AIDS in India: Globalization to Blame

Melissa Frick

The dusty plains outside of Mumbai have transformed into concrete highways in front of Kumar’s eyes during the past two months. He had been working outside of this great city of India for a while and was witnessing a great revolution in India’s history. Just like his uncles and cousins, people were flowing into cities at breakneck speed because of the economic opportunities that globalization had to offer. Even the unskilled workers from the rural areas were promised that they could find work within the cities.  Just last month, Uncle Ganesh was finally able to escape his severe upper-caste landlord because he could afford to live on his own. Kumar had left his small village to become a road worker. Men like him are vital to the growth of India’s economy because they are building the infrastructure to connect these sprouting cities. Overall, these highways are increasing the internal immigration of the country at rates never seen before; yet, Kumar is also witness to a quieter revolution that the government denies and refuses to help with. He sees small shacks on the sides of these highways where female prostitutes live and work. He has heard from coworkers and the increasing number of truck drivers about the red-light districts in the city. Then, he occasionally hears about the “sickness,” or sees that Amir hasn’t shown up for work in the past week, he has gone home too. Kumar doesn’t know what to call it, but first-world countries know perfectly well what to call the affliction of this growing country. The AIDS epidemic in India has been entirely perpetuated by the heterosexual relations of unskilled workers who are traveling further and faster between cities because of India’s new, globalized economy.

Once one of the poorest countries in the world, India has been blessed by the economic prosperity of globalization.  It once was a nation compromised of 600,000 small villages, each of them a separate unit that lived an ordered and traditional life for centuries. Remaking the Indian society, globalization has made these modern cities economical and psychological magnets for many unskilled workers; yet, this globalization has brought hidden consequences such as the HIV epidemic that has exploded in the last ten years. Furthermore, the populations that are falling victim to this disease are not the ones reaping the benefits of globalization. They are the ones who still live at sustenance level and cannot keep up with the escalating medical expenses or have the education to understand preventative measures against contracting the disease.

It was not until the 1980s when AIDS was formally recognized as a major disease internationally. Before then, researchers followed patterns of concentrated epidemics such as sarcoma, tuberculosis, and meningitides which probably signified small pockets of AIDS infections. It has taken this long to diagnose because of its unusual characteristics. These attributes, known as the “triple-cocktail” also lend to the reason why this virus is so lethal and wide-spread. When first infected with the HIV virus, it takes many months or years before one starts showing any symptoms of illness and the initial symptoms are not overtly visible. HIV wreaks havoc on the immune system and lowers the human’s natural ability to defend against viruses, bacteria, and fungi. Also, people do not die quickly of AIDs and can even life a lifetime while being infected. It is precisely this longevity and that people cannot initially tell when they are infected which increases the risk of them spreading the disease to others. 

It has been the globalization in India that has increased the spread of AIDS; this is partially due to the demand for larger highway systems to increase connectivity and mobility between the cities. The expansion of highways will allow roads to carry more traffic and freight than ever before. The Indian government has begun a 15-year $6.25 billion project to widen and pave some 40,000 miles of narrow, decrepit national highways. It amounts to the most ambitious infrastructure project since Indian independence in 1947; it is forecasted to be even more culturally defining that the British building of the subcontinent's railway network of the 19 th century. Globalization has also created a race for economic freedom: many unskilled worker are already earning higher incomes because of the economic progress of India. With rising incomes, men have more disposable income at hand. Unfortunately, they have been dispensing this for sex. Also, the Indian women, who do not have the same freedom in searching for new job because of their cultural repression, see prostitution as their only way to economic prosperity in their transforming nation. They do not want to be left behind. Globalization has led to new plants and factories springing up along the revamped highways. As rural migrants come to work in the factories, poor women follow to sexually service the men. Newly rich locals patronize the abundant supply of women, spawning H.I.V. "hot spots" along the highways. These highways, in many ways, are the reason for the quickly spreading threat of AIDS. When HIV first came to India, it was initially concentrated in three areas: Mumbai and Pune, in the western region; Chennai and the union territory of Pondicherry, in the south; and the state of Manipur, in the east.  Highways are blurring the lines between these high-risk (urban) and low-risk (rural) populations.

There are three native populations that are guilty in this spread of HIV/AIDS. All of these populations share similar backgrounds in that they come from impoverished villages and are prepared only for menial work. This only exacerbates their position because they lack the education or understanding of such a disease. First, there are the five million truckers, where eleven percent are HIV positive, which is a significantly greater percentage than the infection rate of the entire Indian population. These men have been given longer assignments that take them further away from home much longer than any previous generation. In times like these, they are frequenting red-light districts more often. They then come home to infect their wives and future children. The rural, unskilled, migrant workers. The grandeur of these new cities have attracted these workers from many different parts of the entire country. Much like the truckers, many of those migrants visit sex workers because they are farther from their home and small- town morals. Finally, the sex workers are the last guilty population. This epidemic would be much less severe if they used protection, but a majority of these workers do not. Whether it be a cultural belief or not, men pay more for unprotected sex and these women cannot take a pay cut when their livelihood depends on this way of life. The migrancy of these sex-workers has also increased and women have been traveling across the country to live in large cities looking for their big break.

