Birth in the Age of AIDS: Women, Reproduction, and HIV/AIDS in India

289 Pages·2013·10.44 MB·English

by  Cecilia van Hollen

Birth in the Age of AIDS

Birth in the Age of AIDS
Women, Reproduction, and HIV/AIDS in India
Cecilia Van Hollen
Stanford University Press
Stanford, California
For Lila and Jasper
Stanford University Press
Stanford, California
© 2013 by the Board of Trustees of the Leland Stanford Junior University. All rights reserved.
No part of this book may be reproduced or transmitted in any form or by any means, electronic
or mechanical, including photocopying and recording, or in any information storage or retrieval
system without the prior written permission of Stanford University Press.
Printed in the United States of America on acid-free, archival-quality paper
Library of Congress Cataloging-in-Publication Data
Van Hollen, Cecilia Coale, author.
Birth in the age of AIDS : women, reproduction, and HIV/AIDS in India / Cecilia Van Hollen.
pages cm
Includes bibliographical references and index.
ISBN 978-0-8047-8422-1 (cloth : alk. paper) — ISBN 978-0-8047-8423-8 (pbk. : alk. paper)
1. AIDS (Disease) in pregnancy—India. 2. Pregnant women—Services for—India. 3. HIV-
positive women—Services for—India. 4. HIV infections—Transmission—India—Prevention.
5. AIDS (Disease)—Social aspects—India. 6. Childbirth—Social aspects—India. 7. Medical
anthropology—India. I. Title.
RG580.A44V36 2013
362.19697'9200954—dc23
2012040243
Typeset by Bruce Lundquist in 10/14 Minion
Contents
Acknowledgments vii
Note on Statistics and Transliteration ix
Abbreviations xi
Prologue: Into the Well and Out Again 1
1 Birth in the Age of AIDS 5
2 India Responds to the Epidemic 37
3 “The HIV Test Is Like an Immunization”:
Scenes from Prenatal HIV Counseling 55
4 “I Don’t Need My Husband’s Permission”: Women’s
Views on HIV/AIDS and Decisions About Prenatal Testing 75
5 HIV/AIDS and the Gendering of Stigma 95
6 To Birth or Not to Birth? Constraints and Pragmatics
in HIV-Positive Women’s Childbearing Decisions 125
7 HIV-Positive Women Give Birth:
Deception and Determination 155
8 Breast or Bottle? HIV-Positive Women’s
Responses to Global Health Policy on Infant Feeding 183
9 Creating a Storm: Activists’ Hopes and Mothers’ Fears 213
Epilogue: Memory Boxes 241
vi Contents
Notes 245
Bibliography 253
Index 269
Acknowledgments
This book has been a project long in the making, and countless individuals and
institutions have helped to make it possible. First and foremost, I would like
to extend my heartfelt thanks to all the women living with HIV/AIDS and the
pregnant women I met in maternity hospitals who agreed to participate in my
research. I hope that this book accurately reflects their experiences, perspec-
tives, and opinions and that the publication of this book will lead to improve-
ments in policies and programs for the prevention and treatment of HIV/AIDS
and the care of people living with HIV/AIDS in India and around the globe.
I am extremely grateful to the networks of people living with HIV/AIDS
who let me participate in their activities. I have mentioned these organiza-
tions in the book, but I want, in particular, to thank the Positive Women’s Net-
work (PWN+), the Society for Positive Mothers Development (SPMD), and
the HIV Ullor Nala Sangam (HUNS) network for their support and, above all,
P. Kousalya, of PWN+, for allowing me to have a six-month affiliation with that
network. Thanks also to R. Meenakski, of SPMD; Jeypaul of both the Indian
Network for Positive People (INP+) and HUNS; Rama Pandian of the Tamil
Nadu Network for Positive People (TNP+); and K. K. Abraham of INP+. I am
also greatly indebted to Dr. P. Kuganantham, coordinator of the joint Tamil
Nadu State AIDS Control Society (TNSACS)and the UNICEF Prevention of
Parent to Child Transmission (PPTCT) program, for facilitating my research
