POSITIVE LIFE

2010-03-13T21:45:00.000-08:00

Coming back to the blog after ages. Coming back to many parts of my life after ages. Feels good, makes sense to come back.

2008-05-06T04:02:00.000-07:00

Why do sex workers rights violations continue – who isn’t walking the talk?
On April 14, 2008 a sex workers’ habitation area in the remote district of Sitamarhi in North Bihar was yet again targeted, attacked, and subsequently torched and looted. The sex workers were taken away by the police, several people were charged under the anti trafficking act, but the administration was disinterested in ensuring the the basic citizenship rights of the displaced and victimized sex workers be restored. The camp where the sex workers were housed in the interim did not have food and water, those burnt in the incident did not get access to proper medical care; several people died. Subsequently, after local groups advocated for their return to their dwelling under full protection, the sex workers were allowed to go back to their burnt down dwellings – but without adequate food and medicine supplies and protection from further harassment. While the local administration is clearly not inclined to make any special efforts to address the situation, local activist groups are ensuring the well being of the sex workers.

Two years ago, the same location was similarly attacked. We have seen such incidents occur in different parts of the country over the past few years.

The incidents of last week are merely symptomatic of a deeper and now well understood problem, namely the disenfranchised condition of the sex workers. The legal and policy frameworks have a long way to go before they can respond to the basic citizenship rights of sex workers. HIV interventions are typically ill equipped to deal with these situations; at the same time, every time the rights of sex workers are violated in the manner described above, hiv interventions suffer a significant set back. Despite knowing this the national aids programme is unable to intervene in what is euphemistically described as a ‘law and order’ problem. UN agencies, in their bid for neutrality, also find themselves incapacitated. Donor agencies depend on grantees to voice concerns rather than be seen doing it themselves. So the short term, almost emergency level responses to rights violations of sex workers are typically left to the activist organizations on the ground, who also work within resource constraints. Sadly, it seems even the long term responses to rights of sex workers have been, willy nilly, left to the might of small and local grass-root activist organizations.

Is this a viable situation, is the hard question we need to ask and answer. It is time agencies working on hiv prevention among key populations walk the talk and clarify what roles each of us is capable of playing, and what gaps remain. Large multinational agencies need to state in no unclear terms whether they have the wherewithal to respond to the daily violations of citizenship rights of sex workers and other key population groups across India, and indeed other parts of the world.

Before another red light area is torched and people die of burns, humiliation, hunger and exclusion, those who claim to work from the rights based framework, need to stand up and get counted.

supermarket NGOs

2008-04-26T05:33:00.000-07:00

There was a time when we had our fav shops for different bits of life's needs. There was a specific guy we went for the toothpaste, soap types things. Then there was a shop only meant for the best masalas. The corner shop for sweets, and fresh breads. Another whole different shop for fried goodies, namkeens etc. Then came the super market, where all of these are available under one roof.

Similarly there used to be NGOs that specialised: some only worked on child labour, others on setting up hand pumps. Some NGOs only di seminal pieces of reaserch, others worked primarily on generating livelihoods. But then cam the supermarket NGO; underone roof get all you want. There are NGOs today that will do for you anything you pay them for - they will develop and implement livelihood strategies with as much elan as they will consult on an evaluation of a reproductive health project! They will tout themselves as the best training 'institute' as comfortable as they will market themselves as a technical support provider.

Some like this new supermarket NGO avatar. Some like it the old way.

Jharkhand Diary

2008-04-23T06:46:00.000-07:00

I have just spent a few days in Jamshedpur in Jharkhand, was there to meet my parents and family. Apart from the immense effort spent on gourmet matters and on providing a patient ear to geriatric tales and catching up on family intrigue, I did the usual round of chai and chatting with people who continue to struggle on issues of tribal devpt and tribal identity. I feel the conversations with the tribal activists, academics and politicians might interest you, so here's a very brief account.
Salient features of the state, that you may already know:

Tribal population in the 13 schedule districts of Jharkhand is as high as 60% (overall tribal population in Jharkhand is 26%)
One of the rare few states in India where Gram Panchayat elections have never ever taken place 20 of its 24 districts have a significant naxal presence
Highest naxal related police casualty in the country is said to be in Jharkhand
Even tho the state was formed in 2000, after a tribal people's movement that took many tribal lives, the domicile status policy has still not been formulated Santhali, the ancient language of the tribals, has only just a few years back been finally recognized as a language in the 8th schedule of the Constitution (unlike many dialects that are not considered a language)

