Winnipeg Free Press - PRINT EDITION

India on the edge

A Manitoba medical team tries to keep AIDS from ravaging the sub-continent

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Free Press health reporter Jen Skerritt was the winner of an Asia Pacific Foundation of Canada fellowship. She used it for research in India on the anti-AIDS campaign led by a University of Manitoba team. This is the first of two parts of her report.


Jen Skerritt

1Several months ago, Soromya's pimp arranged a date for her with two men in a hotel room off a traffic-packed, bumpy highway on the edge of town.

When Soromya asked the men to wear condoms, they tied her to a cot, gagged her with her own sari, and repeatedly raped her. Now, Soromya is terrified she has contracted HIV and doubts she'd insist on protecting herself again.

"I'm scared," she said, through a translator.

"If I file a complaint I'll be arrested, or (the police) will have sex with me and chase me away."

Like the other women sitting cross-legged on a woven carpet floor next to her, the young sex worker had never seen a condom until a University of Manitoba-led HIV prevention team arrived in Channapattana -- a slum on the outskirts of Bangalore in southern India.

Bangalore has become a hub for high-tech industries and boasts one of the fastest-growing economies in Asia. A flood of foreign companies is eager to outsource call centres and software development here, but those riches and opportunities haven't trickled down to Soromya's neighbourhood.

The dusty streets and grimy brothels in Channapattana are home to more than 900 sex workers -- one of the highest numbers in the Bangalore area.

Between 10 and 12 per cent of sex workers here are HIV positive, and most have little, if any, education or access to other sources of income. While other women make wooden handicrafts, sell freshly-picked bananas in roadside markets and help men harvest sunflower fields, women like Soromya have fallen into a vicious cycle of sexual exploitation.

Some are duped, sold, or forced into the sex trade. Some say it's a way to survive after their husbands abandoned them or died.

Others need the extra money because their husbands are alcoholics.

Up until a few years ago, women like Soromya rarely said no to men who wanted to pay for unprotected sex.

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Medical brainpower from Winnipeg first arrived in India in the late 1990s, after the World Bank asked researchers to step in to support infection control programs in some of the hardest-hit regions of the country.

At the time, worldwide projections pegged India as the next Sub-Saharan Africa, with estimates that the HIV epidemic could reach between 20 and 25 million as early as 2010.

U of M researchers already had an international reputation for being on the cutting edge of HIV/AIDS from two decades of work in Kenya and Uganda.

Dr. Stephen Moses had been fighting the spread of HIV since the mid-1980s in Kenya. He was among the first to show HIV could be transmitted heterosexually and that circumcision in adult men reduces HIV transmission and infection rates.

In India, the disease was spreading primarily among male and female sex-trade workers, and the transient population of men who paid to have sex with them.

Moses knew he had a problem: HIV in India was more contained than in Africa, but the sheer size of the Indian population -- 1.1 billion - meant even a small infection rate had a huge impact on thousands, potentially millions, of people.

In Karnataka state alone -- the Bangalore area -- disease surveillance estimated 1.5 per cent of the population, or more than 500,000 people, were HIV positive .

Moses saw the pilot project's potential as a model for the rest of India and other nations.

If health workers could make an impact on disease rates in Karnataka, other Asian nations could follow suit.

Moses knew his staff needed to infiltrate close-knit communities with a high prevalence of sex workers to make a dent in infection rates.

"That is the biggest challenge in India," he said in his office in Bangalore.

The solution isn't as simple as handing out condoms.

A high number of Karnataka's 55 million people live in crushing poverty, and routinely migrate back and forth from neighbouring states to work as labourers for seasonal harvests, making them difficult to track.

Those rural areas have some of the highest HIV rates in the state, in part due to a long-standing cultural acceptance of sex work.

Some families traditionally "dedicated" a daughter to serve the sexual needs of temple priests, making conditions in northern Karnataka ripe for spreading HIV.

Women who were dedicated to the temple become devadasis -- prostitutes symbolically married to the deity.

Today, devadasis no longer work out of temples. But they can never marry, and do sex work out of their own homes, their family's homes or brothels.

