rajendarmenenblog


INDIA AND THE CHALLENGE OF HIV/AIDS

By Rajendar Menen

We must accept finite disappointment, but never lose infinite hope.

-- Martin Luther King Jr. (1929 - 1968)

 

In countries like India where food, clothing and shelter remain beyond the reach of most people and where old epidemics in new clothes revisit with uncanny regularity, the battle against AIDS can be lost even before the first slingshots are readied. As most of us who live in this part of the world know only too well, even our fire-fighting techniques are obsolete. But, surprisingly, despite habitually blocking up the attic with body and soul to sensitive issues that need urgent repair, the government ofIndia has stretched itself this time. Systems have been readied and battle stations prepared. The immediacy of the situation has magically reached home.

 

India is a large country living in thousands of villages, towns and cities. Randomly throw pebbles from the sky and they could fall squarely on eighth or twenty-first century India overlapping each other without quarrel. Cultures, creeds, religions, beliefs, castes, languages and disparate socio-economic expression live in some argument but still in reasonable harmony with one another. It is another miracle. All this diversity has some unity. But if one were to prepare a national plan for action this diversity can get in the way. Every inch of strategy will have to be reworked in different metaphors and keeping several shades of nuances in mind. A variety of needs and emotions will have to be catered to.

 

Millions of Indians are illiterate and live in considerable material discomfort. All intervention campaigns have to work through the ignorance first before mailing a message of any import. Poverty and illiteracy share a peculiar intimacy. They live off each other. Get rid of one and the other will surely die. As the economy grows and wealth is more evenly distributed, the reach of information will get larger. But this can take time, and a killer disease needs immediate attention. There is little reaction time.

 

There are several other aspects: legal aid for the HIV-infected; medical help that includes indigenous systems of medicine; the legislation of prostitution as it is all pervasive and cannot be done away with; affordable and quality medical care for those testing HIV-positive; compassionate insurance schemes; professional and dignified testing and counselling services; assurance of employment; protracted and effective advertising campaigns; and the involvement not only of the government but the community as well.

 

The media has played a tremendous role. It has pounced on the big story with alacrity. International aid has poured in and celebrity fund-raising jamborees have ensured that money is not a constraint. In January 1998, the government of India announced the draft of a National AIDS Prevention and Control Policy. The prime objective was to get a stranglehold on the virus without wasting time. Women, children and other vulnerable and "high-risk" sections like truckers had to be protected from the onslaught of the virus. The policy also focused on improved healthcare for those affected and decided to adopt new research and approved templates to handle the virus.

 

All blood is now screened for HIV, professional blood donation has been disallowed by legislation, infected pregnant women have access to medicines, sex education has been introduced in schools, alternate sexuality is being viewed with less alarm, condoms are distributed free in the flesh districts, the female condom has been selectively introduced, hospices are being set up, and India has emerged as one of the largest manufacturers of the highly active anti-retroviral therapy (HAART) with a surplus that eyes foreign markets. It is also believed to be close to discovering a conventional and affordable treatment for AIDS with minimal side effects. No medico-social challenge in India has ever been addressed as seriously as AIDS has. It has rocked the front pages and hogged precious time on television and radio, and an entire generation of professionals is working overtime to get a fix on the problem. Indigenous vaccine initiatives have been launched, and with the advent of HIV a new era in medical jurisprudence has taken birth.

 

India still copes miserably with malaria, tuberculosis and several other strains of both old and new epidemics that take a heavy toll of human life. Add natural calamities, endemic corruption and widespread communal and political turbulence to the boil and you have a country that is bent double with trouble. AIDS only adds to the large burden on its back. It is predominantly a sexually transmitted disease and that makes it far more difficult to ambush in a country of so many people subsisting in such diverse cultural sub-texts. Conservative estimates place the number of those infected at close to six million. But those in the know believe that it could be more than double that.

 

Every effort is being made to stem its spread. There's a good chance that India won't spring another leak and allow HIV to blow up its innards like it has done in other parts of the world. It is certainly a situation that is worth watching with a magnifying glass.

 

****************************

 

A few months ago, I met up with John Frederick, the tall, bespectacled American who speaks and smiles gently in the most self-effacing fashion. He is the guru of the street. He knows more about prostitution and trafficking of women than entire governments. We have worked together in the past and decide to check out Kamathipura. We had heard that it was now living in fear after massive police crackdowns. John has come down from Nepalwhere he runs an NGO called Ray of Hope.

