Sridevi M., orphaned by AIDS, dreams of becoming a doctor. Her mother had tested positive for H.I.V. while pregnant after a routine antenatal blood test. Then, Sridevi’s father, a trucker, also tested positive. He had been having unprotected sex with prostitutes while on the road.

Sridevi’s mother, determined to carry the pregnancy to term, began H.I.V. treatment. After birth, Sridevi was given H.I.V. medication for about six weeks and tested negative.

She was six when her mother and father died of AIDS. For the past 10 years, Sridevi, now a 16-year-old high school student, has been living at the convent of the Sacred Heart Congregation, a community of Syro-Malabar Catholic religious sisters serving in the Shimoga district of Karnataka. As a lower-caste Hindu, Sridevi does not have a surname; only an initial follows her given name.

In Shimoga, Father Abraham Areeparambil, director of Malnad Social Service Society of the Syro-Malabar Catholic Eparchy of Bhadravathi, has been working with H.I.V. and AIDS patients for nearly 20 years.

“These patients need sympathy, empathy, care and concern, just like anybody else,” he says. “Through treatment and support, they can lead a nearly normal life. Just like compassionate Jesus, we need to extend compassion to them.”

While H.I.V. has lost its profile as an urgent public health concern in the West, it remains a disease of epidemic proportions in India, where 2.54 million people were estimated to be living with H.I.V. in 2023, according to the National AIDS Control Organization (NACO), ranking it among the five largest H.I.V. populations worldwide. India recorded almost 80,000 AIDS-related deaths that same year.

Globally, H.I.V. and AIDS remain a major public health concern. According to UNAIDS, 39.9 million people worldwide were living with H.I.V. at the end of 2023, with the majority in the Global South. Sub-Saharan Africa had the most cases, with a reported 25.9 million people living with H.I.V., compared with 6.7 million cases in Asia and the Pacific, and 2.3 million in Western and Central Europe and North America combined. To date, more than 42 million people worldwide are estimated to have died of AIDS since it was first diagnosed in 1981.

In India, the southern states of Maharashtra, Andhra Pradesh and Karnataka have among the highest H.I.V. infections rates in the country, according to NACO. In the largely rural state of Karnataka, the rate of infections per capita is higher than the national average.

Father Areeparambil recalls a concerning spike in cases in the state in 2007. “More industries had come up to Shimoga and, with that, more truck drivers and thus sex workers,” he says.

In response, in 2009, Malnad Social Service Society established the Navajeevan Community Care Center to care for H.I.V. and AIDS patients in Bommanakatte, a steel town in the Bhadravathi district of Karnataka. Within a short period, however, a decision was taken to rename it the Navajeevan Holistic and Palliative Care Center, due to the social stigma associated with H.I.V. and AIDS in India, stemming complaints from the local community.

“In India, the stigma of having H.I.V. or AIDS is huge,” says Father Areeparambil. “Most people tend to live in extended families. If your family members find out you are H.I.V.-positive, you’re almost always ostracized.”

While the center has about 200 patients in its catchment area, it also draws H.I.V. and AIDS patients from distant places who seek privacy and discretion during treatment.

The children of H.I.V. and AIDS patients are sometimes segregated or rejected by their peers due to the stigma as well. 

“At times we manage to sort these problems out, at times we fail,” says Father Areeparambil about the center’s work with affected families. “But we’re here for them. We counsel the patients and their families.”

The priest says his faith encourages him to persevere when he feels tested by the challenging circumstances.

“Our presence as Christians itself is a witness to our Gospel values. And our witnessing is valuable for our Catholic Church,” he says. “I know Jesus is with me at all times.”

Father Sajeesh Thrikkodanmalil, director of the Navajeevan Center, says the center offers health care, food and medication to H.I.V. and AIDS patients “irrespective of their faith.”

“Most of our patients are abandoned by their families or their husbands. For older patients, their children don’t want to look after them,” he says. “We help treat them and make sure they’re reintegrated into communities by providing them job opportunities.”

The center organizes public awareness programs about hygiene, nutrition and the general well-being of H.I.V. and AIDS patients. A large part involves educating people about the dangers of sexually transmitted infections — including among marginalized groups that may be at greater risk — and encouraging them to get tested if they have any flu-like symptoms and the slightest suspicion they may be susceptible to H.I.V.

