CREDIT: Peter Goodspeed/National Post Mumbai, India -- Outreach worker from Saheli - Yellavva - who is a prostitute and former devadasi (temple virgin) in her room in the brothel.

One in every eight people in the world infected with HIV lives in India, making it, after Africa, the second epicentre for AIDS. Senior International Affairs reporter Peter Goodspeed travelled there ahead of the International AIDS Conference that begins next week in Toronto. In the first of three stories from there, he describes how prostitutes are on the front lines of the battle against the killer disease.

 

MUMBAI, India - The way Yellavva, a 30-year-old prostitute, describes it, she "lost her life" when she was only eight.

It was then, just as doctors were identifying India's first full-blown case of AIDS, that Yellavva's parents dedicated their only child to the Hindu goddess Yellamma, the Mother of All, in exchange for a wish for a son.

As a "temple virgin" initiated into the infamous and now illegal Devadasi cult, Yellavva became a slave girl to the gods.

"I was given to the goddess, so I'm not allowed to marry," she explains. "I had to do everything in the temple. I had to serve the goddess."

But, under the Devadasi system, that also meant that once she entered puberty, Yellavva became a concubine to the temple priests, who regularly hire out the Devadasi to anyone who wants to sleep with them.

"These worshipping people who used to come there would use the girls," Yellavva says.

"We were used to having sex with many people. But we would not get money for that work. When we got to be 14 years old, we came here [to Mumbai] to earn some money.

"I came here to survive," she says simply.

Yellavva went from being a sanctified prostitute in the northern Karnataka town of Bijapur to a sex worker in a seedy Falkland Road brothel in Mumbai, just as one of the modern world's worst epidemics was colliding with India's ancient culture.

Today, one in every eight people in the world infected with the HIV virus, which causes AIDS, lives in India, and that number is growing by as much as 500,000 a year.

India, with more than 5.7 million people infected with HIV/AIDS, now has more people living with the deadly virus than anywhere else in the world.

South Africa ranks second with 5.5 million infections, a figure that accounts for nearly 19% of that country's adult population.

India's infection rate touches only 0.9% of its adult population.

There's still a great deal of controversy surrounding data on HIV/AIDS in India.

For years, the Indian government denied the disease was a threat and constantly challenged warnings that the misery AIDS caused in Africa now threatens India. In a country plagued by poverty, a population explosion, massive illiteracy, an already struggling health care system and a host of other diseases that claim hundreds of thousands of lives each year, AIDS was frequently regarded as just another problem.

Now, that's changing.

Last month, a major report by India's National Council of Applied Economic Research warned that if the HIV/AIDS virus is allowed to spread unchecked, India's bright economic future may be at risk.

An unhindered HIV/AIDS epidemic will slash nearly a full percentage point off India's annual economic growth over the next decade, the New Delhi think-tank warns.

It predicts that more than 16 million people in India could become infected with HIV/AIDS by 2016. That will rob one of the world's fastest-growing economies of as much as US$235-billion in potential investment, the report warns, saying extra government spending on health care and increased medical bills for families affected by the epidemic will lead to a serious drop in national savings.

Other studies are even more ominous. Four years ago, the U.S. Central Intelligence Agency predicted between 20 million and 25 million Indians could be infected with HIV/AIDS by the year 2010.

"The disease has built up significant momentum, health services are inadequate and the cost of education and treatment programs will be overwhelming," the CIA said.

"AIDS is one of the principal question marks hanging over India's future," warns a study by the Center for Strategic and International Studies in Washington.

The World Bank predicted HIV/AIDS could soon become the single largest cause of death in the world's second most-populous country. "At present, AIDS cases are under-diagnosed, under-reported and ill-treated," insists Ishwar Gilada, a Mumbai physician who 22 years ago was one of the first activists to raise the alarm about HIV/AIDS in India.

"The official HIV estimate for India is 5.2 million [United Nations researchers put the figure at 5.7 million], but a realistic figure could be 10 million or 1% of the total population," Dr. Gilada says.

"Nearly 90% of India's HIV-infected people are totally unaware of their HIV status," he adds. "This is an epidemic that is spread by sex, blood and ignorance."

Twenty-two years ago, when Dr. Gilada first started warning about the dangers of HIV/AIDS, Mumbai's teeming brothels employed up to 120,000 prostitutes. Now, deaths and desertions triggered by fear of AIDS have reduced Mumbai's population of sex workers by up to 80%.

Twenty-thousand prostitutes once worked in Falkland Road. Now only about 4,000 remain.

In a typical brothel, the going rate for sex is between 20 and 50 rupees (50 cents to $1.20) and customers sleep with prostitutes in small, squalid rooms that contain several beds equipped with flimsy cloth partitions.

Up to a dozen women live in each room, taking turns to service customers or lounging provocatively in doorways in brilliantly coloured saris.

Falkland Road is bordered by thin, pungent streams of sewage flushed out by warm monsoon rains, and the street is a river of people, honking taxis and mobs of hard-eyed men -- migrant workers, rickshaw pullers and truck drivers -- searching for a brief liaison.

Only 20 years ago, the scene was a hundred times more chaotic and dangerous.

In 1986, when India's first AIDS case was detected in the city of Chennai (Madras), few of Mumbai's prostitutes or their clients relied on condoms, Dr. Gilada says.

As a result, the decaying slum on Falkland Road became the epicentre of India's AIDS epidemic.

In the early 1990s, when Indian government officials still insisted the country had only a few thousand HIV infections, blood tests among Falkland Road's sex workers showed that more than half of them had already been infected with the virus that causes AIDS.

