A Deadly Passage to India

More than 20 million people could be infected with the AIDS virus by 2010. A journey to the heart of a suffering nation

By Geoffrey Cowley

NEWSWEEK

Nov. 25 issue —  Wonder, degradation, hope—it’s all on parade on a torrid summer night in Kolkata’s Kalighat district. Pilgrims are swarming in the jasmine-scented mist outside the Kali Temple. They’ve come from all over India to pay homage to Kali, the fear-some Hindu goddess who continually devours whatever life the earth generates. The lane leading up to the temple is a joyful riot of rickshaws, mopeds, stray goats and street vendors.

INSIDE, THE MOOD approaches ecstasy as worshipers burn incense and lay garlands and balloons at the feet of Kali’s statue. But the scene grows darker, and death more mundane, as you wander the torch-lit lanes that extend behind the temple to the bank of the Hugli River. Pigs for-age freely at the waterfront for garbage and funeral-pyre leftovers (open fires make imperfect incinerators). Men lounge on cots in front of small huts while, inside, their wives perform sex acts on strangers for a few rupees. Kids play on the pavement amid pimps and johns who hunger to put them to work. The AIDS virus thrives in places like Kalighat, and Asia has many of them. That’s one reason the region is now in such peril.

As the vanguard of what the CIA has dubbed the “next wave” of the global AIDS crisis, India and China could have 40 million HIV-positive people by the end of this decade—the same number the entire world has today. The CIA predicts that India alone will have 20 million to 25 million infections, up from 4 million today, “even if the disease does not break out significantly into the mainstream population.” That’s not to say that disaster is inevitable. Despite its widespread poverty, India has a growing economy and the rudiments of a health-care system. It also enjoys substantial support from international donors such as USAID and the Bill and Melinda Gates Foundation, which last week announced a new $100 million India initiative. But it will take more than money to stop this juggernaut. The challenge, says Dr. Helene Gayle of the Gates Foundation, is to create a national network of AIDS prevention programs to reach all those in need. As anyone traversing this vast country soon learns, that is a tall order.
       
YOUNG WIDOWS
AIDS has varied faces in a country this vast, but those of the women stand out. As I discovered in the Tamil town of Namakkal, a monogamous woman can earn her in-laws’ contempt by getting infected by her husband. With their bright saris, almond eyes and shiny black hair, Chitra, Selvi, Suganda, Selvamani and Vanilla look more like college girls than widows. When the girls were in their late teens or early 20s, all five married truckdrivers and, in keeping with tradition, stayed home to care for babies or in-laws while their husbands plied the highways. All five are now HIV-positive, and all but one have nursed their mates through their own illness and death. The women still wear their wedding necklaces, still care for their young children. Yet each is now reviled by her in-laws. “The family always blames the wife,” Suganda explains matter-of-factly. “Very few husbands will admit their own responsibility.”

It’s easy to feel for Suganda, harder to sympathize with whatever truck-stop prostitute propelled the virus into her life. Then you meet her, or someone like her, and realize what a small role that choice has played in her life. Pattamal is one of 500 young women working the trucks that stop for gas or repairs on a 30-mile stretch of road outside Chennai. She is not a derelict, not a party girl; she’s a mom. Seated on a stool in the roadside office of a service organization called Santoshi, she strokes the hair of her quiet 6-year-old daughter and explains her strategy for keeping the child fed. When a driver propositions her on the roadside, she secures a commitment of 100 rupees ($2), then gives him 10 minutes behind a bush or in the cab of his truck. If the driver pays up, she makes as much as she would from a day of scrubbing floors, and hardly has to leave her daughter’s side.

How did India get into this mess? In many ways the country has been an AIDS disaster waiting to happen. Poverty and illiteracy are rife, and the commercial sex trade is huge. Women have little if any say in their sexual and reproductive lives. And a well-developed transportation system ensures that a sexually transmitted virus will spread widely once it arrives. When HIV arrived, in 1986, it had been battering other countries for five years, and its dynamics were well known. But instead of mobilizing to contain the virus, public officials blithely asserted that India’s “moral character” and conservative sexual mores would keep it from spreading. The virus quickly defied that prediction, racing through red-light districts, infecting both sex workers and their clients. So the police started rounding up sex workers for mandatory blood tests, sometimes jailing the infected instead of promoting safer sex. Hospitals took a similar tack, using blood tests to expose and evict infected patients.

URGENT THREAT
The political landscape is more hospitable today. The leaders of both major parties now acknowledge the urgency of the threat, and the country’s AIDS-control agencies have won worldwide acclaim for their work with high-risk groups such as sex workers and street kids. Unfortunately, many average Indians are still living with more risk, and less protection, than they realize. Some 7 percent of the nation’s adults harbor sexually transmitted infections—and nearly four men in 10 recall at least one homosexual encounter, according to surveys conducted by the Delhi-based Naz Foundation Trust. Sexuality was once a major theme in the culture. Tamil Nadu’s temple sculptures offer elaborate taxonomies of sensual pleasure, both for couples and for trios (“One lady, two gents,” as my guide politely observes). But the Kama Sutra spirit is not much in evidence today. Sex is largely absent from the Bollywood cinema, the mass media and casual conversation. 

