Re: A Bitter Pill/ NACO Rejects Feacham's Nonsense !

[Guest guest]

Dear Forum,

I could not resist the temptation of taking sides with Subir Kole. This is not

to say that India does not have to do more work. I was happy when India's Prime

Minister could tell the world that we can handle the tsunami rehabilitation

ourselves.

I believe India could have handled the AIDS epidemic if not for the distortions

introduced by funding HIV/AIDS programme. If in the past we had taken efforts to

strengthen India's culture ratehr than promoting liberality I believe the story

could have been different.

I have tried a cultural approach in rural Tamilandu and it works. There are

pockets where different strategies are needed. I do not want offend those who

take a differing stand, however without any doubt India needs to know the

numbers as people are questioning every number presented.

Yours sincerely,

Abel

E-mail: <rajaratnamabel@...>

[Guest guest]

Dear Forum,

Well I was interested indeed to read this analysis by Subir K. Kole because it

reflects opinions generally held in the various factional groupings of political

decision makers who still believe that HIV will go away if we just stop

listening to the people whose lives have been dedicated to the eradication of

the pandemic by sharing accurate and well researched information about HIV and

the modes of transmission.

Many of the people including myself have been invited to come and examine what

evidence is there and make up a kind of score card which addresses facts and

behaviour change mechanisms that have been proven to work.

In responding to the castigation message I have placed the honourable ex pat

Indian’s comments in quotes and reflected on what I understand the text to say

in my reply.

The places in India where the transmission rates appear to be declining are

places where overall country numbers of HIV +ve people are not considered

relevant. What counts is the mobilising of community action to identify the

problems and find indian solutions to what they find. Of necessity that means

local action and not national policy arguments.

I know that this works because as an indian story teller I have been there,

looked and listened. I still maintain that national indian numbers are not able

to be determined with any degree of accuracy and there are good and solid

reasons why they can’t, so arguing about how many is not worth the energy.

If India really wanted to know how many are really there they would pass anti

discrimination legislation and actually enforce it and then offer treatment

options which in some cases would involve ART’s but not always.

Good consistent and thorough management of opportunistic illness would manage

most of the detected cases and interrupt the sero conversions that are still on

the increase. Argue with that if you must but if it is happening then actions

need to be taken to address it and there are many options, most of which are not

being actioned or even considered. One of these is teaching sexual health and

safety messages to young Indians before the average age of infection that is 14

yrs of age.

Argue with that if you must but it is a fact that can be demonstrated by

Indians.

“In a relationship of master-servant, domination-subordination, coloniser

-colonised, donor-recipient, many of us are only left with two options: either

we shrink our minds and intellect, or else we shut down our million-dollar AIDS

industry the next day.”

I am not sure I understand this statement.

What I do know is that India is a country with its own masters and its own

servants. The structure of Indian society is very similar to the Raj except that

Indians are sitting where the British used to be sitting. Global funding is

being sought by and offered to India.

It is being recognised as being necessary because of a realisation that a once

low prevalence series of States are fast changing their status to high

prevalence and I hasten to add that this bitter pill is an indian pill

prescribed by various SACS committees, not by me.

India is not a third world country. It is a developing nation with wealth in the

hands of a relative few and poverty affecting more than a third of its 1.2

billion citizens. It is no longer colonised.

”First let me make clear a few assertions. I assert that the actual

potential of HIV/AIDS epidemic in the Indian subcontinent is more of a

" construct " than a " reality. " The " truth " about HIV/AIDS in the third world that

has been propagated over the years is a first world's " construct " to maintain

the vested interests of multinational and transnational NGOs joined by a band of

recipient NGOs in those countries.”

If this means that the numbers are wrong because multinational and

transnational NGO’s are looking for somewhere to hang their hat then I can’t

accept that because I don’t work with any of them. I only move around infected

and affected communities and listen to what they are telling me. My auspice is

an Indian NGO that grew out of activist HIV+ve Indians. Some global networking

has been happening and most of it has been well intergrated into solutions.

The third world (not India) has already realised the reality and is working

damned hard to reverse the damage; albeit Africa is having the most difficult

path for a range of reasons much of which is the rampant corruption of the

bureaucracy and brain drain of competency in health and poverty allieviation

coupled with a failure to embrace sexual risk management with sound education on

the grounds that it will affect the morals of the community.

Well the writing on that wall, not written by me, filters into my email in-box

on a daily basis. A recent decision regarding patent law in India has in fact

pandered to global drug companies but this

was done for reasons that did not resonate with the Indian infected and affected

community and the many other countries who depend on Indian generic medicines

for survival.

”What is the basis of saying that India is approaching 8-10 million mark in HIV

infection?”

The basis is the gradual realisation that the sentinel surveillance figures have

been wrong and the migration of once low prevalence States to moderate to High

prevalence States indicates that the disease spreads more rapidly in the early

infection stages before symptoms develop and sickness becomes apparent.

Fear stops many from seeking a test because there are no protections and no

incentives to test. The numbers of people who have been tested and the instances

of positivity in those numbers compared to

population of post pubescent sexually active Indians suggests that the numbers

will be higher than the official estimates. These are not my assertions.

They come from a range of local Indian NGO’s and CBO’s whose

experience reflects a more accurate figure. Unlike my country where 85% of the

epidemic centres on the same sex attracted community India has a heterosexist

epidemic which is much more difficult to influence for a range of well known

reasons like gender equality and an unsafe sex work industry and high

proportions of infidelity.

I hasten to add that these reasons are not Indian per se, they are common

wherever the epidemic is heterosexist, lest it be concluded that Indians behave

differently to other cultures where the figures are high.

“And should we swallow it just because a western " expert " is saying so?”

This particular western “expert” is only expert in care issues, support issues,

treatment issues, drug toxicity issues and treatment advocacy principles. The

figures are all Indian projections and they come from very reliable grass roots

Indian agencies including government hospitals and private clinics and the

increasing activist projects that get funded (unreliably) from time to time.

My email in box has a hit every 60 secs of every week day and less on weekends.

The information contained there is relevant to understanding and managing this

predominantly sexually transmitted disease.

“What is the basis of presuming that those who are undetected will have HIV? “

The basis of this comment has to do with universal precautions to prevent

disease and is not a comment on the sexual behaviour of Indians or anyone else

for that matter. Just talk to the number of women who became infected by their

spouses on their wedding night and then look at what universal precautions might

have been able to be utilised to avoid this mostly unintended but occasionally

deliberate infection rate. Argue with that if you like but before you do, go and

talk to the Indian Network of Positive Women and listen to their stories.

I do and they are not nice stories. Ask about women infected by their husbands

and then being cast out of the family home usually owned by the husband’s family

after the husband dies.

Anyone proposing to have sex without protection in India should be

submitting to sexual health and safety principles. This includes the

franchised couples (ie heterosexual marrieds) but should also include the bi

sexual partners and the homosexual partners of which there are statistically 100

million Indians, many of whom no longer live in India.

I wonder if Subir K. Kole has examined the GIMP sites that exist globally and

number thousands of hits per day.

The principle is that any post pubescent person who has had a risk exposure

should, after 30 days of said risk, obtain a confidential HIV test. Of course

that presumes that every such Indian (or any other nationality of course) would

need to know what a risk exposure is. Most of the people I lecture to in India

don’t.

Argue with that if you like but it is a fact that the level of knowledge is low

and the reasons are clear. No one is given opportunities to find out. It is also

not common sense as is evidenced by the numbers of otherwise intelligent people

who are HIV +ve. In this class are doctors, lawyers, accountants, police

officers, peace keeping forces, teachers, students, politicians, academics,

drivers, building workers, public servants, and of course sex workers and poor

people of identifiable caste status.

Once people become aware of their status they need to know how to either

maintain their sero negative status if they are lucky enough to be negative, and

most people over 60 who are negative will probably remain so.

Far too many between 14 and 16 are testing positive. That’s not a ‘western

opinion’ by the way but if we don’t HIV- proof the next generation we are in a

lot of trouble. It is the place where I would start but let me share a story of

just how impossible that is with the current moral mind set.

An Indian NGO designed and prepared a very valuable and timely sexual health and

safety study and then sought to find the best place to start using it. They

selected a well known school in a major City and the statistical predictor was

that this co educational school had had the most unintended pregnancies

amongst female students. It seemed an ideal place to start. This story teller

was only an observer. No western influences.

