Stresses and risks

Risky health behaviour among workers in an industrial area of New Delhi is seen to be linked to stresses at the workplace, poor working and living conditions and the limited social support available to them.

"WORKERS in the national capital are highly vulnerable to HIV/AIDS", concludes a recent study, raising in its wake a gamut of issues related to HIV (human immunodeficiency virus)/ AIDS (acquired immune deficiency syndrome) and the workplace. In order to address this issue, a meeting of Central trade unions, employers' associations, women's organisations and labour support groups was held in Delhi. Among the participants were representatives of the Centre of Indian Trade Unions (CITU), the All-India Trade Union Congress (AITUC), the All-India Central Council of Trade Unions (AICCTU) and the Federation of Indian Chambers of Commerce and Industry (FICCI).

"We have decided to call for the formulation of a national policy on HIV/AIDS at the workplace," says H. Mahadevan of the AITUC. Elaborating, he says that this would define the rights of workers and also the responsibility of employers if HIV/AIDS-affected cases are identified in the workplace. There should not be any mandatory testing of HIV in the workplace, nor any discrimination on account of identification of HIV infection in a worker, he says. "We have also taken up the task of organising cluster meetings in the residential areas of workers to sensitise them on this issue," says Madhavan.

The role of employers in ensuring the safety of workers is no less important. Significant here is a document of the CII (Confederation of Indian Industry) - HIV/AIDS policy, which urges both employers and trade unions to ensure that HIV-infected people get the same rights as people suffering from any other illness, to start an awareness programme, empower employees and guarantee confidentiality regarding HIV/AIDS status. The policy opposes making testing a pre-employment requirement. However, for workers in the unorganised sector comprising a majority of India's workforce, the ground reality is very different. For the impoverished migrant workers, among the squatters of India's cities, there is little choice. Not only are they vulnerable to HIV/AIDS transmission, but the socio-economic and cultural realities of their life erect barriers to AIDS prevention efforts.

THE Wazirpur Industrial Area (WPIA) in the heart of New Delhi is like any decaying region in a large city, marked by the presence of unorganised industries, multitudes of migrant labourers, haphazardly stacked clusters of small, nameless factories, and filthy, unhygienic and overcrowded slums. Workers live here under dangerous, and highly stressful conditions. Most of the workers stay with friends or relatives in overcrowded rooms with little space for privacy, far away from their families. Having left home at the age of 15 to 18 years, they limit their visits to native places to once in two or three years. According to Sudhir, a steel cutter in A-124, friends and others from the same village do constitute a support system but that cannot substitute for a home. Besides, there are few opportunities for leisure.

Productivity seemed to be the main concern of the employers. Typically, the owner of an industry watches workers' movements from the window of his office room. Any worker found wasting time is liable to suffer a salary cut. However, the employer does not seem to care about the mental and physical well-being of the workers. The workers engage themselves in taxing and hazardous work from 9 a.m. to 9 p.m. in dark, congested rooms - with infrequent breaks, sometimes with minimal access to food or water, under conditions of tremendous heat, polluted air and often, noisy machinery.

As for stress, accidents (particularly in the steel factories) are the central concern of many workers. They say that they live in daily fear of fatal, mutilating or disabling accidents. The fears are well-founded. On an average, one to two accidents occur every week. Bhola (23), a worker in A-117, lost his left eye as a steel patti (piece of scrap) hit it. Patti injury to the abdomen, liver, chest, eye and so on is common. Fatal accidents are also frequent - 12 cases were reported last year. Accidents in acid factories are also a regular feature. Workers seemed to refer to these accidents in a fatalistic way. "An accident can just happen anytime and kill someone working next to you. It will happen when it has to. If it is your day, you will go," says Radhashyam (27), a steel cutter in B-72.

It is a fact that the health-related behaviour of a person is directly related to that person's sense of control over important aspects of his or her life. The greater one's sense of self-efficacy, the more is one's engagement in health-promoting behaviour. But in Wazirpur, the dominant feeling among the workers is one of helplessness in a range of contexts. Most of the workers said they hated their jobs, but had little choice, given their poor level of education, and the high level of unemployment and chronic poverty in the area of their origin. Narendra Kumar works on a steel rolling machine where steel plates are rolled and stretched. He says: "The work is difficult and risky. Rolling machines are death traps where all too often steel patti injures or kills one of us. But I have no choice, I have to do it".

