Giving AIDS the Red Light
KOLKATA, INDIAIn recent years, public health officials, social workers, and politicians swarmed Kolkata's red-light areas, advocating safe sex, offering medical services, and distributing condoms. These campaigns resulted in tremendously successful initiatives like the Sonagachi AIDS Project, which went from being a quasi-governmental program to one of the largest community-run intervention projects in the world. Sex workers themselves now run the show, and in Sonagachi (meaning "golden tree"), famous as the oldest, largest, and most storied red-light district in the city, only 9 percent of about 6000 sex workers are HIV positive. In comparison, rates of infection among Mumbai (formerly Bombay) prostitutes as of 1997 were as high as 70 percent. At the end of 2001, the total number of people living with AIDS in India was 3,970,000, according to UNAIDS.
But while high-risk communities are way savvier about sexually transmitted diseases (STDs), the rest of society has hardly been as enlightened. According to the U.S. Centers for Disease Control (CDC), new Indian AIDS cases are rapidly seeping out of high-risk groups and into the general population. As is the case in other societies, clients who get infected in the brothels put their unsuspecting wives at risk, and alternatively, wives or "floaters" earning secret cash through sex may also bring the HIV home. Behavior in homosexual communities here is only beginning to be discussed.
Noticing such trends and drawing inspiration from the Sonagachi AIDS Project, a group of doctors, psychologists, and other concerned citizens opened the City Counseling Center (CCC) in downtown Kolkata. The nonprofit provides medical and psychological consultation, as well as cheap antiretroviral drugs. It has also started one of the country's first support networks, the Kolkata Network of HIV Positive People, through which individuals can finally exchange their experiences with HIV without encountering raised eyebrows.
"Intervention programs running in high-risk areas are only the tip of the iceberg. Awareness has to spread to the rest of society," said Dr. Debjani Banerjee, one of the CCC's chief coordinators.
The new center might never have come to life, however, if the city's sex workers had not set such an incredible precedent. In 1995, the Sonagachi women organized themselves into the first union of sex workers in all of Asia, Durbar Mahila Samanwaya Committee (DMSC), and took control of the local government AIDS project. With a current membership of almost 60,000 male and female sex workers from all over the state of West Bengal, the union is fiercely picketing at many sites for the decriminalization of prostitution and equal workers' rights (including entitlement to negotiate issues such as work conditions). Union representatives who might never have dreamed of stepping outside the brothels, have flown as far as Geneva and Australia to publicize their cause.
Union coordinator Putul Singh is now a sex worker by night and activist by day. She calls AIDS her "friend," because, she says, "before the project no one cared if we were healthy or not. After stemming the flow of AIDS among our sisters, we want to spread the message to ordinary people too."
The sex workers' success did not come easy, however, especially in light of the harsh lives they had led for most of their lives. Located on the western fringe of Kolkata, Sonagachi is a maze of narrow lanes with ancient, rotting tenements rising up on either side. Thousands of sex workers rent box-like rooms the size of an office cubicle, usually paying exorbitant rent for a few feet of space. If working for brothel owners, sex workers usually turn over all their income to them. The owners use the money to pay off the police, pimps, and local gangsters, explained "Geeta," a Sonagachi sex worker who did not want her name used. At present, how much a sex worker charges roughly depends on how much time she spends with a customer, how old she is, and how good she looks.
"For most of their lives these people have been outside even the most marginal fringes of society," said Ishika Basu (no relation), one of the first social workers to approach the initially distrustful prostitutes. "They've been constantly cheated and taken advantage of," she added.
So going into Sonagachi to begin AIDS education, Dr. Smarajit Jana, the governmental epidemiologist who spearheaded the project, knew it would be an uphill road. After a preliminary survey to understand the habits and lifestyles of Sonagachi sex workers, he explored enhancing self-esteem as a start to changing deeply entrenched sexual practices. Jana convinced 12 sex workers to come forward and train as "peer educators." For about a $1 a day, and wearing green cotton coats, these women informed their "sisters" about STDs, urged them to get the clinic-provided blood tests every three months, and distributed condoms.
Soon, hundreds of women were refusing unprotected sex, even if their clients offered to pay more. While in 1992 a government survey showed a mere 2.7 percent of 450 sex workers were using condoms, two years later that figure had leaped to 69.3 percent, said Mrinal Kanti Dutta, present director of the sex workers' union and the son of a sex worker.
"When a customer comes, I take the money first and then let him in my room," said Priya Begum, a 23-year-old Sonagachi sex worker who had never heard of AIDS until a peer educator enlightened her last year. "Then I ask whether he'll use a condom. If he says no, I keep the money and show him out," she laughed. This is a tactic made more feasible by the cooperation of pimps, who have in most cases, agreed to back the women's demands for safe sex.
Today, 430 peer educators spread awareness throughout Bengal, and 36 brothel-based medical clinics regularly treat sex workers. Among other things, DMSC has established a school for sex workers' children, a money-lending co-op, and a cultural group that spreads AIDS awareness through music, dance, and street theater.
Meanwhile, the City Counseling Center feels positive that more and more people will visit to get treatment or just to talk. Since January of this year, Banerjee and her colleagues have treated 205 patients, of whom 35 tested positive for HIV. Not surprisingly, only a handful of infected patients are sex workers, says Counselor Nabanita Ghosh. Rather they are mostly ordinary people like housewives and college students from middle-class homes.
The center offers generic antiretroviral drugs like Stavudine, Lamivudine, and Nevirapine, at the dirt cheap price of $10 a month (a 75 percent discount from the already discounted price of $40 a month offered by Aurobindo Pharmaceuticals). But most HIV-positive patients avoid pursuing treatment unless they absolutely have to, probably for fear of social rejection. Center staff hope the Kolkata Network of HIV Positive People will help to clear the stigma veiling AIDS, and will provide easy access to sympathy, support, and guidance. Since January, when the network had 40 members, the size of the network has more than doubled to 85 members.
"Now instead of checking horoscopes, people should check each other's blood before marriage," joked Nandita Banerjee, one of the center counselors.
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