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India's Invisible Poison
Contemporary Review, Sept, 2000 by Alex Ninian
WHICH is the worst country in the world for AIDS? It somewhat depends on what you mean by 'worst', but it could be India. It may not have the highest percentage of population infected, but, frighteningly and tragically, its rate of increase is accelerating. And many of the patterns of India's unique way of life are the patterns of its advance.
In the disastrous HTV areas of central and east Africa, at least the rate of increase is slowing and in Europe and the US the increase is even further over the peak, but in India the figure of the infected, at 1 per cent of the population, or 10 million, is doubling every two to three years. It is possible to envisage a future HIV-positive total greater than the population of Britain.
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'Tackling the problem is like the march of 1000 miles', says Dr L.S. Gilada of the Indian Health Organisation in Bombay, 'and we are just taking the first step'. Most field workers and analysts agree that the first step in any AIDS epidemic is to overcome the 'denial' stage. This was stressed at this summer's AIDS conference in Africa. I met a lady of upper class Indian society who told me 'it comes from European women on package tours who sleep with the local tour guides'. Others of the chattering classes refuse to believe it exists at all or say it is confined to 'sex workers' and lorry drivers. It is easy to understand these attitudes in a country totally circumscribed by the rules of religion, by the tight disciplines of the family and where more than half the population live in villages with closely observed social mores.
Yet the fact is that the disease, although mostly among the poorer off, is raging through all areas and all classes of Indians.
I met Dr Shankar Das, an earnest young campaigner who is a field worker as well as a researcher at the Tata Institute of Social Sciences in Bombay, where I met him. 'The villages may have strict rules of behaviour', he says, 'but the other side of the coin is that the villagers are nearly always poor. One of the clearest patterns is that the menfolk escape their poverty and go to the towns sometimes hundreds of miles away to earn money'. Tens of thousands of them live in the slums of Bombay and Delhi and other big cities and save their money to send home to their wives and families. They only go home once or twice a year. 'They leave their wives behind, but not their libidos', says Dr Das. 'They go to the red light district, get AIDS and take it back to the villages, and now, tragically, they produce children born with it'.
In the villages the ignorance is often such that many HIV-infected people do not know they have it. Symptoms such as stomach trouble, pneumonia and TB are taken to be the ultimate illness rather than the underlying immune deficiency. Even medical statistics are superficially reporting a 'TB epidemic sweeping India', and a corollary of this is that the 1 per cent figure for the HIV-positive may in reality be several times higher.
The same pattern is seen among lorry drivers who, traversing a vast country over 1500 miles in length and breadth, are away from home for weeks on end. The typical Indian lorry carries a gaudily painted sign Goods Carrier. 'It ought to say "AIDS carrier"', says Dr Das.
When the away-from-home workers and lorry drivers visit the red light streets they are entering a world where the so-called sex workers are infected to the tune of 65 per cent.
That great Indian phenomenon of caste appears all over the social map of AIDS. Although caste officially does not exist, everyone knows not only their own caste, but that of everyone else. Despite a proliferation of positive discrimination measures and disapproval of the term 'untouchables' - they are now called Dalits - most Untouchables still rank amongst the poorest and their sheer poverty leaves them vulnerable to abuse. There are some sects among them whose women for generations have never been anything but prostitutes. Even Dalit women with 'proper' jobs in houses, offices or on the land are subject to abuse by landlords, bosses and farm-owners.
A colleague of Dr Das reminded me that the custom of Devadasi continues not only in the great temple cities like Kanchipuram and Madurai in Tamil Nadu, but here in greater Bombay. He had worked with Fakira in the sleazy slum of Kamathipura where among the population of prostitutes every second one is HIV-positive. In a centuries-old tradition some village parents pledge a young daughter to the goddess Yalluma. In days gone by the girls were servants of a temple and, although used by the holy men for sexual services, the girls were well educated, well dressed and well looked after, as were the parents. But now the system is so corrupted that immediately following the village dedication ceremony the girls fall into the hands of pimps who spirit them into the big city brothels.
Fakira has learned the lesson of safe sex following the death from AIDS of several of her friends and she works with the voluntary groups who visit the red light district to fight the disease. The message is a practical one - 'if you stay healthy you will earn more for longer' -- and she hands out this advice along with free condoms.