Dr. Deepa K.M. works at the Navajeevan Center. “In India, marginalized groups, such as sex workers, transgender people and gay men are often stigmatized, not just because they may be H.I.V.-positive but also because they’re from socially excluded groups,” she says. “We know these people experience discrimination even from within their own communities.”

Sister Rosaline Jose of the Sacred Heart Congregation also works with patients at the Navajeevan Center.

“Some of our volunteers are H.I.V.-positive,” she says. “They understand what it’s like living with the condition. They also liaise with government hospitals and bring us any patients who need support beyond medication.”

Sister Rosaline says they are also increasing awareness about people’s rights and responsibilities pertaining to H.I.V. and AIDS under Indian law.

“For example, a man with H.I.V. or AIDS, who knowingly marries a woman and gives her H.I.V., would be found guilty of spreading a life-threatening infection. This is a legally punishable offense and carries a jail term of two years,” she explains.

The country has been working with UNAIDS to implement a rigorous targeted intervention program to achieve the established 90-90-90 target: Identify 90 percent of individuals with H.I.V., give 90 percent of those diagnosed antiretroviral therapy, and achieve sustained viral suppression in 90 percent of patients on antiretroviral therapy. The long-term goals are the elimination of mother-to-child transmission by 2025 and zero transmission by 2030.

Mandya, a district in Karnataka known for its sugarcane, has achieved a steady decline in H.I.V. cases this past decade. In 2014, Mandya was ranked second in the state for the most H.I.V. patients; within a few years, it ranked 16th.

Father Roy Vattakunnel, director of Jyothir Vikasa Social Service Society of the Syro-Malabar Catholic Eparchy of Mandya, attributes the decline to effective awareness campaigns, mostly through community theater, posters and billboards, that “educate people against the spread of the virus.” The campaigns are implemented across the district in collaboration with government agencies, voluntary organizations and local communities.

The church-run charitable organization also collaborates “with the government in its prevention and treatment programs,” along with the support of voluntary service organizations, says Father Vattakunnel.

Its program dedicated to helping people affected by H.I.V. and AIDS, called Asha Kirana, extends its care to people who work in the sex industry, which has grown in Mandya alongside the influx of migrant workers in the sugarcane factories. Official 2021 statistics for Mandya indicate that 92 of the 1,221 female prostitutes registered with the Karnataka Sex Workers Union and 56 of the 991 registered male prostitutes were H.I.V.-positive.

Asha Kirana supports more than 350 patients by referring them to treatment centers and offering them counseling, nutritious meals and education about H.I.V. and AIDS. In the first half of 2024, the organization helped identify 14 new cases in Mandya and referred 55 patients to the local testing center.

“The government provides facilities for treatment for patients at the district hospital in Mandya. But because of social stigma, emotional and economic factors, patients aren’t always able to avail these services on their own,” says Father Vattakunnel. “That’s where we come in.

“Ultimately, our objective is to improve the quality and length of life of patients through emotional, spiritual, nutritional and social support.”

Meena K., one of the organization’s 11 staff members, says the predominantly patriarchal culture in Karnataka is a major challenge in connecting with women over issues related to health, H.I.V. and AIDS.

“Women here have to ask their husbands for permission for everything. Without that, they won’t even lift a finger,” she says, adding that it is equally challenging to speak with men who “are just not open to having a conversation and think they know best.”

She, too, tells the story of a man who was H.I.V.-positive and got married without disclosing it to his bride or her family. Then, during each of his wife’s three pregnancies, he coerced her into having an abortion, claiming he did not want to have children rather than disclosing his condition.

“Men don’t realize that, under Indian law, not disclosing your H.I.V. status when getting married is a punishable offense,” she continues. “In this part of Karnataka, men don’t like to be educated or informed. They don’t take their medication on time, neither do they go for regular blood tests.”

Asha Kirana also organizes monthly support group meetings to accompany H.I.V. and AIDS patients emotionally and psychologically.

“We need to make sure people feel supported and don’t give up on life,” says Father Vattakunnel.

“Ultimately, the goal is to have a H.I.V.- and AIDS-free future, where every individual can thrive and grow,” he says. “We have to do this, especially for the poor and neglected ones in society.”

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