in government maternity hospitals in Chennai; Dr. Suniti Solomon and A. K.
Srikrishnan, who made arrangements for my research at YRG Care; and Janaki
Krishnan, who organized my research with the Zonta Resource Centre. Thanks
also to all the counselors, lab technicians, doctors, and nurses in numerous
hospitals throughout Tamil Nadu who participated in this research and allowed
viii Acknowledgments
me to observe them at work with their patients. I would also like to thank the
following individuals in India and the United States for giving me the time to
interview them and for their valuable information and advice based on their ex-
pertise in the field of HIV/AIDS prevention and care in India: Bill Pick (United
States Agency for International Development [USAID]); Christopher Castle
and Ellen Weiss (Population Council); Dr. P. L. Joshi (National AIDS Control
Organization [NACO]); Dr. Bitra George and Laura Kayser (Family Health In-
ternational [FHI]); Drs. Bimal Charles and Devashish Dutta (AIDS Preven-
tion and Control Project [APAC]); Supriya Sahu (Tamil Nadu Department
of Health and Family Welfare); Mr. Dheenabandhu and Mr. M uruganandh
(TNSACS); Dr. Srilata, Dr. Bir Singh, Tim Schaffter, Vidhya Ganesh, and Aruna
Rathnam (UNICEF); Drs. P. Paramesh, S. Rajasekaran, and O. R. Krishnara-
jasekhar (Tambaram Hospital); Drs. R. Shoba and A. Sundaravalli (Institute for
Obstetrics and Gynecology [IOG]); Jacob Varghese (Centers for Disease Con-
trol and Prevention [CDC]); Shyamala Natarajan (South Indian AIDS Action
Programme [SIAAP]); Geeta Ramaseshan (Chennai High Court); T. A. Majeed
(Fair Pharma); Vandhana Mahajan (United Nations Development Fund for
Women [UNIFEM]); Dr. P. Manorama (Community Health Education Society
[CHES]); and Magdalene Jeyarathnam (Health First).
This research would not have been possible without the hard work of
S. Padmavathy, Beulah Rajakumari, Ms. Punitha, Jasmine Obeyesekere, and
Sharon Watson, who have worked as research assistants on this project both in
India and the United States, and Rajeswari Prabhakaran, Dr. Dasaratan, Sheela
Chavan, and members of the YRG Care research team, who helped with the
transcription and translation of recorded interviews. Thanks also to Haripriya
Narasimhan for guidance on the English transliteration of Tamil words.
Many colleagues and graduate students have provided fruitful feedback on the
book manuscript and on presentations of my research at numerous conferences.
For this I would like to thank, in particular, Susan Wadley, Ann Gold, Maureen
Schwarz, Patricia Whelehan, Lawrence Cohen, Stacy Pigg, Marcia Inhorn, Carolyn
Sargent, Carole Browner, Aditya Bharadwaj, Jeremy Shiffman, Susan Erikson,
Margaret Lock, Martha Selby, Melissa Pashigian, Barbara Koenig, Crista Craven,
Lalit Narayan, Jocelyn Killmer, and Chen-I Kuan. I would also like to thank my
editors at Stanford University Press, Stacy Wagner and Michelle Lipinski, as well
as the anonymous reviewers of my manuscript for their constructive comments.
This research was made possible by the generous financial support from
the following institutions: the Fulbright Foundation, the American Institute for
Indian Studies, the University of Notre Dame, and Syracuse University.
Note on Statistics
and Transliteration
This book was written while I was on leave from teaching in 2009–2010. The
statistics, therefore, reflect updated statistics at that time. Epidemiological sta-
tistics and statistics on public health programs are constantly changing, but I
believe that the statistics included in this book from 2009–2010 accurately de-
pict the current trends as of 2012, when the book manuscript went in to press.
I have chosen not to use diacritical marks for transliteration of non-English
words to facilitate reading.