And Band Plays On               
__________________AMRITA SHAH

Sex, Lies and AIDS
By Siddharth Dube
HarperCollins India
Price: Rs 295

If one considers the reactions evoked by the spread of AIDS/HIV in India, two divergent views are evident. One has it that the country is on the threshold of a massive and horrific AIDS/HIV epidemic and all efforts must be geared towards its prevention. The other view appears to see AIDS as just another health problem in a backward country deserving no more importance than any other.

Siddharth Dube is clearly of the former persuasion. A New York based writer and health policy analyst, he believes that with the experience of the West before it, India could have easily prevented the spread of AIDS/HIV. He supports his claim by tracing the history of the disease in India. He begins in 1986 when the first few HIV positive cases were detected. Most cases at the time, as Dube points out, tended to be from the high risk categories of female sex workers, their clients, men who had sex with men, drug users (particularly in the Northeast) and those who had received blood transfusions.

The official approach at this initial stage was to treat it as a law and order problem giving rise to various ‘unsound’ policies. (Among the solutions proposed were a ban on sexual relations with foreigners and legal sanction to measures such as forced testing.) Many of these proposals were actually put into action: sex workers were forcibly tested and locked up; the Indian Railways, Dube claims, banned HIV/AIDS patients from travelling in trains; government campaigns claiming ‘AID equals death’ and so on. This gave currency to the notion that AIDS was a punishment for deviant behaviour.
Nevertheless, by 1991, Dube reveals, the figure testing positive had jumped to five lakhs according to the government’s official estimate. The disease had also moved into the homes of the rich and begun to affect people who would earlier have been categorised as ‘low risk’ (many being wives of men with high risk behaviour). Two to four out of hundred pregnant women tested in Mumbai and Pune in the early nineties were found to be infected.

The government meanwhile had turned over a new leaf. Recognising its failure in preventing the spread of the disease and under attack for human rights abuse, it retracted from treating AIDS as a law and order problem. Taking a loan of $84 million from the World Bank, it established the National AIDS Control Organisation (NACO) in 1992 and initiated various measures such as state AIDS cells, awareness programmes in the media and in colleges, a risk behaviour survey, steps to upgrade STD clinics and clean up blood supply, and so on. By 1997 however, Dube claims, the optimism aroused by these developments had evaporated. The reasons Dube outlines are, one, denial and a lack of commitment at the top: only a handful of statements on AIDS have been forthcoming from major leaders in the last decade, he points out, and most are so vague that the sexual issues at the core of the issue were obscured.

The other reason Dube emphasises is low standards, whether in screening procedures followed by blood banks or government manufactured condoms. Though the government has taken an even bigger loan from the World Bank, money by itself can do little to fight denial and indifference.

By end 1998, he points out, 35 lakh Indians were infected with over three lakh dying that year alone. At the beginning of 2000, he says, the best estimate is 50 lakh Indians infected — 10 times the number in 1991 and one-eighth of the global total. Dube’s own fears are a holocaust on the scale experienced by many countries in Africa, that is, about four crores in the next five years or 5 per cent of the population.

The problem with Dube’s thesis is that there is little attempt at substantiating it. Much of his prophesising is in the form of subjective assertions. He informs us, for instance, that from 1990 he searched obsessively for ‘answers to this life and death puzzle’. He quotes himself (from a 1991 article) saying: “Hundreds of thousands of Indians will die from AIDS in the next few years. The tragedy of AIDS in the worst-affected countries of Africa is set to repeat itself in India.” Or he likens himself to a man about to witness a forest fire.

Clearly he is aware that there are Indians who do not share his view. But he doesn’t try to change their minds with fact — comparative figures on fatal diseases, a discussion on health in general that perhaps could have put AIDS in perspective. Nor does he mount an argument with emotion.

The writer has travelled widely. He has visited Mumbai’s red light area, Uttar Pradesh, the Northeast; been on research trips to Kenya, Malawi and Congo; has had arguments with doctors, health and government officials everywhere. And yet, apart from brief portraits of 12 AIDS victims — the most moving section in the book — Dube passes up the chance to bring the epidemic alive through narrative and vivid description. In fact, for the most part one feels one is merely going through old news and information that has been widely disseminated in press reports and media campaigns.

Which is a pity, for he is probably right in his criticism that sexual hypocrisy and indifference have obstructed India from adopting the simple measures that the West has undertaken in its efforts to prevent AIDS. It would have helped if he had prepared a stronger argument to support his outrage.

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