India's Growing AIDS Problem

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The World vs. AIDS, 2004
India’s Growing AIDS Problem

Sanchita Sharma, Hindustan Times (centrist), New Delhi, India, Dec. 5, 2003.

Students in New Delhi participate in a march to raise awareness of AIDS on the eve of World AIDS Day, Nov. 30, 2003 (Photo: Pankaj Nangia/The Times of India-AFP).
Have you ever met someone who is HIV-positive? Going by the government’s statistics, you must have. There are 4.58 million people living with HIV/AIDS in India, says the National AIDS Control Organization (NACO). That’s 0.8 percent of the country’s population, roughly one infected person in a group of 100.

Think about it. You probably had dinner with an HIV-positive person at the last wedding you attended, or rubbed shoulders with more than one while shopping at the India International Trade Fair. Your child may be at school with HIV-positive children without your being aware of it. It’s likely that no one in the school knows either.

For if their HIV-positive status were known, chances are they would be thrown out of school, like 5-year-old Benjy and 8-year-old Benson in Thiruvananthapuram [capital of Kerala]. If they are “lucky,” like the Kerala siblings, their plight may make headlines. Union Health Minister Sushma Swaraj may intervene and hug them, and get color posters made of the now familiar embrace for national and international AIDS campaigns. The school would be forced to take them back, but once the photo ops are over, they would become untouchable again and be asked to sit away from other students. No other child would come near them. That’s what’s happening to Benjy and Benson. Their grandfather—their parents and elder brother died of AIDS—is happy that they are at least getting an education. “I hope they get to study and play with other children in the future,” he said on his Delhi visit for World AIDS Day this year.

When it comes to HIV, discrimination is still the norm. Many prefer not to confirm their positive status and be ostracized. While the National AIDS Prevention and Control Policy ensures protection of human rights, it does not have teeth. To give it legal sanction, Swaraj announced recently that she would table the AIDS legislation protecting the human rights of people living with HIV/AIDS in Parliament.

Courts have been proactive in ensuring rights, but the trickle-down effect has been just that—a trickle. In 1997, Mumbai’s High Court ruled that HIV-positive people cannot be denied jobs on account of their status. But while state institutions can be legally forced to hire a person, little enforcement exists in the private sector. Many firms insist on a health checkup before hiring prospective employees, and if a person tests HIV-positive, he or she is denied a job under another pretext.

People with AIDS are considered outsiders. This perception is incorrect. In India, the infection is increasing the fastest in monogamous married women. Now, out of every three HIV-positive people, one is a woman.

If you think NACO doesn’t know its numbers, think again. Actual AIDS cases and deaths apart, NACO’s projected numbers are based on data collected through sentinel surveillance at prenatal clinics, where pregnant women go for tests before delivery. In such states as Maharashtra, Tamil Nadu, Andhra Pradesh, Karnataka, Manipur, and Nagaland, more than 1 percent of women going for institutional deliveries are HIV-positive. These are not sex workers but married monogamous women, who barely speak to a man other than their husband.

In India, about 80 percent of HIV infection spreads through heterosexual sex, with 89 percent of those infected being in the 18-49 age group. Most people have the HIV-1 virus, which is globally the predominant strain. HIV-1 mutates easily and has many subtypes. While most subtypes are found in Africa, three strains—B, C, and E—predominate in the rest of the world. HIV-1 subtype C—which has a higher potential for heterosexual transmission—is the dominant strain in India.

The enormity of the problem has even turned the usually coy Swaraj into a champion of condoms; it has also prompted her to push for AIDS legislation and to offer free AIDS treatment to mothers, children younger than 15 years, and people living with HIV, beginning April 1, 2004.

HIV/AIDS can be contained—there are lessons from Brazil and neighboring Thailand—but to do that you have to talk about it outside conference centers reverberating with NGO rhetoric.

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In the heart of Mumbai, India [also known as Bombay] lies Kamathipura, one of the country’s poorest districts and also its largest red light district, home to more than 60,000 sex workers. In the spring of 2004, FRONTLINE/World correspondent Raney Aronson traveled to Kamathipura to investigate what has quickly become the center of the AIDS epidemic in India, which affects more than four and a half million people.

On the streets of Kamathipura, it’s no challenge for Aronson to find sex workers to talk with. In a small gathering she asks them frankly about the core issues of their trade – economics and health. The women get the equivalent of US$1.50 for sex, $2 on a good night, less than a dollar on a bad night. To have sex without a condom, men will often pay more or, after a few visits, tell the women they love them. The women in the group laugh a bit about the men’s proclamations of love, but there’s a tragic fact behind their laughter: more than half of the sex workers here are HIV positive.

