When AIDS service organization Avahan set out to chronicle the experiences of Indians living with HIV program director Negar Akhavi wanted more than just another report.
“One of the themes we wanted to stress was that AIDS thrives on ignorance but also indifference,” explains Akhavi. “It isn’t sufficient to tell a story that’s compelling but lacks factual information or vice versa. You have to marry the two.”
The resulting anthology, AIDS Sutra: Untold Stories from India (Random House), strikes this balance by teaming up with India’s foremost fiction writers. The unlikely pairing provides a glimpse at how stigma and discrimination threaten lives in the world’s most-populous nation.
In 2007, there were between 2.1 million and three million people living with HIV in India, according to estimates from the United Nation HIV/AIDS Programme UNAIDS. That figure falls far below the worst-case scenarios suggested by some scientists since the country’s first-known case of HIV was reported in 1986.
In some ways India serves as a model for how developing nations can respond effectively to the pandemic. Across the country health centres provide counselling and free antiretroviral drugs to all HIV patients. Community-based programs dole out free condoms in Mumbai’s red-light district and popular cruising spots for gay men.
Yet Akhavi, who served as editor for AIDS Sutra, says the raw numbers hide a tragedy that continues to wreak havoc on India’s most-marginalized groups.
“Compared to a billion people most numbers would seem small,” she explains. “But if you peel away the layers, you start to see large spikes in infection rates in certain regions and among certain groups, to the point where it is a generalized epidemic.”
India’s National AIDS Control Organization (NACO) estimates that 8.4 percent of the country’s sex workers and 8.5 percent of men who have sex with men (MSM) are HIV positive. Among intravenous drug users HIV prevalence is estimated at a devastating 10 percent. What’s more, only a small percentage of people living with HIV in India — 13 percent — are aware of their positive status.
It falls to the writers contributing to AIDS Sutra to explore why current treatment and prevention efforts leave so many Indians out in the cold. Spending time among the communities they were assigned to document, they unravel the complex network of relationships contributing to HIV’s silent spread in traditionally conservative India.
Not surprisingly the individuals encountered in AIDS Sutra share a common quality as outsiders in Indian society. In “The Half-woman God,” internationally acclaimed author Salman Rushdie illuminates the rich history and traditions of the hirja, India’s male-to-female transgendered people, and warns of the poverty and intolerance that drive many to sex work.
Novelist-cum-journo, Siddhartha Deb, travels to the remote northeast provinces, where hopelessness is pacified by the near-endless supply of injection drugs that flow across the border from Burma.
The one Canadian connection former University of Calgary writer-in-residence Jaspreet Singh writes about the stigma that follows HIV-positive orphans, many of whom have been rejected by their extended families as cursed.
But the most-damning accounts of societal neglect come from India’s sex worker population, whose histories often read like fictional tragedies.
“I’ve known cases where husbands will contract HIV, from having unprotected sex at a brothel for example, and they’ll simply give up,” says Sonia Faleiro, a Mumbai-based journalist and author of the 2006 novel The Girl. “They don’t get tested [for opportunisitc infections], they’ll stay at home in bed and stop working. They die quickly and then the responsibility falls on the widow, who may already be HIV positive… she’s then abandoned by her relatives and forced to go into sex work to feed her family.”
Faleiro drew upon her contacts in Mumbai’s community of sex workers when writing “Maarne Ka, Bhagane Ka,” (Beat Them, Kick Them Out), a startling exposé of police brutality.
The essay follows Savita and Ashok, two of the thousands of Mumbai residents who make their living selling sex in the city’s parks and alleyways. Though prostitution is not illegal in India, Savita bares the scars of frequent encounters with the law: blood-stained saris, soreness and fatigue. Already shunned by society as a “randi” (the pejorative term for a sex worker), she’s also targeted by obscure laws governing so-called indecent behaviour, allowing police to pick her up for virtually any reason.
Unable to pay the 1,200 rupee ($30) fine, Savita can either spend the night in jail — depriving her of the nightly income she needs to survive — or pay police with free, often unprotected, sex.
A male sex worker like Ashok has even less recourse under the law. Homosexuality — whether money is exchanged or not — is illegal in India, carrying a punishment of up to life imprisonment.
In reality though it’s more profitable for police to blackmail MSM for money and sex than to lock them away. In one harrowing account Ashok recalls being gang-raped by a cadre of officers during a single night.
Faleiro claims political pressure to legislate morality and the public’s reluctance to talk about sex are two of the major factors fuelling the cycle of violence which in turn contribute to HIV transmission among sex workers and their clients.
“Most people treat sex workers like they’re invisible or they’re bad people… police and clients can do whatever they want, knowing they would get away with it,” she says.
Harassment by police also makes it difficult for sex workers to file complaints against abusers, increasing their vulnerability to attack and decreasing their ability to negotiate safer sex, Faleiro adds.
Still, Faleiro says there’s reason for hope, pointing to a resurgence of sex worker rights campaigns in her home country and a case currently before India’s High Court on decriminalizing homosexuality, a move supported by Indian health minister Anbumani Ramadoss.
But having returned from a book tour that took her across India and United States, Faleiro says more needs to be done to break down the barriers that keep stigma, and HIV, alive.
“We’re still holding onto the belief that what happens to them doesn’t affect us,” she said, “but we see time and time again that it isn’t true.”