Indian NGOs - Interview with Dr. Ashok Rau

[Guest guest]

Ashok Rau - Freedom Foundation

Dealing with the Disease

Ashok Rau, Executive Trustee & CEO Freedom Foundation considers himself

fortunate to meet first two reported HIV persons in India.

Was that a life changing meeting, cultivating in him deep understanding of the

issue? We do not know, but sure, after two decades Ashok & Freedom Foundation

are amongst the most credible voices on the issue. Ashok. K. Rau, one of the

most visible and compassionate faces of India's campaign against Substance Abuse

and HIV/AIDS. IndianNGOs.com met him to know his views on various issues

including high HIV prevalence states, extent of narcotics, recent HIV estimates

& substance abuse.

Specialized in HIV & Substance abuse from USA in 1980s, Ashok listens to music &

enjoys gardening & traveling, besides stamp & coin collection, an old passion,

which his son has recently taken over from him.

What are the dimensions of Alcoholism in India?

Traditionally speaking, alcoholism has had some kind of social acceptability.

Communities have looked at it as a mood altering substance. Right throughout the

history, you had commonly used substances like opium

However, today it has become a bigger & larger problem, simply because there is

a very thin line between social consumption & the point where it ultimately

develops into a problem. You have people starting with alcohol & graduating into

other substances. You can note various celebrities in media brought into focus

for the similar kinds of problems

How many persons are expected to be affected by alcoholism in India?

Unfortunately, we do not have any data on it simply because of sensitivity of

the issue, lack of any clear definition of alcoholic & absence of any credible

nation wide data available. The only data available is from the institutions

like ours, which can give only a relative picture.

Is there any estimated loss to the economy on its account?

One can only make a relative statement. Let's take one of our eradication &

rehabilitation units. At any given point, we have 55-60 people. When we look at

people, who come in for treatment, it's very easy to document financial loss.

However, just because we have 60 people here doesn't mean, that's the only

number we are talking about

When we look at an individual case, over a period of time, let's say 10-15

years, because usually it takes 10-15 years for a person to actually recognize

his problem, we get mind boggling figures. Cumulative loss can be anywhere

between 10-25 lakhs for one individual. Looking from a national perspective, it

assumes a huge figure.

At one of our earlier programs with a PSU, we estimated over a period of 15

years, one alcoholic employee, if not performing to the mark, can cost up to 30

lakhs to the company

This I believe ignoring the loss to the family

Right, that is a separate issue. Here it's the loss to the company. He does not

come to work or if he comes, his productivity goes down & entire company

suffers. We have documented it in companies like BHEL. In one of the company,

hands of a person got chopped off in a machine as he was not in his proper

senses, which caused loss to the company.

Why do we have comparatively lesser NGOs working on the issue? There are so many

for education & environment. Is there lesser importance attached to it?

Well, from the Ministry of Social Justice & Empowerment's point of view, this is

not a lesser issue. We have supposedly 600 NGOs, who work for checking addiction

& offering rehabilitation

600 is too small a figure in a big country

Besides, not all of these NGOs are necessarily functional & are not doing what

is supposed to be done. Society does not accept many of the methods of NGOs. In

UP, they opposed NGOs saying that these works are to undertaken by psychiatrist

& not by NGOs. However, a psychiatrist really doesn't know how to deal with the

problem of addiction.

Curing addiction needs highly specific expertise. If you look at the general

fabric of NGOs, they are supposedly entities coming from the heart rather than

from the head. It is not really necessary for an NGO to come with expertise but

addressal of the issue does require expertise. It becomes a big challenge then.

Many of the corporate employees, especially of high rising industries are seen

partying & indulging in rampant alcoholism. Film personalities & celebrities are

found rising up against HIV, yet there is little concern for alcoholism.

Corporate sector appears to overlook it.

It's an excellent question. This is the question I have been trying to raise

before corporate sector. Actually, the common perception that addiction is more

of a willful behaviour of a certain degree of character denies any serious

addressal of the issue. Perhaps therefore, corporate do not take it at par with

say HIV or girl child or Tsunami.

Actually, they do not see it as an illness. There is a lack of defining criteria

also. There is larger attitude of pushing it under the carpet. Today if a

company goes out to define alcoholism, I wouldn't be surprised if ten percent of

the employees are found alcoholic. And I am being very conservative.

Isn't it a paradox, while we are trying hard to remove the stigma of HIV,

alcoholism still remains neglected?

Absolutely. The issue is similar in other countries also. You can find concerns

for drug abuse, but people usually try to push away alcoholism. The companies

are not able to see that there needs to be sufficient amount of focus on the

issue

I personally believe every disease is of equal priority. However, a good thing

has happened that with HIV, you are looking at the manifestation beyond

individual self. HIV has brought about broader perspective & understanding about

human dignity & life. Before it, even though we had these issues floating

around, somewhere they never received acceptance.

HIV has spread awareness about fundamental human rights, which need to be

respected & advocated. However, alcoholism has not yet received the due concern.