Well the presentation was made to the Principal and staff and immediately there

was shock and horror at the content as being too explicit and parents would not

approve or agree. Parents were consulted in due course, particularly those

parents whose daughter had had to leave their education.

Overwhelming support was intimated by the parents and a further report was made

to the school community. In the end the teachers just said that they would not

be prepared to teach it because it was too difficult and too embarrassing. Of

course such teachers could not have taught this material.

In fact the level of incompetency suggests that this is a job for specially

trained teachers of which the State of Kanataka has trained 100’s through a

local NGO that was initially funded by the Ford Foundation and then

unsuccessfully sought funding from NACO when the sunset clause was activated by

the Foundation to continue the program. Very soon we should see a national

association of such teachers and then we will see on a grander scale what has

been doing well in small rural and tribal communities thus far.

“Presuming that Indians are " consuming " good sex like westerners? “

Well the only comment I can make is the evidence I gathered from four years and

22 States. I saw street girls who were expected to make a living selling flowers

realise that they could make more money for less time selling their bodies. I

met the boys who cared for them. I later saw them become a couple and produce

street children and become a street family.

I also noted that live births number just under 30 million per year. Some are

obviously doing good sex better than most western countries. I also saw kids

getting condoms and not being able to afford the proper lubrication to make the

condom use safe. I also saw evidence of plastic food wrap being used in

emergency situations with slippage creating problems. I saw evidence of girls

being

lured to employment prospects from poor rural villages only to be abandoned into

the field of sex work with no follow up by parents who presumed that the offers

were genuine.

”I even question these exercises as part of the same process of

" constructing the orient. " Let us have a debate over numbers because numbers are

important to win the war! Let us question the very 5.1 million NACO-figure as we

neither believe that this is closer to real - the actual infection and its

potential is much lesser than what is estimated. If NACO claims that " the

process " is certified by WHO and UNAIDS, then the question still remains, that

it runs the risk of being a " construct " rather than a " reality. "

There is no time left to count the numbers. What is needed is proactive

prevention delivered in age appropriate settings for all those who are not yet

sexually active. We need to offer PEP to victims of crime not just to valuable

hospital personnel. We need to counsel couples about ensuring that their

relationship is HIV free before engaging in unprotected sex.

It should not worry those who have never had a risk exposure. We need to train

doctors and patients that being HIV+ve does not inevitably lead to getting AIDS

disease and then say how and what and why. Risk exposure needs to be properly

understood. The old days of saying beware of all body fluids is past.

Those scientists that have been working on vaccine trials have taught many of us

that risk is not as high in this millennium as it was feared in the last one.

Risk is specifically unprotected anal or vaginal intercourse and recent survey

shows that these practices are common within heterosexual as well as bi sexual

partnerships. My case notes will prove that to any sceptics but a recent edition

of India Today documented some rare research on that very subject.

The next risk factor is sharing injecting equipment either deliberately in

illicit drug activity or in a medical setting where used syringes get re-used

without proper sterilisation. Far too common I am reliably informed.

Finally, the use of blood or blood products from the myriad of private blood

banks in India.

This new knowledge has to be assimilated into the Indian community so that the

deliberately induced terror of the early prevention messages can be assuaged.

”What is the rationale of " constructing " Indore, Jabalpur and Ujjain

as the epicentres of the epidemic? Just because the " expert in question " managed

to fly-off there and had a couple of tea-gossips with some young kids? What the

hell such a construction mean? “

The “expert in question” was directed to that State of M.P. by the auspice

agency , an Indian NGO comprising mainly positive Indian activists. This was

also at the behest of the C.M. of the State. The ‘tea-gossip’ was a State SACS

sponsored symposium convened in Bhopal and gathering all the active HIV service

agencies in Madhya Pradesh.

The lectures were being delivered in Hindi with English powerpoint

presentations. The details of the epi-centres of known infection was provided by

these agencies in response to a question.

It was surprising to the ‘expert’ that Bhopal the State capital was under

represented but a collection of agencies that have invited me back will show me

where and possibly why in a future visit. The big lament was that despite the

size of their population, their low prevalence status ensured that AIDS funding

was minimal and it was a very real dilemma for many outlying villages where

migration of bread winners to Mahrashtra, Punjab, Jkarkhand, Bihar and Uttar

Pradesh seemed to be ringing alarm bells.

If this is a ‘construction’ then it better be well understood or M.P. will soon

become a higher prevalence State and they can go about shutting the gates after

the horse has bolted.

“That young people in MP have started prostituting in exchange of study notes

and bed? (I have seen this happening in US and Europe though!).”

That young people have to do that anywhere is a sad indictment. Don’t think for

a moment that this is an M.P. phenomenon. I just know about the approaches that

were made there in Bhopal but I have seen advertisements in many other parts of

India and the diaspora that students studying at home and abroad with

insufficient means are not going without.

”Sick! If not they, but certainly the way you think! The argument that is being

put forth by saying that " the knowledge of sexual risk management is extremely

poor, " " I am safe, " or " kidding themselves " inherently implies that young people

in India are having multi partner sex, or having rampant sex with sex workers,

or all other sexual variants as in the west -- in short Indians are sexually

promiscuous!”

Well based on my many encounters with urban, rural and tribal communities in

India the knowledge of sexual risk management is poor because there is no

tuition and 15 to 18 years between puberty and marriage leave people open to the

trial and error approach and just hope you don’t get caught or get pregnant. Now

I also work in Thailand, Indonesia, Malaysia and the countries of East Africa

and the level of ignorance and the blind dependence on abstinence is rampant

there as well. It is just not the best way to deal with a sexually transmitted

pandemic.

I am 62 years old this year. I have lived and worked through the ravages of HIV

infection in my country where I was involved in the funerals of 4 young people

every week until 1996. I have learned that there is no substitute for accurate

information and frank discussion. In my country now that is all done by

sophisticated peer education programs and we all know that peer influences are

high in effectiveness in adolescent behavioural studies.

”This is another effort to demolish the national pride around sexual

morality that many South Asian countries still maintain. From a social

constructivist perspective, the denial of numbers means that Indians want to

keep their moral standards higher than that of the west.”

What I see and hear from young people throughout the South Asian countries is

that sexual behaviour is common to all of them. Information varies from country

to country. Harm minimisation is achieving better outcomes than zero tolerance.

Accurate information and frank discussion is not making young people more

promiscuous. Irrespective of perceptions of moral standards that filter down

from older to younger adults, sexual behaviour is constant and varied.

It is not only younger citizens of those countries but their parents

as well whose lives fall well outside the parameters of expectation.

The problem with these expectations is that they close the door to timely and

accurate information being available and understood. It also prevents disclosure

should a variant orientation occur. I have lost count of the number of Indian

weddings I have attended where a gay or bisexually active indian man has been

pressured into marrying a woman or where bisexual or lesbian women in India have

been coerced into marrying men.

One of the unfortunate vectors of HIV is where a man is in love with another man

but also has sex with the wife he has been married to.

The grammar in the last sentence is intentional because it is so very different

to the way that marriage occurs in my country but I am only reporting it as I

see it.

”The west feels frustrated/ discriminated against and to prove that " you are as

immoral as us, " there is a systematic attempt to construct India as sexually

promiscuous. It is NOT the CM of Delhi or Goa or people of India with their

wilful ignorance and moral and cultural righteousness worsening the epidemic.”

Sir, the west couldn’t care less about the sexual mores of Indians or Africans

or the muslim majorities of south asia. It never enters their mind.

The only time they are ever likely to know about it is if they come or get

involved in sexual health science and psychology. I have never ever seen in

Australian media any reference to India’s sexual behaviour.

I only know what I see and hear and read and the counselling I do and the essays

I frequently write to answer frequently asked questions from my internet clinic

and the many linkages I have in India, Bangladesh, Pakistan, SriLanka,

Singapore, Malaysia and the East African countries.

I noted in an earlier comment the GIMP web addresses. If you really want to know

about modern sexual mores then read the sites my friend. The I in GIMP is

Indian. There are no similar sites of such magnitude for Arabs, Israelis, or

Africans or Russians.

