x Abu Dhabi, UAEThursday 27 July 2017

Transmission

Books A collection of reporting on India's Aids crisis reveals a nation coming to terms with it, write Scott Sherman and Bharati Sadasivam.

A migrant sex worker waits for a customer near a motorway in Gauhati, India.
A migrant sex worker waits for a customer near a motorway in Gauhati, India.

A new collection of reporting on India's Aids crisis reveals a nation finally coming to terms with the scope of the disease, write Scott Sherman and Bharati Sadasivam.
Aids Sutra: Untold Stories from India Introduction by Bill and Melinda Gates Foreword by Amartya Sen Edited by Negar Akhavi Anchor Books Dh 48
When the Delhi-based reporter Aman Sethi was asked to write about the HIV/Aids crisis in India, he chose to focus on the country's six million lorry drivers, who have played a critical role in the transmission of the virus that infects perhaps 2.5 million Indians. Sethi, who works for the Indian magazine Frontline, could have reported the piece from his desk, with a thick stack of newspaper clips and statistical summaries. Instead, he hopped on a lorry in the small town of Siliguri, 600 kilometres north of Kolkata, and squeezed himself into the vehicle's cramped cab alongside Sanjay Kumar, the garrulous beedi-smoking driver, and his lithe young assistant, Kamlesh. As they made the lengthy journey to Delhi, carrying 25 tonnes of candle wax, Sanjay was Sethi's "able guide through the labyrinthine network of truck drivers, sex workers, pimps and roadside eatery owners", the last of whom, in small villages adjacent to the highways, sometimes function as brothel keepers by facilitating sexual encounters.

Sethi wanted to understand the ways in which lorry drivers serve as conduits for HIV, so he subjected Sanjay to a mild interrogation, in the course of which the latter admitted to a single rendezvous with a sex worker. The year was 1993. Sanjay was 17 and working as an apprentice to an ustaad, or master lorry driver. On the way from Uttar Pradesh to Delhi, his ustaad, drunk on cheap liquor, picked up a roadside prostitute and pressured Sanjay, who was also drinking, to have sex with her. "So how was it?" Sethi inquired with customary journalistic insouciance. "Awful," Sanjay replied, "and what's worse is that she had an upset stomach and was running a high fever. I was scared, she was ill, my ustaad was drunk. It was terrible." The next day Sanjay, who did not use a condom, became violently sick, after which he spent 140 rupees (Dh11) on two Aids tests, both of which came back negative. "It took some time," Sanjay explained, "but they figured it out. I had a severe stomach infection. My doctor said it was from the liquor. I never went back to a whore again - but I started drinking a whole lot more." Sanjay was lucky: while just under half a per cent of adult males in India have HIV/Aids, the figure rises to between three and seven per cent for lorry drivers, many of whom get HIV from sex workers and pass it on to their wives, with devastating consequences. A 2004 survey of transport workers on a major Indian motorway revealed that 67 per cent had paid for sex; only 58 per cent used condoms during those encounters.

Sethi's essay, The Last of the Ustaads, is a darkly humorous and incisive portrait of the unregulated Indian trucking industry. It is among the most revelatory pieces in Aids Sutra: Untold Stories From India, an absorbing new anthology of reportage that illuminates and humanises the Aids crisis in that vast nation. Lately, press accounts of India have tended to focus on lavish billionaires, burgeoning tourism, powerhouse firms like Infosys and an expanding consumer class enamoured of shopping malls and entrepreneurial freedom. Aids Sutra presents a different India, an India in which grinding poverty and sexual taboos combine with sanctimony and ignorance to fuel the spread of HIV. As the country reaches new levels of prosperity, it has left behind hundreds of millions of people who live on the margins of subsistence, battling disease, hunger, caste/gender bias and the daily petty corruption of police and other low level officials - scourges that continue to plague the Indian state.

Hard numbers that pinpoint the extent of HIV/Aids are not easy to come by in most of the developing world, and this is especially true in a country of India's size, diversity and territorial complexity, as Amartya Sen notes in his foreword. Although India has a relatively low rate of infection, the number of Indians infected with the virus is second only to that of South Africa. As in the United States, the virus is mostly contained within high-risk groups: men who have sex with men; addicts who inject drugs; prostitutes and their clients.

The contributors to Aids Sutra have filed dispatches from those Indian states known to have very high rates of the disease - Andhra Pradesh, Maharashtra, Manipur and Karnataka. In Night Claims the Godavari, the novelist Kiran Desai journeys to Andhra's coastal region, to the village of Peddapuram, renowned for its "high class" sex workers from the Kalavanthalu subcaste - "hereditary courtesans and temple dancers famous for their elegant beauty." Desai provides an indelible portrait of these women, some of whom are sixth-generation sex workers, and who have risen from crushing poverty to something rather more stable and secure. "Peddapuram," writes Desai, "is full of proud women, women who build their own homes." But on a dismal "sliver of jungle between the motorway and a flat, dead-looking ocean," Desai also encounters women like Jayati, who ply their trade among shallow pits in the sand, amid cigarette butts and dirty plastic bags, for as little as 50 rupees (Dh4) per customer, a price that drops even lower in bad weather. Among these women, the rate of HIV infection is as high as 26.3 per cent. Andhra, home to five per cent of India's population, represents almost 20 per cent of its Aids cases.

