AIDS in India.

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Aug 27, 1999, 3:00:00 AM8/27/99

In India, the depths of medical prejudice and the scale of HIV
infection rates outclass any language used to describe them, suggests
Abtar Sanga. Yet the indomitable militancy of India's students and the
inventiveness of the country's charity workers mean you can still find
a good word for humanity

It was on the second day of the International Conference on Aids India
2000 that a young woman delegate related the story of how she had
become infected with HIV. An employment broker who had promised her a
job as a maid had sold her to a brothel. Clients paid the brothel
keeper extra not to use a condom.

Now an active HIV prevention campaigner in Madras, she explained how
doctors and hospital staff in India often refused to treat people with
HIV, or were indifferent about the services they offered. The
following morning, her argument was reinforced when two Indian medical
doctors refused to sit on the same conference bus as HIV positive

I was in Madras (now becoming more widely known as Chennai), as a
delegate at the conference, representing the Asian Communities Sexual
Health Project in Sandwell in the West Midlands, where I am a
development worker. The conference, last December, brought together
450 experts from around the world to discuss the virus, testing and
therapy. Few of us were expert enough for the crisis we were
introduced to.

Madras is India's fourth largest city and the capital of Tamil Nadu
state. It has a population of 6.5 million who speak either English or
Tamil. Madras was the site of the East India Company's first
settlement in 1639 and Clive of India made it his base for the
military expeditions that would so enrich the British Empire.

The conference inauguration, with speakers from Brazil, Africa and
Australia, provided a business-like start and then Shyamala Natarajan,
head of the South India Aids Programme, got to her feet. She started
to complain about the shortage of free condoms. This sparked further
protests from students who began shouting slogans demanding regular
free condom distribution. They circulated a press release to all the
delegates saying that condom distribution had been cut so much that
some HIV prevention work in Tamil Nadu had been halted altogether. It
was estimated that the state needed between three and five million
condoms a month while only 500,000 had been offered to HIV projects.
Now, they claimed, the Ministry of Health and Family Welfare was
asking projects to charge people for the condoms they were given.

Yet even this single problem among six million people, daunting as it
is, has to be put into the vast perspective that is India. This is a
country with a population well over 900 million, a fraction of the
global landmass but with 17 per cent of the world's population. There
are more people in India than in Africa, Australasia and South America
combined and by the year 2025 it will have grown to 1,392.1 million -
bigger than China. Every year a new Australia is added to India.

As it enters the next millennium, India will be able to claim the
highest number of people infected with HIV - three to five million
people of whom up to 100,000 are living with Aids already. The best
estimates show that 5,000 Indians are infected daily and that six out
of 10 of them are women aged under 20.

Of course, it was never meant to be like this. The first case of HIV
was diagnosed in Madras in 1986 by Dr Suniti Solomon; her findings
were initially dismissed by government officials who insisted that
India's superior moral and religious framework provided protection
from the virus. The slow response from the health ministry meant HIV
infections continued to spread in India in the face of repeated
ministerial denials that the virus was even a public health issue.

The India Health Organisation (IHO) now estimates that by the year
2000 India will have 20 million HIV infections, figures backed by the
United Nations Aids Programme and the World Health Organisation.

The IHO also believes that from 1992-96, an astonishing 65 per cent of
India's Aids budget (of about 300,000,000 rupees) has gone unspent.
The government response to HIV is described as 'lukewarm' compared
with more determined attacks on public health threats such as ebola,
plague and cancer.

Delegates heard how India is now considered to be experiencing the
'third phase' of an HIV epidemic. The first phase of HIV was
recognised in 1988 when infections were established among sex workers
and professional blood donors.

The second is described as starting after 1989 when men who visited
sex workers, and people who had received blood transfusions, were
found to be infected. The third phase began as the number of HIV
infections among wives (infected by partners) started to increase and
children were born with HIV.

