AIDS in a culture of callousness and shame

Reporting in the American media on the spread of AIDS has focused on Africa. Yet India, with its enormous population, its grinding poverty juxtaposed with rapidly growing wealth and its distinctive attitudes toward sex, has become an epicenter of the disease.

Since the onset of the AIDS pandemic, ignorance and prejudice have been the virus’ greatest allies -- and the most frustrating impediments to care and prevention programs. “AIDS Sutra: Untold Stories From India,” an intelligent, often compelling collection of essays by noted Indian writers, demonstrates that workers on the subcontinent dealing with the disease often confront similar problems.

Some factors that have increased the spread of the disease in India echo the situation in much of the developing world. Trafficking in poor women and girls remains widespread, despite laws and treaties. Relatives abandon HIV-positive children after their parents’ deaths. New highways and booming markets have expanded the trucking industry: Drivers frequent prostitutes along their routes -- and bring the disease home to their wives. In many areas of India, impoverished women who have no other means of survival turn to prostitution.

Other factors are unique to Indian culture. In “The Daughters of Yellamma,” William Dalrymple examines the illegal (but still practiced) tradition of families in Karnataka of “dedicating” young girls to the goddess, i.e. selling them into prostitution. Salman Rushdie explores the flamboyant subculture of the hijra, transsexuals who sometimes have themselves castrated. (A high proportion of the members of this tightly knit community -- that may number 100,000 -- are sex workers.)

Homosexual activity is illegal in India, a legacy of the British Raj that remains in force decades after England liberalized its own laws governing sexual conduct. Family pressures compel gay men to marry, and the unhappy husbands resort to male prostitutes, otherwise known as MSMs: men who have sex with men. Gay males who become infected with HIV face a double stigma. As writer Siddharth Dhanvant Shanghvi comments, the “disgrace shrouding HIV in India provokes menacing acts of hatred, reserved, in another era, for lepers.”

The best essayists bring a novelist’s sensibility to their work, turning grim statistics into moving, personal stories. Sunil Gangopadhyay revisits Sonagachi, the red-light district of Kolkata, and reflects on earlier attitudes in India: “If a woman was beautiful and talented; if she could sing, dance or converse intelligently, why should she waste her skills on one man alone? Why shouldn’t a number of men enjoy her company?” He contrasts the status of the accomplished courtesans of old who were called barnari or barangana (“public women”) with the wretched lot of most prostitutes in modern India.

A life in tatters

In the moving chapter “Mister X Versus Hospital Y,” Nikita Lalwani details the case of “Toku,” an HIV-positive physician who became the subject of a notorious court decision. The staff of a hospital where Toku had donated blood told the politically prominent family of his fiancee about his HIV status before they informed him. The wedding was canceled and Toku sued the hospital. The Indian Supreme Court ruled against him and suspended the right of HIV-positive people to marry. The case was hotly debated in the Indian press and four years of legal action were required to get the judgment dismissed.

Toku eventually married, adopted two sons and established a new practice in another part of India, specializing in HIV treatment. But the most touching aspect of his story may be that he has begun serving as a matchmaker for his patients, men and women who nurture a fragile hope for companionship in a hostile environment. “I think about how Toku is trying to actively restore this right to marriage as part of his own patients’ right to life,” Lalwani concludes, “by attempting to reignite that part of the human psyche that we all share. The part that believes that we own the right to love in that particular way, and be loved in return.”

Overstated case

In his foreword, Nobel laureate in economics Amartya Sen notes that reports on the number of cases of AIDS in India have been wildly exaggerated in the West: “In 2002, the CIA convinced itself that there were going to be 20 to 25 million -- no less -- AIDS cases in India by 2010.” That figure, he pointedly adds, “showed how easily an organization dedicated to intelligence can fail to give much evidence of it.” The current best estimates place the figure at between 2 million and 3.1 million cases.

This important book should be read by anyone concerned with the worldwide progress of the pandemic, not just by physicians, health officials and members of nongovernmental organizations but by any compassionate reader. The anthology was produced in collaboration with the Bill and Melinda Gates Foundation, and some of the proceeds will be used to support programs for children in India affected by HIV.

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Solomon’s most recent book is “Disney Lost and Found: Exploring the Hidden Artwork From Never-Produced Animation.”