An Indian truck driver: Up to 11% of drivers in India have tested HIV positive

The cultural roots of India have fueled the epidemic as well. The unskilled and uneducated populations are the ones who are particularly affected by AIDS and this is no coincidence. Unable to comprehend the consequences of the disease, these people have created their own beliefs about it. Some workers believe that they will only catch HIV if they have unprotected sex daily and are immune if they are only weekly frequenters to the red-light districts. Forty percent of the native population is illiterate, with women, tribal, and lower castes predominantly affected. This illiteracy furthers the ignorance of the disease. For example, the women who use condoms could still be at risk because they were unable to read the expiration dates on the packages. In addition to the lack of education, the puritanical values of British colonialists repressed sexual expression and stigmatized it in many Indians’ eyes as well. They turn a blind eye to the red-light districts even though women openly sell themselves on the street corner. In denying the problem, they also chase away prevention groups because these groups dare to discuss promiscuity and disease, condoms and HIV.

We have seen similar patterns of infection at the start of the AIDS epidemic, much having to do with the onset of modernization and an increase of transportation. On the eve of the African epidemic in the 1960s, two sources of human dislocation took place in Africa immediately after the decolonization of Africa. First, there was an influx of foreigners. These were the tourists and servicemen, both ignorant to their role in spreading a disease through their visits to prostitutes. It was most likely these men, upon returning home, who were the first to carry HIV overseas. Secondly, there was a mass movement of natives who concentrated themselves in urban areas. Africa was more open to polygamous relationships but still interdicted prostitution until the mass move into cities. Once people were removed from the “yoke” of behavioral expectations imposed by traditions of village groups, city-goers composed a new set of sexual patterns. This may also explain why cities are such a cesspool for AIDS in India as well. A great example of the influence of human migration patterns on the spread of disease is found in South Africa. Before the decolonization of Africa, HIV was limited to small, sporadic outbreaks; yet in the 1960’s, there was a migration of seasonal, unskilled workers who traveled down to South Africa searching for work. It was then when cases began to spread rapidly and South Africa has the highest rate of HIV infection in the world today. In addition to these shifts in population, the African epidemic was much like the Indian epidemic in that homosexuality, drug addiction, and hemophilia have played practically no role in the spread of the virus.

Establishment of public policies is desperately needed in India. Medication will help, but that won’t change the habits of the population. Intervention and prevention policies are what will stave off future infections. These will be the “tech fixes” for the AIDS epidemic in India. The government has not been helpful in the establishment of public policies to help in HIV and AIDS prevention. For the most part, they have denied the problem of the epidemic and cite other diseases as more pressing of issues. Globalization has done so much to help them that the government will take no action to limit the immigration of needed workers; thus, a public policy needs to be created in coordination with the government. It would be impossible to try to diminish the number of truck workers or laborers entering the city because that is what the government wants at the eve of its globalizing economy. Yet it is possible to target the uneducated population as well as the jobless women in efforts to undermine this disease. To do this, the Indian government should look to the Bangladeshi as an example. Bangladesh has created an amazing enterprise that is successfully tackling the tuberculosis epidemic within the country. Funded by the government and other private groups, this Bangladesh Rural Advancement Committee deploys an army of women across the country to conduct daily household surveys, look for infected patients, encourage them to get tested, and then administer or advise upon treatment. India should adopt a similar system because it would give many women simple, paid jobs and remove them from the streets – not to mention that it provides some kind of empowering education for the repressed women of India. It would also cross the barrier between the educated and uneducated. Many men and women do not know that the threat of the disease is out there. If one of their own approaches them about the subject, they may be apt to listening. This widespread, traveling and educating treatment group may be the tech fix India needs; if it has been successful in Bangladesh, one of the poorest and most crowded countries in the world, it might have a good shot in India.

So far, Kumar has been one of the lucky workers to not have contracted the disease. If he isn’t educated soon about the dangers of unprotected sex and HIV, he might fall victim. Many of his coworkers chase away the prevention groups that travel up and down the highways, trying to let workers and drivers know the risks they are facing. According to the native population, these people are attacking their way of life and denouncing the Indian culture. What the workers fail to see is that globalization is doing the same thing, not only economically, but politically and morally as well. Sixty years ago before the dawn of globalization, not one man would consider an extra-marital affair. Now, an entire epidemic is fueled upon such a thing. It may be true that foreign prevention groups cannot be of much help to Kumar and his coworkers; not because of their message but because of their cultural differences. This adds to the arguments that that India needs to takes responsibility of this outbreak and take action from within to prevent the growth of this AIDS epidemic.


Works Cited:

Ghosh, Jayati. "A geographcial perspective on HIV/AIDS in India," Geographical Review. Vol. 84, No. 4. Oct, 1994, pp. 367-379.

Grmek, Mirko D. Translated by Russell C. Maulitz and Jacalyn Diffin. "History of AIDS: Emergence and Origin of a Modern Pandemic." Princeton, NJ: Princeton Univeristy Press, 1990.

Waldman, Amy. "On India's roads, cargo and a deadly passenger." New York Times 06 Dec 2005 26 Marh 2008 <>.


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last updated 3/27/2008