Los Angeles Times - Friday, November 27, 1992
Bob Drogin, Los Angeles Times

Behind barred windows known as "cages," thousands of women are captives, having been kidnaped or sold into bondage. Others are rape or incest victims, exiled in shame from rural villages. Many are "devadasi," devotees of a Hindu goddess who were forced into prostitution by unscrupulous priests. Still others are male prostitutes known as "hijras," or castrated men.

Crammed in dark tenements, most prostitutes serve four men a night. The lucky ones make $15 a month; others, including 9-year-old girls, are paid only in clothes, food and makeup.

Waving and hissing from every doorway, dressed in bright saris, blood-red lipstick and jangling bracelets, the sad-eyed sex workers draw hundreds of thousands of men every night from across India.

HIV SPREADING

Millions may die as a result. At least 35 percent of Bombay's prostitutes now carry the virus that causes AIDS, according to the World Health Organization. That is up from only 3 percent in 1988. By early next century, experts say, Bombay will be the epicenter of a catastrophe: India, the world's second most populous country, could outpace sub-Saharan Africa as the chief killing ground of the deadly disease.

"It's out of control," said Dr. I. S. Gilada, head of the Indian Health Organization and Bombay's best-known AIDS activist. "And now it's too late."

Dr. Lev Khodakevich, a WHO medical officer and AIDS specialist in New Delhi, said, "In five years, we will have AIDS cases in every block of the cities and probably in most villages. It will go everywhere." So far, India has confirmed 10,730 human immunodeficiency virus infections and 238 full-blown cases of acquired immune deficiency syndrome, which destroys the body's immune system. But experts say that far more cases are misdiagnosed and unreported. WHO and Indian officials publicly estimate that 500,000 to 1 million Indians carry the virus, and some privately put the figure far higher.

DISCOVERED BY CHANCE

"HIV patients are discovered by chance," said Dr. Subhash Salunke, health director of Maharashtra state, where Bombay is located. "They are only found if they happen to go to the hospital, and their blood happens to be tested, and the doctors happen to know about and do the testing for HIV. It is not systematic."

By 1996, according to reports at the International Congress on AIDS in Asia and the Pacific, held in New Delhi this month, at least 3 million Indians will carry HIV and 179,000 will suffer from AIDS. That will more than double by the end of the decade.

"We're seeing an exponential increase year by year," said Dr. J. P. Narain, head of regional AIDS programs at World Health Organization headquarters in New Delhi. "And this is just the beginning."

Also just starting, however, is an ambitious $100 million, five-year attempt to fight AIDS in India. The obstacles are immense in an impoverished country with widespread illiteracy, strong cultural taboos, inadequate medical care, legendary bureaucracy and a population twice that of sub-Saharan Africa.

Unlike most of the West, where homosexuals were hit first and hardest, AIDS is spreading across India chiefly via heterosexual prostitution. Worst stricken, so far, are Bombay and Madras. But thousands of intravenous drug users also are infected in two northeastern states, where heroin is widely available. Contaminated blood supplies are an additional danger.

FIRST CASE WAS IN 1986

Unlike Africa, where the epidemic has ravaged lives since the early 1980s, the first AIDS case in India was not recorded until 1986. That should have given officials time to prepare for the crisis now under way.

Until this year, however, little was done except to deny the problem. Last year, for example, the national government announced a three-year AIDS prevention program -- but allocated only $1.8 million for a nation of 885 million people, or one-fifth of a penny per person. There was nothing in the plan about public education, medical training or providing condoms.

India's five largest cities began screening blood in 1989 after tests found widespread HIV contamination of human blood products manufactured by Indian companies. But there is little or no screening in rural areas and in the unlicensed blood banks that reuse needles and unsterilized equipment.

Tests show that many professional donors, who repeatedly sell their blood for cash, carry HIV. Up to half of India's blood supply comes from such unregulated blood banks.

Overcoming the myriad obstacles to teaching Indians about AIDS will not be easy. Dismissive attitudes about AIDS are common in Bombay. Truck drivers, migrant workers, salesmen and others who patronize the city's prostitutes increasingly take HIV out on the road and back to their wives and girlfriends when they leave.

"If I have a problem, I'll just go to the doctor," laughed Ramesh, a 25-year-old truck driver who stood on a busy corner of Kamathipura, eyeing the prostitutes. Copyright 1992 The San Francisco Chronicle

Always watch for outdated information. This article first appeared in 1992. This material is designed to support, not replace, the relationship that exists between you and your doctor.

AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.

Copyright ©1980, 1992. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content. .