HIV/AIDS in rural Gujurat - Melissa Snow

Under the railway bridge, beside the bus station, behind the cinema is where commercial sex workers wait in Dahod, Gujarat. If you can’t find one then ask a chai wallah, paan seller, or mechanic. They are the middlemen here.

In this town, all commercial sex workers are women from the surrounding rural tribal villages. They are very poor and illiterate and sex work is one of the only financial opportunities open to them.

Or at least, there are some who choose this line of work because they do not relish the alternative of 8 hours of construction work for the same 50 rupees, (less than £1) that can be earned from half an hour of sex work.

The majority of their clients are the drivers of trucks, jeeps and rickshaws - men who move around the whole of western India. Dahod is situated on the three borders of Rajasthan, Madhya-Pradesh and Gujarat. It also houses the second largest grain storage depot in the whole of Gujarat, giving it the potential to be a high risk HIV area; every month 10,000 truck drivers from Jaipur, Indore, Mumbai, Chennai and Hariyana pass through on the National Highway.

The extended periods of time that the truck drivers spend away from their families results in an increased number of sexual contacts. In their day-in-day-out driving, there is no entertainment so when they stop at ‘dhabas’ they take pleasure in the food, rest, sex, alcohol and drugs that are provided at roadside hotels.

In Dahod, around 25% of truck drivers end up having to wait days for materials to arrive before they can set off on their journey with a full load. Waiting time is prime time for entertainment. Jeep and rickshaw drivers can also wait for long periods between fares and seek out women to help pass the time. Consequently, STDs and HIV are being spread throughout the country in both urban and rural areas.

Misconceptions about STDs and condoms merely ease the paths of infection. Many men believe that placing toothpaste on the penis before intercourse and cleaning the penis with urine afterwards can prevent the spread of STDs and HIV. Myths that condoms diminish sexual satisfaction, that they can affect appearance and sexual performance and that they are too expensive also play a role.

The majority of clients say that they do not use condoms because they are not easily available, or they are not aware of them. There is still great male resistance to condom use. Sex workers who insist their client wear a condom risk losing business to women who take their health less seriously.

Once they have contracted an STD, lack of money makes them try home-based remedies, borrowed prescriptions, traditional healers and over-the-counter medicines.

The exact number of HIV/AIDS cases in Gujarat is not known. However, one field worker stated that although people do not openly admit to being HIV positive, their symptoms suggest they are. The estimate is that 40% of jeep, 40% of rickshaw drivers, 10% of truck drivers and 10% of commercial sex workers have HIV.

It is important to know that in this area it is common for tribal villagers to migrate to urban centres for months at a time to find seasonal work. Migrant workers tend to have little access to HIV/STD information or services. Returning migrants, many of who do not know they are infected, may unknowingly transmit the disease to their wives.

HIV/AIDS is spreading to rural areas and the general population.

The future does not look bright. People here depend heavily on agriculture and cannot manage when family members become infected. Resources are diverted to provide medical treatment and children, especially girls, are taken out of school for additional labour.

Since 1992, the government has supported voluntary testing programs and awareness campaigns, and a National AIDS Control Programme was established. Nevertheless, the government has been criticised for failing to recognise the scale of the problem and the number of HIV cases had risen sharply since the 1990s.

A second phase of the National Programme was launched in 1999 (NACP-II). Its objective is to reduce the spread of HIV and strengthen long-term responses to HIV/AIDS. Specific objectives include intervention to change behaviour, especially among high-risk groups, decentralisation of service delivery, protection of human rights, operational research and management reform.

The National AIDS Control Organisation (NACO) sees NGOs as its primary allies and partners in undertaking targeted interventions among high-risk groups. Joint activities include disseminating the school AIDS education programme, delivering counselling services, providing care and outreach services for people living with HIV/AIDS, and generally evoking a community response to HIV.

NGOs work at the grassroots. They often represent the needs of the most marginalised and vulnerable populations. In this manner, NGOs help complement and supplement the efforts of government to put in place an integrated response.

However, at present there is only one NGO in Dahod that is working with NACO.

To date India has around 5.1 million HIV sufferers. Although the infection rate in the population at large is still low, in absolute numbers India has one of the largest HIV-positive populations in the world, second only to South Africa. The epidemic is generalised.

There is a need to act fast, as future projections are very bleak. The UN Population Division predicts

12.3 million AIDS deaths between 2000-2015; and 49.5 million deaths during 2015-50.

It is estimated that in the next 10 years India could have more AIDS cases than the whole of Africa.

In July 2004, the government launched its biggest anti-AIDS initiative to date but efforts are hampered by the fact that most Indians still find sex and AIDS taboo. The biggest problem to overcome is ignorance.

Melissa Snow volunteered at ASA in Dahod, Gujarat in 2001-02. She is currently a GIS/MIS consultant for an Indian NGO working in Gujarat.