The Karma of Sex?

"Maithunam paramam tatvam
Shrusti stithi, anya karanam,"
(Coitus is the ultimate principle behind
creation, preservation and destruction)
- Lord Shiva in the Kailas Puraan

Janam kundlis don't have HIV chakras. Or maybe Jahnabi Goswami wouldn't have had to, by age 25, cremate a husband, bury a child and be HIV positive herself. In the purgatory of the present, the words of the Lord couldn't have come truer – except that the preservation bit didn't quite hold, for her husband, or her little daughter who died of AIDS-related infections. Jahnobi, who comes from the Nagaon district of Assam, now spends her time running a support group she has founded for people who are HIV positive. Along with the millions of others stricken by the virus, they are the fringe dwellers of India, victims of a country's new state of denial.

Brindapati Das, a state president of ISKON, the Krishna Consciousness Move-ment, exemplifies the contradictions that AIDS has brought about: "We are not only against pre-marital sex but any sexual experience in general." That in a land of a billion, where, once every week, maidens in search of the ideal mate pay obeisance to a divine phallus projected through a womb. For the fringe community, the attitude has frightening implications: Goswami's landlord in Guwahati had asked her to leave after getting to know of her status; in a village in lower Assam, she talks to people about a family they've excommunicated, whose home they won't even walk past anymore. It's easier for her to make the point. "Can you tell I am HIV positive?" she asks. "One of your men could have ended up marrying this girl had she kept her status a secret..." Back in the offices of the AIDS Prevention Society in Guwahati, Dr SI Ahmed, the person in charge, talks about 'long-term survivors'. "Ten, twelve years before the first symptoms of AIDS show," he says. Jahnobi was 16 when she was infected. "My husband knew his status when he married me," she says, "Now my in-laws, who refused to have me back, say I'm a loose character, and responsible for what happened."

CASE STUDY: ANDHRA PRADESH

According to the latest figures available:

• 10 per cent of pregnant women in the coastal areas of Andhra Pradesh are estimated to be HIV positive.

• 2 per cent of the state's total population is estimated to be HIV positive (the national average is 1 per cent)

• 21 per cent of the rural population has multiple sex partners. (Urban figures are not available.)

• The average age of a girl's first sexual experience is 16 years in the state.

The 'Civilisation' Road show: AIDS rips off the purdah of the 'civil, Indian' psyche.

For a guarded, sexually closetted community that considers itself superior to the all that is western and disorganised, this is a situation simply not meant to be. At the recently concluded AIDS 2002 Conference in Barcelona, Suniti Solomon, an Indian representative pointed out that girls and young women show a higher rate of infection compared to men of similar ages. On an average young women are infected 10 years earlier than men due to early marriage, rape, being forced into prostitution, or peer pressure, she pointed out.

The larger picture: that AIDS isn't always about prevention; that the millions of unempowered, and often battered, women, who are, to start with, given away in marriage by parents in a male-dominated society are not in a position to bargain for safe sex and so are prone to infection. Also, AIDS isn't always about promiscuity, or sex beyond what it has been made out to be in the Indian context: breeding. Says Solomon: "How can the target of violence be expected to negotiate with her aggressor, especially for something that the aggressor doesn't want?" What is needed, among others, she said, is an effort to remove the silence and shame that surrounds sexuality.

AIDS or no AIDS, people will have sex, because it's human to do so. A place such as Guwahati is seeing an increasing number of abortions, not among the illiterate but college-going youngsters as well. "The girls come to me accompanied by their parents or their boyfriends," says Dr B Bora of the city's Noonmati area. Says Sushmita Barua, a 17-year- old school student: "When you have a relationship, it is difficult to always draw the line at kissing." Given the country's stringent abortion laws, Dr Bora's clients are at best only an indication of what the real picture could be. As Pranjit, astudent of Cotton College, the premier institution in the region, says: "It's no big deal as long as you practice safe sex." The grey area: that even condom companies now promote "safer sex"; previously promos said "safe". According to AIDS experts, sex itself is high-risk behaviour. Abstinence is low, not zero risk.