Remember that there are many millions of Indians who don’t identify as

heterosexual but there is no place at the table, apart from a lucky few, and

they are also part of our families. The same can be said for all the other

countries I just mentioned as well but the sheer numbers make the epidemic

large.

The sex work industry is one of the largest in the world in India and it is

amongst the most unsafe and unregulated. It is a growth industry of rich and

poor middle aged and young, male and female.

The actions of the CM in Goa and Delhi worsened what were very carefully crafted

education campaigns that had been funded by SACS and worsened the situation in

both of those cities.

That is not my opinion. I don’t work in either project but I am part of the

network of sex workers as a resource person and I am merely reporting the facts.

The education departments enjoy considerable financial benefit from the industry

as do the food vendors. I am not asking you to believe me I am simply reporting

the facts. It would not be allowed in West Bengal or Kerala or even in Assam or

Tamil Nadu or even Kanataka.

”Whatever damage has been done to the epidemic is because of the

highhandedness of western institutions, ideologies, modes of prevention,

delivering programme component, and their interference in constructing

programmes and policies; pressurising NACO to change its National AIDS Control

Policy of 1989; or applying other pressure tactics that best removes the

differences in sexual moral standards between the east and the west.”

The reason the epidemic has not been controlled in india has nothing to do with

western institutions or ideologies. It is largely bad and getting worse because

of a continuing culture of stigma and discrimination towards positive people. It

is bad because it took 20 years to consider anti-discrimination legislation. It

is bad because of the culture of fear manufactured and generated out of the

health and allied professions by people who should have known better. It has

become worse because of an inappropriate focus on prevention that should have

been preceded by care, support and treatment.

Instead almost every crore of rupees for the first ten years was spend on

building the AIDS industry infrastructure. The tide is turning however. Pockets

of best practice are emerging. They are Indian not western and I can’t claim any

credit but I continue to laud the best practice initiatives of Indian

professionals. I participate in continuing medical education programs for

doctors. It is exciting to see the changes beginning to bear fruit.

”And by changing its policy, NACO has done a historical blunder that can never

be undone. I attribute today's 5.1 million-figure only due to the adoption of a

liberal policy that World Bank put down our throat as a loan condition for the

National AIDS Control Programme -Phase I. Can we undo what we have done to all

these 5.1 million Indians? “

I don’t understand exactly what this statement means in terms of ‘an

historical blunder’ unless it is the points I made in the preceding

paragraphs. I do need to remind readers of the verse that my grandmother taught

me and that is – “ he who pays the piper calls the tune.”

So little of the Phase one funding goals were achieved anyway so it suggests

that India had the capacity to make up its own mind and it did.

”Why the hell every Indian should think that they are potentially positive to

HIV? And act accordingly? “

As explained earlier only those who have had a risk exposure need to become

concerned about their status. Any woman has an obligation to herself to ensure

that the man she is having sex with is free of disease. Every man has an

obligation to himself to ensure that the woman he is having sex with is free of

disease. In fact unless we do that systematically we won’t stop the spread.

You can’t do it by looking at a person. You can only tell by couples

practicing safe sex until they have both had two negative HIV antibody tests

measured over 30 days and no risk exposures in between. 20 years ago this didn’t

matter. Many woman are wishing that they knew then what they know now. That’s

why the presumption should be made. I have loads of case notes of examples to

reinforce this principle.

“It is something like saying that every western should think that they are a

potential homosexual and act accordingly!”

In India this is not a pressing analogy because the numbers of gays who are

infected is low by comparison to the bulk of the population.

A person’s sexual orientation has very little to do with risk anyway. The risk

factors are much more easily explained and understood. One that stands out is

that the more partners you have the greater the risk. That is what changed in

Uganda to effect the radical shift in statistics.

'Grazing' stopped fairly rapidly after education campaigns highlighted the risk

you take with every unprotected sex act that happens with multiple partners. The

less partners you have the less risk you are being exposed to.

Based on the work I do in Australia I would encourage every woman there to

imagine that the man they marry could be bi sexual and act accordingly. It could

minimise risk and avoid much misery.

” I am sick of listening this in every forum that " let us not talk about

morality in AIDS. " Why not talk about it? A society without moral is at peril...

And the acronym of IAS that you love is NOT " I am Safe, " BUT it is, " Indians

Are Safe. "

HIV is sexually transmitted in the majority of cases. There is evidence a plenty

that sometimes this happened between a married man and his wife who were moral

as far as their marriage is concerned. I am sick of people assuming that the

epidemic will stop with abstinence and faithfulness. It will only stop when

people stop infecting others. Behaviour change not morality will give the best

results.

People get infected by what they do and the fact that they do it without being

sure of the status of their partner. Indians are only safe if they are sure of

the status of their sexual partner.

This is not the norm and therefore statistically Indians are not safe.

Australians are not safe, British are not safe. Americans are not safe, Russians

are not safe and so on. It has nothing to do with morality it has everything to

do with the serostatus of your partner and the type of sex you do. Risk

management and accurate knowledge is critical to controlling the epidemic.

Probably 90% of Indians have nothing to worry about. Certainly 80% of Indians

have nothing to worry about unless they chose the wrong partner and the wrong

sexual behaviour.

Why is this so difficult to understand.

” They are safe because they have a sexual and moral culture that best protects

its individuals.”

India has never had a sexual and moral culture that fits your description nor

has any other national group. My country is only 200 years old and this is true

of Australia that it has never had a moral culture that supposedly exists in

India. The evidence I have seen carved in stone and the many museums that I have

visited suggests that before, during and after the ‘occupation’ sexual mores

have been the same with the same fluidity and the same disregard for gender

rights as persist today.

If it were not so then India would have no pandemic and we would not be having

this conversation.

”What is a society without morals? And to remind you Sir! if we act

" accordingly, " you will be nowhere! Your billion-dollar-industry will be

nowhere! Because for us " accordingly " means acting contextually, culturally and

situaltionally, which have been systematically destroyed over the past 10 years

with the power of money.”

There are many gems in this paragraph. We do need to have a healthy regard for

everyone and this may well be seen as being moral. It is not evident in many of

the places I have been. It is not being moral to turf a Positive person who is

sick out of a hospital. It is not moral to stone someone to death who has AIDS.

It is not moral to start someone on antiretroviral medicine and then fail to

produce the medicine at an affordable price in a reliable way.

There is growing evidence of the likelihood that many enrolled patients may well

develop drug resistance and thereafter spread a super bug to unsuspecting

partners for whom medicine that should work will not be useful. We did it in

India with TB medicine. We should try to avoid it with HIV medicine if we are

being moral. We deny PEP to victims of crime and thereafter the victims become

patients in HIV wards. There is nothing moral about that.

We provide food for people who can’t produce their own food and

people die of starvation waiting for the program to kick in. That is not moral.

It is not moral to prescribe anti retroviral medicine and not monitor the

patient whilst he or she is taking the medicine. We have no idea of how many

patients on ART’s die of lactic acidosis caused by medicinally induced adverse

side effects. Very immoral for a country that has such a high ratio of doctors

to citizens.

It is not moral to offer to pay an orphaned child’s school fees in exchange for

sexual favours. It is not moral to make destitute widows of positive men who die

before their wives and children but

my files are copious with examples. The most valid of the assertions in the

paragraph is the part that Indian society has been ‘contextually, culturally,

situationally, and systematically destroyed over the past 10 years with the

power of money.’

But my situational analysis is that this has occurred by and large by the ruling

class of India. I would like to conclude with a quote from an eminent Indian who

served as an IAS officer with distinction and he writes it like this – “ There

is an unspoken conspiracy that India belongs exclusively to the ruling class

with the middle class being the beneficiaries of the left overs. All policy

initiatives and development actions are taken by the top half of the population

for their own benefit. All the moves are driven by the group interests of the

major players – the politicians, bureaucrats, businessmen, professionals and the

judiciary. The bottom third of the population is invisible when the curtains are

drawn, counted out in all calculations.

They do not exist in India for all practical purposes. This is the post

independence dharma of India. India’s society had its loyalties to family,

caste, clan and faith and furthermore the ground reality was that of a deeply

hierarchical society with skewed distribution of wealth and privileges, an

inheritance from many centuries. Even now in the fifty odd years since

independence the kinds of checks and balances and accountability to anchor a

modern administration

within a democratic framework are still not yet in place.”

