Why the incidence of AIDS is headed south in Tamil Nadu

Why the incidence of AIDS is headed south in Tamil Nadu
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First Published: Mon, Nov 30 2009. 11 11 PM IST

Intervention project: Jayasheelan (in purple top) with others at the Sahodaran office in Chennai. Sahodaran, a non-profit group, offers social and healthcare support to men who have sex with men. Shar
Intervention project: Jayasheelan (in purple top) with others at the Sahodaran office in Chennai. Sahodaran, a non-profit group, offers social and healthcare support to men who have sex with men. Shar
Updated: Mon, Nov 30 2009. 11 11 PM IST
Chennai: Inside a bylane in central Chennai, up a narrow flight of stairs of a two-storeyed building, erstwhile Bollywood star Madhuri Dixit’s comeback movie’s title song Aaja Nachle is blasting from a television set as two boys in their 20s enthusiastically mirror her moves and expressions.
Intervention project: Jayasheelan (in purple top) with others at the Sahodaran office in Chennai. Sahodaran, a non-profit group, offers social and healthcare support to men who have sex with men. Sharp Image / Mint
This is a drop-in centre or infotainment spot funded by the Tamil Nadu State AIDS Control Society, or Tansac, and is run by Sahodaran (Tamil for brother), a non-profit group that offers social and healthcare support via HIV/AIDS education to men who have sex with men, or MSM.
“The reason for Tamil Nadu’s successful reining in of HIV/AIDS lies in innovative actions such as police advocacy, which has improved their understanding of our population (MSM), reduced harassment and created an enabling environment,” says Jayasheelan, a confident and vocal peer educator at the centre, in Tamil.
The police advocacy programme, one of the several interventions and education efforts supported by the Tamil Nadu government to mainstream AIDS education, has so far trained at least 17,000 police personnel via presentations by the high-HIV-risk groups that are frequently targeted by the police—MSM, injected drug users and female sex workers.
Tamil Nadu, once grouped with Andhra Pradesh, Karnataka and Maharashtra as a high HIV-prevalence state, has in recent years earned the title of being a “trailblazer” for successfully reversing the AIDS epidemic by measures that include educating small store owners and increasing the number of outlets selling condoms in the state from 15,000 in 1999 to 35,000 today.
This southern state, populated by about 70 million people, has seen HIV prevalence among pregnant women, a key indicator, drop to 0.36% in 2006 from 1.59% in 2000, according to the National AIDS Control Organisation, or Naco. Adult HIV prevalence in 2007 stood at 0.34% in Tamil Nadu, compared with 0.62% in Maharashtra, 0.69% in Karnataka, 0.97% in Andhra Pradesh and 1.13% in Manipur.
“Tamil Nadu’s politicians did not turn a blind eye to the issue or deny it. Instead, they proactively allocated funds for the cause,” says S. Vijay Kumar, project director of Tansac, who is also a medical doctor.
Today, the number of integrated counselling and testing centres, which were pioneered in Tamil Nadu for HIV/AIDS, has soared from 65 in 2004 to 835, the highest in the country, according to Tansac data. Several Indian states are benchmarking and replicating practices embraced in Tamil Nadu. The success of its measures is also attributed to partnerships with close to 94 non-profit groups which work with sections of society vulnerable to the disease.
A key objective for non-profit educators such as Jayasheelan of Sahodaran is to patrol hot spots such as Marina Beach in Chennai for MSMs who are commercial sex workers. He usually befriends them and casually requests them to visit a drop-in centre. The HIV/AIDS education happens only after they come into the infotainment area and get comfortable with the environment that induces a willingness to learn about key preventive measures such as condom usage.
At another drop-in centre at Perambur in north Chennai, injected drug users are pouring in. Around noon, about 15 of them converge in a small room on the first floor of a building, at least two of them HIV-positive, most of them frail, and some dizzy and nodding off.
G. Gasper, a former drug addict and now president of Hopers Foundation, which runs the Perambur centre, has the job of offering drug users new syringes in exchange for old ones. Often, he goes out and collects used syringes from dark street corners where drug users inject themselves.
“We’ve also started a harm-reduction programme using opioid substitutes, where we offer them an oral form of the drug to get them off the injections that are rife with risk and also create abscesses” when they hit the wrong spot, says Gasper, a one-time air-conditioning mechanic who became an HIV/AIDS counsellor more than a decade ago.
One area that Tamil Nadu still grapples with is the education of female sex workers. While Kamathipura in Mumbai or Sonagachi in Kolkata are demarcated as red-light areas, Chennai’s sex workers are largely married women from low-income families dispersed in various parts of the city.
“Usually clients are unwilling to wear a condom, so we sometimes cajole them like kids lovingly mentioning the safety of their wives or children or sometimes we lie that we are infected to scare them into putting on protection,” says a 32-year-old former flower seller and mother of two children. She picks her stock of free condoms from a drop-in centre in south Chennai that she heard of from a friend.
Constant overtures from auto drivers who used to buy flowers from her, coupled with an alcoholic and suspicious husband who refused to support the family, pushed her into the trade. Her family doesn’t know about it.
Though Tamil Nadu has recorded a drop in HIV infections among commercial sex workers, spreading the word is getting more challenging.
“It is getting tougher to organize and educate the commercial sex workers in Tamil Nadu using peer education as more and more of them use cellphones to solicit clients instead of hanging out with their friends to pick up customers,” says Bimal Charles, project director of the Chennai-based AIDS Prevention and Control Project that gets funding from the United States Agency for International Development. “So we are looking at sending text messages in Tamil to bring them to a central place for distribution of condoms or to update their information on sexually transmitted diseases.”
anupama.c@livemint.com
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First Published: Mon, Nov 30 2009. 11 11 PM IST