For the pimps and brothel owners of Mumbai, the sex industry is a multi-million dollar business in which money, not health, is the bottom line. The highest prices go for the youngest girls, many of whom have been kidnapped from other countries and trafficked to India, or sold by their own families into the industry.

Aronson travels to the Sanlaap Shelter, where she meets a group of girls who have been rescued from prostitution. The girls tell their stories – fathers and uncles who sold them, madams who held them hostage. None of them was told about the dangers of HIV. They found out only upon arriving at the shelter, and now it’s too late. Many of them are already HIV positive.

Aronson meets Anju Pawar, a social worker with the ASHA project, dedicated to educating women about AIDS. ASHA is made up of sex workers who go into the brothels as peer educators to talk to the women about safe sex. The work is frequently frustrating. Anju says that the brothel keepers often keep new girls from peer educators for their first few months.

Soliciting for sex is illegal in India, but as Aronson surveys Kamathipura, she sees that the police are often part of the problem. Prostitutes tell Aronson that when arrested, they’re forced to either have sex or pay bribes for their release. And the youngest girls are the most vulnerable.

Not surprisingly, Mumbai’s AIDS rate has soared in recent years. Aronson visits one of Mumbai’s largest public hospitals, one of the few in India that doesn’t turn away AIDS patients. There she finds a man who is well into his sickness. This man is a migrant worker who’s come to Mumbai to make money, contracted AIDS from a sex worker and has likely taken it back to his home community. The man is married, but his wife is far away, at home. The doctors have no way of contacting or treating the wife. Health experts estimate that one-fifth of all AIDS cases in India are married women who have been infected by their husbands.

More than a thousand miles east of Mumbai, along the banks of the Ganges, India’s holiest river, things are different in the city of Kolkata [Calcutta]. Notoriously poor and overpopulated, Kolkata would seem especially vulnerable to infectious diseases, but the red light district there has the lowest AIDS rate of any in the country.

This is due to the efforts of people like Putul Singh, who was sold into prostitution by her husband eight years ago at the age of 20. She now works full-time for the Sonagachi Project, the model AIDS prevention group in the country. As Aronson follows Putul on her rounds through Kolkata talking to sex workers, Putul talks about Sonagachi’s strategy for combating AIDS. Offering basic health care, she says, is the best way to open the discussion about safe sex.

When Putul talks to women she is extremely frank about requiring men to use condoms. As she tells one woman, “[You] must say ‘Look - you have a family at home and so do I. If we don’t use a condom our families will be ruined.’ You have to look at the big picture.”

The Sonagachi Project works with men as well as women to explain the necessity of condoms. Aronson attends a meeting of some of the area’s pimps and regular clients, locally called babus. Listening to Putul’s arguments with one man, who insists that he is disease-free and at the same time refuses to accept that condoms will do anything for him, it’s clear she faces an uphill battle.

Another group meeting, of the sex workers’ union in Kolkata, is more encouraging. Even though prostitution is also illegal in Kolkata, the union is recognized by the state of West Bengal, which has been run by a communist government for 25 years. Union president Rama Debnath explains to union members that when they’re confronted by the police, they need to stand up to them and have courage. “What’s your rank? Where’s the charge?” she tells them to ask.

It turns out that the combination of the sex workers’ union and the Sonagachi Project is making a difference. Condom use has soared in Kolkata, from an estimated three percent to 90 percent. Kolkata’s AIDS rate is one fifth that of Mumbai’s.

But even in Kolkata, a monumental challenge still remains: reaching the thousands of young girls sold into the sex trade. Rama says one way to do it is to legalize prostitution, so there would be regulations. “In the same way other industries don’t employ children,” she says, “This industry wouldn’t employ children either.”

Aronson asks the girls back at the Sanlaap Shelter if they’ve heard of the sex workers’ union. “Nobody came to talk to us,” one girl says. “The only people who came were the police to raid the brothels.”

Although haunted by their memories, the Sanlaap girls are at least now far from the red-light districts from which they were rescued. Most of their families won’t take them back after they’ve worked as prostitutes, but Sanlaap attempts to give them hope for some sort of a future. But these girls are the fortunate ones. Thousands of other young girls are left behind. And what happens to them in many ways will determine the future of AIDS in India.
Reported and Produced by
RANEY ARONSON

Map showing AIDS around the world.

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where is matsui when u need him?

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Every country has an Aids problem. No country is immune from this dreadful catastrophe. The world's materially-richest countries face the problem as well.

i hope no one uses this issue for political purposes.

(Since i find this topic interesting, i'll post more thoughts on this later, once i am done my exam Insha'Allah).

