out of them is very difficult, but we try our best. Unfortunately they also transmit the virus to their partners, that is their wives and, then, on to their children."
Extending prevention program to include more groups
Asa Andersson at UNAIDS says India needs to target more prevention and treatment programs at groups where the incidence of HIV is still a big concern, such as injecting drug users, young female sex workers and homosexuals. "Where they need to focus more is of course to increase the coverage among these groups," Andersson says. "I think the crucial heart to reach among the population, among this group, need further attention."
For many volunteers involved in the fight against AIDS, the most important concern has not changed since the first HIV case came to light -- the need to cajole more people to determine if they carry the AIDS virus.
Suniti Solomon says about half the people living with HIV are not even aware of it. "Most important, I think they should focus on voluntary counseling, testing. Though India has about 4,000 voluntary counseling, testing centers all over the country, very few really come up, because of stigma again to have a test done," Solomon said. "So I think it should be a community mobilization to help people to come up for testing."
That is exactly what the 'Red Ribbon Express' hopes to do, as it winds its way through the country for the rest of the year.