I found this extract from his recent book in which he gives example after

example of just what this looked like to be so helpful and refreshing.

THEN ALONG CAME HIV/AIDS

” It is high time that we assert our moral-right that what we need for our

country, let that not be decided by the colonisers from the west. Let us reclaim

what we lost to these colonizers over the last decade.”

I think the quite above says it all in a way that most Indians will agree is the

situational analysis. Colonisers left 50 odd years ago and their place was taken

by the elite ruling class.

Nothing from my observations and attempts to invoke District collectors in

matters pertinent to their duties makes me disagree with anything that this

eminent Indian has said.

” Your conclusion tells us everything. That " the writing is on the wall but the

problem is, not enough people are reading the right wall. " Do you think people

are fools? And they can not decide what is " right " for themselves? “

I don’t think that people are fools. I am sure that many people have decided

what is right for themselves. I have been hearing it in one way or another for

the four years I have been an honorary Indian.

What I would like to see is a policy that unskewes the distribution of wealth

and privilege for the moral good of the whole nation. Indians are definitely not

fools and you have 1.2 billion of them to look after adding at the rate of 28

million each and every year.

Come back to India and take a look for yourself my friend. Talk to the Indians

who are here. Read the newspapers. I do everyday even from Australia where I am

writing at present.

“ You wrote the wall because you think " this is what is right for the people. "

And the result is obvious -- this is NOT what they want! Yet you keep on writing

the wall because you have your own agenda to complete. People are not reading

the wall because, they think, this is not their need. You are still writing the

wall because you believe this is how a need should be " constructed " that

maintains your own best interest. And even if people read, deciding its priority

and acting accordingly, let that be at their absolute disposal. Why this hue and

cry from the west that we are not doing the " right thing " that the west wants us

to do?

Sir I am not writing the wall. My only interest is in using the hard won skills

and knowledge about HIV/AIDS to ensure that this scourge disappears from the

south asian and east african landscape. It can be done in a generation. If the

powers that be in this generation don’t act it will take two generations.

The HIV virus is as smart as it is ever going to be unless

of course it is allowed to mutate. What we thought we knew about HIV before 1996

we now understand differently. What this new millennium is telling us is that we

are having even more answers and more potential solutions.

Much of this information is gathered and paid for in the west. What the whole

world realises is that this is a global problem and the best minds and the most

compassionate of souls want to see a level playing field where the best

practices are followed to eliminate the scourge before it destroys whole

communities. That they keep coming back and spending time and money evidences

their commitment.

I would be fascinated to understand where you think India’s priorities and

practices should be focussed because you are obviously an Indian and it is your

civilisation that is at stake.

I have been applying my knowledge and behavioural skills to ensure that Indians

are safer in their sexual practices and skilled in the art of risk management.

They in turn of course become local ambassadors for their peers. Those who are

not infected are being given enough information to stay negative. Those that are

having HIV

infection are being taught how to prevent their viral infection progressing to

AIDS.

Not all are able to afford the means to that end unfortunately.

Also not all medical practitioners are skilled enough to be able to help in the

process but that is improving constantly.

Please share what you consider should be India’s priorities for Indians. They

are doing a great job for Ugandans and Kenyans and Tanzanians and many other

countries of Africa and elsewhere but what should the response be to Indians.

Geoffrey

E-mail: <gheaviside@...>

[Guest guest]

Dear Forum,

In the midst of hundreds other commitments for all of us, we are

taking the time out to read this conversation because we believe that

there is a difference in opinion about how a problem as HIV/AIDS need

to be addressed. Let me quickly respond to Geoffrey Heaviside's last

message in response to my argument. I will go point by point:

" Well I was interested indeed to read this analysis ... because it

reflects opinions generally held in the various factional groupings

of political decision makers who still believe that HIV will go away

if we just stop listening to the people whose lives have been

dedicated to the eradication of the pandemic.... "

Wrong! Immediately after posting the message, I received 107 personal

e-mail messages from people in India and abroad describing it as " the

best ever rejoinder to a holistically constructed evil. " Out of 107 e-

mails, 22 e-mail messages were from Executive Directors of some of

the prominent Indian NGOs and Foundations working on HIV; 17 messages

were from Secretaries of some organisations or Presidents (again

working on HIV); 37 were from researchers, academicians, NGO workers

(list readers of this forum); and rest of them were anonymous or

those who did not want to be identified (again list readers).

Do you still think that this kind of opinion is held in the factional

groupings of political decision makers? People feel it - we, the

Indians feel it. What I argued is also believed by a wide segment of

NGO-heads, workers, activists, academicians, researchers, policy

makers and of course political decision makers working on HIV.

Yet, they can not take such a position in public forum (as is evident from their

personal e-mail messages to me instead of posting it in the e-forum). The

reasons are primarily two, besides personal choice:

first, by taking such a position in public, nobody wants to lose

their potential funding (this is what seems to guide their present

action about implementing HIV/AIDS programmes). And second, taking an

opposite stand has become so much stigmatised within the NGO-world

that nobody wants to be ridiculed or make fun of themselves by

questioning even if they feel it otherwise.

This is a " construction " - the ways " truths " about HIV are " constructed " and

diffused through the process of socialisation so that they come to appear as

" natural order of things. " Hence questioning what others believe is a stigma.

Come, talk to these 107 NGO leaders and activists in privacy. You

would wonder whom you are working with today, many of them are just

nice to you on your face (or they are just nice to me on my face? I

don't work with a funding agency either!). When you realise that

the " evil lies within, " then you would think that there must be

something wrong in the approach that you adopted. With money, you

could well change the agenda and the way the agenda to be handled.

But you could not change the ideology. And that is where the failure

lies. And I believe, the ideology will finally win, because it is the

ideas that move the world.

Let me answer your last question first before I take your other

points one by one.

" Please share what you consider should be India's priorities for

Indians. They are doing a great job for Ugandans and Kenyans and

Tanzanians and many other countries of Africa and elsewhere but what

should the response be to Indians. "

In response to this question, I present you the following statistics,

which I presented to this forum in my earlier posting. We will decide

the priority based on the following facts compiled from published

reports by WHO/SEARO, UNAIDS, UN Demographic Yearbook, World Health

Report, Census of India, MOHFW among others.

As of end 2004, about 5.1 million Indians were living with HIV/AIDS

(estimated) as compared to about 15 million people living with cancer

of various kinds (includes lung, liver and other kinds of cancer).

The adult prevalence rate of HIV in general population is 0.8 percent

compared to tuberculosis, 2.5 percent (this is NOT co-infection).

Estimated AIDS death since its inception (1986-2000) in the Indian

subcontinent is about two million (while reported figure is only

62,000) and currently stands at less than 3,100 per year, compared to

more than 10 million deaths in the last decade, almost a million per

year due to common fever, dengue and malaria.

Diarrhoea alone contributes to about 4 million deaths per year in the

subcontinent.

Nearly 10 million children die of vaccine preventable diseases every

year as opposed to 1 lakh children infected and orphaned by AIDS so

far (no correct estimate is available). The life expectancy after

being HIV infected remains 6-8 years on the average, unlike killer

diseases, during which a person remain engaged in economic activities

and contributes to the national income. Both the drugs for HIV and

dengue, cholera or diarrhoea still remain inaccessible and

unaffordable for the majority of the poor. Leprosy or TB still

carries the same level of stigma and discrimination in the Indian

society, no less than a HIV positive person.

There are nearly 30 million homeless people who live on the streets, footpaths,

railway stations, flyover-sheds, under the shed of parked vehicles, and more

than 200 million Indians do not have basic amenities like safe drinking water,

electricity and toilet. Another 200 million do not have access to basic/ primary

health care facilities.

There are 350 million " sheer illiterates. " And yet, the money that is being

pumped into tackling the HIV/AIDS problem " alone " ($350 million/

1999-2004)constitutes the sum of all the investments made in the above sectors

($380 million/ 1999-2004) both by the government and donors/NGOs in the country.

Let us be rational and by applying any sense of logic let me know

what the priorities stand for India under such a circumstance.

Doesn't it become clear that the priorities for development

are " distorted? " How this distortion took place precisely after 1991?

