Education, open conversations must to control HIV epidemic in Meghalaya

Earlier this year, when Meghalaya’s health department admitted a 221% increase in the number of HIV cases in the past two decades, it marked a worrying milestone.

According to the National AIDS Control Organisation’s 2023 estimates, the total number of people living with HIV in Meghalaya is over 9,500, and the percentage of HIV prevalence between 15 and 49 years of age is 0.43, which is higher than the national percentage. The total number of AIDS-related deaths in 2023 was 52.

While the numbers are much lower than those in Mizoram, Nagaland and Manipur, it is undoubtedly an alarming situation for a small state like Meghalaya.

And yet, a comprehensive knowledge of HIV and A   IDS and awareness of the subject are abysmally low in the state. The National Family Health Survey data collected between 2019 and 2021 show that 21.6% women and 30.7% men have a comprehensive knowledge of HIV and AIDS. And the percentages are even lower in Meghalaya.

More than half of the people living with HIV in Meghalaya are below 30 years of age, according to the Meghalaya State AIDS Control Society.

The two primary reasons for such high prevalence among the youths are intravenous drug use and unsafe sex. Adding to this are a lack of awareness and a complete apathy toward having open conversations.

HIV/AIDS is still a stigma. In fact, this stigma remains the biggest barrier to the success of any government action. Many people refuse to get tested or seek treatment for fear of being ostracised. This is despite the several awareness campaigns by the state government.

In one case, a child was denied the right to education because the mother was HIV positive. In another case, villagers dispersed out of fear when an HIV screening van came to their village.

Studies have shown that Jaintia Hills is the most affected region in the state, and yet it lacks knowledge about safe sex and awareness about HIV and AIDS. For many, HIV is still a ‘distant’ disease.

While writing an article about the mental health of HIV/AIDS patients, I came across several people living with HIV who told me that they had nobody to talk to after they were diagnosed. Some people can muster the strength to fight through, but many give up. There are counsellors at designated hospitals, but again, stigma stops many from making that first step.

The state government has been doing its part. The Meghalaya State AIDS Control Society (MSACS) has expanded its network of testing and treatment centres. Free antiretroviral therapy (ART) is available at designated hospitals. The government is also planning to make HIV testing mandatory before marriage.

And despite these measures, the numbers tell a different truth. Meghalaya’s response needs to go beyond periodic awareness drives. If the government can think about mandatory pre-marriage HIV testing, then why not make comprehensive sex education mainstream?

Testing coverage must be increased, with regular screenings in colleges, workplaces and local clinics. The government must also strengthen data collection and reporting. The MACS website must be updated with the latest reports so that citizens are informed about the current status of the disease.

There’s also an urgent need to address stigma. Religious and community leaders should be included in awareness campaigns to make conversations about safe sex and HIV less taboo. Recently, the governor urged all religious leaders in the state to join hands against HIV. This appeal must be taken seriously.

Another stigmatised aspect in society that most people refuse to talk about is sex workers. The state government must start a drive to identify sex workers, make HIV tests mandatory and provide them with identity cards, which will also mention HIV test status. This way, the spread of the disease can be controlled to a great extent. It will also help in destigmatising the profession.

Meghalaya’s rising HIV numbers reflect a public health crisis that is unfolding quietly. Unless the state focuses equally on education, community engagement and healthcare access, the epidemic will continue to outpace the response. If we want to reverse the trend, we must first break the silence.

Banner image by sergey mikheev on Unsplash