Even ministry level officials scoff at the alcoholics. While with HIV, you find

greater sympathy & understanding. HIV figures right on top of the list of global

priorities

Doesn't it reflect the concerns more of the western world than of the third

world countries? After all, perhaps the biggest philanthropic act of west, Bill

Gates donates billions for HIV. I do not undermine HIV, but while USA has

probably only HIV to worry for, we have countless issues including malnutrition,

primary education, girl child, primary health & sanitation. HIV is just one of

the diseases

Well, to a certain extent, yes. The impact of HIV is felt more in western world.

Even in terms of redressal, it's largely a western thing. However, the issue is

also about looking at the experience of devastation. Experiences of the west, be

it HIV or substance abuse need to be taken into account.

There is a very clear geographical pattern of HIV spread in India. Does any such

pattern exist for alcoholism as well?

Well, let's talk about HIV first. Documentations, perceptions & prevalence

indicate some geographical prevalence of HIV. We talk of six high prevalence

states. But I find it misleading because HIV does not really have any personal,

community or state level boundary. We still say that 90% of the transmission is

through the sexual route, which is applicable to every single human being, any

part of the country or globe. In that context, saying that these are the only

six high prevalence states does not make sense

They talk about these states because you had the initial initiation of HIV in

these states. But are you saying that in UP, Bihar there is no HIV, then the

answer is no. These are highly vulnerable states but not listed so because you

do not have data to identify HIV cases in these states.

In my opinion, whole country is vulnerable. HIV has no boundaries. Even for

these six high prevalence states, if you look at data, you would see that in

certain districts of certain regions, prevalence rates are overshooting even

Botswana & South Africa. It is reaching 20% in some of the areas of Andhra

Pradesh. But at national prevalence, they have magically reduced the figures to

2.5 millions.

Once the prevalence rate reaches beyond 1%, alarm bells ring, indicating HIV has

moved beyond specific communities & is in the general zone. Then it spreads like

wild fire.

That brings me to another question. What about narcotics? What is the extent of

narcotic mafia in India?

It's huge. Let's try to understand slightly from a historical perspective.

Demand of substances has always been there. If you go back to our holy books, be

it Quran, Bible or Mahabharata, we have references & documented evidences of

substance abuses. That has always been a part of our human psyche. We have

always looked at various ways to alter our consciousness. You might like to

watch a TV serial, I might use my stereo system, someone may go for game of

cricket, we all do these to alter our state of conscious, where we think we rare

feeling better than what we are. Some people then decide go beyond that & decide

to have a drink or a substance. However, some people have an inherent problem

that they become an alcoholic at the end of the day.

When there is a demand, supply emerges. In many countries, alcohol purchase &

consumption is legitimate. In some states, say Gujarat, when you bring

restriction, you find people indulging in illegal trade

Narcotics demand has brought about a supply system in the country controlled by

the mafia. Though you have restriction, yet, in a city like Delhi, you just have

to walk around Paharganj to find several persons, locals & foreigners indulging

in drugs, right under the eye of the policeman because the money involved is

huge. Right from police to politicians everybody is involved because it entails

huge money.

In fact, India has taken a pride of place amongst Golden Triangle & Golden

Crescent because people have realized that routing drugs through India has

become very simple & easy. It has created a spill over for local consumption

also.

Is it because of lesser police action?

It is. But remember, India is one of those countries, which has certain amount

of legitimacy, at least in some areas, to produce it. Some parts of Rajasthan &

UP have legitimate areas of opium & poppy production. Search through history &

you also find documented opium addicts, who had a government issued card which

allowed them to pick up opium from local panwallah.

Which are the prevalence areas for substance abuse? It is generally believed

North Eastern states have higher incidence.

For substance abuse, unfortunately we just do not have a system of surveillance.

We do not have answer as to which sates have higher prevalence.

NE states have a specific mode of use, abuse & transmission, the intra venous

drug use & resultant HIV. But remember, we are talking only about injecting drug

use, we do not have any idea of alcoholism in NE. Besides NE, go down South, say

Chennai, you would be surprised to find the extent of addiction amongst poor

fishermen. They are using drugs which were earlier considered to be the drugs of

the rich & affluent.

Is complete prohibition a solution?

No, it's just not a solution. It is like trying to close the doors because the

horses are bolted. Today there is a high degree of permissibility of alcohol

consumption. One can not wish it away. Prohibition has not helped addressing the

problem. Take Gujarat, the state with prohibition, yet, media recently showed

how openly alcohol is sold in Gujarat

More awareness is the only solution. Unfortunately people do not have any idea

of it. The only idea they have is based on what they see, hear & read. That is

usually glossed over stuff. Recently I saw champagne advertisement displaying a

young girl & a handsome guy enjoying champagne on an island with some caption

like Live Life Kingsize. This advertisement did not tell the aftermath of the

couple getting drunk & puking.

In fact, celebrities appear to validate, even glamorize the alcohol use.

