The Wall Street Journal - 25 Sep 1996
Miriam Jordan, Staff Reporter of The Wall Street Journal

A blue box full of free prophylactics stands in plain view of his customers as Mr. Mani trims hair and dispenses advice on safe sex, a new dimension to his 20-year career. "I start by talking about the family and children," Mr. Mani explains, snipping a client's moustache. "Slowly, I get to women, AIDS and condoms."

Many Indian men are too embarrassed to buy condoms at a drugstore or to talk freely about sex with health counselors and family members. There's one place where they let down their hair: the barbershop. So, the state of Tamil Nadu is training barbers to be frontline soldiers in the fight against AIDS.

Programs like the barber scheme are what make Tamil Nadu, a relatively poor Indian state that's home to 60 million people, a possible model for innovative and cost-effective methods to contain AIDS in the developing world.

Six years after it was first detected in India, the AIDS virus is quickly spreading in the world's second most-populous nation. Already, up to five million of India's 920 million people are infected with HIV -- more than in any other country, according to UNAIDS, the United Nations' AIDS agency.

But faced with more immediate and widespread health woes, such as tuberculosis and malaria, officials in many Indian states are reluctant to make AIDS-prevention a priority. And in some states, the acquired immune deficiency syndrome is regarded as a Western disease of decadence; officials deny that prostitution and drug use even exist in their midst.

"Some Indian states are still in total denial or ignorance about the AIDS problem," says Salim Habayeb, a World Bank physician who oversees an $84-million loan to India for AIDS-prevention activities.

Tamil Nadu, the state with the third-highest incidence of HIV infection, has been open about its problem. Before turning to barbers for help, Tamil Nadu was the first state to introduce AIDS education in high school and the first to set up a statewide information hotline. Its comprehensive AIDS-education program targets the overall population, rather than only high-risk groups.

In the past two years, awareness of AIDS in Tamil Nadu has jumped to 95% of those polled, from 64%, according to Operations Research Group, an independent survey group. "Just two years ago, it was very difficult to talk about AIDS and the condom," says P.R. Bindhu Madhavan, director of the Tamil Nadu State AIDS Control Society, the autonomous state agency managing the prevention effort.

The AIDS fighters take maximum advantage of the local culture to get the message across. Tamils are among the most ardent moviegoers in this film-crazed country. In the city of Madras, people line up for morning screenings even during weekdays. Half of the state's 630 theaters are paid to screen an AIDS-awareness short before the main feature. The spots are usually melodramatic musicals laced with warnings.

In the countryside, where cinemas are scarce, a movie mobile does the job. The concept mimics that used by multinationals, such as Colgate-Palmolive Co., for rural advertising. Bright red-and-blue trucks ply the back roads, blaring music from well-known movie soundtracks whose lyrics have been rewritten to address AIDS issues. In villages, hundreds gather for the show, on a screen that pops out of the rear of the truck.

In one six-minute musical, a young husband's infidelity leads to his death from AIDS, the financial ruin of his family, and then the death of his wife, also infected. The couple's toddler is left alone in the world. The heart-rending tale is followed by a brief lecture by an AIDS educator -- and the offer of a free pack of condoms and an AIDS brochure.

Tamil Nadu's innovations have met with obstacles. It took several months for state officials to persuade Indian government television, Doordarshan, to broadcast an AIDS commercial featuring the Hindu gods of chastity and death. Even then, Mr. Madhavan says, Doordarshan "wouldn't do it as a social ad, so we have to pay a commercial rate."

Later, the network refused to air a three-minute spot in which a woman urges her husband, a truck driver, to use a condom when he's on the road. Safe infidelity was deemed "inappropriate for Indian living rooms," says Mr. Madhavan. A number of commercial satellite channels have been willing to run the ad.

Tamil Nadu has met little resistance recruiting prostitutes for the cause. For almost a year, 37-year-old prostitute Vasanthi has been distributing condoms to colleagues. With state funding, a nongovernmental agency has trained her to spread the word about AIDS and other sexually-transmitted diseases. As an incentive, the state pays participants like Ms. Vasanthi, a mother of three, the equivalent of $14 a month, about what she earns from entertaining a client.

Before Ms. Vasanthi joined the plan, she didn't know that the condom could help prevent HIV infection. These days, if any client refuses to wear a condom, "I kick him out, even if it takes using my shoes," she says. "I'm not flexible about this." More men are also carrying their own condoms, she says.

Thank barbers such as Mr. Mani for that. Especially in blue-collar areas of Madras, men "trim their hair and beard before frequenting a commercial sex worker," says Mr. Madhavan. They can pick up their condom on the way out.

Tamil Nadu launched the barber program in Madras last March. So far, it has enlisted 5,000 barbers, who receive AIDS education at meetings each Tuesday -- the barbers' day off. The barbers aren't paid to be AIDS counselors, but they appear to take pride in their new responsibility.

Over the generations, India's barbers have been respected as traditional healers and trusted advisers. "If you want to get to the king's ears, you tell his barber," says Mr. Madhavan, the state AIDS director. Reinforcing the image of barbers as healers, the local trade group is called the Tamil Nadu Medical Barber Association.

"I first talked about AIDS with my barber," says Thiyagrajan, an electrician in his 40s. "I don't have multiple partners, so I don't need a condom, but I take them for my friends."

One recent night, a man in his 30s walked into Aruna Hair Arts, greeted Mr. Swami, then headed out the door with a fistful of condoms scooped from the plastic dispenser. "That's OK," Mr. Swami says approvingly. "He's a regular customer."

A local nongovernmental organization helps barbers replenish condom stocks by providing each shop with self-addressed order forms. But the central government hasn't always been able to meet supply, for reasons ranging from bureaucracy to price disputes with manufacturers.

Tamil Nadu has started sourcing condoms from elsewhere. But they're too expensive to give away. So the next stage of the barber scheme, just under way, is to charge two rupees (six cents) for a two-condom "pleasure pack." The barbers will get a 25% commission. Thus far, the only perk of participating has been a free wall calendar listing AIDS-prevention tips.

Roughly 30% of barbers approached by Tamil Nadu have refused to participate in the AIDS program, fearing that they would alienate customers. But those who take part insist that carrying the AIDS message hasn't hurt business. "We give the message about AIDS, but we still gossip about women," says barber N.V. Durairaj at Rolex Salon.

960925
WJ960907

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, 1996. 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. .