Motor-biking through rural India on an HIV mission

[Guest guest]

Motor-biking through rural India on an HIV mission

Koen K. A. Van Rompay

AIDS 2004, 18:N13–N16

Keywords: HIV, AIDS, India, rural, awareness

At the break of dawn, the nightly sounds of croaking frog choirs

resonating from the rice fields fade into those of the awakening

communities: women preparing breakfast or sweeping the porch of

their hut, the vendor on his bicycle chanting `uppu' (salt), the

background sounds of Tamil movie songs and honking cars.

As we're cruising on a motorbike along the country roads and passing

small villages, we see people leaving the comfort of their simple

huts, farmers leaving to work in the field, women in beautiful

saris, with flower garlands in their hair, boys and girls in clean

uniforms carrying their school-bag, and walking bare-footed or

in sandals through the muddy tracks caused by last night's rain,

smiling with surprise to see a `white man' in this area. Despite the

material poverty and harsh living conditions here, most people

manage the dedication to look surprisingly clean and well-dressed.

The birds and butterflies, the many farm animals wandering

around for some food – oh, it's not hard to fall in love with this

place. Yet, at the same time, I realize that these people are

largely unaware that a rather invisible enemy, HIV, has already

started to erode these colorful communities, and is slowly combing

out villagers.

In remote rural areas such as here (Andimadam, in Perambalur

district, Tamil Nadu, India), the HIV epidemic thrives on ignorance

and indifference, fuelled by socio-economic conditions of poverty,

high illiteracy, poor basic health care infrastructure, and cultural

traditions that consider sexual topics as taboo. Due to their lower

status, women are especially vulnerable to infection, violence,

stigma and rejection. Add on top of this a few more ingredients

(high-mobility populations in a drought-prone area, major trucking

routes, sex work that is dispersed and casual unlike that in many

large cities, and quacks who spread false information about

HIV/AIDS), and it is obvious why rural Perambalur district has,

relative to its population ( 1.2 million people), a

disproportionately high incidence of AIDS cases. Despite being the

fifth smallest district in Tamil Nadu and having very limited

voluntary counselling and testing services, Perambalur district

ranked fourteenth in cumulative reported AIDS cases among the 29

state districts (Tamil Nadu State AIDS Control Society, report

2000).

A survey performed by a network of nongovernmental organizations

(NGOs) led by Rural Education and Action Development (READ) from

November 2001 until March 2002 revealed that the level of HIV

awareness in this district was dangerously low. Of

10 000 respondents (from different occupational groups), overall

only 41% answered they had heard about HIV/AIDS, and only 63% of

these `knowing respondents' (i.e., 26% of the total population) were

aware about HIV transmission through `unsafe sex', while 68– 74%

of `knowing respondents' wrongly identified touch and sharing the

same house or clothing as transmission routes. Statistics only

become meaningful to me with a face on them. One evening I had met

in private with a young HIV-infected school teacher; her husband,

who worked in north-India, and with whom she had slept only four

times, had died of AIDS, and her `doctor' had advised her to starve

out the virus by fasting. While talking to us, her infant daughter

(whose HIV test was fortunately negative) was sleeping on her

lap...but the mother was in fear of infecting her daughter by

hugging or eating from the same plate, and in her motherly love, she

was seriously considering leaving the child, her main beacon of

strength and purpose for living, with her parents in a different

state...

It is no surprise that such low awareness is a breeding ground for

stigma, and that upon talking to villagers anecdotal stories of

rejection, abandonment or suicide emerged readily. The few HIV

awareness programs that had been done in this area in previous years

clearly suffered from several problems: a limited target audience,

and the lack of open dialogue with practical information in an

understandable vocabulary. HIV prevention programs are unlikely to

succeed unless integrated into a broader movement that attacks the

roots, by improving socio-economic development, empowering these

underprivileged communities, and creating an environment conducive

to proper communication, behavioural change and risk reduction.

The NGO READ, since its birth in 1994, had been cementing such

foundation in this area: schools and skill-training programs for

children and youth; the formation of youth groups and women self-

help groups. The women self-help groups, with their

savings, credit and micro-enterprise activities, have had a

tremendous impact: the improved economic status of these women has

helped to uplift their social status and gain respect from their

spouses, families and communities. It was clear to me that the good

community rapport of these existing socio-economic programs could be

used as a foundation to incorporate HIV awareness programs.

I remember asking myself back in 2001 ``why can't the skilled social

workers just go out into the villages to talk about HIV as part of

their ongoing programs?''. However, these field workers, being

villagers themselves, were initially hesitant to discuss sexuality-

related issues.

