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Cutting across barriers

The spread of AIDS is not confined to an unknown high-risk group. The need to increase awareness levels of this dreaded disease is the first step in fighting it, says LILY VENKATARANGAM on the occasion of World Aids Day on December 1.

A poster display... spreading the message.

AIDS is staring India in the eye. Is the problem only applicable to the so-called high-risk group? How vulnerable are the others? How far have we progressed in our awareness campaigns? What else can we do to stop the spread?

There are different views about the disease, but these are not the answer to the problem. Sex is a means of livelihood for certain segments of society. The rich operate on a high level, with a network of customers and `business contacts'. Those in the middle who are trapped into the trade in what begins as a means of making a few more bucks. And for the economically deprived, it is easy money replacing hard labour. AIDS has not altered the way of life for the sex workers.

"The basic problem is with irresponsible husbands," claims Bala, a `retired' sex worker in Chennai. "He gets drunk, beats his wife and grabs whatever little money she has earned. She has nothing to feed her family.

"A neighbour tells her how she earned Rs. 200 just for two `sittings'. When she compares this against the Rs. 30 or 35-odd she earns after a hard day's labour at a construction site or in an agricultural field, isn't this an easy way out?"

The poor in general do not think of the future. One day at a time is their way of life. You tell them that they'll get AIDS and they turn back and say, "so what, anyhow you have to die one day."

Take for instance the Dommara community in Vijayawada, a community whose only way of livelihood is sex. But what about the hundreds of people they infect along the way! And the men, in turn, infect their innocent wives back home. The tragedy of it all often goes unheard.

Madavi is one such victim. Her husband, a lorry driver, contracted the disease in February 1999. Left to care for her five children, Madavi, who had no job, earned some money by making dresses at home. Slowly her health began to diminish. When she could not take care of herself anymore, her father took her home.

As Madavi's condition worsened, they sought medical help. When she was known to be HIV positive, her doctor asked her father to contact World Vision's Chennai Integrated HIV/AIDS Centre (CIHAC). Christopher Baskaran, Dr. Punitha and Arputha Raj from CIHAC went to her house.

Says Raj: "We located the house and found what seemed like a heap of bones outside the door. When we knocked, the family came out. When Dr. Punitha touched Madavi, they were shocked. They had many misconceptions — that AIDS spreads through mosquito bites and through touch. We admitted Madavi in CSI Rainy Hospital.

"When she was discharged, we asked the father to take her home. He said that he did not want to take her back After much persuasion, we brought her to World Vision's Care Home.

"The next day, we wondered what about her children. We went to their house late one evening. Once again, we saw them, sleeping on a mat outside the house and the door locked from within. This time there were two plates and two tumblers beside the children.

"We woke up the family and they said we could take the children away as they didn't want them to infect others in the family. So we brought them to our Care Home."

"I could tolerate my sickness, but not the way my family, including my mother, treated me," say Madavi. "I can bear ill treatment but not on my children. We were segregated from the family... " her voice trails off into quiet sobs. These are not isolated cases.

Dr. B. Joshua, in Vijayawada, Andhra Pradesh, runs the Society for Community Awareness and Rehabilitation Service (SCARS) for AIDS and TB patients. He explains how the middle-class are torn apart when infected with AIDS. Nearly 20 to 30 patients visit SCARS. Many a suicide has been averted through his counselling. There was a young man who was engaged to be married. A week before the wedding, he found that he was HIV positive. "His world literally caved in," says Dr. Joshua, "I advised him to postpone the wedding and later on withdraw from marriage negotiations." The patient took the doctor's advice. Dr. Joshua feels that more Care Centres and availability of drugs are the need of the hour.

Dr. Sheila Prasad, a gynaecologist from Rainy Hospital in Chennai, says that awareness level is still low. "As a gynaecologist, I often come across young pregnant girls, who are HIV positive. Many have probably been infected by their husbands. I feel very sad when I think of what lies in store for them when they have just begun married life and look forward to becoming mothers. Some of them may become widows before the disease shows up in their bodies. And you know the plight of widows in India."

Talking about counselling, Dr. Prasad says, "I do the post-test counselling. The reactions largely depend on the level of awareness. Some don't understand the seriousness at all. Some girls even giggle when I tell them that they are HIV-positive. Many feel that it will not happen to them. If there is a programme on TV on a general health problem, they may watch it. But if it is anything on AIDS, they just switch channels. Some women, who know all about it, are shattered when they are told about being positive. The men are shattered too for they know that they infected their spouse."

Vijayawada, being a business centre, is a hotbed of sex workers. The city has an estimated 30,000 floating population on which five per cent are sex "clients".

Vasavya Mahila Mandal, Rotary Club, Dolphin Medical Services, Municipal Corporation, Overseas Development Agency and the Commissioner of Police in Vijayawada jointly conducted a sample survey on sex workers infected by HIV in the city.

More than 50 per cent of those tested were found positive. A screening on 300 street children in the 14-18 age group showed that 240 of them are infected with STD, and of those, 70 were tested for HIV and 19 were found positive (27per cent).

The report further says that condom usage before counselling was a mere five to 10 per cent and after counselling it has risen to 90 to 95 per cent. Dr. G. Samaran, Medical Director of Vasavya Mahila Mandal, feels that using condoms is the only way to keep HIV/AIDS at bay. He acknowledges that condoms give only 80 per cent protection; nevertheless, he says one cannot change behavioural patterns of people. Truck drivers are a high-risk group who cannot be ignored. Stories of their ignorance are amazing. There are those who thought that the HIV "germs" would be killed by the heat of the engines.

One driver was sure that he would be cured of this disease if he got married. He was misled by an awareness advertisement, which read "Marriage, the only cure for AIDS". Myths created by ignorance and misinformation is one of the causes of spread of HIV not only along the highway, but also in the homes of the truckers.

In India, from the first case in 1981, the numbers have shot up to roughly three million cases according to an estimate. According to Dr. Dilip Mathai of Christian Medical College, Vellore, by 2005 India will touch 10 million cases.

"But all is not lost", said Dr. U. Thant, Regional Director of WHO, South Asia Region, addressing the participants of the AIDS 2000 conference at Chennai on World AIDS Day, "We may not have a vaccine, but we have other tools", he said. These are Prevention, Care and Advocacy.

Names have been changed to protect identity

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