25 November 2009
Words by Alex Renton, photographs by Abbie Trayler-Smith
There isn’t often good news in development work; too often the job of assisting the world’s poorest seems a hard and unwinnable slog. But in India there has been a major success. “Ten years ago the numbers suggested AIDS was going to run wild through the sub-continent,” says Emma Spicer, senior programme manager for DFID in India. “People were talking about a developing emergency. But India has started to win the battle to reverse the HIV infection rate.”
DFID has spent £140 million over the last 12 years assisting the Indian government in this fight, working on every aspect of HIV prevention from tackling mother-to-child transmission to the legal rights of homosexuals. And it seems to be paying off. “I think we can be proud of the part we’ve played in India’s success,” says Sabina Bindra Barnes, DFID’s HIV and AIDS Task Team Leader.
That success is measured not just in the overall numbers of people living with HIV, which are less than half what was predicted a decade ago (at about 2.3 million, now, in a population of over one billion). It also lies in other indicators: the massive increases in the number of pregnant mothers and other vulnerable people being tested for HIV, and in access to counselling and treatment for those who need it. National HIV prevalence rates in India are now about the same as those in Spain and Portugal, with some states and particular groups having higher rates.
Rishi kant , an HIV educator among sex workers in a DFID–supported programme in Delhi, says: “Seeing the figures on HIV stabilise gives us motivation. Our job is hard, it gives us the energy to continue because we know what can be achieved.” There is still work to be done. Infection rates are still high among certain groups, such as men who have sex with men, sex workers and injecting drug users. Some poor regions of India are “HIV hotspots”.
So DFID’s funding is now targeted at these areas. Over the next four years, Britain is contributing £102 million towards India’s National Aids Control Programme, about 10% of its total budget. We went out into the streets of Delhi to see this work in action.
First stop was a care home which supports children with HIV. It was lunchtime when we arrived, and the big kitchen was full of younger children eating a noisy lunch of dal, rice and potatoes, before running off to rest or play. Pretty quickly I found myself involved in a skipping rope game with two seven-year-olds: they were in fits of giggles at my clumsiness.
It’s clear that this is no sombre, forbidding institution. Anuradha Mukherjee, programs manager, says the Naz – the word means Pride – Care Home is “a family”. She spoke to me over the shoulder of a small six-year-old. Tired-out after a long morning at a nearby primary school the girl sought Anuradha for a cuddle, and fallen asleep in her arms. Like almost all the children at Naz she looks perfectly healthy. The 43 children are between 15 months old and 16 years old and most are HIV positive.
“Twenty-seven of our children are on anti-retroviral therapy, and they have access to nursing care and a doctor full time. But the main thing, and this is something we stress, is that you don’t need to do anything different. We take care of them as we would any child.” She points out a few children who have visible problems – scarring from skin infections picked up on the street, one with the distended stomach that is a side-effect of long-term malnutrition, and in a couple of cases, mental and physical damage.
“Most of the children are orphaned, and were found abandoned in the streets or left at temples. Three or four have one parent, who was not in a condition to care for them.”
Looking after these children takes kindness and good care: it costs about 9,000 rupees (£110) a month for each of them. But Naz’s work goes beyond this: it is trying to break down the prejudice and ignorance that condemns HIV positive people in India to hide, and, in turn, is a crucial part of the job of controlling the spread of the disease.
“We’re the only orphanage like this in India, and we get calls every day asking us to take children. We try to convince parents or extended family that they can look after the kids. But it is difficult – there is fear of the disease and as a result a lot of homeless HIV children out there, and most of them don’t even know their status.” The most awful thing, says Anuradha, is that they have come across examples of orphanages taking some children from a family but refusing to take those that are HIV positive. Now Naz is training government orphanages in how to care for people living with HIV.
DFID globally and in India supports a range of interventions to ensure that children made vulnerable by AIDS are cared for and supported, enabling them to eat well, go to school and realise their potential. The majority of children made vulnerable by AIDS are living in family environments. Across the world, DFID supports social protection policies and programmes that provide effective and predictable support to the most vulnerable households, including those with children affected by AIDS. Care homes are a last resort, for those who face abuse and neglect, often due to stigma and discrimination, as Naz’s experiences demonstrate.
Addressing the stigma and ignorance around HIV is key to halting the spread of the disease itself. So while much of Naz’s work involves providing education and counselling to sex workers and men who have sex with men (the one group in India where HIV infection rates are not yet dropping), it has also had to become involved with the gay rights movement. Under section 377 of the penal code introduced in colonial times, homosexuality is not only a criminal offence, but technically Naz and other organisations’ work in counselling and advising homosexuals on their health is illegal too. Thanks to the lobbying and campaigning work, “section 377” is now being repealed.
Elsewhere in India, DFID works with the Indian government’s much praised National AIDS Control Programmes to target the problems that, according to the research, contribute most to the spread of HIV. The priority is to rapidly scale up prevention, treatment, care and support services for vulnerable groups. In addition, DFID provides support to address legislation that makes it difficult for vulnerable groups to access prevention and treatment programmes.
One example is the injecting drug users among the huge population of street people who inhabit the old city centre in Delhi. At a drop in centre close to the railway station we watched the men arrive from their sleeping places or their casual jobs as rubbish pickers or street vendors. The Sharan centre sees around 200 such cases a day – it gives them food, substitute drugs, basic medical help and counselling. Many of the men are migrants who originally arrived from rural India looking for work in Delhi.
Paul is a drug injector who earns his living picking rags to recycle. He is caring for his wife who is living with HIV. He told us the centre was crucial to him and people like him. “It does a very good job: it helps us with food, gives us condoms, clean needles, counselling. They found me training to work as a rickshaw driver. Now I’m too busy looking after my family, but one day I will try the rehab that they offer: it’s hard but I will have to do it.” Paul has been visiting the clinic for eight years.
Successes are hard won in this world, but the stories of people like Paul and the others using Sharan add up to India’s extraordinary success in tackling AIDS. And that is also about lives changed for the better. Another beneficiary of the funding, 34-year-old Rekha, is now a counsellor with the NGO Shakti Vahini, supported through DFID’s HIV programme, helping female sex workers in India and educating them about HIV prevention.
Rekha’s story is typical of many. Aged 17, she was sold to a brothel nearby, beaten, tortured, and had to service ten to 15 clients in the building for five years. When she contracted TB – a common complaint among people living with HIV – the owner refused to let her go to hospital and instead told her she would die, still working, in the brothel in Delhi’s notorious GB Road.
“I met activists working from Shakti Vahini who helped me. They got me medicines and told me they would support me if I ran away. That gave me confidence and courage and it saved me,” Rekha tells us. Delhi’s closeted sex work industry – in a country that famously “does not talk about sex”, as one NGO worker told us – is now at last opening up to the crucial messages about HIV, safe sex and prevention.
Rekha’s job takes her to Delhi’s train station, where she spots girls arriving from the country. They may have been brought to the big city under false pretences only to be sold into sex work. Which is what happened to Rekha. She has already saved some girls, and brought about one prosecution. She has even come face-to-face with the woman who sold her to the brothel.
The work of preventing HIV is many-faceted: but one satisfying aspect is that it can put an end to some of the other injustices of the big city too. “I tell my story to inspire other people like me,” says Rekha. “I believe others can escape that fate, too.”