Analysts and experts highlighted 4 distinct themes that require increased consultation:
1- Tribals feel that tribal aspirations have not been understood at all by the administration, not by planners, not by politicians. Hence the kind of development they seek is not being provided to them. Many make the significant observation that despite all CMs being tribals themselves, tribal aspirations have not found expression either at the policy level or at the implementation level. The formation of Jharkhand, built on the martyrdom of local tribals, they say, has only benefitted industrialists and urban areas. Local tribals feel very seriously alienated, and display a high level of mistrust in the local administration, political parties and development workers.
2- Tribals feel that democracy is a farce, that their constitutional rights have been violated and liken the separate treatment they receive to the apartheid of SAfrica. Panchayat elections have never been held in the state; tribals say this is despite PESA (Panchayat Extension to the Scheduled Areas Act, 1996), which specifically applies to high tribal concentration states like Jharkhand. The Hon'ble High Court has struck down the provisions relating to the reservation of seats of the head of the Panchayat for the members of the ST Communities. The matter has been taken to the Hon'ble Supreme Court by the Government of India by the State Govt. A number of other parties have also moved the Hon'ble Supreme Court. Many tribal groups go as far as to say that they sense a conspiracy to keep tribals marginalized, after their hopes from the judiciary also seem to be diminishing. The fact that there are no elected panchayats has also meant that central govt funds for local village level development is rarely flowing into Jharkhand, impacting the processes of rural development, education, health, including NREGA etc.
3- It is significant to note here that because the Chotanagpur tenancy Act (decreeing that non tribals cannot buy land in Jharkhand) is not being upheld by the state govt, large industries have started buying land. Tribals, who take pride in their land, rivers and forests , see this as an irretrievable betrayal by all stakeholders. Many tribal leaders say there is a Singur and Nandigram like atmosphere of dissent growing in Jharkhand. While on the one hand NREGA is providing negligible employment opportunities, on the other, tribals are losing their land and forests. This situation gets a trifle more complicated because the Domicile Status Policy of the state has not yet been formulated; this means that local tribals do not get preference in local government jobs.
4- Some tribal activists and politicians go to the extent of pointing out that even the media rarely highlights tribal isues, as much as it does, say, the issues of muslims and other minorities. Even when a tribal girl from Jharkhand was paraded naked in Assam, the media barely made a mention of it. Tribals in Assam also face very dire conditions, they say. During the British rule, tribals from Jharkhand were sent off to work in the tea plantations of Assam, in order to weaken their resistance movements in Jharkhand. Sinc then there tribal population in Assam has grown, but they have none of the protected status that tribals elsewhere seem to enjoy; recent people's movements in Assam have been trying to challenge the status quo.
5- Young tribal girls have, over the years, been travelling out under extremely unsafe conditions; some to big and small city brothels, some as unorganized labour with construction company labour agents, some as domestic help. Young tribal boys say they have little choice but to become part of the naxal underground forces. Naxals are perceived by local villagers with respect and trust, in direct contrast to the way local administration and police is viewed. The forests, where the naxals thrive under covr, are protected by villagers sounding the forests. Villagers provide the naxals with food, medicines, arms, cash, information and protection from patrol parties. Naxal leaders promise young boys monthly cash salaries and protection to their families; this is more than the govt promises them, they say. Someone's driving the car into the ditch, is the repeated refrain. Urgent and broad-based action is required to put this young state and its ancient tribes on the road to dignity and development -- they say they are seeking the help of groups in south Africa to address what they see as apartheid; some see hope in the way the new Australian govt is working closely with Aborigine groups.

The stench of tolerance

2008-04-23T06:42:00.000-07:00

Well finally, let’s just be truly honest and admit it. This whole ‘unity in diversity’ fairy tale is going horribly wrong. We have to be one of those societies in the world that is most prone to discriminatory behavior. We must be a country that is totally committed to keeping the ‘other’ at bay, constantly harping at the ‘separateness’ of people, and manifesting this in small and big ways, subtle and overt actions, and sometimes in ugly, inhuman and violent ways. Mumbai and its recent display of brute politics cannot have us believe any other way.