In Bagalkot, a northern district in Karnataka, AIDS was reported as the cause of 17 per cent of deaths in 2003 -- the single leading cause of death among people aged 15 to 49.

Despite a growing number of deaths, Moses said the epidemic is still somewhat hidden since many men and wom en are reluctant to get an HIV test.

Low literacy levels makes educating at-risk women and men difficult, and many women are pressured, duped or sold into the sex trade to make ends meet.

* * *

Perhaps the greatest incongruity is a group of Prairie researchers plunked in bucolic India aren't here with Canadian funds.

Some of their main support comes from an American philanthropic organization run by the same man who has a multi-million dollar technology research lab in Bangalore -- Microsoft magnate Bill Gates.

In 2003, the Bill and Melinda Gates Foundation was shopping around to invest major dollars in an HIV prevention project in southeast Asia.

As luck would have it that was around the same time the U of M program hit a funding snag with the Canadian International Development Agency. CIDA wanted to pull out after a tiff with the Indian government, and ignored pleas from Moses and his team to keep the HIV program afloat.

At the time, Moses said the project's future looked dismal.

Fortunately, U of M researchers received overwhelming support from the Bill and Melinda Gates Foundation and United States Agency for International Aid.

To date, the program has received more than $50 million to fund prevention and treatment projects across the state.

U of M joined forces with the Karnataka State government to form the Karnataka Health Promotion Trust -- the largest HIV prevention organization in India, which now has regular contact with more than 80,000 sex workers in 31 state districts.

U of M decided to tackle the problem by focusing the majority of infection control efforts on male and female sex workers in Karnataka.

Moses and a team of Winnipeggers, including Dr. Jamie Blanchard and community health professor Dr. Shiva Halli, worked to develop contacts with sex workers in communities with a high prevalence of HIV.

Halli, who was born in a remote Karnataka village, proved a key link between Canadian researchers and Indians. He visited dozens of villages in northern Karnataka to introduce HIV programs and KHPT staff workers.

At the same time, KHPT hired social workers and infection control staff and gave money to well-established non-governmental organizations to run HIV prevention projects there.

Today, KHPT has 1,200 staff members and funds about 25 HIV prevention projects run by NGOs across the state.

KHPT outreach workers identify a handful of sex workers who are well connected to the network of prostitutes in the neighbourhood and train them to act as peer educators.

The women keep in close contact with community sex workers, hand out condoms and encourage women to visit a doctor regularly.

Peer educators make lists of all the sex workers in a certain district, where they solicit and where they do sex work, to determine the best way to reach them.

Moses and his team set up drop-in centres for sex workers, health clinics, train HIV counsellors in government hospitals and work to empower women to learn their legal rights and take control of their bodies.

* * *

At ground zero of the epidemic, infection control isn't so cut and dried.

Although women like Soromya learned how to use a condom and try to persuade men sex is more pleasurable if he uses a rubber, women's empowerment incited a backlash in Bangalore -- women are being beaten, raped, and arrested the more they demand safe sex.

The same households that worship Indian goddesses like Lakshmi, the goddess of wealth, don't necessarily believe in a woman's worth.

In some rural areas, women are the last people to eat, and sometimes don't get any food at all if men want a second helping.

Although Moses said KHPT held sensitivity workshops for hundreds of Bangalore-area police officers to help reduce violence, in places like Channapattana the problem is getting worse.

Some officers are corrupt, and accept bribes or sexual favours from the women they arrest. Others feel inclined to "morality policing" and strive to punish sex workers for what they see as a reprehensible lifestyle.

Last June, Channapattana police raided a home and arrested four sex workers, including two KHPT outreach workers.

Chikkathayamma, a peer educator, was illegally detained for a week. She said if it weren't for KHPT staff linking her with a lawyer, she would probably still be in prison.

Uma, a sex worker in her early 20s, sits next to Chikkathayamma and coos at her toddler in her lap. She said drunken men are increasingly causing her trouble and worries about her safety the more she protects her rights.

"They say to me, 'I'll murder you,'" said Uma, "'I'll knife you.'" SFlb

Republished from the Winnipeg Free Press print edition March 22, 2008 $sourceSection$sourcePage

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