The train that told 6 mn the story of a virus

Inside, Mohan Singh Rana impatiently taps his fingers on a white formica-topped table. He has showered early, dressed and finished breakfast while half a dozen colleagues are still in slumber or are just waking up. “I’ve been on this train for a year now," he says with a chuckle. “Wouldn’t you be in a hurry to get home after a journey that long?"

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Rana is chief executive of the Red Ribbon Express (RRE), billed as the world’s largest social mobilization campaign against HIV/AIDS by the United Nations Children’s Fund (Unicef). Over its year-long run of 27,000km across the country, the National AIDS Control Organization, or Naco, which is spearheading the Union government’s fight against the disease, estimates that RRE covered some 6.2 million people. The awareness created by the train, which returned to New Delhi on 1 December on World AIDS Day, say health experts, non-governmental organizations and administrators, is unprecedented, in part because of an unusually high level of coordination among New Delhi and state governments outside of emergency situations.

Visitors who thronged the train exceeded the planned 1,500 a day several times, with state government officials engaged in what Naco director-general K. Sujatha Rao called “competitive politics". Word spread ahead of the train, she says, and as it progressed from one station to another on its 180-halt route, district collectors and administrators ratcheted up local interest.

On a muggy day in June, in Dindigul, an industrial town in central Tamil Nadu, the mood had been one of bated anticipation on a platform teeming with schoolchildren. A beaming Arul Prakash, district programme manager for RRE, had expected 15,000 visitors over two days. “I hope it is in the top three or five halts in national statistics," he said. Rana is not sure if Dindigul made it; he ranks Gwalior on top with at least 17,000 visitors and reckons that halts in Kerala, Uttar Pradesh and Jharkhand were likely close. Statistics are still being tabulated.

Mass appeal

The popularity of the RRE initiative hinged on its content, says Supriya Mukherjee, programme communication specialist at Unicef. “At the very basic, it’s a travelling exhibition," she said, adding what eventually turned out was a “communication innovation". After a four-station run in Rajasthan in the first week of December 2007, the first state the train headed to after New Delhi, it was obvious to Naco that the content—prepared by advertising firm JWT India Ltd—needed to change.

“We cut down on 30% of the text content and focused a lot more on visuals," says Rao. The train, then with specially adorned posters, cut-outs, electronic panels, interactive games, and dummy telephone booths, became a one-stop all-you-can-learn avenue for those interested in HIV transmission and prevention (JWT’s Thompson Social team won a handful of advertising awards for its work).

In Karur, a town 75km north of Dindigul, on railway platform No. 3, the visual appeal of the train and the exhibits was evident. Muthukumar, a social worker at an old age home, dressed colourfully as Yamraj, or the god of death in the Hindu mythology, strutted across the platform with a placard: “If you don’t use condoms, then I’ll come and get you."

Population Services International, an NGO that collaborated with the RRE campaign in Andhra Pradesh and Tamil Nadu, put up a “dare game" kiosk. Those who dared, cheered on by onlookers, had to roll a condom down on a wooden phallus and answer questions on HIV/AIDS. Those who finished the task were photographed with a “Mr Karur" sash, wearing a crown and holding a sword.

Long lines of boys in uniforms of violet dots in pink and girls in blue-check salwar suits and well-oiled looped plaits sat in double column rows on the platform, waiting to be shown in. “Just to have a look," Priyadarshini, a class XII student from Karur, answered when asked why she was there.

But, the disciplined curiosity quickly turned into a frenzy as the first batch of children stepped in. Inside the coach, there was a huge cutout of a pregnant woman with a stethoscope on her stomach. Pressing a button played the recorded voice of a child imploring the mother to get tested for HIV. “I also have a right to live," the child’s voice pleaded in Tamil (voiceovers and displays switched to the local language in the 21 states the train traversed through).

The message seemed lost on the children who were more amused than moved. The boys were animated, tugging at each other to look through the bioscope peep-ins, and the girls were giggly. But their minders believed the message was getting through.

“They may not know what the disease is fully but they will know that it doesn’t spread by touch or sharing food. They will learn not to shun HIV-positive people," said Mohana Amba, a 26-year-old teacher-in-training. Deep-rooted beliefs remain strong, though. R. Kumar, a 45-year-old real estate broker, was indignant about the money he thought was being wasted on the train. “Government is spending all this money when the basic problem is that partners stray. They should advocate monogamy," he said.

Rana, who undertook a cross-country, 6,885km “Walk for Life" for AIDS awareness between December of 2004 and 2005, hears such rebukes often but points to a qualitative difference now. “Back then, people didn’t know about HIV. They were in a state of denial. Now, people openly talk about it."

In Moradabad, an inebriated man demanded that the exhibition be opened at 9.30pm on a night three hours after it had closed for housekeeping and internal inspection. When denied, the man put a revolver behind Rana’s left ear. The local police and district officials had to be called in to defuse the “very scary" situation, Rana said with a shudder.

