Combating dreaded virus
Reviewed by Nonika Singh

Dialogue on AIDS: Perspectives for the Indian Context
Edited by Ritu Priya and Shalina Mehta.
Vasudhaiva Kutumbakam Publications (P) Ltd.
Pages 633. Rs 680.

SINCE the first case of AIDS virus came to light over two decades ago, the spectre of the much-dreaded disease has clouded our collective psyche. In the process, it has fuelled many misconceptions and even a paranoid fear about the HIV infection that often manifests in blatant discrimination of HIV infected people, thus further compounding the complexity of a serious health issue facing the country.

Now, this book on AIDS takes a hard look and puts things in a proper perspective. Truly, a dialogue that takes place simultaneously at many levels and explores nearly all-possible facets of AIDS and does a reality check that covers full circle. Throwing light on a gamut of concerns that are inextricably linked, here is a holistic look that challenges pre-set notion about AIDS and probes many ticklish areas like why the first phase of National AIDS Control Organisation wasn’t a success. Besides, it raises several questions, e.g., why was care and support given a low priority and gender sensitivity not an issue?

Food for thought for planners and policy makers, this dialogue is not only multidimensional, expectedly serious, but often engaging and funny too. In particular, Vijay Thakur in his paper Cacophony and Catastrophe not only introduces readers to the horrific face of AIDS, which has taken many lives, but also goes on to comment tongue-in-cheek. Taking on the role of NGOs and research on AIDS, he lists out the futility of many a study. He writes: "The association of AIDS and HIV with sex has triggered a flurry of knowledge, attitude and behaviour studies in India. Suddenly, there was on occasion to have a peek into the sex life of people."

However, his rather irreverent tone doesn’t take away the gravity of his argument that focuses on imperatives like supply of antiretroviral drugs to pregnant mothers. Besides, there are chilling reminders of reports of villagers murdering a woman whose husband allegedly died of AIDS and of a woman who burnt her child and herself when told that her husband was HIV positive. Arguing for the cacophony to be replaced by voices of those on whose behalf we act, his paper is based on plausible reasoning and logic. So are all other papers. Extensively researched and well referenced, the book comprises of several papers and is divided into five sections and even has a first-person foreword by HIV positive counsellor.

Besides calling for the need for proper strategies, the book also touches on the "victim-blaming" approach. Rama V. Baru and Chris M. Kurian in Towards an Expanded Conceptualisation of Quality in Public Health challenge the assumption that private sector provides better quality care. In fact, the chapter compares the premise on which both public and private care are based and rightly asserts that the principle of public healthcare is universality, equity and comprehensiveness and addresses the needs of population rather than individuals.

Vijay Rai’s paper makes another valid point that advance in medical science and research is no guarantee that quality will reach grassroots level. For that processes and procedures need to be standardised. In lieu of what he says the need for the Bill to regulate clinics assumes greater significance. Atul Kotwal’s detailed analysis of safe use of injection technology not only deliberates on the role of injections in "the insidious spread of HIV/ AIDS", but also the reasons behind the increased prevalence of injection use.

In a nation where women have few rights what can the HIV infection imply, particularly to illiterate and poor women, is revealed rather disturbingly by Shalini Bharat as she explores the gender dimension of HIV and AIDS. Manisha Joshi mentions how rape is linked with the spread of HIV among women and talks of how violence against women creates greater social vulnerability. Flavia Agnes while elaborating on gender neutrality being discussed within the rape law, argues for a gender perspective on HIV. She discusses the Supreme Court judgement that examined the right of the afflicted person to confidentiality and that of the prospective bride to information. Taking the thread further, Amita Dhanda delving into the role of law rightly argues that there should "neither be oppression of nor oppression by a person living with HIV". In short, rights and responsibilities have to be balanced.

From the faults of strategies of IEC (Information, Education and Communication) that played upon the fear factor and thus led to myths about the disease and ostracism of infected persons to the new phase of NACO laying stress on the right initiatives, the book provides more than an insight. With a complete background and foreground, the book reiterates the need for a complete multi-pronged approach to tackle AIDS.

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