India... a very sick place....
Straydog
100-150 million child laborers? In India?
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diseases. India has the largest numbers of child laborers of all
countries ? an estimated 100-150
million. children between the ages of 5-14 are not in ...
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Page 1
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Risky Sex, Addictions, and Communicable Diseases in India:
Implications for Health, Development, and Security
Rajan Gupta
Theoretical Division
Los Alamos National laboratory,
Los Alamos, NM 87545
LAUR 02-5305
This monograph was published as Special Report 8 in the Health and Security Series by the
Chemical and Biological Arms Control Institute (CBACI), Washington D.C., September 2004.
ABSTRACT: This monograph provides a comprehensive and unifying view of a number of health
issues
confronting India and how, over time, they could impact the stability and security of the nation.
New pandemics
like HIV/AIDS have confounded attempts at containment because their spread highlights
vulnerabilities in
social and political norms and behaviors that have historically been ignored. Their spread also
exposes a highly
inadequate medical and educational infrastructure. To stop the spread of communicable diseases
for which risky
individual lifestyles and behaviors, societal norms and beliefs, poverty and lack of empowerment,
and stigma
and discrimination are major factors it is necessary to examine the system as a whole and to
develop new
paradigms and tools. Sexually transmitted infections and addictions to alcohol and drugs have
emerged as a
major interconnected global threat. This monograph makes the case that India is highly vulnerable
to this threat
and major policy changes, an unprecedented cooperation between public and private sector, and
an order of
magnitude more investment in health and education is needed to prevent a runaway situation as
has transpired
in much of Sub-Saharan Africa.
Page 2
2
CONTENTS
FOREWORD................................................................................................................................
4
AUTHOR’S
PREFACE...............................................................................................................5
I. INTRODUCTION
....................................................................................................................6
IIA. INDIA MUST ACT DECISIVELY TO STOP THE SPREAD OF HIV/AIDS..............9
IIB. THE HIV/AIDS SITUATION IN INDIA.........................................................................12
Status of HIV Infections in the Armed and Police Forces...................................................16
Factors Preventing Effective Response to HIV/AIDS and other STIs...............................18
Poor Public Health and Health Care.....................................................................................19
Poor Policy in an era of Simultaneously Occurring and Mutually Reinforcing Health
Crises.........................................................................................................................................2
1
Poor Implementation...............................................................................................................23
III A. RISKY
SEX......................................................................................................................25
Sex Work
..................................................................................................................................25
Sex Industry:........................................................................................................................25
Brothel Based Workers:......................................................................................................26
Street Workers:....................................................................................................................27
Housewives and Casual Sex Workers: ..............................................................................27
Call Girls and Boys: ............................................................................................................27
Sex in Exchange for Favors:...............................................................................................27
Men Having Sex with Men (MSM)........................................................................................28
Hijras and Transsexuals:....................................................................................................28
Migrant Workers and Slum Dwellers ...................................................................................28
Child Labor and Work Gangs ...............................................................................................29
III B. Social Norms and Practices, and Reproductive Health in India.................................30
Religion and Culture:..........................................................................................................30
Private Sector: .....................................................................................................................30
School and College Students: .............................................................................................30
Abortions:.............................................................................................................................31
Rape:.....................................................................................................................................32
Abuse of Children: ..............................................................................................................33
Incest:....................................................................................................................................34
Pre-Marital Sex And Sex Education: ................................................................................34
INTERVIEW...........................................................................................................37
A Taxi Driver in Delhi Talks about Risky Sex.......................................................37
INTERVIEW...........................................................................................................41
Sex Workers in Chennai talk about their trade .....................................................41
IV. ALCOHOL AND DRUG ABUSE ......................................................................................45
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3
Background on alcohol abuse.................................................................................................45
Failures at Control ..................................................................................................................46
Trafficking Of Illegal Drugs and Unregulated Sales of Pharmaceutical Drugs ...............48
INTERVIEW...........................................................................................................52
Conversation with an Alcoholic..............................................................................52
INTERVIEW...........................................................................................................57
Conversation with a Taxi Driver in Delhi on drug abuse .....................................57
V. PREVAILING REALITIES, BELIEFS, AND CHALLENGES ......................................61
VI. WHY HAS THE SONAGACHI PROJECT NOT BEEN REPLICATED?...................65
VII. CREATING SOCIAL AND POLITICAL WILL...........................................................69
VIII. RECOMMENDATIONS FOR INTERVENTION STRATEGIES.............................74
Health, Sex, and Life Skills Education..............................................................................74
Public Health Campaigns:..................................................................................................75
Harm Reduction Strategies:...............................................................................................76
Voluntary Testing and Counseling:...................................................................................77
Care and Treatment:...........................................................................................................77
APPLYING THE STRATEGIES ..........................................................................................77
Empowerment:.....................................................................................................................78
Treatment:............................................................................................................................79
Targeted intervention: ........................................................................................................79
Stigma and Discrimination:................................................................................................80
Prohibition: ..........................................................................................................................81
Monitoring: ..........................................................................................................................81
The role of donor nations, international and charitable organizations:........................82
Examples of decisive action:...............................................................................................82
IX. IMPLICATIONS FOR STABILITY AND SECURITY OF INDIA..............................84
X.
SUMMARY............................................................................................................................92
ACKNOWLEDGMENTS..........................................................................................................9
5
REFERENCES
...........................................................................................................................96
Page 4
4
FOREWORD
This study on India is part of the Chemical and Biological Arms Control Institute’s program
on Health and
Security – Special Report Number 8. In addition to the present study, there exist companion
monographs on the
impact of health on the security of China, Russia, and South Africa.
1 2 3 4
Rajan Gupta is the leader of the Elementary Particles and Field Theory group at Los Alamos
National
Laboratory. He came to the USA after obtaining his Masters in Physics from Delhi University,
India, in 1975
and earned his Ph.D. in Theoretical Physics from The California Institute of Technology in 1982.
The main
thrust of his research is to understand the fundamental theories of elementary particle interactions,
to model and
simulate Biological and Statistical Mechanics systems, and to push the envelope of High
Performance
Computing. He has published over 100 research papers in prestigious refereed journals and is a
fellow of the
American Physical Society.
Starting in 1998 his interests broadened into the areas of health, education and development. The
initial
motivator was the specter of the global spread of HIV, and in particular, the ominous situation in
his country of
origin – India. To understand the issues and to make a difference he visits India twice a year to
work with
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