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^ samarra, why is this in the culture forum? Any clue? Plus, why is this posting of an article from 2003 and an old PBS documentary. Furthermore, any comments from the poster? Political, do you think so? :smack:

Now someone should tell the nudnik about the programs in place to curb the scourge, someone should tell them about aggregate spending on education in INdia ont his topic. SOmeone should the poster that we are fast apprioaching the inflection point where the epidemiology is going to change to manageable numbers…anyway, good good…Gamma posted the same article like a few months ago. Maybe the mod can go search it. At least he had a funny comment.

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Hey India is a superpower, whats a few million out of a few billion eh?

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Who would i expect but Matsui......

Welcome.....

Since you are a great admirer of your country in which honey and milk flow (actually ganga flows), please.....i mean please .....contribute and enlighten us about all the different programs your country has, to cure this widespread problem. We are hear to learn. So lets hear what sensible stuff you have to say......Come on.....be a good boy...instead of throwing trash.

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AIDS in India

More than 4.5 million people in India are infected with HIV, making it the second-largest HIV-positive population in the world, behind South Africa. Given India’s large population, a rise of just 0.1 percent in the prevalence rate would increase the number of persons with AIDS by 500,000.

AIDS is most prevalent in the Indian states Andhra Pradesh, Karnataka, Maharashtra, Manipur, Nagaland and Tamil Nadu, where the infection rate is higher than 1 percent. Heterosexual sex is responsible for 84 percent of new HIV infections in India.

The World Health Organization estimates that 330,000 new AIDS cases occur in India each year and predicts that by 2033, AIDS will account for 17 percent of all deaths in India and will be a factor in 40 percent of deaths from infectious disease.

Health experts say mobile workers are at particularly high risk for acquiring HIV and transmitting it to other people. For example, truckers in India are up to 10 times more likely to have HIV than are other workers. **Truckers are away from their families up to 80 percent of the time, and more than half report having sex with prostitutes. **

In a survey, 70 percent of commercial sex workers in India reported that their main reason for not using condoms was that their customers objected.

India has drafted a five-year nationwide intervention program to combat the spread of HIV infection. The government has allotted $320 million in funds for health, education and treatment programs.

S O U R C E

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hmmm.

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FRONTLINE/World producer and reporter Raney Aronson has been tracking AIDS in India for 15 years (Photographer: Niels Alpert)
The last time producer and reporter Raney Aronson set off for India, she was covering traveling theater companies for the FRONTLINE/World segment “Starring Osama bin Laden.” This time Aronson returns to the planet’s second-most-populated country on an investigative journey, exposing India’s AIDS crisis – through the eyes of sex workers. FRONTLINE/World Web producer Angela Morgenstern interviewed Aronson by email about AIDS myths, filming in red-light districts and the prostitute who became an organizer.

How did you come to this story? Why did you decide to cover AIDS right now, and why did you choose India?

A private doctor’s office in Kolkata, one of hundreds offering help for those affected by sexually transmitted diseases and impotency (Photographer: Niels Alpert)
About 15 years ago, I was a college student living in Benares, India. It was 1990, and on college campuses in America there was this explosion of activism and awareness about HIV/AIDS. I would always ask my classmates and my professors about the epidemic; without fail they all assumed it was a Westerners’ disease. So since then I’ve been watching what has been happening to India with great dismay. The first time I filmed on the story of HIV/AIDS was in 2000, when I went with the support of the Pew Fellowships [now the International Reporting Project Fellowships] in International Journalism to four [Indian] cities and focused on women who were HIV-positive and living and working in the red-light districts.

You have a pretty unique personal background: Your father is a medical doctor, but your mother is interested in alternative medicine. How does this affect your view of the AIDS story?

On this my parents pretty much agree – they advocate for prevention and education. In terms of treatment, so far there are no herbal remedies to treat HIV/AIDS … so on the treatment side they’d pretty much agree as well.

A sex worker in a brothel in Ram Bagan, an area of Kolkata (Photographer: Niels Alpert)
Some have described Kamathipura, the red-light district in Bombay [also known as Mumbai], as the “fleshy center of India’s HIV time bomb.” Can you talk about sex workers and the conditions they face in Bombay?

For the most part, sex workers in Mumbai face what sex workers around the world face – many of them are sold into prostitution as young girls and are not there by choice. However, Mumbai is an extreme by all accounts. Many of the brothels in Mumbai are run by local Indian mafia, so there is no way for advocacy groups to work with [the prostitutes] when it comes to prevention of HIV.

A sex worker lifts her dress in Kamathipura, Mumbai’s red-light district (Photographer: Jon Veleas)
Is prostitution legal in India?

No, it is not. In Kolkata [Calcutta], there is a sex worker union that is fighting for the right to be legal. They say this will help them fight HIV and AIDS because it will give them the proper rights they need to stand up for themselves.

What did men tell you about why they don’t wear condoms?

