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 in- 40 NEWSWEEK NOVEMBER 25 , 2002 fections, 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 substan- tial 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. AIDS has varied faces in a country this vast, but those of the women stand out. As I discovered in the Tamil town ofNamakkal, a monogamous woman can earn her inlaws' 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 HIVpositive, 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 For more of Alex Majoli's photographs from the AIDS crisis in India go to Newsweek MSNBC com 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. The political landscape is more hospitable today. The le_aders 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 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 Portrait of a Public-·Health Crisis Amobile population and a reluctance to acknowledge risky sexual behavior have hindered efforts to control AIDS in India. It could become the most HIV-afflicted country by 2010. Victims by Sex/ Age Group Rise in HIV Infections 4million 3.75 . / 3.5 z 3.25 ｾ ｾＭ 1998 '99 '00 ｾ＠ Low • Medium • High 0 Mumbai: More than 50% of the city's thousands of sex workers are infected with HIV. f) Tamil Nadu: Truckers Estimated Future Infections India will be the hardest ｾＭＮ｡＠ bn countries with surging HIV rates. patronizing prostitutes have helped spread HIV in southern states; 15% of drivers are infected. 8 Manipur: A conduit for Burmese heroin; 56% of the state's injecting drug users have contracted HIV. SOURCES: NACO, NATIONAL INTELL!GENCE COUNCIL, UNAIOS; WRITIEN BY JOSH ULICK; GRAPHIC BY JEFF FERZOCO 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 out- 42 NEWSWEEK NOVEMBER 25 , 2002 reach 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 hersel£ 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. 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 rothel keeper. Manju's father, a subsistence lffiler, had died and her mother and broth: were facing starvation. She was comletely illiterate. "I was kept in a small, dark >om locked for days by the madam," she 1ld me. "Then one night I was forced to rink something that made me dizzy, and ten this huge, drunken man was on top of 1e. I was screaming in pain but I fainted. /hen I woke up I was bleeding heavily. The 1adam told me I was now a fallen woman 1d should stop pestering her to let me go Jme. These men, 10 to 15 a day, would call 1 me. It was a horrible life." Through simple coalition-building, the iMSC gradually transformed the surmnding district and became a legitimate Jwer broker. "We have now branches in almost all the towns and cities in West Ben- avoid contracting HIY. The Sanlaap kids gal;' says Swapna Gayen, DMSC's presi- have recently launched a campaign to raise dent. "We now sit across from officials and AIDS awareness within the red-light disdiscuss matters relating to our health and trict- and the older ones are now seeking a welfare." The group also runs a 24-hour wider audience. "We want to be leaders;' AIDS hot line that offers free medical and says Sushmita, a poised 18-year-old who has legal guidance to anyone seeking help. just completed her college-entrance exam. Whatever their circumstances, few sex "We want to show people outside Kalighat workers would choose prostitution for their that a youth group from this district can daughters. While standing up for their own make a difference." rights, most also do whatever they can to see Small victories add up, but neither the their own children liberatKalighat kids nor the Sonagachi sex workers ed entirely from the trade. We want to be will transform a nation of On that front, too, signs of progress are easy to find. leaders. We want 28 states, 24 languages On the edge of Mumbai's and a billion people. It's crumbling Kamathipura to show people that one thing to get a child red-light district, a group through school, quite ancalled Apne Aap has creat- kids from a redother to shatter a legacy ed a safe place for schoolof fear, ignorance and light district can age girls (they call themstigma. Fortunately, bigselves "Sparrows") to read, make a difference. ger players are now empaint and socialize. Anbracing that goal. The - SUSHMITA, AGE lB Gates Foundation has yet other group, Sanlaap, runs a sinlliar operation in to work out the details of Kolkata's Kalighat. Because this district's its new $100 million program, but its inlprostitutes work in their huts, the kids are mediate goal is to target the country's huge essentially homeless from dusk until mid- mobile population-not only truckers but night. But for the past few years they have also soldiers, railway workers and oil workspent their evenings in Sanlaap's two con- ers. The foundation has the clout to foster crete shacks, getting the encouragement and alliances among employers in all those secelectric lights a kid needs to become literate. tors, and the freedom to cross the publicAs I sat down with a dozen of the teens who private divide. One can only guess how all frequent the drop-in center, its inlpact was these efforts will play out. What's clear is palpable. All but two are in school. Seven are that Asia's infant plague does not have to planning for college. And any one of them, grow into a disaster. even the 10-year-olds, can tell you how to With SUDIP MAZ UMDAR NOVEMBER 25 , 2002 NEWSWEE K 43