In Maarne Ka, Bhagane Ka (Beat Them, Kick Them Out), the journalist Sonia Faleiro brings to life the sex workers of Mumbai - of whom there are an estimated 100,000 - with intensity and insight. The numbers are grim: 18 per cent of the city's female sex workers and eight per cent of its male sex workers are HIV-positive. Faleiro possesses an anthropological eye, and she is interested in the experiences of these men and women, especially their relationship with the police, an interminable cat-and-mouse game in which the prostitutes are by turns tolerated and harassed, and routinely subjected to arbitrary fines and demands for "free sex". Male prostitutes are treated with special cruelty. Explains one young man: "Male sex work is a cultural glitch policemen cannot accept. It outrages their concept of masculinity." Faleiro illustrates that point with a chilling coda: a hair-raising description of the rape and brutalisation of male sex workers by depraved police officers. Indeed, it is precisely because some cops engage in sex with prostitutes that the Mumbai police force is itself combating an epidemic: Faleiro notes that at least 450 members of the force are HIV-positive.

One might expect a book about Aids in India to be uniformly bleak, and some of the essays in Aids Sutra certainly do leave the reader feeling disheartened. But many of the pieces achieve a fine balance between despair and hope. They highlight the vibrant grassroots activism, led by non-governmental organisations and sex workers themselves, which has allowed some Aids sufferers to lead more dignified lives with a greater degree of social acceptance. Faleiro, Mukul Kesavan and Sunil Gangopadhyay, for example, present compelling evidence that sex workers are steadily empowering themselves - despite stifling puritanical attitudes and intolerance on the part of both ordinary families and officialdom. In the past, prostitutes in India were quietly relegated to the shadows and the slums - "used but not talked about", in the words of Gangopadhyay, a prolific poet and novelist who has written more than 200 books in various genres. In his essay, he describes how, in the 1960s, his bohemian cohort occasionally took refuge in Kolkata's vast red light district, known as Sonagachhi, where far from the prying eyes of family members and the police department, they would drink prized Scotch and argue about literature. Back then, Gangopadhyay recalls, the brothel was a "dark world" with "hundreds of cell-like rooms - dim and airless?the toilets were filthy and there was scarcely any water". As for the women, most of them looked "crushed and defeated."

Gangopadhyay recently returned to Sonagachhi and was astonished by its transformation. In 1995, women from Sonagachhi helped to set up the Durbar Mahila Samanwaya Committee (DMSC), a self-help organisation of sex workers and their children. Gangopadhyay attended a conference organised by DMSC in Kolkata, and was amazed to see some 7,000 sex workers packed into a stadium. Returning to Sonagachhi itself, he detected "a distinct change in the psyche of the women [who] don't perceive themselves as sinners and fallen women anymore. They speak of their profession, quite naturally and spontaneously, as though it was one of many." Education, solidarity and confidence have brought other changes to Sonagachhi: a co-operative bank; a new determination to confront abusive customers; and a firm commitment to condom use - all of which have helped to contain its HIV rates to between five and 10 per cent. It's a remarkable feat: sex workers in Kamathipura, Bombay's red light district, had an infection rate of nearly 50 per cent in 2000.

Drug addiction also contributes to the transmission of HIV/Aids in India. In a finely-etched portrait of young addicts and "positives" caught between fragile hope and continual despair, Siddhartha Deb travels to Manipur (in the isolated and insurgent North-East) to analyse the drug-driven spread of HIV. Deb shows how sex work and drug habits feed on each other: 20 per cent of sex workers are also drug addicts. Deb reports that "sex workers are among the most invisible groups in this already invisible state" - and targeted for intimidation not only by the authorities but by guerrilla insurgents and churches as well.

Aids Sutra conveys the impression that India, a country that has been slow to acknowledge the presence and spread of HIV, is gradually beginning to meet the challenges presented by the disease. The old attitudes of cruelty and intolerance are slowly beginning to recede. In Bhoot Ki Kahaanian (Ghost Stories), an affecting essay about HIV/Aids care homes for children, Jaspreet Singh visits the principal of an elite school in south Delhi, and asks him if he would admit children who are HIV-positive. At first the principal equivocates: "It's a hard question. I don't know how my teachers might respond." But he then confesses, in a whisper, that he has already accepted two HIV-positive children: "No other parent, no other teacher in the school knows about it." Both Singh and the principal see steady progress, along with continued impediments, on the matter of Aids awareness. Singh relates a recent conversation he had with a cabbie, who said that Aids is not a "choot ki bimari", a disease that spreads by touch, and that 60 per cent of the people in his village were properly informed about the virus. Singh inquired about the rest. "They are different," the cabbie responded. "For them an Aids wallah is worse than an animal."

After 250 pages in which the spotlight is cast on the victims of HIV/Aids, it is refreshing to shift gears and read Healing, Amit Chaudhuri's sensitive account of his conversations with doctors who have devoted their careers to the care of patients with the disease. Chaudhuri introduces us to Dr Mamta Manglani of Sion's Lokmanya Tilak Hospital in Mumbai, who saw her first Aids case in 1994: a four-year-old boy, whom one doctor, out of fear and ignorance, simply refused to treat. Two years later the child was put on antiretroviral therapy (ART); today, he is a teenager studying in Mumbai.

In 1997 the hospital opened a clinic for HIV-positive children, most of whom are treated with ART, which the Indian government provides, to a certain extent, free of charge. Chaudhuri notes that ART has ushered in a period of relative calm among doctors, for it has partly removed HIV "from the hysteria that surrounded it" in the dark days of the 1980s and 1990s. Today the mood of the doctors oscillates between realism and optimism. "I not only feel hopeful, I feel fulfilled," Manglani tells Chaudhuri. "The children are getting better. They are putting on weight. I believe they will live to see the day when there is a cure."
Scott Sherman is a contributing writer at The Nation and a contributing editor of the Columbia Journalism Review. Bharati Sadasivam is a freelance writer. They both live in New York.