During the symposium on young people and prevention, Indian delegates
explained how the first two phases were completed within a general
assumption in Indian society that HIV was an issue that could not
affect the majority. The 'arranged marriage' system and power of
religion were cited as adequate protection against infection.
Prevention initiatives were seen as unnecessary because pre- or
extra-marital sex did not take place.

The most rapid and well-documented spread of HIV has occurred in
Bombay (now called Mumbai) and in Tamil Nadu. In Bombay, HIV
prevalence has reached the level of 50 per cent among sex workers, 36
per cent among STD patients and 2.5 per cent in women attending
antenatal clinics. Contrary to traditional belief, STDs and sex with
multiple partners are common in places like Mumbai, which alone has a
population of 17 million.

People living with HIV and Aids face varying degrees of discrimination
and, at times, are isolated in hospitals. The taboos around sexuality
and the stigma attached to STDs mean most people living with the virus
hesitate to approach clinics or hospitals fearing discrimination and a
breach of confidentiality.

Some very good HIV prevention initiatives are taking place in India
through non-governmental organisations, voluntary effort and student
activity. For example, in Madras the Teddy Trust spread HIV prevention
messages to rural areas through puppet theatre delivered by young
children. The Aids Prevention and Control Project has been involved in
a project with a Tamil Nadu film star who agreed to appear on a poster
and other publicity material. The conference made very little mention
of transmission between men, yet initiatives targeted at men who have
sex with men and also launched among the significant population of
eunuchs are underway.

On a wider scale, condoms are now advertised on television and
prevention messages are visible via billboard advertising. Public
transport vehicles carry prevention messages, which also appear on
street signs.

World Aids Day produced very public events in Madras and Bombay. In
Madras, children formed a human chain stretching several miles along
the popular beachfront leading to public readings from prominent
guests including the state's Minister of Health..

In Bombay, the Indian Health Organisation held two 'Aids Exhibitions'
at the central train station and at the very busy Churchgate Station,
giving out information and condoms. According to the IHO,
approximately three million people pass through the station every day.

A city college performed street plays and an Aids effigy was burnt as
part of a vigil against the virus at Girgaim Chowpatty.

For me, the conference brought home just how good community level
initiatives can be. These are often done on very low budgets, or
entirely through charitable donations or by using volunteers. Some
prevention work in India now has a high public profile and is able to
reach thousands of people. However, the discussions that I had with
other delegates suggested the need for a stronger commitment from
government departments to fund prevention and care programmes. One
personal lesson, that will be incorporated into the work of the Asian
Communities Sexual Health Project in England, was the need to use
bolder campaigns and to use examples of work done in India to support
future initiatives in the West Midlands.

Homeless in Goa
a personal story by Celina D'Costa
Among the Indian delegates at the World Aids Conference in Geneva will
be Celina D'Costa, a 27-year-old HIV positive woman from Goa. Celina,
who tested positive two years ago, is now homeless having been thrown
out of the house she shared with her husband's family - the same
husband who infected her and who has since died.

Nervous about speaking at a major international gathering, she can
still manage a rueful smile at the irony of her situation: jetting
away from poverty to live, however briefly, in one of the richest
cities on earth.

She will tell the conference how, like most other young women in Goa,
she had once thought that Aids was a disease that was visited upon
promiscuous foreigners and how she thought "they deserved it". Then
she will tell them how she was forced to marry her husband, a violent
drunk, how he refused to work and regularly beat her. Then she will
tell them how she loved and nursed him until his death.

Celina will say that she cried for two days after her own positive
diagnosis and then she will explain how, disowned by her own family
because she had married an alcoholic, she sought refuge with her
in-laws - a widow's 'right' in Goa.

Her in-laws at first agreed, but only if she touched nothing and ate
nothing and then they padlocked the toilet door and told her to use
the street. Last month they threw her out, telling her to live in a
tiny, abandoned hut, with no water, high on a hill above the town.

Finally, she will tell the conference that she joined a self-help
group, Positive People (which selected her to be their delegate in
Geneva), and how she has since met doctors and bankers who are
positive, too.

"I used to stand in front of such people and feel like I was no-one
next to them," she says. "Now we are the same."

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