Stubborn Tuberculosis Stalks Indian Women
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Three years into the millennium, yet there is no sign of tuberculosis leaving us. It continues to thrive in the company of poverty and ignorance, claiming about 450,000 lives every year in India — more than any other disease.
Now and then one catches glimmers of hope between the covers of the World Health Organization reports that India is moving in the right direction by expanding the tried-and-true TB treatment, DOTS. News from India suggests that the Directly Observed Treatment Short Course has gained momentum with 2 million TB patients on the plan. In addition, New Delhi is hastily expanding DOTS coverage to 1 billion Indians, in line with WHO goals of detecting 70% patients and curing 85% of them by 2005. With so much adrenalin flowing into control efforts, will India be able to stem tuberculosis before HIV/AIDS balloons to an unthinkable size? Stigma impeding progress If the sobering experience in South Africa is any indication, India has to urgently respond to the most vulnerable segment of its population - women. Despite decades of public health efforts, taboos surrounding tuberculosis remain strong, and relief programs have failed to produce significant behavioral change.
Fear of their disease becoming known to others holds women back from getting tested and treated, leading to a vicious cycle of propagation. Worse still, women are blamed for spreading the disease as they have traditionally shouldered the burden of family care. It is said about 100,000 women are rejected by their relatives yearly on account of tuberculosis. There are other factors working against TB control as well. Gender inequality and ignorance are the usual suspects in rural areas, where there is high illiteracy. Even after finding a cure more than 50 years ago, women remain unaware of the causes, symptoms and treatment of tuberculosis. And even if they know, they are denied adequate help, leaving them chronically ill. When women move to cities with their families in search of jobs and huddle together in crowded markets or shantytowns, the TB bug hitchhikes with them. Because the infected women are in the prime age of 15-54, they put serious economic strain on family members and community. In many cases, men abandon women to avoid contracting the disease, and children are yanked from school for providing care. Small wonder India suffers $300 million loss as a direct cost of TB. Unhealthy union of HIV/AIDS and TB Whether women fail to get tested because of stigma, or they simply don’t know about the disease, it is impeding the pace of TB detection. For every one infected person who goes undetected, the WHO estimates 10-15 people are at risk of being infected. Adding to worries, when TB patients quit abruptly the 6-month DOTS regimen or take faulty medications from quacks, they evolve deadlier drug-resistant super bugs that endanger control efforts. With 4.5 million people infected in India, the new TB strains could undermine the progress made so far. The combined weight of HIV/AIDS and tuberculosis is pressing women’s progress. The stigma tied to sexually transmitted diseases is far more serious than tuberculosis. Instances of death by stoning and suicide have been reported in the papers. Citing double standards, Human Rights Watch has noted that Indian men face no stigma for sexual encounters outside marriage, while women lack the power to even demand condom use of husbands. Many get infected unknowingly through husbands who then leave them pregnant and widowed. Unable to share their woes with anyone, women suffer in silence. It is estimated that one in four cases of HIV in India is among women and there are an estimated 4.5 million HIV/AIDS-affected people — second highest in the world after South Africa. Out of that number, 180,000 people with HIV are co-infected with tuberculosis, and most will reportedly perish if untreated. Warning that AIDS in India is following the same pattern as that of sub-Saharan Africa in the 1980s, a study published in the British Medical Journal in June said it has potential to be just as devastating.
Independence for women The mantra in New Delhi is that HIV/AIDS is confined to traditional high-risk groups such as sex workers, IV drug users and truckers, and prevention must lead relief efforts. Minister for Health and Family Welfare Sushma Swaraj was reported to have recently said that pushing self-control and conjugal fidelity should top the HIV/AIDS prevention agenda; but its merits are questionable in a society where women lack control over their sexuality. Unless male attitudes and gender bias are changed through education, counseling, and training, prevention programs are unlikely to turn the tide against the disease. In this regard, the Kolkata-based Sonagachi Project has set an example for non-governmental groups by significantly controlling the spread of HIV among sex workers through propagation of consistent condom use and independence of women. Given the explosive nature of the epidemics and their impact on women, New Delhi must swiftly bring all available weapons to bear. Winning the war against micro-enemies depends on political will to alter social attitudes, correct power imbalance, and enrich women’s socio-economic status. For India’s sustained development, empowering women is no longer an option; it is essential. Renuka Naj is a freelance writer based in Boston, MA, USA. --- OneWorld Guest Editorials represent the viewpoint of the authors and not necessarily that of the OneWorld Network. Read and comment on previous Guest Editorials. If you would like to contribute or suggest a future OneWorld Guest Editorial, please contact Miles Litvinoff. |
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