That is, after adopting IMF sponsored Structural Adjustment

Programme? The research project I am currently engaged in analyses

all this data and I would like to present an excerpt here only for

your reference:

....During the year 1990-91, India experienced one of the worst years

in its economic, social and political history. It was marked by

political instability (frequent change of governments), with shooting

rate of stagflation up to 20 percent per year, a stagnant growth of

the economy of less than 2 percent, and a billion dollar of balance

of payment problem. (You can read the special issue on India's

Economic Liberalisation and Economic Development in the " Journal of

Asian Economics, " Vol. 7, 1996). The IMF agreed to extend

its " generous " help to rescue the government out of this economic

crisis provided India accepts its structural adjustment programme

(SAP) of promoting free trade and free market regime. Ravaged by

economic depression, devaluation of Indian currency in the

international market, the Parliamentary Standing Committee

recommended the government to open up the economy and adopt a

structural adjustment programme.

By adopting such a historic measure, India tried to take the

advantage of economic globalisation by promoting free trade and

deregulation of market. On the contrary, the giant players in the

global economy tried to take advantage of the vast unexplored Indian

market. Thus with multinational and trans-national corporations (such

as LG, Samsung, Pepsi, Mcs) came the multinational and trans-

national NGOs. (I call these NGOs multinational and trans-national

because of two reasons: first, their presence in most of the

developing countries taking advantage of a free market regime; and

second, maintaining a huge corporate infrastructure with high staff-

salary and excessive administrative and travel cost; and to sustain

this corporate structure and comfort, mobilising resources from the

global economic market).

I have a countless list of NGOs who came to India after 1991 say FHI, Population

Council, Project Concern, HIV/AIDS Alliance, CEDPA, ICRW, Bill Gates, Packard

Foundation and hundreds others).

They came like locusts- probably the last decade (1991-2001) would mark the

greatest invasion of Indian territory by the multinational and trans-national

NGOs to take advantage of the virgin Indian land and society.

Compiling data from several NGO Directories published both by the Government of

India and NGOs, I can find the largest number of AIDS-NGOs were ever registered

between 1993-2001.

Some of these NGOs were " exclusively " registered keeping in mind the donor

agenda (for example NGOs exclusively registered on sexuality/ HIV/AIDS).

We have the evidence that the donor-agenda changed the NGO agenda and most of

the earlier established NGOs started working on sexuality and AIDS prevention,

albeit their mission was to promote education or working on environment, and

forestry (I have countless examples of both national and international NGOs

changing their agenda from poverty reduction, sustainable livelihood,

diversified agriculture, forestry, watershed management and fishing to

HIV/AIDS).

Do we need to talk more on how this " distortion " in the development

agenda took place? I am calling the agenda as " distorted " because

based on the facts presented above, I believe that the priorities for

the country should be different. And that is how I label HIV/AIDS

agenda as a " construct. " Why don't we just take the example of 30

million homeless population (in addition to another 30 million

migrant workers who do not live in any formal residence unit) who, I

think, should be given top priority in the development programmes?

Because of their homelessness, they could not bring their families

whom they leave at village and have sexual relations outside.

Families are a well-documented " protective factor " in HIV

transmission. Once you address the " homelessness " the HIV prevention

is automatically addressed. Or why don't you just talk about 350

million " sheer illiterates " of the country? What makes HIV a bigger

problem than illiteracy in the 21st century?

You have made your point clear that you do not believe that western

ideologies or institutions have anything to do with shaping the

national policies and programmes. Let me remind you the Indian

economic and political history that we just talked above. Under the

prolonged economic depression in the 1990s, as the IMF took the

advantage of an economic crisis by pushing it's agenda of SAP, World

Bank used the same opportunity for providing loan to the Indian

government to implement its national AIDS control programme in 1994.

As with SAP, the loan came with " conditions " -- the foremost was to

withdraw the National AIDS Control Policy of 1989 and adopt a

liberal, rights based perspective of prevention and control of AIDS.

For developing this new rights-based policy, technical support would

be imported from abroad and organisations like WHO and UNAIDS would

help India developing such a policy. We accepted the money and we did

the blunder. I wonder whether I can call this as " exploitation "

simply because the policy that was foisted upon by the World Bank was

NOT sensitive to the social and cultural context of the country.

Sorry for the distraction, but let me come back to your argument

again:

" What counts is the mobilising of community action to identify the

problems and find Indian solutions to what they find... "

Do you think that with regard to HIV, whatever solution has been

found so far or we have been adopting are Indian? In almost all the

cases, the entire programme inputs have been imported from far across

the sea. Toolkits, handbooks, guidelines, strategic plan, resource

materials, virtually every " truths and norms " about HIV/AIDS

programme is imported from the donor's home country.

In the name of providing technical support and capacity building, a gospel of

western truths and norms about development is pumped into the NGO programmes.

This is what is available in US and this is how Americans do, so we must do this

in India. The LGBT community in US have their rights, so we must advocate for

the same in India. The HIV prevention programme in US recognise the rights of

sex-workers, homosexuals and others, so India must do the same. Have we been

able to mitigate the new infection in US by giving information and adopting such

an approach? In USA 100 percent population are aware about " risk exposure " and

modes of transmission of HIV. Have we been able to stop new infection still now?

" If India really wanted to know how many are really there they would

pass anti discrimination legislation and actually enforce it ... "

I don't see any logical connection between the numbers and the

legislation. Also this is where I have the major contestation with

you. Take the example of the case against IPC 377. Only because of

the influence of the western funding agencies, the case made upto the

Delhi High Court. You do not seem to understand what is applicable in

the western social and cultural context can not be made applicable

everywhere. Legislation emerges out of social and cultural contexts.

Sexual tolerance in the west is due to a host of contextual factors

in the society that are not present in the countries of South Asia. I

use the term " sexual tolerance " to indicate tolerance to a wide range

of sexual behaviour (exhibitionism, nudism, orgy, swapping, etc.);

sexual preferences and orientation (lesbian, gay, bisexual,

transgender); sexual products (toys, pornography both print and

electronic, peep-shows/ live sex-shows); and sexual ideologies (a

feeling that all these are okay and a part of our culture!).

Hence the same concept of sexual tolerance can not be applied to the Indian

social and cultural context. Thus challenging the constitutional validity of IPC

377 was wrong. Let us examine why other countries in the west are sensitive to

LGBT issues. I will just show example from US.

In a society, where 64 percent of total marriages end in divorce;

where 28 percent of total children under 18 are single parent; where

50 percent of total youth by age 30 see their families breaking down

or become single parent; where 32% of total birth occur to unmarried

women; where 4 percent of total children are parentless due to

divorce; and where 1 million children become involved in divorce

every year, extending support structure to the sexually minority

groups become a state responsibility.

In am not arguing that all the LGBT communities in US are single parent. But

what my fundamental contention is that since single parent homes account for 90%

of homeless and runaway children, 85% of children with behaviour problems, 71%

of high school dropouts, 85% of youths in prison, and well over 50% of teenage

mothers, parentless children are more likely to be LGBT than children living in

a family (These figures are from US Census Bureau and National Center for Health

Statistics reported in Divorce Magazine. See, US Divorce Statistics,

http://www.divorcemagazine.com/statistics/statsUS.shtml).

Thus marriage and family as an institution have a strong influence on

people's sexual identities and in majority of the cases, people

living in families can not become a homosexual. (You would argue,

that it is because of the familial pressure: the sexual identity is

imposed upon by the family, which is against individual liberty and

rights (see Khan 1994).

My question is then, do we break the family- institution and take someone out of

it to declare himself as homosexual? Or should we promote more divorce as

programme strategy to let people develop their sexual identity independent of

the familial control?) Since it is well established that a person's sexual

identity is formed during the late adolescent age, and well over 30 percent of

total adolescents become single parent, the familial factors can not influence

in developing their sexual identities.

It is no wonder that such a society would be more tolerant about LGBT rights

where large number of parents see their own children as a homosexual. Thus LGBT

Activism in US has a structural context where family and marriage is a decaying

institution. The same activism does not apply to India until it reaches that

stage. Are we by any means trying to be equal to US in this regard to let people

develop their sexual identities outside a familial institution and hence promote

more divorce?

