Whether they belong to the Theni district of Tamil Nadu, Chandel district of Manipur or Pune district of Maharashtra, life for a majority of the widows infected by HIV is a battle against stigma, discrimination and poverty. Many have no choice but to sell sex to survive.

According to a recently concluded study - `Gender: Impact of HIV and AIDS in India'- conducted by the National Council of Applied Economic Research (NCAER), the number of households affected by HIV and AIDS would increase in the future.

With men accounting for 70 per cent of the 1,11,608 cases of AIDS reported in India, experts fear the number of widows infected with HIV is likely to increase. According to the study, most of the men who have AIDS are old and likely to die soon. In the absence of a regular source of income, most women are likely to earn through sex work.

Women account for 39 per cent of the total infections in India. This means two million of the approximately 5.2 million people living with HIV, are women. Like in other countries, the rate of infection among women in India is steadily rising. The study is of particular significance for India which is finalizing the strategy for the third phase of National AIDS Control Programme - III, and the state level Programme Implementation Plans. "If we have a sound strategy, we can reverse the trend," contends K Sujatha Rao, Director General, National AIDS Control Organization (NACO).

"The position of HIV+ widows (women infected by their husbands) is worse than that of other widows and other HIV+ women. Such women not only have to suffer the loss of a husband but also have to face stigma attached to AIDS. The economic repercussions and lack of income leaves them with no option but to opt for sex trade, and in this process they infect many more people," says Ramamani Sundar, co-author of the study.

The study says that biological, socio-cultural and economic factors make women and girls more vulnerable to HIV and AIDS. Factors like early marriage, low status of women, trafficking, sex work, migration, lack of education and gender discrimination increase this vulnerability.

The study was commissioned by NACO and supported by UNDP to assess the social and economic impact of HIV and AIDS on households. It was conducted in 2004-2005 in the six high prevalence states of Andhra Pradesh, Tamil Nadu, Karnataka, Maharashtra, Manipur and Nagaland. It covered over 8,000 households in both rural and urban areas and included both HIV and non-HIV households to enable a comparison of the social and economic impact.

The most daunting challenge before NACO will be to address the startling finding that nearly 60 per cent of the HIV+ widows are less than 30 years of age. In addition, nearly 30 per cent of them are illiterate. Compared to other HIV-affected households, their income is much lower. While the average annual income of other HIV-affected households is Rs 51,111 per year, it is Rs 32,993 per year for households run by HIV+ widows. In addition, the widow households have huge debts and little assets. The high cost of healthcare, declining assets and breakdown of social bonds also lead to food insecurity among widow households.
A distressing finding of the study is the pervasiveness of stigma and discrimination and the burden on women. More than 90 per cent of the HIV + widows were thrown out of their marital homes after their husbands died, according to the study.

In a majority of the cases, these women were denied a share in their husband's property and also faced the trauma of not being allowed to even touch their own children. Many were forced to give up their rights over their children. While the grandparents were willing to take care of their grandson (if he was not infected) they didn't want to take care of their granddaughter even if she was not infected.
When it comes to care of people living with HIV and AIDS (PLWHA), women account for more than 70 per cent of the caregivers. More alarmingly, 20 per cent of these caregivers are HIV+ themselves. "Yet, the discrimination against women is higher than against men," says Maxine Olson, UNDP's Resident Representative. Olson feels that not only is there an urgent need for more women-centric components within the HIV and AIDS programs, but a stronger focus to empower women to make them less vulnerable to HIV and AIDS."
In spite of the ill-tidings the data offers, there is a glimmer of hope for the policymakers: HIV + widow households spend more on education of their children as compared to other households. More importantly, they give equal opportunities to girls. "As HIV+ widows, they realize the importance of educating their daughters and to enabling them to stand on their own feet," says Sundar.

However, the study notes that the impact on education of female children would be more severe if they were to become orphans. In the prevailing social conditions in the country, girls would be more vulnerable to exploitation and sex trade.

While ensuring education of the children of the HIV+ widows is imperative to break the vicious cycle of selling sex for survival, economic empowerment is also necessary.

One of the many recommendations suggested by the study is to train the women to form self-help groups to enable income generation from micro credit. But what would really help these women manage the adverse impact of HIV is a mechanism which protects women's property and inheritance rights. This would not only empower them economically and improve their status but also reduce their vulnerability to domestic violence, unsafe sex and HIV.