We’ve just had enough of this feel good sloganeering that we are a tolerant society. Are we, really? And I’d go a step further, tolerance is hardly enough; it is a word that is built upon difference rather than sameness and stinks of being on the brink of tipping over into intolerance. One tolerates pain, because there is nothing else one can do about it. Tolerate the pain till it goes. Grin and bear it. Its silly to think we are a great nation just because we can do no better than to just, merely tolerate other Indians who are different. Stuff up the tolerance.

The real and more thorny question is, are we really ‘accepting’ of the other? That is the question. And recent events in different parts of the country say it loud and clear that the answer is a simple and sometimes almost inaudible no. Every time someone asks me that ugly question ‘where are you from’ I can almost hear the questioner’s mind-chatter that is readying itself to define the separateness or the sameness; and as soon as I provide the answer, I am tagged.

While we take the holier than thou position of being a tolerant society, let us not forget, that tolerance can and does harbor discriminatory beliefs, tolerance can be a charade. This is an imponderable to some who’d rather hide behind the comfortable mask of being tolerant, hiding their sniggers and discriminatory thoughts of ‘we’ are better but ‘they’ aren’t too bad either. Tolerance is merely an act of restraint, of non reaction to stimuli provide by the ‘other’. Acceptance on the other hand is being respectful of differences and responding to them from the frame of reference of equity. Basic tolerance is one thing. Real acceptance of difference and respect is quite another matter.

The recent violence in Mumbai against Biharis and people from Uttar Pradesh (euphemistically called North Indians by the saner voices of the media) has made a lot of people cringe with shame, as though they were seeing themselves in those horrifying pictures either as the victim or the aggressor. Observe the language used in the sloganeering. The word Bihari is almost used as a vile, vulgar, abuse. The word Bihari has always been used as an abuse, in different contexts. The word Bihari is hurled at anyone who is seen as weak. Anyone who looks poor and weak and timid and looking-for-work and not urbane and self effacing, is called a Bihari. It is amazing that the Biharis have been docile enough, tolerant enough, weak enough, and strong enough to defy the urge to hurl back abuses and retaliate with as much venom as they have received bone shattering, deliberate and painful assault to his/her personal identity.

Yes Biharis have been strong enough not to stoop as low as to retaliate. In some strange Gandhian way, they have taken in the degrading references to their identity in their stride, and dare I say so, in their human spirit have emerged as large receptacles that can truly and humbly accept the grossness of their fellow countrymen, and even forgiving their aggressors. Raj Thakeray is begging to be forgiven. Vilas Rao Deshmukh who is on the verge of doing a Modi on ‘north indians’ is begging to be forgiven. Bertrand Russell would call it the ‘superior virtue of the oppressed’.

It is indeed funny how when people from UP are addressed as ‘Biharis’ they immediately retort saying they are from UP, and not from Bihar. Save yourself from anything Bihari, lest the maligned and ridiculed identity of the Bihari touch you with it’s pooh. Grow up India.

How much longer will people have to stand up and get counted for their demand for basic dignity? I am a woman, I demand my dignity. I am a dalit woman, I want my place under the sun. I am person with disability, but I can be productive. I am a person living with HIV, but that does not make me dispensable. I am a tribal, don’t take away my land. I cannot speak English, but that does not mean I cannot access higher studies. I am not fair skinned, but that does not mean I cannot be beautiful. How many of these hands will go up for due attention? Aren’t we ready yet, as a nation to become more accepting of people who may not be like us?

I started this article by saying that maybe, despite all the feel good sloganeering, we are a being merely facile when we say we are a tolerant society. What have we been tolerant about? On an everyday basis, we read about men women and children being vandalized and brutalized and dehumanized on the basis of differences. When Laxmi Oraon, an advasi from Jharkhand is paraded naked in Assam, or a Bihari taxi drivers’ taxi is pulverized in Mumbai, some analysts take the sublimated view that this is merely an outcome of competition arising from deprivation. False. Were we an accepting people, nothing would be provocation enough to commit hate crimes and vandalism against the weakest and the poorest and the most marginalized. Some eternal optimists or even escapists would say, the events of hate are far fewer than those occasions where people show tolerance towards each other. False. Each hate crime, each act of abuse, of dehumanizing treatment against the weak and poor has an ugly underbelly of thousands of such acts that have gone unreported, thousands of such acts that have simmered as possibilities and not found utterance.

