Innovative intervention program improves life for rural women in India living with HIV/AIDS

A multidisciplinary team of researchers from UCLA and India has found that a new type of intervention program, in which lay women in the rural Indian province of Andra Pradesh were trained as social health activists to assist women who have HIV/AIDS, significantly improved patients' adherence to antiretroviral therapy and boosted their immune-cell counts and nutrition levels.

The lay women were trained by the research team to serve as accredited social health activists, or ASHA, and their work was overseen by rural nurses and physicians. These ASHA then provided counseling and support to the women with HIV/AIDS, as well as assistance aimed at removing the barriers they face in accessing health care and treatment.

"For rural women living with AIDS in India, stigma, financial constraints and transportation challenges continue to exist, making lifesaving antiretroviral therapy difficult to obtain," said lead researcher Adey Nyamathi, distinguished professor and associate dean of international research and scholarly activities at the UCLA School of Nursing.

In India, 2.47 million people are affected with HIV/AIDS, and more than half are women. The epidemic is shifting from urban to rural areas, and the rice-producing Andhra Pradesh district in southeastern India is at the epicenter; this area has the highest total number of HIV/AIDS cases of all states in the country, with nearly 20 percent of the population infected.

For the intervention study, women with HIV/AIDS in Andra Pradesh were randomly selected to participate either in the intervention, called AHSA-LIFE (AL), or in a control group.

Over a six-month period, the ASHA visited the women in the AL group to monitor the barriers they faced in accessing health care and adhering to their antiretroviral therapy and provided assistance to help mitigate these barriers. The ASHA also provided counseling to help women develop coping strategies to deal with discrimination. The intervention group also received monthly supplies of high-protein foods, such as black gram and pigeon pea.

The Government of India estimates that about 2.40 million Indians are living with HIV (1.93 ‐3.04 million) with an adult prevalence of 0.31% (2009). Children (<15 yrs) account for 3.5% of all infections, while 83% are the in age group 15-49 years. Of all HIV infections, 39% (930,000) are among women. India’s highly heterogeneous epidemic is largely concentrated in only a few states — in the industrialized south and west, and in the north‐east. The four high prevalence states of South India (Andhra Pradesh – 500,000, Maharashtra – 420,000, Karnataka – 250,000, Tamil Nadu – 150,000) account for 55% of all HIV infections in the country. West Bengal, Gujarat, Bihar and Uttar Pradesh are estimated to have more than 100,000 PLHA each and together account for another 22% of HIV infections in India.

The Indian epidemic is concentrated among vulnerable populations at high risk for HIV. The concentrated epidemics are driven by unprotected sex between sex workers and their clients and by injecting drug use with contaminated injecting equipment. Several of the most at risk groups have high and still rising HIV prevalence rates. According to India’s National AIDS Control Organization (NACO), the bulk of HIV infections in India occur during unprotected heterosexual intercourse. Consequently, and as the epidemic has matured, women account for a growing proportion of people living with HIV, especially in rural areas. The low rate of multiple partner concurrent sexual relationships among the wider community seems to have, so far, protected the larger body of people. However, although overall prevalence remains low, even relatively minor increases in HIV infection rates in a country of more than one billion people translate into large numbers of people becoming infected.