This is only anecdotal. But most of the men I spoke to as they were visiting brothels said they saw no relationship between wearing a condom and preventing HIV and AIDS. So they saw no compelling reason to wear them. Although I’ve heard this is changing, especially in Kolkata.

In Sonagachi, Calcutta, the other red-light district you profile in your piece, the sex workers run the show, demanding that clients wear condoms in an effort to stop the spread of AIDS. Why is Calcutta so different from Bombay?

A young sex worker, sitting on the street in Kamathipura, Mumbai’s red-light district (Photographer: Katherine Patterson)
Well, I don’t think all sex workers can say “no condoms, no sex,” but if they’re able to anywhere in India, it does seem to be more possible in Kolkata.

The two cities are so different it’s hard to compare them, but many say that the major difference is that while Kolkata also has mafia-run brothels, they are more independent than those in Mumbai, and the sex worker unions have actually been able to make an impact. There’s also a very different structure in terms of the sex industry. In Mumbai, most girls are sold into prostitution and are essentially slaves to the brothels. In Kolkata, many of the girls are born into it – and while they have no choice but to be sex workers, there’s a different level of respect.

What specifically do you think helps sex workers in Calcutta to stand their ground?

I do think that the fact that the sex worker unions have stood up for sex workers’ rights helps … Part of the unions’ program is to help women save money and become more independent … so with independence comes the ability to say no when a client wants to have sex without a condom.

India still has many taboos about sex, yet prostitution seems like an accepted part of life. Why is it such a huge phenomenon there?

What we’ve found is that most of the prostitution exists in the cities with the highest number of migrant workers. If you track where the red-light districts are booming over the last century, it’s in the country’s commercial centers – Mumbai, Delhi, Kolkata and Chennai. These cities are the temporary homes for millions of men who are far away from home and their wives. And although men from all classes and lines of work visit prostitutes, these migrant workers are really the bread and butter of the red-light areas. And… there’s the grave risk that they’ll spread it to their rural communities when they return home.

It’s hard to know exactly why prostitution is such a booming industry. India is otherwise a very socially conservative country – women and men marry very early, and divorce is rare. But I’ve noticed that whereas the women are expected to be monogamous, the men are not. I’ve also been told that even though the wives are not happy that their husbands visit sex workers, they feel powerless to stop them or even to question them about it.

An aerial view of Kamathipura from the top floor of a brothel (Photographer: Katherine Patterson)
Your story takes viewers right inside red-light districts and brothels. What obstacles did you face during filming? Were prostitutes or their clients upset by having you nearby?

The prostitutes seemed fine; the clients, of course, were not fine!

It was incredibly difficult … It took me months to actually gain access to the red-light district, and we only filmed in the district for three weeks – much of that time was downtime as we negotiated further access. Actually filming inside the red-light district is very hard, especially at night. When we filmed in 2000, men threw things at us, and even with escorts we had trouble filming.

Men outside of a brothel in Kamathipura (Photographer: Katherine Patterson)
Were you scared? What did the cops think about you?

It’s not an ideal situation, but it’s okay – and we spent most of our time filming during the day, so it worked out in the end. But filming at night is always the most challenging part of the shoot by far.

We were able to pretty much film inside the districts without the police knowing. We’re on journalist visas, so we’re legitimate, and we actually even told the Indian government where we planned to film – but the police are notorious for shutting down film crews in the red-light district. In Mumbai, many people say that’s because of their ties to the mafia, but, of course, I have no proof of that.

In India, it’s traditionally taboo to talk about sex – one of the reasons that education about HIV/AIDS is hard. How did you get women to open up on camera?

It’s very difficult – the subject of sex is taboo, and AIDS is really off limits. Many of the women told me they couldn’t talk to each other about it but they could talk to me. That has much to do with the fact that I’m a foreigner, and they felt the same social rules and mores didn’t apply [to me].

FRONTLINE/World producer and reporter Raney Aronson with one of Kolkata’s sex workers (Photographer: Niels Alpert)
What do you think the sex workers thought about you?

They seemed to like that I was talking to them about their health and their future. I think many of them were wary, and worried. But a few of them actually made an effort to talk to me and explain what was going on.

Who was the most interesting woman you talked with?

I suppose a woman named Putul Singh in Kolkata. She was this woman who had given up the sex industry to work in the union full time. She welcomed me into her home and told me her story. Putul was sold into sex slavery by her first husband, but along the way was fortunate enough to meet up with the sex worker union. Through their help, she was actually able to leave the trade and work full time for them as a union member. After a few years doing this, she met her current husband, whom she married and lives happily with – now no longer in the city, but in the country. I hope to follow up on her story. There aren’t many happy stories in the red-light district, so she stood out to me.

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India should set up a separate ministry to handle AIDS? It's good that Sonia Gandhi is personally attending the AIDS conference in Bangkok.