Women's rights and gender equality Global
development
The untold story of how India's sex workers prevented
an Aids epidemic
Beating Aids is India’s greatest public
health achievement. A new book says it wouldn’t have happened without women.
Amrit Dhillon in New Delhi
Thu 13 Dec 2018 05.00 GMT
In 2002, a major report predicted an Aids catastrophe
in India. The country would have 20-25m Aids cases by 2010. People were being
infected at the rate of about 1,000 a day. Aids orphans numbered 2 million.
This scourge would ravage families, society,
and the economy. India was going to be the Aids capital of the world.
Scourge: Plague
Ravage: Destroy
But 2010 came and went. India averted an Aids epidemic. That victory –
India’s biggest public health achievement – has remained uncelebrated. But a
new book by one of the major HIV campaigners of that time finally honours the
people he says were crucial in guiding India away from its seemingly
inescapable destiny: the country’s sex workers.
Averted: Prevented,
aborted
Ashok Alexander spent a decade at the helm of the Bill & Melinda Gates
Foundation’s campaign against HIV. In his book, A Stranger Truth: Lessons in
Love, Leadership and Courage from India’s Sex Workers, he says the miracle
would never have happened without the cooperation of sex workers.
At the helm: At the control
Alexander, 64, was born into India’s elite. His
father, PC Alexander, was principal secretary to Indira Gandhi. In leaving his
career as senior director in the India office of McKinsey & Company to join
the campaign to stop the spread of HIV, Alexander swapped a life of plush boardrooms and fine dining
with CEOs for sitting on mud floors with sex workers, gay and transgender
people and intravenous drug users. In short, a world of which he had little
knowledge.
His account
begins with his first day in the field, walking through a park in Vizag, in
south India, in pitch
darkness. As they
navigated around couples having sex on the grass or behind the bushes, a local
NGO worker urged: “Please don’t step on the people having sex.”
Account: story,
explanation
Pitch darkness: Total darkness
This was where sex work took place in India – in
parks, at bus stops, on street corners. The fact that brothels accounted for
only 7% of sex work presented a fundamental difficulty for the success of
Avahan, as the foundation’s programme was called. How do you contain an
epidemic in a setting where women are not clustered in one place, but dispersed
and on the move? Where sex workers on the highways would get picked up by
truckers then, when finished, cross the road to return on another truck?
Inevitably, a lot of data crunching and analysis had to happen –
about which sex workers worked where, for how long, at what risk, and with how
many customers – and this was entrusted to impoverished sex workers. They could
have refused, but took on the task.
Crunching: Process large amounts of information or perform operations of great complexity,
especially by computer.
Tackling fatalism, an aspect of the national
psyche, was harder. This quality can be seen every day on India’s roads, where
drivers burst on to highways in the path of oncoming traffic without looking
right or left. As one trucker told Alexander: “HIV might kill us in 10 years
but this truck might kill us the next minute.”
Tackling: Deal
with
Add the poverty, helplessness and lack of choice
facing sex workers to this inherent fatalism, and the risk of catching the
virus from unprotected sex seems remote and hypothetical compared with the
brutal reality of survival. “You are telling me that if I get HIV I will die in
10 years’ time. But sir, 10 years is a lifetime for me. I have other, more
serious things to worry about now,” said Theny, 25, a street-based sex worker.
Simple things often worked beautifully. At the outset,
Alexander had no idea that a safe place to sit for a few hours, away from the
violence of boyfriends, pimps, and police, could be so important. Avahan opened
drop-in centres where, from 1-4 pm, they could unwind, have a hot shower and
rest on a mattress on the floor. There was also the chance to be checked for
sexually transmitted infection by a doctor without fear of being identified and
stigmatised. For Avahan, the centres were a way of collecting the women in one
place to be able to give them the information, support and condoms they needed.
As a former management consultant who has guided
corporate executives on leadership qualities, Alexander couldn’t help but
notice that the women – who gradually became his friends and colleagues – had
these skills in abundance. In fact, he places sex workers a notch above
business leaders on account of the sheer range of their
skills. They are excellent judges of character and tough negotiators. Every day, they
courageously battle emotional, financial and health crises while simultaneously
keeping violence at bay.
A notch above: Over
Sheer range. Wide range
Keep at bay: Keep to line
Avahan scaled up with striking
speed. It had a presence in 550 towns in just two years; within three, it had
become the world’s largest privately sponsored HIV prevention programme.
Striking:
remarcable
But before scaling up, Alexander had to figure out the
solutions. That required understanding sex workers’ lives and why they took the
risks they did. Helpful here was the willingness of sex workers to mobilise as
a community. The women knew what was best for them. All Alexander had to do, as
he says, was tap into “the strength inherent in even
the most marginalised of people if they are enabled to come together in a
common cause”.
Tap into: to take
advantage of
At the height of Avahan’s activities, Alexander and
his teams were providing HIV prevention services to more than 270,000 sex
workers, working in 672 towns, and distributing over 13m condoms a month. The
programme, which cost $375m (£297m), is credited with an important role in the
subsequent decline in India’s HIV status. Today, 2.1 million Indians are living
with HIV. The prevalence of HIV is 0.22%, lower than that of the US.
The reason India’s sex workers never been praised for their contribution to this achievement, says
Alexander, is that this was a success story no one wanted to author: “Their
selfless contribution will never be recognised because of the stigma that still
surrounds this disease.”
Praised: Honoured
A Stranger Truth by Ashok Alexander is published by
Juggernaut
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