Hinterland rigour

Notwithstanding such incidents, trained hands on RRE counselled some 120,000 and referred at least 8,700 to testing centres, according to Unicef’s Mukherjee. The express managers were helped by some 68,000 teachers, members of self-help groups, health and village community centres, police and government officials who were trained in the train’s auditorium coach.

Apart from train exhibits and audio-visual presentations, a critical component of the RRE campaign, which cost Rs16 crore, was the band of street theatre volunteers from Nehru Yuva Kendra Sangathan, or NYKS, who fanned out in the villages surrounding the train route, performing plays and screening movies.

The train reached out to at least 43,200 villages through its outreach programmes in bus and cycle caravans. “The significance of RRE is that the policymakers realized the importance of going to villages, tackling them on an urgent basis. They were not on the Naco map earlier," says Vagish Jha, an RRE consultant with NYKS. “Any society in a state of flux, that sees movement of people, values and customs, is vulnerable. Villages are not insulated from this phenomenon."

At every station the train drew up in, NYKS volunteers and state representatives spread out into surrounding towns and hamlets. The initial plan was to send them on cycles, said Rana, but it quickly became evident that it was not sustainable given the distances. “How would a volunteer pedal for 15km and then be energetic enough to perform a play?" he asked. The volunteers travelled on utility vehicles and cars.

A two-bus caravan run by Naco and its local partners played four short films themed around HIV/AIDS made by the likes of Mira Nair (the New York-based maker of films including Salaam Bombay) and Vishal Bharadwaj (the director of movies such as Omkara and Makdee).

“One huge learning for us has been how entertainment-starved people in Indian villages are; the movies were a huge hit," says Naco’s Rao. “The buses were perfect for this because we would not be able to set up a screen and projector in a station where RRE rolled in."

The villages were prepared through “environment building exercises" involving wall writing, posters and briefings with village councils, at least two months before the NYKS volunteers or the bus caravan came to perform.

Result: The caravan made contact with nearly five million people compared with the 1.2 million who visited the train.

The buses and performing NYKS volunteers also came face to face with the social stigma and reservations among the locals against HIV/AIDS. At the bus stand in Kulithalai town, some 50km away from the RRE halt in Karur, this came out clearly.

The crowd began thinning when volunteers asked them to enter the bus. A man was trying to persuade his friend to see the bus exhibition with little success. “No..no, I won’t go in. They might do a blood test," said the friend, digging in his heels. Acceptance is a little easier for who have seen the virus at close quarters. The first one on the Kulithalai bus stand to walk up to a Mint reporter and praise RRE’s efforts was M. Veeramani. The 74-year-old lost his daughter and son-in-law to AIDS about four years ago. “I lost half my family to this (disease). Now, my 24-year-old grandson is not getting married because of the stigma," he said, a grimace deepening the wrinkles around his eyes.

Elsewhere, the turnout of women surprised the express’ managers. “Rajasthan was the first state on the route (after Delhi) and we were unsure of the response we will get from villagers," said Jha of NYKS. “But women turned up in such large numbers." In Karur, R. Sumitra Devi, the first woman village council chief in neighbouring Ranaganathanpuram, insisted that a rupee spent on educating women about HIV yielded greater returns. “Men don’t discuss things but women do and spread the message among their peers and family. It is important for them to know their rights so that they can protect themselves and their children," she said.

The road ahead

Yet, Devi was concerned that the increased awareness and social caution would fade away along with the buzz around RRE. “Such initiatives require follow-up action. I don’t know how to pitch such an awareness effort again," she said.

Other experts echoed the concern. Unicef’s Mukherjee listed two main deliverables to aim for post-RRE: how to leverage partnerships across national, state, local and NGO levels in the initiative and how to mainstream HIV as part of the government’s main health programmes.“The task now is to take that partnership forward; otherwise there will not be much by way of long-term benefits," she said.

In New Delhi, officials are at work on this. “In HIV/AIDS (eradication), there is never any end to spreading the message. Every year there are children growing into youth, a vulnerable age," said Naco’s Rao, adding the agency would ask states if there was, for instance, an increase in people coming for testing of the disease as the message spreads.

About one million among India’s estimated 2.47 million HIV-positive people have been identified and Naco’s focus is to identify as many more as possible so that the virus’ spread can be halted.

As for RRE, she said, there is a proposal to have it run once again on a different route taking the HIV/AIDS message around. There are also plans to replace the bus caravans with permanent bus exhibitions in states such as Tamil Nadu, Delhi, Karnataka, Rajasthan and Andhra Pradesh.

Arjun Manohar, a freelance photographer in Chennai, doubled as a Tamil translator for this story, and Josey Puliyenthuruthel John in New Delhi contributed to it.

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