FACTS AND FIGURES — INDIA

• Number of people infected by HIV in India: 4 million
• 65.5 per cent of the total number of infected people in South East Asia are from India
• Number of infected people in the 15-29 age group: 2 million
• More than 1 per cent of the total population in Nagaland and Manipur are infected
• In Manipur's Churachandpur, 5 per cent of pregnant women have tested positive.

Up to March 2002, of the 38,559 people tested for the virus in Assam, 152 were found to be positive. Of them, 129 were males and 23 female. The state has reported 25 deaths so far from the disease. "But that doesn't reflect the real scenario," says Dr JC Deuri, director, Assam AIDS Control Society

Matching notes: Minds over machines and other dispatches from the fringe managers:

Dr SI Ahmed, chief of the AIDS prevention Society in Guwahati offers a solution to the lack of a CD4 counter, a sophisticated piece of equipment that counts the level of CD4 lymphocytes (the first of the body's white blood corpuscles to be attacked by the HIV virus) in a patient: "In such a situation, we went for the total lymphocyte count, which can be detected easily," he says. "We can treat the patient on that basis. As long as the count of these cells stay at or above a particular level, the secondary infections, which are the real killers, cannot set in." Prior to the improvisation, patients lost precious weeks waiting for blood test reports to come in from Mumbai.

Doctors here in the country are at a loss over a number of other issues. First, while countries such as America have had success with the cocktail therapy—the country has now cut back on AIDS research funding—others such as India are still grappling with issues as basic, for example, as the identity and classification of HIV strains found among patients in the North-east, an important factor in fighting the virus which survives by mutating and developing resistance to drugs in an unprecedented manner. The result of this has been that for all purposes, doctors in India are still looking at the West for a cure. Worst of all: doctors in India are as clueless as their counterparts in the rest of the world, when it comes to a prognosis of AIDS. Charting a road map for HIV vis a vis the secondary infections has so far been a close to impossible task.

Add to that the country's poverty and low literacy and it probably explains why AIDS is poised to be the single largest killer in the country over the next decade. India already has second largest number of HIV infected people in the world after China. Fifty per cent of those infected come from the 15 to 29 age group.

Not that the country is without its fighters. Indian pharmaceutical giants Cipla, for example, now dictates international prices of AIDS drugs, having cut theirs to meet the buying power of millions in Africa, the Americans' claims of research and development costs, and hence market rates, notwithstanding. The tragedy here has been that at Rs 1,500 a month, the combination drugs used in Northeastern India are still beyond the reach of many. Not to mention the serious side effects.

How alternative is alternative? Caught in international approaches and programmes, are we sitting more effective indigenous medicinal solutions?

It may not be to the liking of most allopaths, but there is a plane that they seem to have been pushed back to by the AIDS, realising now that viruses and sometimes their carriers are as, and in the case of HIV, more adaptable than humans and so need to be treated with a certain amount of respect. The anopheles mosquito, for example, has become increasingly resistant to DDT. Tuberculosis, which had been brought under the control of antibiotics completely is back on the World Health Organi-sation's list of killer diseases, having become a major secondary infection in AIDS. In its new avatar, TB is multi-drug resistant, the virus having mutated to strains that can now kill victims with relative ease. This is where allopathy (by definition the treatment of diseases with drugs that have the opposite effects to the symptoms) seems to have come to a dead-end. Dr Ahmed agrees that with allopathic medicine against the fast-mutating HIV having failed by and large, it is now time for all schools to work out a common strategy against the fight against AIDS. That could include Ayurveda, the traditional Indian school based on the balance of bodily systems (and emphasising diet, herbal and yogic treatment) and homoeopathy (the treatment of diseases with medicine that have effects similar to those of the symptoms). The difference: that while allopathy treats the disease, ayurveda and homoeopathy treat the patient—the plane being the same as Dr Ahmed and his allopathic colleagues trying keep up the levels of the CD4 cells, rather than just try to eliminate the AIDS virus. It's simply back to basics.