" In a relationship of master-servant, domination-subordination,

coloniser-colonised, donor-recipient..., I am not sure I understand

this statement. "

Yes you misunderstood, particularly when you say India is no longer

colonised. Can we define the process of colonisation, particularly

neo-colonialism in the age of globalisation? Look at the contemporary

world economic and social order and tell me whether it is

hierarchical or anarchical? My analysis of using an economic

depression and imposing SAP; taking opportunities of an economic

depression to change the policies of a nation; using a free trade

regime to invade the society of a nation and imposing one's own

social and cultural construct; carrying out donor-driven research and

programme agenda; and dictating the way it needs to be implemented

are all examples of the above relationship.

" If this means that the numbers are wrong because multinational and

transnational NGO's are looking for somewhere to hang their hat then

I can't accept that because I don't work with any of them... "

I don't work with them either, but I have already demonstrated where

and how multinational and transnational NGOs hang their hat.

" Anyone proposing to have sex without protection in India should be

submitting to sexual health and safety principles. "

I beg to differ on the statement simply because it inherently

presumes that someone is having multi partner sex or is sexually

promiscuous.

" Of course that presumes that every such Indian (or any other

nationality of course) would need to know what a risk exposure is.

Most of the people I lecture to in India don't. It is also not common

sense as is evidenced by the numbers of otherwise intelligent people

who are HIV +ve. In this class are doctors, lawyers, accountants,

police officers, peace keeping forces, teachers, students,

politicians, academics, drivers, building workers, public servants,

and of course sex workers and poor people of identifiable caste

status. "

I have already made my position clear on this. Take examples from

America. Almost 100 percent people know the modes of transmission and

what a " risk exposure " is. What difference has it made there? Have

you been able to stop the new infection among high-risk groups as

well as in general population? Check these statistics from CDC and

NCHS and you would find that the HIV infections rose more than 7%

from 2001 to 2002, with an overall increase of almost 18% since 1999

among gay and bisexual men. There is also absolutely no evidence

that " intelligent " people in US or Western Europe who knows what

a " risk exposure " is have been able to prevent being infected by HIV.

Check this website yourself that lists about a hundred famous people

including athletes, entertainer, artists, writers, musicians,

politicians, singers and porn stars in US who have been infected by

HIV. http://en.wikipedia.org/wiki/List_of_HIV-positive_individuals.

Did they not know what a risk exposure is?

" Far too many between 14 and 16 are testing positive. That's not

a 'western opinion' by the way but if we don't HIV- proof the next

generation we are in a lot of trouble. "

I challenge this statement and say that this is statistically not

supported. Projections, simulation and modelling of age sex structure

(that is done in the west for example USAID, or that I am

doing) " with " and " without " HIV suggests that the current or even the

moderate rate of HIV infection in the developing countries will not

have any significant impact on the age-sex structure simply because

every year 30 million live births are added to the total population

base. Thus the size of the cohort who enters the reproductive age

group every year is far greater than the cohort who is infected.

With a moderate level of HIV infection, India's age-sex structure will not

" substantially change " at least in next 30 years. You can check these

projections yourself for other countries that are done by USAID 2004.

" I have learned that there is no substitute for accurate information

and frank discussion... "

I do not buy this argument, as this is NOT the only variable that

affects the probability of getting infected with STDs/ HIV/AIDS.

Again taking examples from the West, it emerges statistically that

other contextual factors in the society play more important role

than " just accurate information and frank discussion. " Among these

are, physical quality of life, per capita income, standard of living,

education and health and treatment seeking behaviour. I strongly

believe that we need to be careful before suggesting something

as " the magic formula " that would work for a nation.

" I have lost count of the number of Indian weddings I have attended

where a gay or bisexually active Indian man has been pressured into

marrying a woman or where bisexual or lesbian women in India have

been coerced into marrying men.... "

I have already made my point clear on this and argued that the

activism for LGBT rights in India must be viewed in relation to the

structural and contextual factors in the society. The liberal

policies towards sexual minorities in US have been developed out of

its existing social realities. Although it required certain level of

activism, State clearly recognised the need for a policy under the

changing social structure (divorce rate, single parent adolescents

etc., mentioned earlier). Where no one is available to extend the

support, it becomes obligatory for the State to extend the support

structure and protect the rights of sexually minority groups.

In contrast, India has a handful of self-proclaimed LGBTs living outside the

family. Even if there are millions of them hiding in the society, they are

already living with their families. Why the hell we take them out of an

institution to promote individual liberty and rights?

In the name of promoting an institution of liberty and rights, are we

not breaking down another important institution of marriage and

family?

" Sexual tolerance " in US needs to be juxtaposed with other contextual

factors within American society. A country that produces 4,000

pornographic films earning over 13 billion dollars per year (The

Observer, April 18, New York); a country where people choose 'porn

star' as a career option without any social stigma (being a " Play Boy

Playmate " or a " Penthouse Pet " still remains glamour in American

society); a country where a " female porn star " contests for the

governor of a state (Famous Porn Star Carey who performed in

more than 30 hardcore porn movies as of 2004, contested for the post

of Governor of California in 2003. Out of 135 candidates, she came in

10th place); a country where well over 1,200 female " porn stars "

enter the adult industry every year (Only in 2004, 1,231 new female

porn stars entered in the adult industry in California. See

Cyberspace Adult Video Review, CAVR List of Newbies 2004,

http://cavr.com/hots2004.htm); a country where sexual products such

as sex shops and live sex shows is a part of culture in every city (I

don't know of any city where there is no such shops); a country where

prominent stars and celebrities often get AIDS (see List of HIV

positive people, http://en.wikipedia.org/wiki/List_of_HIV-

positive_individuals); tolerance to LGBTs likely to be higher as such

society already tolerates a wide range of sexual ideologies. Contrary

to this, a country where all these are stigmatised, LGBTs are also

likely to be a part of the wider sexual stigma. For example, even

after two decades of HIV epidemic in India, no celebrities have yet

been infected by HIV/AIDS (even if they are, they have not yet

boasted of having the virus publicly).

Indian porn industry is negligible, still limited within the sex workers and the

law prohibits both adult industry and sex work. Since there is no concept of

'porn stars' in India, such stars do not enjoy any social status too. You would

probably argue, it is because of the high level of stigma prevalent in Indian

society. Hence, we must fight to reduce sexual stigma so that people can enjoy

their sexual freedom in the name of individual liberty and rights. But look, we

are structurally so different...! What if we do not want this sexual freedom?

Let the people of this country decide what they want... let us have a national

debate whether we would promote our sexual freedom in the name of individual

liberty and rights.

This rights based approach seems to be so contradictory and self-defeating that

the very concept of " individual freedom and rights " are being " imposed " on

people forgetting their rights to decide what they want for themselves!

" The sex work industry is one of the largest in the world in India

and it is amongst the most unsafe and unregulated. It is a growth

industry of rich and poor middle aged and young, male and female... "

So what do you suggest? Instead of saying that we need a proper

legislation that is implemented correctly at the ground level and

taking necessary steps to correct the policemen who implement it, do

you want to argue that the Immoral Trafficking and Prevention Act be

withdrawn? I again beg to differ. Legislating sex work has done no

good to other countries. Tell me concretely what good it has done

(other than promoting individual liberty and rights) to other

countries and to the epidemic? And I am sorry to say, that I do not

want to see my sister as a " Porn Star " as an easy fallout of such

legislation. You have already mentioned that young people in MP have

started prostituting even under the presence of an Act. Can you

imagine the magnitude of sex work without any barriers? I am sorry

Sir! I do not want to perceive such a country for my own.

" The reason the epidemic has not been controlled in india has nothing

to do with western institutions or ideologies. "

I have already made my point clear on this. We have never tried our

approach. The time was too short since the virus was discovered till

NACO was established and World Bank foisted its policy upon us. We do

not even know whether an Indian approach to the epidemic would do any

good. Pleased refer to the message from Mr Abel in Tamil Nadu, who

also feels in the same way and trying out a cultural approach in the

community he works. His message clearly says that " it works. " But is

does not fit the " standards " of the western institutions or funding

agencies. I attribute today's 5.1 million figure only due to the

approach to the epidemic that we adopted under donor pressure

forgetting the structural context of our country.