Exactly. And every now & then, you have some reports or studies that some

quantity or regular usage of alcohol is good for health. These are used as

alibis to consume

But people do not understand that our bodies are not made for these things. If

you go back into the prehistoric times, people did not have alcohol to begin

with. We have developed these elements over the time as permissible adult

pleasure seeking behaviour

We need awareness & not prohibition. Take smoking, we have posters in public

places, yet it does not check the problem. Most offices now have no smoking

zones. But if you go to the corridor, you find everyone taking a fag. Otherwise,

most probably the person would have finished a cigarette & back to his work, but

now every two minute, you find them rushing to the corridor.

HIV estimates in India recently reported by UNAIDS mark a drastic reduction from

close to 6 million to around 2 million. How do you find them?

I understand why the figure is reduced. There is certain amount of political

pressure. But from scientific point of view, these figures make absolutely no

sense. Their methodology is faulty. They looked at small cohorts of people, say

200-300 & then used these numbers to arrive at the total number, magically

reducing the number.

When you earlier estimated close to 6 millions, even though accepting some

calculating error, it can't be accepted that you goofed up by more than half.

I do not think this is a reliable estimate. We were actually debating even 5-6

millions as a very conservative estimate. We felt it to be more or less 10

million. Government does not seem to understand that many of the leading HIV

activists in the country, after fighting tooth & nail at various platforms,

managed to make international community understand that HIV is not only the

Africa's problem. India too has a problem & needs support & redressal. Indian

government does not realize that lowering the figure may push international

community to withdraw the support from HIV cause. It may cause neglect of the

issue.

You find these findings mere statistical jugglery. How many AIDS cases do you

estimate in India?

Well, it's a big question mark. So far, in terms of reported cases, whether HIV

or AIDS, the only figure we have are those collated by the government. The

private & civil society factor never really contributed into that figure

One of the things that NACO did was that because of ongoing challenge of

achieving a figure in the country, it said that we would figure only AIDS cases.

At NACO web site, you find only AIDS cases & no HIV cases. However, at state

level, you have cumulative figures. Again these figures are based on the reports

they get. Incidentally, many cases remain unreported & therefore do not figure

in government's estimates

Bangalore unit of Freedom Foundation is the first Care & Support centre of the

country. We started in 1994. Since then, we have 10000 cases documented at this

centre alone. If you ask Karnataka officials, the total cumulative figures since

1986 till today are sixty odd thousand. If in this small corner of Bangalore, we

have 10000 cases since 1994; the whole of Karnataka claim becomes fallacious.

Regarding HIV, which issues need immediate deliberation but have been neglected

so far?

At the national level, one of the key issues should be to create a platform

where there can be a very intense discussion on normalizing issues like HIV &

substance abuses. One of the biggest problems is intense stigma involved, which

further accentuates the alienation.

I have always noticed that even if they are taking up an issue, unwittingly they

further stigmatize that issue. All stakeholders need to converge & have a

proactive level playing field. Everybody thinks he is the expert, which brings

ego & unwittingly the issue remains neglected

What does Freedom Foundation do to rehabilitate HIV persons? What is your model?

Our vision is to ensure a better quality of life for them. This is the

touchstone of our model. There has always been a clichéd thing that prevention

is better than cure. But in case of HIV the prevention strategies do not have

legitimacy. For HIV, there are only two core strategies of entire prevention

campaign. Don't do it & do it safely. From cultural point of view, neither of

these two is permissible because they are contradictory to our cultural

practices. In a marriage, there are certain expectations. You need to do it with

your spouse. You can't remain away from it. And if you do it safely, again there

are family expectations of procreation

Our model of care & support normalizes the things to a certain extent. We help

people live a better quality life. Our model does not say that this is more

important. Every thing is equally important. We fire from all cylinders. We have

prevention component, treatment, legal rights, SHGs & income generation.

HIV AIDS is a Pandora box. You know a rabbit may come out, but something may

also come out. Therefore I do not prefer the word model; it's all the time

changing, ever dynamic. We keep on adding various elements to it.

Freedom Foundation undertakes certain economic activities for rehabilitating

them. Across the country, various NGOs deal with same candle making, match box

designs. Isn't it time for different & more productive activities?

In fact, we have actually stopped doing lot of these things. Our expertise

showed us that even though we try various things, the broader philosophy is to

come in & move out. They are here only for some time. I realized that there

wasn't much willingness to look at these activities as an option.

We then formed collectives of ten fifteen people & helped them forming SHG,

undertaking long income generation activities. Today we no longer have any

product of Freedom Foundation. The communities own everything

Can we offer them better source of work, say in IT or BPO?

Well, in principle yes. We also try the same. Many of our boys are in good BPO

companies. Our intention is to help community understand & destigmatize the

issue. We do not necessarily tell a company to employ our HIV boys & girls. We

teach them to have skills & apply to a company

Ashutosh Bhardwaj

July2007

Bangalore

http://www.indianngos.com/interviews/ashokrau.htm

__________________________

Madhuri Venketesh

e-mail: <madhuri.kv@...>