Laxmi, 14, like other girls of her village, met her husband for the first time at their wedding. Then she discovered that he was around 30 years her senior, had two daughters from a previous marriage, was epileptic and exceedingly poor. After four years of grinding poverty, Laxmi found a job: at a brothel in Kolkata. A decade later, Laxmi is HIV+.

When Asha's husband contracted HIV, she had no inkling of his ailment. He had visited the doctor alone and would not talk about the diagnosis. "It's a man's thing," he said, snubbing his concerned wife. He soon began falling ill repeatedly. Asha, 35, took up additional work as a domestic helper in Howrah to sustain the family and pay for his treatment. Despite having subsequently acquired the infection, Asha juggles between frail health, work, and being her husband's foremost caregiver.

These were some of the stories heard when a team from the School of Women's Studies, Jadavpur University (JU), Kolkata, which together with Action Aid India, launched the project to examine the spread of HIV/AIDS and its linkages with violence against women. The rationale behind the six month long study, which was released earlier this year, was a finding by the National AIDS Control Programme III that monogamous women are increasingly at risk of being infected.

For the study, 60 interviews of HIV+ women were conducted over a period of six months in several areas of West Bengal. Almost all these women were from the lower-income group.

The study established beyond doubt that violence against women is both a cause and a result of the spread of HIV/AIDS in West Bengal. One of the basic reasons for women contracting of the virus is their helplessness in negotiating safe sex. This is as true for sex workers as it is for monogamous women. However, monogamous women often remain more vulnerable.

Awareness campaigns launched by both government and non-government organisations have managed to ensure safe sex for at least some sex workers, usually in areas where they tend to live and work in a collective. Sex workers, too, have come up with initiatives to negotiate and ensure that clients engage in safe sex. According to Breakthrough, an international human rights organisation based in New York, while the  public continues to believe that most women with HIV/AIDS are sex workers, official numbers indicate that they make up less than one per cent of the two million women infected.

No support
Monogamous women, however, lack that kind of support and collective system to bargain for safe sex with their husbands. Most of the interviews conducted with married and positive women reveal that they have no choice but to succumb to their husband's demands. If they refuse, or voice suspicions that the husband visits other women, they are beaten up, raped or, in some cases, thrown out of the house. Often, women just give in. Few put up a fight in any case, having been conditioned that they are their husbands' property, to be dealt with as he wishes. 

Arati, a positive woman, was blamed by her husband's family for the fact that her husband visited sex workers regularly. She was accused of 'not being able to satisfy him' and that her 'shortcomings' drove him to other women.

Many women were also found to have been simply ignorant of the HIV/AIDS disease till they were affected. The National Family Health Survey III has found that only 46 per cent of rural women and 57 per cent of the entire population of married women aged between 15 to 49 - both in rural and urban areas - have heard of AIDS.

The overriding reason for this state of affairs is found to be extreme poverty and the plethora of ills it engenders - illiteracy, early marriage, economic debilitation and  dependency. On the one hand, many women have no knowledge of the virus; on the other, they cannot negotiate safe sex with their husbands. Bharti, another positive woman who had contracted the infection from her husband, was accused of being immoral and infecting him!

 Once infected, however, women become targets of newer forms of violence. Bharti, for example, was thrown out of her house when her family came to know of her positive condition. Another interviewee said that after her husband, who had infected her, died, she was thrown out of his home by her in-laws, without any compensation or inheritance.

Yet another interviewee who had been infected by her husband revealed that when she started falling sick, her positive status became known to her employer and she was dismissed from her job. When the 'basti' (slum locality) came to know about the infected couple they threatened and harassed them till they had to leave the place and stay with some relatives.

Worse, however, is the humiliation and discrimination faced by women at hospitals and health centres where they go for treatment.

Hospital nightmares
The study found that the health structure is such that women need to spend long hours and commute long distances to access the necessary drugs. Complete Anti-Retrovial Therapy (ART) is available at only two centres in West Bengal. Two more centres simply distribute drugs. This not only delays the treatment but also entails extra expenditure on transport.

Saleha Begum, a domestic help, who lives in Howrah and is HIV+, finds it an expensive and time-consuming affair to commute to the Kolkata Medical College on the dates prescribed by the doctor. No medical help is available at the local hospital. Though local or sub-medical centres are meant to distribute drugs for opportunistic infections such as diarrhoea and fever, often when the staff find out that the patient is HIV+, they refuse to deal with her, advising instead a visit to an ART centre. At times, in many of the sub-centres, these basic drugs are simply out of stock.

One interviewee, who had gone to the local hospital for her delivery, recounted that after the nurses saw her report they refused to touch her. She was left unattended for two whole days. It was only when the doctor arrived that she was able to deliver her child. But the baby died after two days. The study, which makes several recommendations, proves the urgent need for a holistic approach to combating HIV/AIDS and for viewing Violence Against Women (VAW) as a citizenship issue.

The tales of humiliation and pain that have surfaced through the study are reminders that 38.4 per cent of HIV-infected persons in India are women and that, as mentioned by the National AIDS Control Programme III, monogamous women are increasingly at risk of being infected.

(Names of individuals have been changed to protect their identity.)

Women’s Feature Service