For a 21st century nation growing for a few at 9%, tolerance just isn’t enough. As Shah Rukh khan says famously in his advert ‘we need to wish for more’.

premarital HIV testing - SOME FACTS

2008-04-23T06:40:00.000-07:00

Testing for HIV should be compulsory before marriage. A couple of days ago it was Maharashtra’s turn to make this ridiculous announcement. A 25-member committee set up by the state government recommended that this be done. This is a suggestion doomed to failure at all levels. It is at best a pedestrian suggestion meant merely to pay lip service attention to the growing demands of the epidemic. At worst this suggestion is a crippling example of the proverbial ostrich.

What is wrong with pre marriage compulsory HIV Testing? EVERYTHING. It is technically difficult. It is not foolproof and it can be misused and misappropriated.. It is ethically wrong and it is against government policy. It is a failed strategy; testing, by itself, does not prevent HIV infection.

It is technically difficult because of the following very important reason. An HIV test does not always detect the virus in the body even if it is present. This is not because the testing kit is faulty. This is because the HIV test is designed to detect antibodies of the virus and not the virus itself. The antibodies of the virus take no more than 6-12 weeks to develop. In medicine, this is called the window period i.e the time between first infection and when the test can reliably detect that infection. The window period is important to safe sex strategies, because during this time, an infected person cannot be detected as infected by testing his/her blood but may still be able to infect others.

It is not foolproof. An HIV positive or HIV negative blood test report is not foolproof. This is easy to understand for us Indians. Certificates of any kind can be had for a few or more rupees.

It is ethically wrong. Mandatory testing means HIV testing without consent. This form of testing is useful only for screening of blood, semen, organs and human tissue for treatment of medical conditions. It must not be used for any other purpose. Mandatory testing has no role in National AIDS programmes.

“The Government feels that there is no public health rationale for mandatory testing of a person for HIV/AIDS. On the other hand, such an approach could be counter-productive as it may scare away a large number of suspected cases from getting detected and treated. HIV testing carried out on a voluntary basis with appropriate pre-test and post-test counseling is considered to be a better strategy and is in line with the WHO guidelines on HIV testing.“ This is stated unequivocally in the National Aids Prevention and Control Policy, Government of India.
Talking about safer sex, practicing safer sex, these are issues that challenge status quo and are therefore difficult to preach and practice. Calling for mandatory testing is merely escapism, a refined form of denial, indicating a denial to look safer sexual behaviour and practices in the eye ensure behavior modification through means that are closely linked with social change. An HIV test result, by itself, cannot prevent HIV infection. Because the test result, either HIV positive or HIV negative, is merely that – a test result. What can of course prevent infection is knowledge and appropriate practice of safer sex; within or outside the context of marriage. Also, there is absolutely no guarantee that a person will not undertake high risk behavior after marriage and expose him/herself to HIV infection.
But there is a question that still remains unasked and far less answered. What if, hypothetically, a to-be-married couple undergoes this mandatory test without their consent and one of them tests positive. Assuming that the test results are made public in a situation that is already based on poor ethics, the couple know each others’ test results and everyone else does too. What then? What is the prescription? Given the very high levels of mis-information and absurd levels of stigma, chances are the marriage will be called off. The person who has tested positive will be dumped, deemed unfit for the esteemed institution of marriage. And now imagine for a bit that the person who has tested HIV positive is in fact the woman and not the man. What then? The scenario then becomes far more worrisome. If the current levels of ignorance and stigma are so high that a woman who tests positive much after her marriage is dumped most unceremoniously, what to say of this happening before marriage.
Those who call for mandatory testing should consider a longer term view of their communities and societies and indeed the nation, and call for increasing voluntary HIV testing. Young people who are seeking partners for life or otherwise need to be encouraged to get themselves tested for HIV – not under duress, not against their wishes but merely as an act of empowered health seeking behaviour. Can our politicians consider doing this, rather than trying absurd and draconian antics? Can our politicians be urged, educated and motivated to themselves go for an HIV test publicly and become role models?

mandatory premarital HIV testing - AGAIN !

2008-04-23T06:37:00.000-07:00

Some say that pre-marriage HIV testing has been ‘done to death’ in the media. Regardless of the regular debates and question-raising, however, not to mention the endless attempts at consciousness-raising on the part of health workers, legislators in India continue to demand that such testing be made mandatory. In early February 08, Maharashtra’s legislature became only the latest in a long string of state assemblies to try, again, to push this misguided approach into law.

