“A bureaucrat and a truck-driver (both frequently traveling men) went to a Doctor for oral thrush. The bureaucrat got an antibiotic. The truck driver was sent for HIV TEST”
Mmhonlümo Kikon
It was precisely two years back that the issue of Stigma and Discrimination in relation to people with HIV/AIDS was raised in the Naga Areas by a group of conscientious organizations, supported by NACO, NSACS and the UNAIDS. The issue remains as relevant today as it was then. It was just a beginning, albeit a glorious one. However there has been less effort to follow through the brilliant ideas generated at that point of time. It is in continuation with the same effort that the present attempt to focus on the diverse and often controversial topic of HIV/AIDS will be based. Like the previous write ups on HIV/AIDS this will also challenge hitherto believed notions which have flown down the bridge. In particular it will focus on the notion of “High Risk Groups” (HRG for convenience) which has gained currency in the HIV/AIDS discourse today. Following the French intellectual Michel Foucault’s attempt to trace the historical and cultural development of the clinic, madness and sexuality, an investigation will be made on the cultural definitions constructed in the field of HIV/AIDS and the unfair divisions between those who meet and those who deviate from social norms.
The notion of HRG for HIV/AIDS is a central construct of the public health strategy being promoted by donor agencies through “targeted interventions”, “highway clinics”, “coastal area projects”, “reproductive and child health projects”, “sexual health projects”, etc. Over the years various “classes” of people – commercial sex workers, truck drivers, street children, etc. – have come to be labeled HRGs for HIV/AIDS. And most of what is being done in the matter of prevention and control of HIV/AIDS is in the form of targeted interventions for these HRGs.
Some targeted interventions are taking shape and others are said to have “effectively” worked, such as the well known Sonagachi initiative launched in 1992 in one of the oldest and largest red light areas of Kolkata. By 1996 the Sonagachi initiative had earned the status of an “effective approach” meriting nation-wide replication. Even as donors are standing on the efficacy of the HRG approach on increased use of condoms that is claimed to have succeeded there, we must ask:
• Are manipulated statistics on increased use of condoms, decline in STDs and no increase in HIV infection over a 4-year period in a localized red light area sufficient for identifying an “effective approach” for HIV/AIDS in India?
• Does the fact that, notwithstanding the Sonagachi success, Kolkata did record the highest increases in HIV/AIDS cases not suggest that the targeted intervention was not really an effective approach for HIV/AIDS?
• What is the basis for the assumption of rampant Indian male promiscuity or prostitute-like behavior amongst the Indian populace that is implicit in the suggestion that this “model” be replicated in other parts of India?
There is also the matter of how HRGs are actually being addressed. Staying with the example of commercial sex workers (CSWs), it is well known that very large percentages of these in major cities are mobile and do not operate out of identifiable “red light areas”. In Delhi only 4000 of the city’s estimated one lakh commercial sex workers are found in GB road. Even in complete “condomization” of this, 4% of the HRG is likely to achieve little beyond glamorizing selected NGOs, as evident from official claims of 50% of the CSWs in GB road being HIV positive!
The fact is that the HRG construct cannot possibly do much for prevention of HIV/AIDS inasmuch as it is a flawed approach that focuses on identifying “HRGs” rather than building awareness on “HRGS”.
Further, a closer look at the basis of identifying HRGs clearly shows that it is highly suspect and tantamount to a scientific fraud on the people. Take the Kerala experience for instance.
The British Government’s ODA (Overseas Development Administration, now Department For International Development) launched in April 1996 a project on targeted interventions in Kerala. It listed tribals, street children and sex workers among HRGs and said this was based on NACO’s studies in 65 cities, including 3 in Kerala. When asked for the study, ODA said it was confidential. Nor was the study available with the Kerala Government.
• Surely a Government of India report meant to help in prevention of HIV/AIDS and generated at huge public expense could not be confidential.
• Surely a foreign donor cannot keep material relating to people’s health confidential from the very people concerned.
But still, it was only after approaching the Kerala High Court by some social activists and after fourteen months of effort that three portions of a patchy report could be obtained. It turned out that the 65-city HRG study was only a 36-city study, in which only 21 city-reports had been completed. The study does not mention tribals at all and nowhere does it mention prevalence of HIV in other groups listed as HRGs. In fact, Kerala has no identified street children and sex workers are also not a visible group.
In other words, most of the population is being excluded from the purview of substantive HIV/AIDS prevention and control measures which are only being targeted at a dubiously identified priority group. Clearly there is now way such a strategy can achieve any significant success in preventing HIV/AIDS.
Meanwhile, the HRG construct has had three significant damaging effects:
• First, it has misled public in respect of perceptions of risk. People are lulled into the belief that if they do not belong to or associate with HRGs they are not at risk.
• Second, the medical profession – in an appalling display of ignorance and “quack” like behavior – has come to consider the HRG label a “symptom” of HIV/AIDS. This was obvious from the remarks in a recent television program of no less than the Head of Microbiology of Rohtak Medical College that a truck driver admitted with a number of problems was “clinically diagnosed” as having AIDS.
• Thirdly, since HIV is an infection with extreme social stigma attached to it, labeling groups of people as HRGs leads to marginalization – even ostracism and can be viewed as being undemocratic, subversive, discriminatory and a violation of individual’s rights.
All these raises a number of questions: why are certain donor countries interested in interventions in, say tribals in Kerala in the name of HIV/AIDS? Could such communities really be seriously at risk? Or is there a hidden agenda? Why are NGOs content to be implementing unscientifically identified and formulated HRG projects? After all aren’t they the ones usually most concerned about resource crunches and flaws in approaches? Then why are they running (for foreign donors) HIV projects like highway clinics, coastal area projects, red light area projects and, of course, projects in tribal areas? The whole issue must be taken further to fully realize the impact of the current practices of NGOs and government agencies dealing with HIV/AIDS. The core of the whole matrix will be unraveled as we investigate the case of blood banks, vertical transmissions, the involvement of the World Bank and the Bill and Melinda Gates foundation. In a recent review of the whole issue in the Hindustan Times, the hidden agendas behind the entire strategy involved in tackling HIV/AIDS in India has been challenged. In fact renowned scientist like Harvard molecular biologist Walter Gilbert and University of Berkeley Professor of Molecular and Cell Biology, Peter H. Duesberg have even gone to the extent of postulating whether the AIDS virus is actually a science fiction? Their scientific papers can be found on the website for the reference. In this scenario we need to handle an issue which involves the whole gamut of our society with care, proper research and non-monetary concern – not just because we need the money from Bill Gates or UNAIDS or NACO for the sake of whatever projects we may be doing or proposing.
