AIDS Initiative in West Godavari: Something to talk about

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AIDS - INITIATIVE – WEST GODAVARI, Something to talk about

In the coastal districts of West Godavari in Andhra Pradesh, sex

workers are spearheading a programme for prevention of HIV

infection. The state, incidentally, has one of highest incidences of

HIV/AIDS in the country. Ranjita Biswas reports

The journey from Hyderabad to Bheemavaram in West Godavari district

is picturesque, lush green with paddy fields and swaying palms. After

all, it is known as the `rice bowl' of Andhra Pradesh (AP). But

behind this façade are also hidden stories of change, some for the

better, some for the worse. Veterans observe that the changeover to

aquaculture, mainly to cash-rich prawn culture, has brought

prosperity but also misery. Disease of the seedling can wipe out a

farmer's fortune within a season which has been witnessed in Orissa

too. The farmers cannot revert to agriculture either as paddy fields

need sweet water while aquaculture needs salty water. Thus rural

poverty occurs side by side with prosperity for some.

Social inequality and the race for survival are obvious fallouts.

Male population's migration has led to desertions too. Thus coastal

areas like Palakollu have seen an escalation in the number of

commercial sex workers (CSW). Many women are home-based - housewives

who operate from outside, some are floating population renting rooms

in lodges for a few days at a time while some operate from bus stands

and markets.

The worrying thing, health officials point out, is the danger of

spread of HIV infection due to risky behaviour, particularly as

Bheemavaram has a varied profile. Many of the clients are seasonal

labourers who come to work in the marine industry; the national

highway is nearby with truckers frequenting the area; there are also

many famous temples around which attract a great many people during

festivals. The town also has some of the best known educational

institutions in the region which means a young population coming from

distant places to stay in hostels. AP has one of the highest rates of

HIV infection in the country. The majority of infections are believed

to be result of sexual transmission.

Hence, intervention programmes to disseminate information and

advocate safe sex practices are of utmost importance. Specialists

working in the field contend that interventions involving the CSW pay

rich dividends because the women themselves can work as catalysts in

changing risky behaviour by advocating condom use as well as ensuring

prevention of infection through regular check-ups for sexually

transmitted infections (STI). Kolkata's red light area Sonagachi

Project has shown how successful such an initiative can become.

But local variants exist and problems pose different challenges. For

example, AP does not have big brothels in demarcated areas as in,

say, Kolkata or Mumbai. Hence intervention programmes among CSWs

have first to cross the hurdle of reaching the target population: Who

are they? Where are they? Then comes the second hurdle: How to earn

their trust and reach them across the natural fear psychosis

about `officers' and mobilise them to become stakeholders in the

programme?

The Swagati Project of Action For Development (AFD), an NGO in the

coastal area, focuses on crossing these hurdles through a " targetted

intervention programme. " Working in collaboration with Hindustan

Latex Family Planning Promotion Trust (HLFPPT) it targets CSWs above

18 years with the aim of empowering them to adopt safer sex

behaviour, reduce the incidence of STI, and increase correct and

consistent condom use among clients.

The first step was to " map " the CSW population- to find out from

where the women operate and how to reach them. For this, help was

taken from women from the community itself. Then Community Guides

(CG) were chosen to persuade fellow women visit the drop-in-centres

(DIC) with the clinics which provide sexual health counselling

services as well as sexually transmitted infection diagnosis and

treatment. All clinics are equipped with examination equipment,

diagnostic procedures and basic medical supplies, including treatment

kits. Comparatively cheaper treatment facilities is another

incentive for the women.

But it was an arduous task in the beginning. Many of the women are

home-based and did not want to reveal their identity. Ignorance was

another problem. As Amulya, a counsellor, recalls, " We faced many

teething problems. The first CG we identified assumed that the

project would take care of all the welfare needs of the community

like housing , bank loans etc. " She did not want to mislead the women

and adopted a more pragmatic approach. As a first step, she

identified a group of community members and used the `snowballing'

technique, that is, each member introduced another, brought her to

group meetings where discussions were held on the aim of project and

motivated them to commit themselves to its activities.

This had the salutary effect Amulya hoped for and attendance at the

DIC picked up.. " However, initially, we didn't tell the women it was

an office working for rural women's health, not even a clinic, so

that they won't be put off. Once they started coming and interacted,

it was easy to introduce the subject, " reveals Santha Rao, project

development officer.

The strategy is carefully thought out. The women are not asked

straightway to come to the DIC. Repeated visits, establishing

friendship through general discussions and then gradually discussing

the health problems and the risk of infection are used to convince

the women. Sometimes contacting the women result in threats from the

local populace and intimidation too but the women are a determined

lot and the CGs have largely been able to convince even the general

population about the intention of the project: to ensure prevention

of HIV spread and not act as moral police.

The outreach activities target the `hotspots' –places where CSWs

congregate, overtly or covertly, for their business. It can be a

makeshift shed in the market of Palakollu where women come from

distant villages ( " My husband has deserted me. They believe that I

work in the town. I want my daughter to get a government job, " says

mma ). Or it can be a narrow strip like Yetigattu, on the bank

of a stream amidst paddy fields and palm fronds inhabited mainly by

fishermen community. Here, besides other problems, they have to

encounter frequent harassment from local goons who demand money and

also `free sex', reveals Savitha. Project officials were informed

about this place by one of the key people (KP). " This is how the

network helps because the women know about these areas through the

grapevine and facilitate us to conduct our outreach programmes, "

reiterates D. Isaac Newton, training specialist, HLFPPT. Condoms are

distributed free and the women are given education on why they should

visit the clinic for health check-ups.

Lodge-based CSWs pose a different challenge. The women come from

distant places like Guntur, Khammam etc and establish base

temporarily. Besides, the lodge-owners have to be involved in the

process without whose cooperation it's not possible to approach the

women. But CGs like Saraswathi has been able to achieve it through

persuasion.

Through all these efforts in the last two years, Swagati claims,

there has been a 60 per cent increase in safer sex, reduction of STI

by 30 to 80 per cent depending on the infection, and 60 per cent

increase in condom usage.

Pleasantly, an offshoot of the programme has been a certain bonding

among the women. Says Sathyamani, a CG at the Palakollu

centre: " Thanks to this opportunity I got out of deep depression…in

the process I also discovered that I've the strength within to help

others. "

A silent revolution is perhaps happening as many women have

discovered a hitherto unknown leadership quality in themselves. Many

of them confess that they come to the DIC not just to see the doctor

but also to meet their friends; they feel it is " our centre " and

enjoy spending hours turning out posters and paper designs to

decorate it. DICs are also introducing craft and tailoring classes

gradually.

The positive attitude is also incorporated in the joyous figure of

the icon Missamma extolling safe sex.

(Some names have been changed to protect privacy)

Trans World Features (TWF)

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