So some extra push was needed, and I understood that the solution

wasn't going to fall from the sky, but that the man in the mirror

had to start. So at a first workshop for READ's field workers, I had

to overcome my own inhibitions and shyness (from having been raised

in a strict Catholic environment in Europe long time ago).

So with Mr. Selvam (CEO of READ) as translator, we discussed

specific information on HIV and AIDS, gave a condom demonstration,

and then passed the wooden model and extra condoms around the table,

to give hands-on experience to the social workers, whose giggles and

sweat drops betrayed some nervousness too.

Although our program was short and was limited by my inability to

speak Tamil, we achieved a first step: we somehow punctured the

silence.

Over the course of the following year, the field workers received

more training in their native language on issues of gender and

sexuality, sexual and reproductive health, HIV and AIDS basics,

communication skills, counselling, and support. These trainings

instilled confidence among the field workers to address these issues

with rural people. Field workers are now using locally relevant ways

of education to spread correct HIV/ AIDS awareness and promote

better behaviour: folk songs, street theatre, HIV rallies,

brochures, stickers, and one-to-one communication. Despite very

limited financial resources, field workers have started to provide

assistance to individuals and families affected by HIV, including

counselling, referrals, a positive support group and orphan

programs.

Late one evening, as I sit on the backseat of his motorbike, Mr.

Selvam and I are returning to our village along small, dark country

roads. I feel tired but satisfied after having spent the whole day

in various corners of the district. In several high schools, we had

patiently answered many questions written anonymously by students

eager to clarify the many doubts about sex and HIV that occupy their

minds, but for which they had nobody to ask (``you don't get HIV

from mosquitoes, or from swimming in the same lake as a menstruating

woman'', ``a wet dream doesn't mean you have HIV'', ``you don't get

weak or dumb from masturbating''). Teachers were also thankful for

understanding HIV beyond the rather vague terms of their school

syllabus (``HIV is transmitted through immoral sex''). After the

school programs, we had travelled to a remote village, for a street

theatre performance of READ's cultural team, and witnessed how at

the end of the program, community leaders summarized the main

messages

Being part of this movement provides me with some of the happiest

moments in my life, and I feel grateful for the lessons I am

learning here about the true essence of life.

As the motorbike continues to cruise through many interspersed small

villages, the smell of food emerging from the huts only boosts my

hunger. Overlooking the dark fields, the countless stars in the sky

remind me that despite the difference we're making there is no

reason for complacency. This is, after all, only a small rural area

in such a large country, and in so many villages, in India and other

countries, little or nothing is being done about HIV. This is not an

issue of ``it's too big, we can't do it'', because if we, humans,

succeed quite well in using brain technology to link rather remote

corners in the world with mobile phones and other gadgets, why does

basic knowledge, solidarity and compassion fail to do so?

Ignorance and indifference exist at so many levels. It takes

relatively few financial resources to spark and maintain low-cost

efforts to spread HIV awareness in rural areas, and potentially

avert a major HIV explosion there. Yet, with rare exceptions, most

national and international agencies don't give enough attention to

such rural areas. Most HIV scientists, instead of also being HIV

advocates and educators, confine themselves to unravel the mysteries

of HIV within the sterile comfort of their laboratory or office

cubicle; but afraid (or `too busy') to set foot in a developing

country, how much do they really know the true face of HIV?

Finally, the motorbike pulls up into the guesthouse.

My frustration subsides a bit after a delicious Indian meal

(chapattis with chutney), prepared by the cook, a dedicated

grandmother. With my energy revitalized, I realize that culture,

traditions, lack of training, can be obstacles but are too often

used as excuses to defer responsibility to others and to justify our

own relative silence, complacency, ignorance and indifference.

Barriers can be broken with determination and dedication, but the

spark for change has to come from within us.

The people here show this is possible...

Acknowledgments

I thank Mr. Durai Selvam, all READ staff and the AIM NGO network for

their dedication to social work and HIV programs; Dr. Venkatesan

Chakrapani, Latha Mani, SAATHII and SIAAP for providing training on

HIV, AIDS and sexuality to the field came from Sahaya International,

the M. Lloyd workers; Dr. Purnima Madhivanan and Karl Krupp

Foundation, and Global Strategies for HIV Prevention for useful

guidance. Funding for these programs

Correspondence to K. Van Rompay, University of California, ,

California, USA; e-mail: kkvanrompay@... Note: Koen Van

Rompay is an HIV/AIDS researcher at the University of California,

; as founder and volunteer for Sahaya International

(www.sahaya.org), he spends a few weeks every year in rural villages

in South-India to help with HIV programs.

Received: 21 June 2003; revised: 5 August 2004; accepted: 17 August

2004. ISSN 0269-9370 & 2004 Lippincott & Wilkins N13

Copyright © Lippincott & Wilkins.