Sunday Times (Johannesburg) - Sunday 07 April 2002
Bobby Jordan

Vaneshree is one of a group of female prostitutes sitting two flights of stairs above the streets of India's largest red-light district, Kamathipura in Mumbai.

Dressed in a green and mauve sari hanging loosely on her ample figure, Vaneshree talks quickly, as if the subject were scalding her mouth. Given up by her family and sent to the city to feed herself when she was only 12 years old, she has been a prostitute ever since. She works nights only, earning about 2 000 rupees a month (about R500).

Next to Vaneshree sits Gita, who, at 25, is tired of being rounded up by police along with dozens of child prostitutes. "I look like a small girl so they always take me," she mutters. Gita works at her mother's brothel.

The women sit in a circle beneath a ceiling fan. They are volunteer counsellors for the Asha Project - one of a handful of NGOs at the forefront of the country's battle against the HIV.

By day they are a roving information service, moving through the sprawling red-light district, offering advice such as practical tips on sexual health: where to find condoms or treatment for sexually transmitted diseases . By night they sell their bodies - 120 rupees (about R30) for an hour, up to 400 rupees (about R100) for a full night.

Kamathipura is the fleshy centre of India's HIV time-bomb. Home to 10 000 prostitutes, more than half of whom are HIV-positive according to a survey last year , it is also the centre of the Indian government's Aids programme.

Out of a population of 1.2 billion, India has an estimated four million infected people, an infection rate of less than half a percent - far less than South Africa's estimated 10% - but this looks set to change.

Of India's four million infections, nearly 350 000, almost 10%, are in Mumbai, India's largest commercial centre . It is a city built up by the British about 350 years ago and, for many, a portent of where India is going. Already it's believed to be the most infected city outside Southern Africa, a fertile ground for disease due to poverty, malnutrition and illiteracy.

India has two million new cases of tuberculosis each year; more than a thousand people die from it every day, a significant proportion in Mumbai. Leprosy, malaria and Japanese encephalitis are also rife.

The result is a citizenry that sees killer illnesses as a depressing but integral part of community life, and tends to be fatalistic about the chances of contracting a virus nobody seems to have heard much about.

But by far the biggest obstacle facing India's health practitioners is the widespread taboo about discussing matters sexual, which effectively scuppers all attempts to promote safe sex.

For many devout Muslims, Hindus and Christians, condom use is considered sacrilegious - an abrogation of natural law - and is not something to discuss.

"Anything about sex is a secret here," says Dr Dilip Vaswani, who is part of a team spearheading Aids prevention programmes in Mumbai. Behavioural change, he adds, happens slowly in such a deeply religious society.

At the moment, India's Aids nightmare is mainly visible in the sex and transport industries. But people are fast waking up to the reality of a society where the virus affects everyone, cutting across ethnicity, class, politics, religion and cultural taboos.

Fuelled by thoughts of an impending catastrophe, the Indian government's prevention programme is starting to take root, with a broad network of NGOs tasked with breaking the silence surrounding HIV.

The Asha Project in Kamathipura, for example, has been in existence for seven years and is almost ready to be handed over to sex workers who will manage their own programme.

That way they can address their own specific needs, often misunderstood by those on the outside, says project manager Seema Shroff .

"Sex workers here have been offered to the goddess Yellama, which means they can't get married," Shroff says.

"Also they are owned by the brothel owners - they can't get out of the profession. In most cases they wouldn't want to because they are the only breadwinners in their family. This life is a luxury for them."

Though illegal, the Kamathipura red-light district is an accepted, some say vital, feature of Mumbai society where, once a year, sex workers stage a communal marriage ceremony, first removing all the copper bangles from their arms, then replacing them in a symbolic renewal of their allegiance to Yellama - a Hindu deity who they believe protects them from the pitfalls of their trade.

Many young girls are similarly dedicated to Yellama, including virgin minors, who are thereafter barred from marriage. This keeps them in prostitution.

The custom is widely accepted in southern India. Any Aids intervention that shows disrespect to local customs would more than likely be doomed to failure, Shroff says.

The pragmatic approach is a hallmark of India's Aids programme, which in some respects makes South Africa's efforts look like a dodgy high school project.

Dr Alka Gogate, head of Mumbai's Aids programme , speaks candidly about its successes and failures.

After the first reported cases of HIV in 1986 in southeast India, the government established a National Aids Control Organisation to coordinate all intervention programmes. It didn't last long.

Though grand in scale, this approach ultimately proved ineffective in dealing with the melting pot of India's ethnic and cultural life; it was decentralised to state level in 1997, and later to city level, thereby removing troublesome bureaucratic hurdles and making provision of services more immediate.

Government funding now flows directly to semi-autonomous Aids "societies" that design and implement their own prevention and treatment programmes.

"This country is so vast and so populous, with so many regional varieties, ethnic groups and cultural taboos, that we realised that vertical programmes can't run," Gogate says.

Her programme is divided into five main "care and support" components, each actively targeting a different level of infection . Sex workers use a network of nine STD clinics and 19 voluntary counselling and testing clinics, while those with opportunistic infections are offered free drug treatment at 20 public hospitals. Antiretrovirals are not yet included.

Full triple therapy treatment is available, however, in the private sector and to those with full-blown Aids and low CD4 cell counts, who are treated at two community care centres.

India is the world's largest producer of generic drugs, and generic anti-Aids drugs are available at a fraction of the cost elsewhere in the world, but still beyond the reach of most Indians. The debate about whether to make them freely available in the public health sector is beginning to hot up.

"As of now , as per national policy, we don't give antiretrovirals free due to the enormous cost," says Gogate, adding that she is unclear how the programme might be scaled up in future. "That will depend on how the epidemic goes."

In the narrow streets of Kamathipura, nobody knows the future, but prostitutes like Vaneshree hope they can, with their volunteer counselling services, help stem the tide of HIV/Aids.

"Business is down, but I feel good that I am doing something about Aids," she says, gazing out at a group of potential clients outside the window.

"One day business will get better again," she smiles.
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