" So little of the Phase one funding goals were achieved anyway... "

It was obvious. Picking up something from somewhere and fitting it in

another context would always result in such disaster. I do not worry

why Phase I goals were not achieved.

" I am sick of people assuming that the epidemic will stop with

abstinence and faithfulness. It will only stop when people stop

infecting others. Behaviour change not morality will give the best

results.... "

It is just we are different varieties of people who are sick of

listening different things. I am sick of what you say. Morality

guides action - argue if you can but thousands of youth I interact

with do not go to the sex workers even if they want to only because

of a high level of stigma attached to sex work and constructing a

moral standard that this is wrong! Of course epidemic will stop when

people stop infecting others. And people stop infecting others only

when they " abstain " or " remain faithful " to their partners.

Your behaviour change argument reminds me of the famous argument one

Indian journalist once made in Pioneer -- that behaviour change and

safe sex is something like saying that when there is pollution, use

mask because mask manages the risk of being exposed to allergens. You

do not seem to say that, well, the root cause of pollution needs to

be tackled, say using clean fuel, planting more trees, using public

transport instead of using one's own vehicle and so on. And to my

analogy, you are actually arguing that OK, you can take the bribe,

but before you take it, wear a set of gloves. It no more remains

immoral. Let us ask ourselves what guides our action and so called

behaviour change? Morality or something else?

" India has never had a sexual and moral culture that fits your

description nor has any other national group... "

Are you still not convinced whether we have a sexual and moral

culture even after presenting such hard facts about sexual culture in

the west? I have presented data from US porn industry, porn stars,

sexual toys, shops, sexual ideologies, sexual tolerance, preferences,

and some sexual characteristics that define every US city, and the

like. What else best describes the west, I do not understand.

If you want, I would present these figures for Western Europe and

Scandinavian countries later, but let that keep outside this argument

as it is already presented for US. You do not seem to find any

reference to India's sexual behaviour in Australian media. But just

to give you an example, here is one " A Lesbian Film Idyll and the

Movie Theatres Surrender, " New York Times, December 24, 1998, other

than hundreds other research papers in peer reviewed journals

published from the west.

What is a society without morals? It is no moral to engage in divorce

and leave the children single parent (30%) or neither parent (4%). It

is no moral to separate the children as soon as they become adult. It

is no moral just to preserve one's own individual freedom and

liberty, leaving the parents on the road during their old age, which

we do under poverty and the west do under affluence. There are

differences between East and West that we must acknowledge- we have

it with HIV and you have it with everyone in the society.

Let me conclude by just showing you an example of how " situation

assessment " or the " community needs assessment " is done in a power

relation of donor vs. recipient. This is my own experience that I

would like to share with you and an excerpt from my paper.

....The situation assessment or the CNAs are one of the most " biased "

and " questionable " exercise of programme implementation as in all the

cases, CNAs are done by the NGOs themselves. Thus for conducting the

needs assessment, NGO workers go on searching for HIV positive

individuals and other vulnerable groups such as homosexuals, gays and

eunuchs. (I have reported this in one of my earlier study with

particular reference to injecting drug users in Delhi). Such an

exercise puts two interest groups at stake: first, if a threshold

population of HIV positive individuals, gays and eunuchs were not

found, the outreach workers lose their job! And second, if the " need "

is not reflected from such an exercise, the NGOs lose their potential

funding. Hence " construction " of an agenda and inflation in reporting

was inevitable. I started my career as a need assessment worker in

Delhi, Mumbai, Surat, Guwahati, Pune, Lucknow, and other cities.

Sir, believe me, I have no conspiracy against anybody. But whatever

is going on, worries me a lot as I see that things have gone totally

worst in certain pockets. We are arguing only because of a difference

in opinion about what would work in India. Any other argument that

you provide would strengthen our viewpoints about what we believe.

And finally, I would beg apologies of the readers that since I am

travelling, I can not reply to these debates immediately. Let me join

my office after a week, and I would love to supplement what I feel.

Sincerely

Subir K. Kole

Research Fellow, East West Center

Director, Research and Training

Development Experts International

Honolulu, Hawaii, USA

E-mail: subir@...

[Guest guest]

Dear Forum:

I agree with Mr. Kole-- that in the middle of hundreds of commitments in our

busy lives we have to waste our time reading his long comments especially when

he is contradicting himself-- at one place he is saying " in majority of the

cases, people living in families can not become a homosexual " but he also says

" Even if there are millions of them hiding in the society, they are already

living with their families " (in India).

Basically-- he is coming from a position where divorce is immoral-- well that is

his opinion which he should keep to himself.

Also from where did get the information that 100% of population in the US has

HIV transmission awareness?

It looks like he has lots of time in his hand to ramble about his opinion and

comments which he should keep to hoimself.

Sathi Dasgupta.

E-mail: <sathi_dasgupta@...>

[Guest guest]

Dear Forum readers,

I must say I was saddened by Mr.Suber Kole and the incredible hotch-potch of

dialogic and didactic discourse that mixes public health issues, epidemiology

and even " morality and tradition " among other things in the battle of figures

started by Feecham.

What is horrifying is that he justifies this chauldron of wild Western

constructions by saying he got over a 100 emails supporting him. A

majority just results in " majoritarianism " and does not signify either the truth

behind an agrument and nor does it justify attacking minorities who may not be

in a position to reply to blatant homophobic statements juxtaposing tradition

versus liberty and human rights.

The fact is that this forum is to discuss HIV/AIDS. The fact is that a lot of us

activists and NGOs are caught in between the " reality " and the way " truths

regarding HIV are constructed " . But to mock the whole national HIV/AIDS/STI

intervention program shows a cruel refusal to face the hard " reality " that we

are facing a grave epidemic of massive proportions.

I speak more as a one of the " handful of self-proclaimed LGBTs " living very much

within the family and not " outside " as he insists.. Kole's next two

sentences: " Even if there are millions of them hiding in the society, they are

already living with their families. Why the hell we take them out of an

institution to promote individual liberty and rights? " need not necessarily be

truthful to the first. I shall explain the false discourse he tries to impose on

us LGBT people.

Firstly, may I strongly protest a " Research Fellow " in Hawai writing in such

derogatory language about emerging communities in India in a totally ignorant

manner.

It's the usual NRI complex (Na Raha Indian, as Amir Khan says in the infamous

Cocacola Ad). Preach from afar. I shall not talk about Mr. Kole's " disgust " with

NGOs and his disillusionment while studying in Mumbai.

But firstly! No LGBT activist in India wishes to be taken " out of an

institution (like marriage) " to " promote individual liberty and rights " . In fact

we not just insist on freedom to be within our families but to be respected as

such within familial structures. I'm horrified that he thinks Indian LGBT rights

are something.new in contrast to tradition which is supposed to reside within

families alone. Ironically, Section 377 of the IPC itself is new and remains a

colonial imposition in Indian criminal law.

The research book " Same-Sex Love in India -- Readings from Literature and

History " by Prof Ruth Vanitha and Saleem Kidwai makes it very clear.

Their observation: " Our study suggests that at most times and places in

pre-nineteenth-century India, love between women and between men, even when

disaproved of, was not actively persecuted. As far as we know, no one has ever

been executed for homosexuality in India " . (Pages xviii in the Preface). Compare

that to Kole's present home in Hawaii where Christian missionaries burnt to

death ancient berdache (homosexual) medicine men in the late 19th century and

you know where this homophobia is coming from.

Yet people like Kole actively maintain that homophobia is part of Indian

tradition. In every sensitisation workshop on " Sex,Sexuality and Gender " , which

I conduct at the Tata Institute of Social Sciences and the Clinical Psychology

Faculty of Mumbai University,(which I have been doing over the last five years)

this startling fact -- of the deep understanding of the pluralistic sexual

identity constructs within our tradition -- are clear 'reality' contrary to what

Kole and his " Research Fellow " ilk wish to impose on modern India.

I dare say that from his perch in picturesque Hawaii, Kole

is as guilty as the MNCs he accuses, of imposing his own agenda.

I too wish I could go point by point in replying to his arguments but some of us

have to work very hard for a living. Yes! Many of us activists were agittating

for our rights long before the HIV/AIDS " crisis " in India started. I, for

example, am drawing a salary today from my NGO which I was drawing as a

journalist 17 years ago in Mumbai in 1989. So it's not as if all of us are

making a

living (or otherwise) out of HIV/AIDS.