Schools offer little or no sex education. And homosexuality is not only a moral offense but a legal one under Section 377 of the Indian Penal Code. If sex has become a difficult topic for ordinary Indians, AIDS is often an impossible one. Groups providing care for patients or orphans risk eviction if their landlords or neighbors discover their true mission. In several recent instances, local cops have detained or harassed outreach workers for distributing the government’s own safe-sex education materials.

Where, then, is the basis for hope? A mom with other options would not turn $2 tricks on a roadside. A wife with other options would think twice about waiting on her in-laws while sex workers waited on her spouse. And children with options would surely look beyond the alleys of Kalighat for their livelihoods. No one—not even Bill Gates—can create such choices by fiat. But at every level of Indian society, one sees hints that change is possible. Pattamal may live humbly, but she learned about HIV in time to avoid contracting it herself. She has used condoms consistently for the past five years. As an educator for Santoshi, she now distributes them to her clients and her peers. In a benevolent pyramid scheme, she then enlists them to do the same. Similar programs have sprouted in most of India’s red-light districts in recent years, and some have shown dramatic results.

RECALLING BAD DREAMS
In Kolkata’s Sonagachi district, a grassroots sex workers’ collective called the Durbar Mahila Samanwaya Committee (DMSC) has held its 30,000 members’ HIV rate below 10 percent for the past decade, even as the rates among other cities’ sex workers has topped 50 percent. When members talk about the years before DMSC started in 1992, it’s as though they’re recalling bad dreams. Manju Biswas is typical. She was barely 13 when a neighbor in her village brought her to Kolkata on the pretext of finding her a job and sold her for $30 to a brothel keeper. Manju’s father, a subsistence farmer, had died and her mother and brother were facing starvation. She was completely illiterate. “I was kept in a small, dark room locked for days by the madam,” she told me. “Then one night I was forced to drink something that made me dizzy, and then this huge, drunken man was on top of me. I was screaming in pain but I fainted. When I woke up I was bleeding heavily. The madam told me I was now a fallen woman and should stop pestering her to let me go home. These men, 10 to 15 a day, would call on me. It was a horrible life.”

Through simple coalition-building, the DMSC gradually transformed the surrounding district and became a legitimate power broker. “We have now branches in almost all the towns and cities in West Bengal,” says Swapna Gayen, DMSC’s president. “We now sit across from officials and discuss matters relating to our health and welfare.” The group also runs a 24-hour AIDS hot line that offers free medical and legal guidance to anyone seeking help.

Whatever their circumstances, few sex workers would choose prostitution for their daughters. While standing up for their own rights, most also do whatever they can to see their own children liberated entirely from the trade. On that front, too, signs of progress are easy to find. On the edge of Mumbai’s crumbling Kamathipura red-light district, a group called Apne Aap has created a safe place for school-age girls (they call themselves “Sparrows”) to read, paint and socialize. Another group, Sanlaap, runs a similar operation in Kolkata’s Kalighat. Because this district’s prostitutes work in their huts, the kids are essentially homeless from dusk until midnight. But for the past few years they have spent their evenings in Sanlaap’s two concrete shacks, getting the encouragement and electric lights a kid needs to become literate. As I sat down with a dozen of the teens who frequent the drop-in center, its impact was palpable. All but two are in school. Seven are planning for college. And any one of them, even the 10-year-olds, can tell you how to avoid contracting HIV. The Sanlaap kids have recently launched a campaign to raise AIDS awareness within the red-light district—and the older ones are now seeking a wider audience. “We want to be leaders,” says Sushmita, a poised 18-year-old who has just completed her college-entrance exam. “We want to show people outside Kalighat that a youth group from this district can make a difference.”

Small victories add up, but neither the Kalighat kids nor the Sonagachi sex workers will transform a nation of 28 states, 24 languages and a billion people. It’s one thing to get a child through school, quite another to shatter a legacy of fear, ignorance and stigma. Fortunately, bigger players are now embracing that goal. The Gates Foundation has yet to work out the details of its new $100 million program, but its immediate goal is to target the country’s huge mobile population—not only truckers but also soldiers, railway workers and oil workers. The foundation has the clout to foster alliances among employers in all those sectors, and the freedom to cross the public-private divide. One can only guess how all these efforts will play out. What’s clear is that Asia’s infant plague does not have to grow into a disaster.
       

With Sudip Mazumdar
       
© 2002 Newsweek, Inc.