A comprehensive study of the socio-economic impact of HIV and AIDS in six high prevalence Indian States has yielded compelling data. They make the case for immediate action to strengthen welfare in healthcare and education. The survey of households of persons living with HIV, sponsored by the UNDP and the National AIDS Control Organisation and conducted by the National Council of Applied Economic Research (NCAER), reveals that such chronic infections impoverish thousands of families and, as a consequence, deny children the right to education. Little comfort can be drawn from the relatively low national adult HIV prevalence rate (0.91 per cent), because even at that level there are thousands of people who lose jobs and livelihood, and earn reduced incomes owing to absence from work. For the affected families, health expenditure is higher than for comparable non-HIV families; and the children are compelled to drop out of school, often to supplement the income of a breadwinner who has acquired HIV. The survey shows that the burden of handling the impact of HIV/AIDS is disproportionately heavy on women; they must sacrifice their interests and earn more so that male family members can have better care. These are disturbing pointers to the failure of the welfare system to respond to the basic needs of mass education and healthcare. Unsurprisingly, it is now struggling to cope with the impact of HIV. That it is unable to improve its record in this area in an era of high economic growth is particularly poignant.
The hope is that the NCAER survey in Andhra Pradesh, Karnataka, Maharashtra, Tamil Nadu, Manipur, and Nagaland, classified as high prevalence States, will lead to more focussed welfare measures as part of the third National AIDS Control Programme. Some notable findings relate to the erosion of income owing to absence from work or, in more severe instances, the total loss of employment. The financial distress is compounded when the caregiver in the family is unable to take up a gainful job. The remedy would seem to lie in the institution of a cash compensation scheme for such individuals (about half of those surveyed were wage or salary earners), and more effective and sensitive public health interventions. Such action can save the affected families from liquidating their meagre economic assets, as they tend to do now. The finding that school dropout rates are higher in HIV households than in non-HIV ones is troubling and calls for urgent action. Rural families, especially those with girl children, have a greater number of dropouts and need additional help. The United Progressive Alliance Government, which has committed itself to the universalisation of elementary education, needs to recognise the inadequacies of existing relief programmes. It must come up with bold welfare measures that guarantee effective support for the families hit by HIV-AIDS, above all adequate nutrition and schooling for the affected children.