Superstition, Poverty May Bring AIDS Crisis in India

The scene at the Sexually Transmitted Disease Clinic, in the heart of Bombay’s red-light district, provided painful proof that India is losing the battle with AIDS.

It was a Tuesday, and two hours are set aside every Tuesday for prostitutes to come in for blood tests and counseling. Dr. Geeta Bhave and her staff of female doctors from the government’s only AIDS surveillance center were chatting in the doctors’ meeting room.

There are about 100,000 prostitutes in the district, and Bhave estimates that as many as 40% of them may be infected with the AIDS virus.

Only 26 showed up on this Tuesday. Most of them have already tested positive for AIDS, but they have gone on working, and each has at least four customers a day.

Experts say this could well bring on perhaps the world’s worst AIDS nightmare.

The prostitutes who did show up, all illiterate and all afraid, were not here for condoms, education or even a medical examination. They were here for Bhave’s “miracle” AIDS cure--a sugar pill dusted with a powder made of ground insects, herbs, diseased human tissue, flowers and chemicals.

“This is my invention,” said Bhave, who is described as at the cutting edge of the government’s effort to deal with India’s AIDS problem. “I admit we are working in crude ways. But we have almost no money budgeted for this program. The government is too busy in meetings to realize what is going on. So I’m taking the initiative.

“And, personally, I believe in homeopathy. I believe in miracles.”

So, apparently, does the government.

Sexual promiscuity is taboo but rampant among India’s 833 million people, and medical experts such as Bhave say the AIDS virus is already spreading explosively.

Fueled by a lethal combination of superstition, ignorance, poverty, poor hygiene and a moribund, inefficient bureaucracy, India is on the brink of an AIDS crisis that experts predict will rival that of Africa.

Officially, the government maintains that there are just 2,167 documented cases among the 461,118 people tested between October, 1985, when a screening program began, and last March 31. These are people who tested positive for HIV, the virus of acquired immune deficiency syndrome.

But medical experts insist that the government figures have no bearing on reality and that the AIDS virus is spreading rapidly through sex and contaminated blood products.

They cite as evidence:

In Bombay’s Falkland Road, the notorious red-light district that draws thousands of men a night from throughout India and the Persian Gulf countries, only 12,000 of the estimated 100,000 prostitutes have been tested since Bhave’s surveillance program began a year ago. The infection rate has risen sharply. Of the first 2,400 women tested, only 139 tested positive, less than 6%, but in the past six months the level has increased to 20%.

“I would not be surprised,” Bhave said, “if the real infection rate is 40%. I remember one day when 52% of the women from a single brothel tested positive.”

Outside of Bombay there is virtually no testing of prostitutes, although there are brothels in every major city and town in India, many of which are frequented by some of the same men who visit Falkland Road. The government has sanctioned 40 test centers in the five major cities, Bombay, New Delhi, Calcutta, Madras and Bangalore, but many of these exist only on paper. Even in Bombay, Bhave said, hers is the only functioning center; the other seven authorized and funded 18 months ago have not been opened.

The failure to provide test facilities has permitted gallons and gallons of AIDS-contaminated blood to be pumped into hospital patients. There are tens of thousands of professional blood donors in impoverished India, and they provide 1.5 million units of blood a year. Much of this donated blood has been tested since a screening program began in 1987, and the blood of hundreds of donors has tested positive, but most of them continue to donate.

One infected professional donor, M. R. Joshi, 60, said he is no longer permitted to give blood in Bombay, where every donated unit is tested for AIDS, so he travels 20 miles to suburban Thane, where he continues to donate every month.

“My AIDS are gone,” he declared. “I drank my own urine for three months, and the AIDS went away.”

“Urine therapy,” a technique marketed by the Bombay-based Water of Life Foundation, is a staple of Indian medicine.

Such beliefs, including homeopathic medicine of the sort practiced by Bhave, have deepened the crisis by leading AIDS patients to believe they are cured: “So Indians are particularly vulnerable to a disease like AIDS that has no symptoms during the years it’s dormant in the blood,” said Dr. Ishwar Satyanarayan Gilada, who is regarded as India’s foremost AIDS expert and is its most vocal spokesman on the subject.