Workers also feel that they cannot avoid health problems. Harvinder is 22. He washes steel sheets in acid tanks. According to him, he will inevitably get tuberculosis (TB), no matter how hard he tries to avoid it. Thirty-year-old Omprakash looks older than his age and sounds depressed and apathetic. Speaking about his recurrent bouts of TB, he doubts whether he would ever return to normal health. "What can I do? I do not have the privilege to improve my health. Living in this hell, I have no choice as to how I conduct my life; it is imposed on me. The workers here eat jaggery to save themselves from toxic fumes. I have stopped doing even that," he says. Not a year passes without Omprakash entering a hospital.

WHILE the workers speak with feeling about the frightening working atmosphere and poor living conditions, they have little faith in their ability to improve the situation. "Complaints to unions barely bear fruit," said one of them. According to Jai Kumar Gupta, an Indian National Trade Union Congress (INTUC) activist, the risk of HIV/AIDS appears small compared to the everyday risks in the life of a worker in WPIA. This, he feels, is the reason why many workers did not bother about the ill-effects of drugs, alcohol, risky sexual behaviour and so on. "The risks involved in everyday life are such that one can hardly be interested in life and the only thing that motivates one is pleasure."

There is a large number of medical practitioners in WPIA: each locality has 100 to 150 of them. Most of them are quacks. For any ailment, a takat ki goli (power pill) or an injection is given. Shivakumar, who works in A-145, said one of his village kinsmen came from Mumbai and he had AIDS. He went to the "Bengali doctor" for treatment; he was given an injection, slept for two days and went back home. He is fine now. Did he really have HIV/AIDS? Dr. Banerjee thinks so because he had rashes on his body and also boils on his private parts. What was the treatment given? There are no disposable syringes in sight, except a dirty bowl to wash the oft-used syringe. However workers and their families visit these doctors for treatment.

When workers talked about their sexual experiences, their notion about masculinity came out. Workers seemed to have developed a sense of being 'machos' to tackle their fears in their day-to-day working lives. Shankar Magar, of B-46/4, speaks of his fears as a new worker: "As we stretched the steel sheets through the roller, holding it with our hands, pattis of all sizes broke and flew like bullets in different directions. That very week Krishan Nandan from my village, working next to me, died of stomach injury." Shankar was terror-stricken and wanted to leave the place but his more experienced colleagues asked him to stay on saying that he is a man, he has the responsibility of supporting his family and has no choice but to put up with the risks and stresses of work. "A man is someone brave enough to withstand the rigours of the job," he feels. According to him, the theme of "being a man" is commonly used to encourage or console co-workers. Thus the notion of masculinity plays an important role as a coping mechanism with which workers overcome their daily fears of injury and death as well as the demands of their work.

Mohan Singh (22) says: "Being a man means facing hardships, taking care of family and chasing women." Linked to this masculine identity are insatiable sexuality, the need for multiple sexual partners and a "manly" desire for the pleasures of the "flesh". All kinds of notions are widely prevalent. Sex is seen as crucial in the regulation and a balanced supply of blood and sperm, and prolonged celibacy is seen as a factor that causes depression, tendency to violence, inability to think clearly, and impulsive behaviour. According to Jai Kumar, an INTUC activist, "If a man has been a celibate for too long, he cannot control his desire when he encounters a commercial sex-worker."

Dangerous sexual behaviour among workers in WPIA must also be seen in the context of the limited social support available and their living away from homes and families. The fact that most of the workers in WPIA come from patriarchal rural communities of north India is also a causative factor. In such communities masculine identities are often constructed through participation in homestead and family leaderships. For the migrant workers of WPIA, frequent assertion of what are regarded as "healthy and manly sexual urges" could be attempts to compensate for reduced opportunities in other contexts.

Thus to view the risk-taking health behaviour of the workers in WPIA as an ignorant choice of theirs would be too simplistic. Although 60 per cent of the 147 workers interviewed in WPIA said that HIV/AIDS spread by visits to sex workers (an underestimate, given the sensitive nature of the subject), 30 per cent were aware that the condom was an important preventive device. However, only 0.7 per cent said they used condoms. These workers' notions about masculinity and sexuality often drive them to a point where, despite their awareness about AIDS, they gamble away their precious lives.

Richa Singh is a Shastri Indo-Canadian Fellow at McGill University, Canada and is doing her Ph.D. in Jawaharlal Nehru University, Delhi.