The growing incidence of HIV infection in J&K has been an open secret for some time, but now the monster has extended its reach to schools and colleges. Officials say two cases have surfaced in a private elite school, and three others in a professional college. Haroon Mirani reports.
The Human Immunodeficiency Virus or HIV that causes the dreaded AIDS disease is unshackling itself from high-risk categories in Kashmir. While its incidence is growing, it is also surfacing in unsuspecting corners.
The HIV testing laboratory in Srinagar has detected five HIV positive cases from a private school and a college.
Dr. Munir Masoodi, Head of Social and Preventive Medicine (SPM) department in Government Medical College Srinagar while confirming the reports said, “Three cases of HIV were reported from a professional college of Srinagar and two cases from an elite private school.”
It is for the first time that cases from schools or colleges with minor victims have been detected in Kashmir. Experts call the development frightening. The HIV positive school children are in the age group of 14 -15. “Alcoholism, drug addiction and behavioural changes are fast catching up among the teenagers,” says Masoodi. “The prevalence of HIV infection is also correspondingly increasing.”
Ninety per cent of the new HIV infections in the state are however being attributed to sexual transmission. The worrying factor is that HIV detection depends on voluntary checks by victims, which is not very effective. Even in cases where doctors suspect a person as potentially HIV positive, such as a partner of an HIV positive patient, they can’t force him or her to take the test. Doctors don’t have any authority to enforce HIV determination tests and can only offer counselling for such people. The limitation means more many HIV cases remain undetected.
Most of the people with whom the infected students had sexual relations are out of the ambit of detection. “We just offer them counselling for encouraging voluntary testing and guide them in coping with the dreaded situation,” says Masoodi. “A couple of them are coming for counselling,” he confirmed.
It is feared that dozens more roam free as carriers of the virus. Another worrying trend has the indigenisation of HIV spread. “Earlier most of the cases used to be those people who had visited outside or had contact with outsiders in Kashmir, but now virus is very much in Kashmiri society and it is spreading,” says Dr Salim Khan of Department of Social and Preventive Medicine at GMC Srinagar.
The virus is travelling from the high-risk group (security forces, long-distance truckers, out-going students and businessmen) to low-risk population (that is entire population). “The prevalence is going down but numbers are up because of awareness. In last nine months, 51000 people reported for voluntary testing and it is a record,” says Dr Mohammad Amin, who heads the State AIDS Prevention and Control Society (SAPCS).
Some Kashmiri students in mainland India have also been detected HIV positive. “When a person from here visits outside for say education, entire culture changes for him or her and family pressure, rules and regulations also loosen up,” says Dr Khan. “The result is that people take liberty in their behaviour with dangerous consequences.” The profile of HIV positive patients in Kashmir is extremely heterogeneous with people from every possible category.
The HIV testing laboratories in Srinagar have detected the virus in businessmen, long-distance truck drivers, students, teenagers, elderly men and women from upper and middle-class families of Kashmir.
“There is no particular category in which we can put such patients as they are from every possible genre,” says Mushtaq Siddiqi, HOD Immunology department of SKIMS. “The youngest patient visiting our clinic for treatment is a child who contracted it from his mother and the eldest is a person in his late 60’s.”
The HIV cases are usually detected by voluntary testing, screening of blood donors and pregnant women. Recently a pregnant woman at Lalded Hospital needed a blood transfusion. Her husband offered blood and during a routine check, he was found to be HIV positive. Later the woman too was found to be HIV positive. On investigation, the husband was found to have contracted the virus due to his sexual relations outside the marriage and then passed on the virus unwittingly to his wife.
It is the second case of a pregnant woman being detected HIV positive in Kashmir.
According to experts the transition of society from a conservative one to more open kind is a contributing factor. “The loosening of family and social values is a big factor in the current situation,” says Dr. Khan. “In the mad rush we are trampling all norms in behaviour with disastrous results.”
Recently, an 18 year old college student was confirmed HIV positive. “Next day he brought his friend for the test and he was also confirmed positive,” says a doctor who handled their case at SMHS Hospital. “We were shocked to hear that the two were indulging in homosexual activity, which is more dangerous.” Last year, an old city eunuch treated at SKIMS admitted 27 physical contacts including those with security forces.
