Mon, Dec 17, 2018 - Page 7 News List

How India’s sex workers prevented an AIDS epidemic

Beating AIDS is India’s greatest public health achievement, and Ashok Alexander’s book shares the story of why it would not have happened without the help of sex workers

By Amrit Dhillon  /  The Guardian, NEW DELHI

Illustration: Yusha

In 2002, a major report predicted an AIDS catastrophe in India. The country would have 20 to 25 million 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.

Yet 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 honors the people he says were crucial in guiding India away from its seemingly inescapable destiny: the country’s sex workers.

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.

Alexander, 64, was born into India’s elite. His father, P.C. Alexander, was principal secretary to former Indian Prime Minister Indira Gandhi.

In leaving his career as senior director in the India office of McKinsey & Co to join the campaign to stop the spread of HIV, Alexander swapped a life of plush boardrooms and fine dining with chief executive officers 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 non-governmental organization worker said: “Please don’t step on the people having sex.”

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 percent of sex work presented a fundamental difficulty for the success of Avahan, as the foundation’s program 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 are 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.

Tackling fatalism, an aspect of the national psyche, was harder. This quality can be seen every day on India’s roads, where drivers burst onto 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.”

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 1pm to 4 pm, sex workers could unwind, have a hot shower and rest on a mattress on the floor.

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