No nation immune' from AIDS

[Guest guest]

No nation immune' from AIDS

Indian physician treats sex workers Was first to sound alarm on

disease

PRITHI YELAJA, STAFF REPORTER. Aug. 26, 2006. 01:00 AM

Prithi Yelaja went to India to explore the extraordinary ties that

bind this dynamic, rapidly changing nation to Greater Toronto. One

in an ongoing series.

MUMBAI—On a sultry monsoon day, Yellavva Kamla, dressed in her best

sari, stands on tiptoe, straining to catch the attention of Dr.

Ishwar Gilada.

She is among 150 former sex workers jammed into the foyer of a

decrepit cinema in Mumbai's red light district. They are here for

Raksha Bandhan, the annual festival marking the protective bond

between brother and sister.

Pushing her way through the sweaty crowd, Kamla lovingly etches a

red tilak on Gilada's forehead, ties a rakhee — a bracelet of gold

and red thread — on his wrist and pushes a sweet into his mouth.

Gilada rewards her in the customary way, with a small monetary gift.

" He saved my life by rescuing me and my daughter from prostitution,

so he is like a brother to me, " says the beaming Kamla, a three-time

grandmother at 40. A prostitute from age 14, she now earns a living

in the Saheli (Friend) project, counselling other former sex

workers.

Gilada, who helped found Saheli in 1991, was among 500 delegates

from India in Toronto this month for the international AIDS

conference.

Among the delegates were women much like Kamla, former sex workers,

whose way was paid by an Indian organization. They won the

opportunity to go by making impassioned speeches on HIV/AIDS as part

of a competition modelled after the popular Indian Idol show.

Gilada, on the other hand, is a regular at AIDS conferences. One of

India's foremost experts on the disease, he says they're " like going

to marriage ceremonies, where you meet lots of people in a short

time and pick up fresh ideas. "

He thought it " ridiculous " that Prime Minister Harper didn't

address the conference. " He should have come. It's such an important

event not only for Canada, but for the world. "

But he had the joy of seeing his activist daughter among the winners

of an MTV video competition held in connection with the event.

It's all a long way from his private clinic, which provides

counselling, testing and drugs for AIDS patients, just 10 minutes on

foot from the red light district.

In 1985, Gilada, now 48, was the first doctor in India to sound the

alarm about AIDS.

" I was ridiculed at the time, " recalls the U.S.-educated physician,

sitting in his tiny office as monsoon showers pelt the window. He

blames the " holier-than-thou attitude " of Indian officials for

failure to take early action to prevent its spread.

" They felt our marriage and cultural traditions are so strong, the

virus won't spread here — but no nation is immune. If they had acted

quickly then, we would not have an epidemic now. "

Based on sheer population, he says, India has the largest number of

HIV cases in the world.

Though the U.N. estimates 5.7 million Indians carry the virus — a

figure the Indian government disputes as too high — Gilada believes

the real figure is closer to 10 million.

" Government should not feel shy about these numbers. The first step

in solving a problem is admitting the scope of it. "

And indeed, the tide could be turning. A report released by India's

registrar general and census commissioner this month estimates that

11 million people in India could die of AIDS-related illnesses by

2026. Officials and ministers simultaneously attending a national

meeting of mayors and district council chiefs called on leaders in

rural areas — where poverty and limited health care leave people

especially vulnerable — to join a nationwide campaign against HIV

and AIDS.

Rajkumari, 45, is typical of Gilada's patients, 70 per cent of whom

travel from other parts of India to see him because of the lack of

specialized AIDS clinics.

A factory worker, Rajkumari's husband died of AIDS in 1999 after

passing on the virus, leaving her to raise five children alone. Her

brother took her in and pays the 1,000-rupee ($24) monthly cost for

her anti-retroviral drugs.

While grassroots programs such as Saheli have raised awareness about

AIDS among the lower echelons, such as sex workers, cabbies and

truck drivers, a new wave of AIDS is brewing in the burgeoning

middle class, particularly in the states of Bihar, Uttar Pradesh,

Rajasthan and Gujarat, says Gilada.

Among the middle class, he says, the stigma of AIDS " is not related

to the disease per se. It's linked to sexuality and sex outside of

marriage, which is still taboo. "

Gilada has tirelessly championed measures such as mandatory HIV

testing for pregnant women and free drugs for the poor. In 1989, he

won the release of an AIDS patient held in indefinite quarantine in

Goa. He also fought for screening to ensure a safe blood supply.

Although generic AIDS drugs are readily available in India, lack of

awareness means that only 7 per cent of HIV patients receive

antiretroviral therapy, Gilada says.

By 2007, the government plans to offer free treatment to 100,000

poor patients per year.

With Gilada in Toronto was daughter Trupti, 20, a third-year medical

student and accomplished AIDS activist.

At 12, she was performing street plays to raise AIDS awareness among

slum dwellers. At the 1998 AIDS conference in Geneva, she presented

a paper on the People's Health Organization — a non-government group

her father founded — that presents safe-sex messages during

religious festivals, which sometimes draw millions of people.

In Toronto, she was part of a team that took top honours in an MTV

contest for putting together a documentary in 48 hours on AIDS and

stigmatization.

Even among Indians of her generation, sex is not openly discussed,

says Trupti.

Yet social agencies conservatively estimate that one-third of Indian

youth engage in sex before marriage, says Meena Naik, another Indian

delegate.

Naik's brainchild is Kalsootri, a 35-minute theatrical production

using puppets and a troupe of six actors aged 18 to 22, including

Naik's daughter Manava. It's designed to teach youth how to

communicate with their peers and parents about sexuality and AIDS

prevention.

" Denial is there. They always think `it won't happen to us,' " says

Naik, who has done 110 shows for high school and college students in

Mumbai since January 2005, funded by the Mumbai AIDS Control

Society.

Gilada estimates there were 100,000 sex workers in Mumbai in 1991,

and half of them died of AIDS.

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DR GILADA <gilada@...>