In another case, the doctors had tough time getting information about the cause of infection from an 18-year-old unmarried girl, who was tested positive for HIV infection. “Most of the cases occurring in Kashmir are in the age group of 15-30,” says Dr Masoodi.
The increasing level of sexual activity among teenagers is driving HIV infection in Kashmir. Late marriages too have catalysed the behavioural change. Dr Khan blames society for the situation. “Actually we have made marriages difficult and adultery easy and it is the reason we have to suffer,” says Dr Khan.
One of the biggest problems facing HIV counsellors is how to keep an HIV positive person under surveillance, treatment and counselling. In many cases patients flee on detection of the virus. As the entire process has to be voluntary, doctors are forced to be mute spectators and HIV positive people roam freely in society without any guidance.
Doctors attribute rising flesh trade as another cause of rising HIV infections. “The number of makeshift brothels has increased particularly in the areas adjacent to highways and they have become hotbeds of infection,” says a doctor on the basis of his observation. Experts fear that the way all the accused got scot free during the infamous sexual abuse scandal, the criminals have become more daring.
Tourism is another driver. Jammu and Kashmir get around eight million visitors annually. Tourist traffic to Ladakh has crossed 91,000 and arrivals in Srinagar have touched an all-time high this year. Tourism involves a host of the population including boatmen, hoteliers, taxi drivers and tour operators. Tourists are in direct touch with the host population. Interestingly, a few years back when a French visitor was hit by a bullet, he was rushed to hospital where incidentally he was detected HIV positive.
Cases of HIV infection occurring due to marriage with outside girls have also surfaced in Kashmir. Every year hundreds of women from Bengal, Bihar, UP and other such places are brought to Kashmir for marriage. It has been found that some of them were infected and they passed on the infection to their husbands.
“More such cases are coming out,” says a doctor at Immunology Department of SKIMS. In one case a man was infected with HIV virus from his non-local wife. “Upon investigation, it was learnt that the particular woman was indulging in prostitution before coming to Kashmir,” he further added. As no prior screening is done and nobody knows what the non-local woman was doing before being passed on for marriage to a Kashmiri.
While we get women (for marriage), labour force from comparatively HIV-prone areas, students and seasonal traders spend most of their winters in the same belt doubling the risk.
Another cause of HIV infections is drug abuse. Recently two cases of HIV positive infections from south Kashmir were detected by doctors at SMHS. The duo had contracted the virus after sharing needles for drugs. “They confirmed that they were a large group and all of them share the same needle for taking drugs,” says a doctor. “The problem is that the rest of the group, whose number runs into dozens, are not coming forward for tests.”
So if some cases have been detected, many times more remain undetected. “The symptoms are not quite specific, peoples’ ignorance and societal pressures can keep the higher level of infection hidden in the population,” says Siddiqui. Dr Masoodi says the figure might be as high as 5000 for the state. Other experts say that the figure can be very high, as much as five times more.
On an All India scale too the picture looks grim. From a low prevalence state, Jammu and Kashmir is moving towards the high prevalence zone. A report published in the Indian Journal of Medical Research recently disclosed that an increasing epidemic trend was noticed in seven of the low prevalence states such as Pudducherry, Jammu and Kashmir, Jharkhand, Bihar, Orissa, Rajasthan and West Bengal.
The prevalence rate among Kashmiris during the last six months has also shown an increase. At a single counselling centre, 15 cases have been detected and all of them are Kashmiris. “This is the highest number detected so far by us,” says the doctor manning the centre.
The first HIV positive case in Kashmir was detected in 1986. He was a Kashmiri doing business in Germany and had returned with the virus.
The case is also one of the earliest detected in entire India. After that, there was a long gap in HIV detection and a regular flow came after 1995. In 2008, 211 new cases of HIV/AIDS were detected in entire state.
Officially, J&K has 1812 detected HIV positive cases. SAPCS has 95 documented deaths as 264 full blown cases are passing through different stages of ultimate immunological collapse. But a conservative Kashmir having 0.6 percent prevalence only in high–risk groups is wishful thinking. The iceberg is showing just its tip. J&K, especially Kashmir, has all the ingredients for becoming an AIDS hotbed.