For Gilada, the AIDS problem is more frustrating than for most. He has been lobbying the Indian government for more than five years in an effort to mobilize concerted action against the disease--and he has little or nothing to show for his effort.

“Since the beginning, when the first AIDS case showed up here, the government has taken a head-in-the-sand attitude toward this disease,” the 32-year-old Bombay doctor charged earlier this month.

He cited a controversial solution proposed in June, 1988, by Prof. A. S. Paintal, the government’s chief medical research official. Paintal, who is director of the Indian Council on Medical Research, proposed a law that would ban sex between Indians and foreigners.

“The African nations weren’t careful, and now they have to bear with the curse of AIDS,” Paintal was quoted as saying at the time. “The foreigners gave it to them, and now they’re giving it to us. Only foreigners can transmit AIDS. I would say, roughly, that 10 times with 10 different partners in the U.S.A. is enough. The solution to the problem is to restrict yourself to one partner.”

Now, after two years of AIDS deaths and statistics that document the spread of the disease, Paintal is trying a new tactic. A flood of domestic and international criticism of Paintal’s position already has killed his proposed legislation.

Faced with mounting pressure from the World Health Organization, which has mounted a worldwide campaign against AIDS, Paintal’s council recently unveiled a $20-million master plan to combat AIDS in India. It calls for more AIDS testing centers, a mass education campaign using posters, pamphlets and word-of-mouth in local languages and the screening of blood banks.

Nevertheless, experts such as Gilada are skeptical of the council’s plan and fearful for the future.

“It is the right idea if it goes into the right hands,” Gilada said, “but if it doesn’t, it will fail. And the main reason it will fail is the attitude of the top bureaucrats of the health ministries in our government, who will be the ones trying to implement it.

“AIDS is still seen here as a disease of the poor, the illiterate, the prostitutes and the deviants. The bureaucrats still don’t think this is their disease. It is not a problem of the ministries or their politicians or their bureaucrats. I hate to say it, but we need an Indian Rock Hudson to die here before this attitude will change.”

According to Bhave, it is only a matter of time before some prominent person meets this need. “We get samples from the so-called five-star hospitals all the time, and many are positive,” she said, “so it has definitely already reached the ruling-class level of our society. But even then, it’s all just pushed under the rug. In India, nobody accepts openly that this promiscuous sex is going on. Of course it is going on, but no one will talk about it. So for them, it doesn’t exist. And neither does AIDS.”

Meanwhile, Indians are getting AIDS. They are dying. And the attitude of blissful ignorance is making death painful and lonely.

The situation is graphically illustrated in Goa, India’s internationally known beach resort region on the Arabian Sea. Significant numbers of tourists visit Goa, among them luxury travelers, tour groups, 1990s hippies and heroin addicts.

Goa recorded its first AIDS case in 1989, and the state government promptly enacted a Draconian law that permitted health officers to test on demand any Indian or foreigner suspected of carrying the virus. The law required that anyone who tested positive would be isolated in a hospital or prison.

Dominic de Souza, a World Wildlife Fund employee who was found to be infected with the virus, was dragged to the police station and kept in solitary confinement for a month.

Gilada, working through the private International Health Organization, which he and hundreds of other concerned young doctors formed, undertook a protest campaign, organizing marches, public meetings and legislative speeches in Goa. In April, 1989, Goa repealed the law.

Still, more than a year later, attitudes toward AIDS are largely unchanged. This month, after weeks in an isolation ward in Goa, Joaquim Afonzo, 31, died from what newspapers described as “an agonizing death of AIDS.”

He had not been placed forcibly in the isolation ward, said Gilada, who had counseled Afonzo for several months. But he had no choice.

“His family reacted like the government,” Gilada said. “When he grew sicker and sicker, when he could no longer wash or clothe himself, when he could no longer eat, they washed their hands of him. No one would so much as touch him, and they threw him out of the house.

“It’s typical of India’s reaction to AIDS. Patients who test positive, for example, are supposed to get 1,200 rupees a month compensation (about $70) from the government. But no one has ever received it.

“The whole pattern of the government AIDS program is on the wrong foot. And it’s clear where it’s all going to lead. AIDS will play anarchy in India. It will be chaos everywhere. And, even now, no one seems to care enough to do anything to control it.”