During the mid-1980s, soon after HIV was discovered, each of the 50 states in the United States seriously considered the possibility of forcing couples planning to get married to first be tested for the virus. Even then, however, only two states, Illinois and Louisiana, which eventually followed through on doing so, and then only in 1989, only implemented this legislation for less than a year before quickly accepting it as a failure. The laws were repealed soon after, and the verdict widely pronounced: Chester Kelly, from the Illinois Department of Public Health, speaking at an international AIDS conference that year, said that the premarital testing in his state had proved an expensive and ineffective approach to containing the epidemic.

Two decades later, government after government in India (and elsewhere) nonetheless continue to repeat demands for premarital testing, making little effort to learn from experiences elsewhere, nor from those working with HIV/AIDS in their own country. Before Maharashtra, Goa made similar noises in 2002 (as did China that same year). In 2005, it was Kerala that claimed that legislators’ demands were merely reflecting the will of citizens of the state. In 2006, Andhra Pradesh followed the same tact. Last year, as Karnataka was rising to the soap box, Saudi Arabia and Nigeria were likewise in the process of becoming part of the vogue.

Why does this bandwagon continue to appear so enticing for government officials? By and large, the answer is simple, and cuts across nearly every one of these situations: Because legislators would rather talk about the simplicities of marriage than about the complexities of safer sex. Because if everyone is married to an HIV-negative person, then there would not be any need to talk about safe sex, because sex only happens within marriage! Because pre-marriage mandatory testing is a handy, seemingly straightforward answer to the truly difficult proposition of preventing HIV – among monogamous married women, in particular.

Indeed, government officials cannot really be blamed for arriving at this inefficient but notably dexterous answer. As a longtime AIDS activist, I have engaged with widely diverse groups of people over the years, ranging from well-heeled executives, lawyers, media people and gender activists, to rural communities across the country. During the course of these conversations, this ‘solution’ has been proposed time and again, seemingly by anyone who puts in any amount of time and seriousness to trying to formulate answers to how to deal with HIV and its prevention. But make no mistake: this idea is born out of a rudimentary understanding of the HIV epidemic at best , if not outright ignorance. It is born out of that most basic of instincts – run to survive – gone into overdrive. As such, as a public-health approach to problem-solving, it is hopelessly short-sighted.

Beyond intervention
As state after state attempts to impose this pat solution, it is ultimately the AIDS workers who need to take responsibility for how little our policymakers, judges, media people, activists and opinion-makers of various breed know about HIV. It has been more than 20 years since AIDS activists began holding workshops and conferences; developing messages, television spots and documentaries; felling thousands of trees to be made into informational pamphlets. And all for this? Even two decades ago, we must have already realised that, if we were to make a real dent in the epidemic in Southasia, we would have to invest specifically in developing the understanding of our opinion-makers, at multiple levels?

Clearly this has yet to happen. As such, in the current context, the AIDS-advocacy community would do well to take a long, hard look in the mirror, and seriously consider whether we have had any success in this area whatsoever. If not, this is then the first area to be prioritised in the near future.

The ferocity with which AIDS workers are targeting gay men (and other men who have sex with men), sex workers and intravenous-drug users with intervention-type approaches is blurring a key reality of the epidemic in India: that this epidemic is a long-term problem. As such, let us not delude ourselves by utilising only short-term methods. In reality, we need both – emergency-style, short-term interventions and imaginative long-term strategies. And both of these need to be used in good measure.

That a 25-member committee in Maharashtra has now suggested, again, the imposition of mandatory pre-marriage testing offers just another example of where AIDS activism has clearly failed. The idea of mandating premarital HIV testing is admittedly well intentioned. But it is also flawed at several technical and ethical levels. In addition to the fact that it is not a foolproof method even of preventing HIV within a marriage, the ordering of such a test is a human-rights issue in itself. Calling for such legislation also incorrectly assumes that a state or country’s public-health infrastructure has the logistical preparedness to see through such a venture. And even if, hypothetically speaking, such testing was to begin, it would only raise a host of additional ethical issues.

The fact that HIV is not a mere public-health cannot be overlooked, least of all by the advocacy community. AIDS workers need to engage opinion-makers on the more complex and fluid aspects of such propositions, with high-quality debates and discussions, and by investing in high-quality techniques and human resources. During the past two decades’ of India’s response to the AIDS epidemic, we have succeeded some; but we have failed enough.