Still, India's government insisted there really wasn't a crisis. A former head of the Indian Council on Medical Research went so far as to suggest AIDS could be controlled in India by simply outlawing sexual relations with foreigners.

The government largely left it to private groups and individuals to wage the early war against AIDS.

Dr. Gilada established a privately funded Indian Health Organization (now the People's Health Organization) and regularly descended on Mumbai's brothel districts with a bullhorn and boxes of condoms that he handed out to prostitutes, warning them of the dangers of unprotected sex.

He also organized the sex workers into self-care groups, held street theatre exhibitions to teach safe sex and handed out information about condoms to truck drivers, migrant workers and factory hands.

In a land that is slightly neurotic about sex -- families refuse to talk about it and newspapers regularly argue over whether Mumbai movie actors should be allowed to kiss on camera -- Dr. Gilada suggested the Kama Sutra should be used as a national tool to prevent AIDS.

"Many Postures with One is better than One with Many," he argued and produced postcards, key rings and T-shirts to popularize the Kama Sutra among truckers.

Over the past decade, Dr. Gilada's Saheli Project, (Saheli means "friend" in Hindi) has hired working prostitutes to educate their peers about safe-sex practices and handed out more than 70 million condoms in Mumbai.

On a recent foray into Falkland Road, Saheli workers doled out condoms from an industrial-sized box in the back of a white truck.

"We used to go from house to house distributing these condoms, and some people used to scold us," explained Yellavva Kadimhni (who has the same first name as Yellavva, the Devadasi), a former prostitute now working with Saheli. "They would fight us and insist nothing would happen if they didn't use condoms. They didn't want to have anything to do with us. Now, when they see our vehicle, they come running right up, asking for condoms."

According to Dr. Gilada, condom use in Mumbai's red-light districts has jumped from less than 5% in 1991 to nearly 90% today.

"Because of AIDS, people have started thinking that if I get this disease, no one is there to look after me. No one will be there to look after my children," says Monica, a native of West Bengal who came to Mumbai 20 years ago as a child to work as a maid.

Now, after 12 years of working as a prostitute, she says few sex workers think of serving a client who refuses to use a condom.

"We're still trying to survive," she said. 'We've seen people dying here. We've seen other girls die. If one customer has said no to condoms, all the other girls will say no to him as well. We have a new unity."

Still, Yellavva, the Devadasi, regrets some of the changes AIDS has made to Falkland Road's red-light district.

"It has changed," she says. "In the beginning, we used to get nice customers from very big families. Good people used to visit us, but not now. Now we only see the people who are poor and they don't have much money."

Things are changing nationally, as well. For the first time, India's government has earmarked $150-million of its own money in this year's budget to promote safer sex, to popularize the use of condoms and to expand the network of treatment facilities helping HIV/AIDS victims in the six high-prevalence states across the country.

In another new initiative, the government intends to target HIV-positive pregnant mothers in an attempt to control the mother-to-child transmission of AIDS. So far, only 4,500 pregnant mothers in India have been given doses of nevrapine, a drug that helps prevent the transmission of the HIV virus from an infected mother to a newborn infant.

The vast majority of people living with AIDS in India have no access to life-extending antiretroviral drugs, but the Indian government recently announced plans to provide antiretroviral medicine to up to 100,000 people by early next year.

According to the International Treatment Preparedness Coalition, an anti-AIDS watchdog group, an estimated 770,000 individuals in India still need antiretroviral drugs and are unlikely to get them.

Still, despite the new initiatives, India spends only about 17 cents per person on HIV/AIDS, compared to a country such as Uganda, which spends around $1.85 per person.

"Had the government been more active in the initial period of the epidemic, it could have changed things in a big way," Dr. Gilada says. "But the central or state governments haven't spent a single pie [penny] from their coffers until 2005. Whatever money was spent here on AIDS prevention before that was from the World Bank or grants from donor countries. Not a rupee came from the government's own coffers."

After 22 years of fighting India's reluctance to face its crisis, Dr. Gilada says he's confident things will change.

"If [Microsoft billionaire Bill] Gates can support $200-million for India's AIDS programs, why can't our business giants match it for our own people," he asks. "This needs serious debate and some high political will."

In almost the same breath though, Dr. Gilada admits India will be grappling with HIV/AIDS for decades to come.

"India's HIV numbers will ultimately rise to almost 25% of the world figure, simply to match India's contribution to the world's pool of sexually transmitted disease," he predicts.

"'We really need to become pragmatic about prevention.

"We can no longer afford to continue to think of AIDS as a disease of the poor, illiterate sex workers and deviants. This is a disease with the power to touch us all."

HIV/AIDS IN INDIA BY THE NUMBERS

1,080,264,388 Population of India (July, 2005 est.)

5.7 MILLION Estimated number of people living with HIV in India by the end of 2005 (UNAIDS estimate)

5.2 MILLION Estimated number of people living with HIV in India by the end of 2005 (India's National AIDS Control Organization estimate)

0.9% Estimated percentage of adults living with HIV/AIDS

1.6 MILLION Estimated number of women (ages 15-49) living with HIV/AIDS by the end of 2005

270,000 - 680,000 Estimated number of deaths due to AIDS during 2005

UNAIDS 2006 Report on the Global AIDS Epidemic. May, 2006; CIA World Factbook 2005

TUESDAY

BATTLING AIDS: Peter Goodspeed tells how a University of Manitoba team is teaching 45,000 prostitutes in India how to survive a devastating HIV/AIDS epidemic in part two of a series.

Ran with fact boxes "HIV/AIDS in India: By the Numbers" and"Tuesday", which have been appended to the story.