 

We meet up at his digs in Colaba and take a cab to Kamathipura. We check out old places together; we have known several sex workers in the area well and we have gifts and words of encouragement for them. We also talk to local doctors and exchange notes with other NGOs in the field. Then we walk into a little dimly lit bar with a lot of noise. It watches the street and so is a good observation post. We have beer, talk and watch.

 

John tells me about the situation in Nepal. With more guerilla groups attacking the government, the focus on sex work and HIV/AIDS is diluted now. With the increase in population, the numbers in prostitution everywhere, certainly in the developing world, have also grown over the years. "The government is in a mess, the NGOs are trying hard but they are under funded, have dismal conceptual clarity of the issues and are often donor driven," he says. He feels that the Nepali girls in the Mumbai brothels "probably get a better deal than local girls in their everyday slavery/trafficked situation. They appear to live okay. Our studies have shown that they stay in the trafficked/slavery/bondage situation three to five years longer than their Indian counterparts. Probably when they get older, their situation is the same as local girls. But, remember, the work situation differs in both countries. There are no brothel areas in Nepal. The sex industry is a floating population. It is a loose network. Whatever the system, HIV is on the rise everywhere. Our studies have also shown that the police raids in Mumbai have made the brothel communities very paranoid and so HIV/AIDS workers can't reach the women. We feel that AIDS is rising due to the pseudo rescues." 

 

Nepal has an old, informal network of female gharwalis(brothel owners), which is very different from the way girls are recruited to brothels in India. However, irrespective of the type of the organisation of prostitution, John believes that there is a "symbiotic relationship between the police and sex work everywhere. In most big cities, the Mafia too exerts some control over prostitution. Regarding political involvement, I think it depends on the politician."

 

Of all the intervention campaigns he has seen over the years, John rates the Durbar in Kolkata as the most effective. Sonagachi, Kolkata's legendary red-light area, has among the lowest levels of HIV in the subcontinent. The best way to clean up prostitution, he feels, is to "collect and organise the sex workers, give them power to regulate and clean up their own brothel communities with support from others including the government and the police. Strengthen sex worker collectives to reach out to others of their ilk in rural communities and smaller cities and towns. The street and bar sex workers should also be included so that they are all protected and supported at the same time." The bottom line is sex worker empowerment. It's a hard task considering the enormous gender inequity even in more compassionate settings.

 

We pay up and decide to walk around a bit. Pimps follow us with great hope. John is a 'white' man and I look like I have just walked out of a merchant vessel docked in Mumbai harbour. We are choice targets. The pimps surround us. Most of them are alcoholics and drug addicts and don’t believe that we are not flesh shoppers. Earlier, before legislation banned it, they were also professional blood donors. They look like ruins and fit in well with the decay all around. They don’t even understand our disinterest in what is on sale. They recommend different brothels, reel out rates and the virtues of all the girls who, they insist, are pristine pure, highly educated, very sexy, young, healthy, inexpensive and available for as long as we want. I am always amused when pimps everywhere never fail to mention that the girls "are from good families". It almost sounds like a marriage proposal. I tell them that we are from the government and are mapping an AIDS intervention drive. They are not interested and can't be shrugged off. It is irritating and funny too. They keep following us, sometimes tugging at our shirtsleeves. Finally, they blackmail us. "Give us money and we will go." 

 

Kamathipura has changed a lot from the early days. It has been badly kicked in the butt. First, HIV latched on, and now the police have become more aggressive spurred by various concerns of human rights organisations. Quite rightly, there is a watch on children and teenagers entering the profession. But now there are no customers either. They get mopped up in police raids and don’t want to take a chance. As a result, prices have fallen and the women are more desperate. There is talk of leaving the area and moving to other places. New red-light areas are mushrooming all over the city.

 

We talk to Jaya, in her twenties, thin, tall and acne marked, nervously standing on the road, close to a police outpost, looking for clients. She is a 'floater'. She doesn’t belong to a brothel but has visiting rights. If she picks up a customer, she can take him to a brothel she has struck a deal with. She pays for bed space and time wrenching it off the customer's bill.

 

Jaya hasn't had a customer for days. She is worried. There is no money for the family and she doesn’t know what to do or where to go. She also has a lot of competition and there are hundreds like her on the street not protected by the collective economics of a brothel. Her rates are rock bottom now, and she is not standing here, in the noise of traffic and pollution, warding off disease and destitution with all her prayers, for free sex.

We continue walking through the maze of lanes and head back. There is nothing to say. Harsh walls of silence accompany us on the journey home.