AIDS & Hinduism in India. Interview with Nalini Tarakeshwar

[Guest guest]

AIDS & Hinduism in India

Researcher Nalini Tarakeshwar looks at the intersection of religion,

culture, and people with HIV/AIDS in India.

By C. Keller

In India, where culture and religion are central, the stigma of

disease adds an extra burden to families and individuals with HIV,

according to Nalini Tarakeshwar. Tarakeshwar, a postdoctoral fellow

at Yale University School of Medicine, is pursuing two projects in

southern India. The first takes an in-depth look at the role of

religion and culture in the behavior of HIV-positive people receiving

treatment. Tarakeshwar's second project examines the psychosocial

impact of HIV/AIDS treatment on families.

Tarakeshwar is interested in the role that religion plays in the

global HIV epidemic. She focuses her studies in India, where more

than 5 million people are HIV-positive, according to the World Health

Organization. Before Tarakeshwar left for another research trip to

India this summer, she took the time to talk to Science & Theology

News' Science Editor C. Keller about the intersection of

India's religion, culture and HIV-positive population.

How did you become interested in studying how religion, culture, and

disease intersect?

Before coming to the United States, I had worked as a special-

education teacher for children with mental retardation. Parents of

these children, although quite informed about biomedical explanations

for their children's condition, almost always attributed the ultimate

cause of their situation to a higher power or to sins they had

committed in this life or presumably their previous life, or karma.

Anecdotally, I found that this attribution was associated with both

positive emotions--life satisfaction, hope--as well as negative

emotions, like anger.

Why did you want to focus on HIV/AIDS, and specifically in India?

In my pilot research in India, I found that most infected individuals

are religious, and their religious beliefs provide them the

motivation to persevere in the face of numerous calamities. Duty

toward family is another element that keeps patients coming for

treatment. Finally, HIV forces us to consider gender roles and

expectations within society, another topic that is of interest to me.

What is the current climate for HIV-positive individuals in India?

Since AIDS was first diagnosed in a female sex worker in 1986, much

improvement in HIV/AIDS awareness and related services can be

discerned, particularly in the urban areas and within the non-

government organization, or NGO, sector. Over the last few years, the

Indian government has demonstrated better commitment by increasing

the number of HIV-related programs (including antiretroviral

treatment) offered through its government hospitals, which the poor

and those from rural areas can better access. However, the greatest

obstacle is the stigma that is attributed to HIV disease, which is

associated with " immoral " sexual behavior.

But the negative impact of stigma is greater for women than men. The

wives who are infected through their husbands (who visit sex workers)

and subsequently transmit the virus to their children are usually

blamed for their husband's illness. Wives often worry about impending

widowhood, which is associated with an inferior social status and

limited financial resources. In a patriarchal society such as India,

HIV-infected men are usually taken care of by their wives and/or

their families. The female sex workers are perhaps stigmatized even

more. The health providers find it much easier to empathize with

the " innocent " housewives, but the already existing stigma of sex

work makes it challenging for them to feel for the sex workers.

Overall, if you are HIV-positive, you are better off living in an

urban area and if you can afford to pay for care received at an NGO.

Unfortunately, HIV affects the socially disadvantaged the greatest,

many of whom live in rural areas. For these individuals, HIV may just

be one of a host of challenges that could include rent, food, school

fees and so on.

In India, what is the biggest challenge to addressing cultural or

religious issues in HIV prevention?

Over 80 percent of Indians are Hindus. Unlike churches, Hindu temples

or priests do not offer health services or discuss " personal "

problems. Most prefer to think of Hinduism as something more personal

and that has nothing to do with HIV. Hence, in India, I believe

issues of religion and culture have to be integrated within the

patient-care system that HIV-infected or affected populations are

likely to access. There are a number of spiritual leaders of

different Hindu sects who wield significant social and political

influence, but this collective force has not been tapped to spread

messages about HIV.

" The fact that they are alive is due to God's desire to keep them

In the HIV-positive population, how important is good mental health

in conjunction with good physical health care?

It is terribly important to integrate good mental health care with

good physical health care. For instance, research in the United

States has shown that depression can significantly influence HIV-

related mortality and treatment adherence. In my opinion, this is one

of the challenges of working in India, where mental-health care is

not given due importance.

Through my work, I have recognized that mental-health care, if

addressed, is usually done by HIV counselors and social workers. This

involves education, pre- and post-test counseling, adherence

counseling and so on. These counselors work hard to motivate their

clients. But structured programs and services are not available that

specifically address mental-health problems such as depression,

anxiety and so on. Unfortunately, mental health in India is

associated with psychiatric disorders such as schizophrenia, which

are also highly stigmatized.

How have religious communities responded to people with HIV?

In my interviews with HIV-infected individuals and families, I have

learned of local churches supporting HIV-infected and affected

individuals and their communities through prayers, food, and

providing shelter. It is not clear how many of these individuals had

informed the churches of their HIV status. Religious communities have

not been very active in India but I do think they can be mobilized to

raise greater awareness about HIV and compassion for affected

families.

From your studies, what role does religion or spirituality play in

the lives of HIV-positive people?

As with so many other tragedies and misfortunes that befall human

beings, the main role of religion in the lives of HIV-positive people

seems to be as a source of strength, guidance, and hope.

Religious beliefs often help individuals develop a perspective on the

meaning and purpose of their life with HIV infection. This does not

mean that people are always pleased with what they perceive to be

their lot in life--they often express feelings of anger at God. But

for most individuals with HIV, the fact that they are alive is due to

God's desire to keep them alive.

What is secondary HIV prevention and how might religious or

culturally sensitive interventions help prevent transmission?

As HIV treatment becomes increasingly available and accessible, HIV-

infected individuals in India will live longer lives. Interventions

that enhance the physical and mental health of these individuals and

reduce their risk of HIV transmission are referred to as secondary

HIV prevention.

In serving as a source of strength, guidance, hope, and meaning in

life, religious and culturally sensitive interventions can play an

important role in improving the mental health of these individuals,

which can thereby influence their physical health. A few religious

practices, such as meditation and yoga, have been found to have a

direct influence on physical health as well, although I do not know

of studies in India among HIV-positive individuals. Moreover,

religion/culture is only a part of the picture--high quality

treatment and family support are also essential. These three factors

can bring greater life satisfaction, thus reducing opportunities for

unsafe sexual practices and poor health behaviors like substance use.

What is the future of HIV in India in relation to religion and

spirituality?

At the individual level, health providers need to be sensitized to

the religious/cultural beliefs of their patients as it can have an

influence on treatment and adherence. Change is harder at the

community level. Several Christian missionaries--World Vision,

Catholic Relief Services--are currently active in providing care and

prevention services. Hindu organizations have yet to show initiative.

To begin with, I think we need to investigate their level of interest

and commitment, and determine how we can garner their support. Stigma

will be a significant barrier, and hence I believe we should be

realistic about our expectations.

Ideally, I would be pleased if religious groups can become actively

involved in providing or supporting services for HIV-affected

families, such as education and health care for children from HIV-

affected families.

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