What must be understood is the discourse surrounding HIV/AIDS is being

confused willfully on purpose. It is not that homelessness, malaria, TB are

divorced from the health issues around HIV/AIDS prevention; it is why they are

not being integrated into the HIV/AIDS programs which have become a bugbear for

public health professionals unable to deal with the stark " reality' that

HIV/AIDS has a more immediate impact on the whole socio-economic landscape

unlike TB/Malaria/Polio, which require more managerial political mandates.

Many of us have been insisting that the HIV/AIDS crisis is compounded by

illiteracy, homelessness and general paucity of lack of access to health

facilities for the poor. Hence, it is not which disease must get priority but

how the holistic health package must be programmed into our overall health

strategy.

Who, for example, does one blame for the fact that the government which talks of

the socialistic mode of production and property rights is witness to increasing

levels of disparity between the rich and poor? Who does one blame for the fact

that malaria, TB, polio still exist in a country where spending on health has

actually decreased to reach an abysmal 0.7 per cent of the development

expenditures by the state?.

Surely the Five Year Plans were made by well-meaning people not really

influenced by the World Bank or IMF. Yet Kole will start his tirade starting

only from 1991, propagating a general amnesia regarding the gruelling reality

pre-1991. Why is he starting

from 1991 and, say, not from 1947?

What fascinates me as an Indian, always accused as being rooted in Indian

" tradition " , is that Kole has all his facts about America in place, but his

facts regarding India are woefully lacking. Why does he not check with the

Family Planning Association of India (FPAI), one of the oldest NGOs in India,

whose dossiers stated long before the HIV/AIDS crisis began, that divorce rates

were much higher in rural India than in the cities! Why not state the stark

reality that 80 per cent of the women infected by HIV in India had only one

partner -- their husbands! Surely sir, that is a telling commentary on your

" family and tradition " ?

I would heartily recommend to him the research paper by indigenous

researchers about the rates of male-male sexual activity in rural Indian men

(please read Research letters -AIDS 2004 18:1845-56 by Ravi Verma and e

Collumbien) where the rates for male-male sex are THE SAME as reported by Alfred

Kinsey in the USA ie 10 per cent of single and 3 per cent of married men had

unprotected anal sex with a man in the past year. In other words, whatever be

the " cultural " or other context of a population, we human beings are all the

same inhabiting every corner on this planet.

HIV/AIDS, even today in America, is still mostly restricted to the gay

population where it has been rising again. However, can Kole please explain why

15 years into the " epidemic " , nearly 80 per cent of the infections are still

among males in India? Is it possible that his " cultural context " fails to see

what happens when homosexuality is driven underground?. If he wishes to protect

" tradition " then why not bring back child marriage and sati, as even luminaries

like Dr.Rajendra Prasad did in the momentous arguments over the Hindu Marriage

Act in the 1950s, where the Hindu progresssives won? Why not

bring back the Varna-Ashrama itself because it was a " tradition " in our

" cultural context " defended by no less a person than Mohandas Karamchand Gandhi!

Kole's playing arouind with figures even as he takes potshots at UN

agencies, international funding agencies and governmental priorities are for

these individuals entities to defend and I hold no brief for them but the

following statement must be challenged on its very merit.

" I don't see any logical connection between the numbers and the legislation.

Also this is where I have the major contestation with you. Take the example of

the case against IPC 377. Only because of the influence of the western funding

agencies, the case made upto the Delhi High Court. You do not seem to

understand what is applicable in the western social and cultural context can

not be made applicable everywhere. Legislation emerges out of social and

cultural contexts. " .

As a represenatative of the Indian homosexual community, I strongly object to

his linking up the case against Section 377 with foreign funding.

In fact the case against Section 377 has been building up for a long time now.

It was challenged by a Trotskyite group, the AIDS Bhedbhav Virodhi Andolan

(ABVA), in the late 1980s. The ABVA actually made a virtue out of NOT taking any

funding whatsoever. Every lawyer fighting the case has refused to charge

anything for taking up the matter.Our organisation has been collecting field

data of harassment and violence against sexual minorities without any funding

till date.

Not a single foreign funding agency, starting with USAID, contributes even one

rupee inthe fight against Section

377.

In fact, many of them are particularly hostile to the word 'homosexual " wence

has come the obsession to turn us alll into simple " MSM " .

However, I must warn Kole that if asking for assistance from wherever it comes

is taken as an anti-nationaal act, then very many human rights issues neglected

on purpose by the Indian political class will fall by the wayside.

But the self-righteous tone in Kole's statement " You do not seem to

understand what is applicable in the western social and cultural context can

not be made applicable everywhere " must be challenged straightaway.

Pray inform us why " what is applicable in the western social and cultural

context cannot be made applicable everywhere? " Democracy itself as we have it is

a " Western construct " .So why not reject it! Why, even the language we are having

this discourse in is a foreign western language! Why and who are you to accept

and reject what is western and what is oriental? Please pray tell us!

The unfortunate truth is that I too tend to agree with Mr. Kole on very many

statements regarding the funding agencies imposing their agendas. Very many of

us are in situations where we try to maintain a delicate balance between running

our own agendas and compromising with the funders' agenda. But being an NGO

which got India's first pilot project from public money (our first grant was the

from the Directorate of Health Services,Maharashtra), I must ask Kole to explain

what his tirade is really about.

Is it about numbers? If it is, then I can say that NACO itself comprehends that

its estimates are guestimates at best. With a sentinel survellance network that

has been in place for hardly a decade compared to survellance of other

infectious/contagageous diseases which have been quietly chugging away for

nearly a century (the Bombay Plague Act was enacted in 1929, for example), let

me inform Kole that it is not numbers that reflect any reality but what those

numbers may actually mean in affecting communities

at peace till now and who face disruption due to both State and

international intervention.

For example, India has always recognised a " Third Sex " ,(Tritiya-panthis)so much

so that there have been Male Temple Prostitutes called Jogtas and Jogappas since

time memorial.

Mr. Kole forgets that the greatest playback singer of our times comes

from the Devdasi tradition and is today ashamed of the institution

which led to so much exploitation in years gone by.

The " cultural context " of this reality is that temple prostitution

as an institution have been recorded in ancient Jewish history,

Pre-Islamic Arabia and in earlier times Before the Common Era (BCE).

Yet,today the whole institution has collapsed like a house of cards. Not only

are Jogappas on the streets but have got into prostitution at truck spots, on

highways and are displacing women in prostitution. Could Kole and his kind

please inform me what we shall do with this " tradition " ridden group who are now

reaching infection levels of 50 per cent or more.And this is a hard 'fact'.

The first sentinel survillance done among hijras in 2004-2005 at Mumbai's Sion

Hospital gives HIV prevalence at 49.5 per cent.

The very 'reality' of their high HIV prevalence shows that there is same-sex

activity going on within " traditional " society. How are you going to engage it

without throwing out a British Law enacted in 1869, could you please tell me

without bringing in your precious " family " into the picture? In a famous Marathi

play, 'Julva', the forlorn ostracised Jogta pleads for a mouthful of rice " even

if you all fuck me dry " .

Do not try to do that to us for we will fight back with all our might to avoid

marginalisation. By throwing in a whole mix of epidemiological props, gross

xenophobia, clever manipulation of figures, neo-con philosophy and plain

disinformation together, Mr. Kole should not be allowed to get away with

pandering to the most vile of pompous passions -- cultural nationalism.

There is much to what Mr. Kole says, But there is much more he is trying to hide

through a profuse display of data from a western civilisation that is the most

transparent of modern societies. This is startling compared to the hidden

" cultural " realities within a closed highly hierarchal society like modern

India, where the basic " right to information " laws are still being stone-walled

by

the ruling political class.

Finally a word of caution: Let us not ride roughshod over the existence of

silent oppressed segments of society who have found a voice in a rapidly

globalising world.

If you cannot reverse the tide, please also do not live on islands of

precocious pretences.

History has a habit of repeating itself not only as farce but as tragedy too.

Ashok Row Kavi

Humsafar Trust

Mumbai Metro.

E-mail:<humsafar@...>