Reprinted from Science & Theology News. Used with permission.

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 Julia 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 alive."

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