Indian women struggling with HIV/AIDS and disclosure

Stigma and gender inequality are helping to drive HIV/AIDS in South Africa's traditionally conservative Indian communities. Thirty-year-old Poppy Naicker is illiterate and barely able to make ends meet. But poverty and her inability to write her own name are the least of her concerns. She is HIV-positive and has been laid low by opportunistic infections, but is shunned by the Indian community of Chatsworth near the port city of Durban, where she lives with her older sister and three teenage children in a small overcrowded council flat. One of just a handful of Indian women in the community willing to disclose their HIV-positive status, Poppy told PlusNews she had contracted HIV from a number of encounters with men who paid her for sex that was often unprotected. "It is difficult to refuse something if you are not sure of how good or bad it really is. Now I know about the importance of condoms and how to use them, but it is too late for me. If I knew then what I know now, I would definitely have refused unprotected sex." Since her disclosure, her family has turned their backs on her and blame her illness on "conduct unbecoming to an Indian woman". "Indian families always have a strong support for struggling members, but more needs to be done about educating the families about HIV/AIDS and making them speak more freely about the dangers of having the virus, and how to avoid infection," Poppy explained. Savy Subramany, chief coordinator for the Chatsworth Community Care Centre, one of the few AIDS NGOs operating there, said the stigma against HIV/AIDS - that infection stemmed mainly from promiscuous sexual behaviour - had stopped many people in the Indian community from acknowledging their status. Subramany said because a woman's morals and faithfulness were questioned when she tried to negotiate safer sex, couples were still engaging in unprotected sex, even when they suspected that one or both of them might be HIV-positive. "I have come across people who suffer silently without disclosing their status, and without counselling or the appropriate care. Those who are not willing to disclose often die slowly, alone and in agony," Subramany commented. Gender-based inequality leaves all women - not just those from the Indian community - more vulnerable to contracting HIV/AIDS because they are less able to control how, when and where sex takes place. Forty-five-year-old Nimmi Ramsarran found herself in this situation when her husband, who often travelled for his work, suddenly became quite ill.

Educating the community

Nimmi said she suspected her husband might have contracted HIV during his road trips, but was afraid to confront him about it - not out of fear of her husband, whom she said she loved dearly, but rather out of her commitment to him as a traditional Indian wife. The couple continued to engage in unprotected sexual intercourse and it was only when Nimmi's husband became worryingly ill that he decided to get a full medical examination, including an HIV test. Following her husband's HIV-positive result, the private clinic where the tests were done advised Nimmi to be tested as well, but her result was negative. "It was only when I was referred to the Chatsworth Community Care Centre for counselling that I met Savy, who spent many hours offering me the support and education I needed to make it through to a second HIV test," she explained. The period between tests was gruelling for Nimmi - apart from the fear of discrimination, she also had to conceal the cause of her husband's death when he died. "With help from the centre I was able to hold on until the second HIV test, which also turned out negative, and I have only recently overcome the fear of community members discovering mine and my dead husband's secret." Although she is a lot more confident that her third HIV test will also turn out negative, she speaks anxiously about the episode and still refers to HIV/AIDS as "that thing". The project manager for the University of Natal's Health Economics and AIDS Research Division, Marlene Abrahams, says more needs to be done to encourage people to speak openly about HIV/AIDS, and agrees that research on individual households could also help to bring about a greater understanding of the impact of HIV/AIDS on various cultural groups. A recent study commissioned by former president Nelson Mandela through the Human Sciences Research Council, claims to provide the most systematic and comprehensive view available on how HIV/AIDS is affecting South Africans according to race, gender, age and geographical location. According to these findings, Indians make up 2.6 percent of the 46 million South African population, but represent 1.6 percent of all HIV-positive people. Abrahams stressed: "I feel more could done in the way of advertising campaigns, as the HIV/AIDS pandemic is also still largely regarded as a white or black person's illness and recent advertising campaigns don't do much to change that perception. It is difficult for someone of Indian ... [heritage] to relate to the urgency of AIDS awareness and behavioural change when you look at a billboard and see black or white or mixed race, but no Indians."