The AIDS challenge

Print edition : September 15, 2001

Sex, Lies and AIDS by Siddharth Dube; HarperCollins India, New Delhi, 2000 (second edition, available in Hindi, Malayalam and Telugu); Rs.195.

IT is now more than two years since the Kargil War ended. It is hardly necessary to remind anyone of the much-hailed "spirit" that was evident during that war. Many people applauded the way in which the country "united" behind our soldiers in the battle against Pakistan, how we all "came together" in a time of adversity. We decided that we would defeat the intruders "at all costs"- perhaps our leaders' three favourite English words at the time.

In the course of about 10 weeks, Kargil killed about 500 Indian soldiers. Without in any way meaning to overlook the tragic loss of those fine Indians, consider another calamity that we are in the middle of as I write this. In 2001, it will kill about 300,000 Indians. That is, one Indian lost to us every two minutes; a rate of death 115 times greater than the rate at which Kargil claimed the lives of Indian soldiers. By any definition, this calamity seems to qualify as a major adversity. And yet I do not know of a single leader who has exhorted Indians to "come together" to fight off this murderous, implacable enemy. I have not heard those three English words used by any national figure to urge a national effort as they did during Kargil.

Why? What will it take to, first, acknowledge what Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome is doing to us; and, secondly, come together to fight its assault on India? Will it take the comparison to Kargil that has been made above? Or other comparisons - that the impact of the AIDS epidemic in terms of human lives lost would be equivalent to that of 30 Orissa cyclones, or 15 Gujarat earthquakes; and that it kills Indians about 50 times faster than does the imbroglio in Kashmir? Will it take the heartrending stories of victims Siddharth Dube mourns in this book? Like the slender long-haired Maharashtrian 29-year-old, infected by a middle-aged and married "important client" who bullied her into having sex with him, shunned by neighbours, friends and even her own brother, dying in her bed while her shattered parents watch in mute despair?

Whatever it takes, we will have to dig in sometime. Otherwise this disease threatens to damage India irreparably, and in ways far worse than Pakistan can ever hope to do. The HIV/AIDS epidemic, writes Dube, is "India's greatest health problem today, as well as a potent threat to our economic and development prospects". This deeply disturbing book is Dube's heart-felt appeal to his country to look this deadly reality square in the face. The problem, of course, is that his is a country that seems determined to victimise the victims.

Dube catalogues a sheaf of evidence that fairly shouts this out. And solid research makes it hard to refute his evidence, though some people have tried to. What is more, he does it with language and passion that leave you wrung out. His easy style makes this book accessible to all.

In Imphal, Dube found the jail stuffed with several hundred HIV-positive men and women. There were "no plans," he writes, "to ever release this group... not because they had committed a crime that required life-long imprisonment but simply because the State government had decided that they posed a risk to society." Is there any comparable instance of hundreds of Indians being detained because they suffer from, for instance, typhoid? In 1994, the Maharashtra government proposed a law that would have allowed it "to brand infected sex workers with indelible ink". Is there any comparable effort to brand sufferers of, for instance, tuberculosis? In 1996, when a 29-year-old woman tested positive for HIV, the doctors at a private clinic in Mumbai threw her out "even though she was covered with open sores". This is apparently the routine behaviour of doctors and nurses across the country. The All India Institute of Medical Sciences (AIIMS) in New Delhi, "set up to establish the best standards of medical practice, had turned away scores of infected people. So the beds in its small but well-equipped AIDS wards stood empty." Is there any comparable "medical treatment" given to sufferers of, for instance, cholera? And why these peculiar, if not stupid and inhuman, practices? Because parallel to the AIDS epidemic is an epidemic of blind irrationality.

Ever since cases of AIDS surfaced in India, they have been greeted with reactions that could have been described as wildly funny had they not been so horribly serious. Many of the officials concerned, or unconcerned, believed that this was a disease of deviants, society's outcasts and the poor - worthless people far removed from the "mainstream". They also believed that HIV/AIDS was cosmic punishment for the promiscuity of these worthless people; that their deaths were in fact good because they would alleviate India's enormous problems of population and poverty.

IN any case, officials in charge of dealing with AIDS refuse to believe even the reliable figures given by Dube. Not that the annual AIDS casualty figure of 100,000 - a number closer to what they will admit - is substantially "better" than 300,000. After all, it is still 40 times more murderous than Kargil. And if all that was not bizarre enough, the authorities would tell Dube over and over, in various ways, that since we are a uniquely "moral" society, AIDS could never spread here as it had elsewhere and that therefore there was no need to take steps to halt the disease. Dr. A.N. Malviya of the AIIMS pronounced that Indians were "of a higher moral order" than those promiscuous Africans who were reeling under the onslaught of AIDS. Dr. A.S. Paintal, Director-General of the Indian Council of Medical Research, expressed the belief that "nowhere else in the world is chastity considered an important aspect of a woman's life apart from India". Going strictly by the rate at which Indians produce more Indians, it is clear that sex is happening here all the time and "chastity" is not a particularly apt word under the circumstances.

It is not that I see anything in the least immoral about these features of India. The real immorality lies in the callousness with which victims of HIV/AIDS have been treated by officials and society; in the apathy and neglect that have turned a disease that might have been controlled into a glowering monster that is reaching into every city, every cluster of homes, virtually every family in this country; in the fact that a 29-year-old victim's neighbours stopped even speaking to her and her parents.

The day I began this book, I also read a column by Pramod Navalkar, once Minister for Cultural Affairs in Maharashtra. Explaining the measures he took while he was Minister, he said he put "curbs on obscenity" and "a check on the Westernised hungama in theatres". These were necessary, he wrote, because "not only do we respect women, we also worship them". I wondered as to how to reconcile Navalkar's words with those of Dube. The author says: "[One factor] greatly responsible for the ferocity of India's (AIDS) epidemic is the shamefully oppressed state of Indian women. The conditions of women in India are still amongst the worst of any society in the world, certainly far worse than in most African countries." Yes, the state of Indian women has helped AIDS rage through the country. Sex, Lies and AIDS is a frightening book not just because it paints a grim picture of India's AIDS-blighted future but because it holds a mirror up to Indians. It shows them the result of the attitudes they hold dear, the pretences they like to clutch at, the mistakes they have made, the commitments they have ignored and the foolish policies they have followed. "The actions and investments required for HIV/AIDS prevention need to be made," writes Dube, "should already have been made, irrespective of whether this disease had ever surfaced in India." That is, India should be concentrating on those basics that any functioning society must address: health care, education, justice and the fight against prejudice. And all these for all Indians. These are commitments Indians made to themselves over half a century ago. It is precisely because they have paid no attention to these commitments that AIDS flourishes in India today.

Dube sees a window of opportunity that is still open to India to fight off the kind of spectre that AIDS has become across Africa. Still, the challenge is enormous. Going by the number of HIV-affected Indians today, the year 2005 will probably see one million Indians dying of AIDS even if first-rate measures are put in place rightaway, even if the wrongs that Indians suffer are corrected immediately, even if it is ensured that not a single Indian is infected with HIV starting today. Two thousand Kargils. Not even all the nuclear bombs in the world will protect us from that.

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