A Hidden Scourge
India's huge population disguises the growing number of HIV-infected citizens
Along Falkland Road, a chaotic street crowded day and night with pedestrians and honking traffic, women beckon from curtained doorways. Some 4,000 prostitutes work the area. Some of the older ones are joginis from impoverished families who, following an ancient (now banned) tradition, were "married" to a deity before puberty and designated to live as prostitutes. In Sheikh's brothel, the sole decoration is an 8-by-10 picture of the joginis' deity, the goddess Yellamma. Others here have been sold into prostitution (sometimes after being abducted), are victims of rape or incest, were abandoned by husbands who absconded with their dowries, or are in the brothels because they have no other way to survive or pay off debts.
Sheikh, who came to Mumbai from Bangladesh when she was 8, says she is one of the last group, without any good alternatives. Dressed in a pale-blue sari, she shows a smooth complexion and shy, girlish smile that defy the downward arc of her life. It's not clear how much she understands about AIDS. After being tested, she was unable to read the report and put it away with her few possessions until someone could read it for her.
Outreach. She pulled out the papers during a visit by Gilada, who for more than 20 years has been an advocate for providing health services to the city's sex workers. And in recent years--with limited outside funding--his Peoples Health Organization has run an acclaimed peer education program that provides condoms, information, and testing for the Falkland Road women. Establishing a network of outreach workers among older prostitutes, his Saheli Project has helped spread AIDS awareness with, for instance, testing facilities and with posters inside the brothels comparing using condoms to wearing protective gear when playing cricket. Prevention efforts are doubly important because few Indians, once infected, can get life-extending antiretroviral drugs. Ironically, India has been a leading global supplier of generic copies of HIV/AIDS drugs, but few Indians can afford them, and the government has lagged in promises to provide for the needy.
At his private infectious-disease clinic a short drive from Falkland Road, Gilada sees about 10 new patients a week for HIV tests, mostly middle-class office or shop workers. About 1 in 4, he says, tests positive. He is concerned that infected patients, even with counseling, rarely tell their wives and live in denial. "It is seen as a disease of sex workers, truck drivers, and drug users," he says, "not as a disease of everybody."
If that broader reality is not apparent now, sadly, it may be very soon.
HIV in India
1981-2004
Number of infected (estimates in millions)
'81 0
'04 5.1, 5.3*
[Other labels] 0, 1, 2, 3, 4, 5, 6
'90, '94, '98, '99, '00, '01, '02, '03, '04
*Global Fund to Fight AIDS, Tuberculosis and Malaria estimate
Sources: United Nations, Indian government
USN&WR
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