The gender face of HIV/AIDS The divide runs deep Neo, natty, unhealthy Something to talk about Promises to keep Looking at life positively Healthy option The bone crusher

The journey from Hyderabad to Bheemavaram in West Godavari district is picturesque, lush green with paddy fields and swaying palms. After all, it is known as the ‘rice bowl’ of Andhra Pradesh (AP). But behind this façade are also hidden stories of change, some for the better, some for the worse. Veterans observe that the changeover to aquaculture, mainly to cash-rich prawn culture, has brought prosperity but also misery. Disease of the seedling can wipe out a farmer’s fortune within a season which has been witnessed in Orissa too. The farmers cannot revert to agriculture either as paddy fields need sweet water while aquaculture needs salty water. Thus rural poverty occurs side by side with prosperity for some.

Social inequality and the race for survival are obvious fallouts. Male population’s migration has led to desertions too. Thus coastal areas like Palakollu have seen an escalation in the number of commercial sex workers (CSW). Many women are home-based - housewives who operate from outside, some are floating population renting rooms in lodges for a few days at a time while some operate from bus stands and markets.

The worrying thing, health officials point out, is the danger of spread of HIV infection due to risky behaviour, particularly as Bheemavaram has a varied profile. Many of the clients are seasonal labourers who come to work in the marine industry; the national highway is nearby with truckers frequenting the area; there are also many famous temples around which attract a great many people during festivals. The town also has some of the best known educational institutions in the region which means a young population coming from distant places to stay in hostels. AP has one of the highest rates of HIV infection in the country. The majority of infections are believed to be result of sexual transmission.

Hence, intervention programmes to disseminate information and advocate safe sex practices are of utmost importance. Specialists working in the field contend that interventions involving the CSW pay rich dividends because the women themselves can work as catalysts in changing risky behaviour by advocating condom use as well as ensuring prevention of infection through regular check-ups for sexually transmitted infections (STI). Kolkata’s red light area Sonagachi Project has shown how successful such an initiative can become.

But local variants exist and problems pose different challenges. For example, AP does not have big brothels in demarcated areas as in, say, Kolkata or Mumbai. Hence intervention programmes among CSWs have first to cross the hurdle of reaching the target population: Who are they? Where are they? Then comes the second hurdle: How to earn their trust and reach them across the natural fear psychosis about ‘officers’ and mobilise them to become stakeholders in the programme?

The Swagati Project of Action For Development (AFD), an NGO in the coastal area, focuses on crossing these hurdles through a “targetted intervention programme.” Working in collaboration with Hindustan Latex Family Planning Promotion Trust (HLFPPT) it targets CSWs above 18 years with the aim of empowering them to adopt safer sex behaviour, reduce the incidence of STI, and increase correct and consistent condom use among clients.

The first step was to “map” the CSW population- to find out from where the women operate and how to reach them. For this, help was taken from women from the community itself. Then Community Guides (CG) were chosen to persuade fellow women visit the drop-in-centres (DIC) with the clinics which provide sexual health counselling services as well as sexually transmitted infection diagnosis and treatment. All clinics are equipped with examination equipment, diagnostic procedures and basic medical supplies, including treatment kits. Comparatively cheaper treatment facilities is another incentive for the women.

But it was an arduous task in the beginning. Many of the women are home-based and did not want to reveal their identity. Ignorance was another problem. As Amulya, a counsellor, recalls, “We faced many teething problems. The first CG we identified assumed that the project would take care of all the welfare needs of the community like housing , bank loans etc.” She did not want to mislead the women and adopted a more pragmatic approach. As a first step, she identified a group of community members and used the ‘snowballing’ technique, that is, each member introduced another, brought her to group meetings where discussions were held on the aim of project and motivated them to commit themselves to its activities.

This had the salutary effect Amulya hoped for and attendance at the DIC picked up.. “However, initially, we didn’t tell the women it was an office working for rural women’s health, not even a clinic, so that they won’t be put off. Once they started coming and interacted, it was easy to introduce the subject,” reveals Santha Rao, project development officer.

The strategy is carefully thought out. The women are not asked straightway to come to the DIC. Repeated visits, establishing friendship through general discussions and then gradually discussing the health problems and the risk of infection are used to convince the women. Sometimes contacting the women result in threats from the local populace and intimidation too but the women are a determined lot and the CGs have largely been able to convince even the general population about the intention of the project: to ensure prevention of HIV spread and not act as moral police.

The outreach activities target the ‘hotspots’ –places where CSWs congregate, overtly or covertly, for their business. It can be a makeshift shed in the market of Palakollu where women come from distant villages ( “My husband has deserted me. They believe that I work in the town. I want my daughter to get a government job,” says Mariamma ). Or it can be a narrow strip like Yetigattu, on the bank of a stream amidst paddy fields and palm fronds inhabited mainly by fishermen community. Here, besides other problems, they have to encounter frequent harassment from local goons who demand money and also ‘free sex’, reveals Savitha. Project officials were informed about this place by one of the key people (KP). “This is how the network helps because the women know about these areas through the grapevine and facilitate us to conduct our outreach programmes,” reiterates D. Isaac Newton, training specialist, HLFPPT. Condoms are distributed free and the women are given education on why they should visit the clinic for health check-ups.

Lodge-based CSWs pose a different challenge. The women come from distant places like Guntur, Khammam etc and establish base temporarily. Besides, the lodge-owners have to be involved in the process without whose cooperation it’s not possible to approach the women. But CGs like Saraswathi has been able to achieve it through persuasion.

Through all these efforts in the last two years, Swagati claims, there has been a 60 per cent increase in safer sex, reduction of STI by 30 to 80 per cent depending on the infection, and 60 per cent increase in condom usage.

Pleasantly, an offshoot of the programme has been a certain bonding among the women. Says Sathyamani, a CG at the Palakollu centre: “Thanks to this opportunity I got out of deep depression…in the process I also discovered that I’ve the strength within to help others.”

A silent revolution is perhaps happening as many women have discovered a hitherto unknown leadership quality in themselves. Many of them confess that they come to the DIC not just to see the doctor but also to meet their friends; they feel it is “our centre “ and enjoy spending hours turning out posters and paper designs to decorate it. DICs are also introducing craft and tailoring classes gradually. The positive attitude is also incorporated in the joyous figure of the icon Missamma extolling safe sex.