Says Dr Janardan Bezbaruah, an ayurvedic physician: "The more you fight the virus directly with external agents, the stronger it gets. In ayurveda it is our job is to keep the victim's system stronger than the virus." Significantly, ayurveda and homoeopathy may have the means of working out a prognosis of AIDS, and hence could stand a better chance of preempting the onset of secondary infections. The edge: that both these schools of medicine are based on constitutional treatment. Ayurveda, for example, divides people on the basis of bayu, pitta, kafa, the categorisation used to study the ailments that each group could be more prone to, the different symptoms that an ailment may show in different people as per the category, and the route that a disease may take in a particular person depending on his constitution. In homoeopathy, its founding father, Samuel Hahneman divided the entire human species into those affected by psora, syphillis, and sycotic, providing a similar system for treatment based on the specific constitution of the individual, identifying areas where he is most vulnerable. The entire treatment in both ayurveda and homoeopathy is based on arming the immune system, not attacking the virus. "This is exactly what is needed in the treatment of AIDS," says Bezbaruah.

Going further, Bezbaruah says that AIDS may not be an entirely new phenomenon. Texts by ayurvedic physicians such as Bhaba Mishra and Kuj Amritlal Gupta speak of the occurance of a firanga roga (foreign disease), after the invasion of India by Europeans, the symptoms of the ailment, he says, being similar to those of AIDS. "Ayurvedic combinations called masallar jal (decoction of herbs) were used to treat the disease, with excellent results." People such as Ahmed and Bezbaruah however, may be a part of a largely silent minority, as are people like Majid from Kochy in Kerala. An architect by profession, Majid has for a long time claimed that given a board of experts from the Indian Medical Council (IMC) to verify his claims, he could inject himself with HIV, and then cure himself with an ayurvedic drug that he has formulated. According to reports, a drug based on neem generated in India is now undergoing trials in France. If effective, it could turn out to be the silver bullet against AIDS.

Through hundreds of years, says Bezbaruah, Ayurveda has successfully documented and treated sexually transmitted diseases such as syphillis (upadangsa) and gonorrhoea (oupasargic meha), without the use of antibiotics, which over time only strengthen virus strains. "Man by nature is predisposed to multi-partner sex," says Bezbaruah. "We have to understand, accept and go beyond that for the treatment of AIDS."

FACTS AND FIGURES –WORLD

By the end of December 2001, UNAIDS and WHO estimated a total of 40 million AIDS patients around the globe

• Of them, 50 per cent are from the age group of 15 to29.

• 14,000 people were infected every day in the year 2001.

• An estimated 11 people are infected by the virus every minute in the world.

• Number of people infected (and identified) in the year 2001 alone stood at 8,00,000

• 580,000 people lost their lives in 2001 because of AIDS

• Despite a roaring sex industry, the rate of HIV infection in Thailand has dropped by 75 per cent.

The radical other: Factoring in the anti-thesis

Equally, lines of treatment suggested by the ancient ayurvedic school of medicine and others such as homoeopathy could also inherently consider within their working ambit the claims and conclusions of experts such as Dr Etienne de Harven of France. According to them, HIV simply does not exist. The antibodies which are the basis of the detection of the virus are not specific to any single disease, they say, and that the disorders now being associated with AIDS are in reality illnesses triggered by 'stressors' of modern-day life, including ones created by pollution, fast food and loud music. Worst of all, this school, represented by researchers such as Harven, Dr Roberto Giraldo and Dr Claus Koehnlein believe AIDS is the money spinner of NGOs, pharmaceutical multinationals and genetic researchers working through WHO, UNAIDS and dollar-rich western nations. Koehnlein, for example, has been treating "AIDS patients" in an orthodox manner and keeping them alive. That the radicalism of these doctors isn't completely without substance is perhaps reflected by the fact that the AIDS school had initially attempted to stop them from presenting their views at the AIDS convention in Durban, South Africa, last year.

Ignoring the Oldest with the Medieval:

Has India woken up to openness on the sexuality front? Is India, for example, ready to legalise prostitution, with sex workers being a high risk group in the age of HIV? Not quite it seems. "Prostitution can be legalised, but it shouldn't be patronised," says an internationally renowned poet and lyricist of Guwahati who did not wish to be named. "At least it should not be illegalised." He believes AIDS is not as serious a problem as it has been made out to be. "We don't have drinking water, for example..." So just where does one go from here? Legalisation of prostitution, for instance, would give this country a head count of sex workers, prevent their exploitation by pimps, and police who now look away from children being forced into the trade, help the government enforce health permits and by that calculate workable figures of HIV infected people in dingy brothels. In Mumbai's Kamathipura, the biggest red light district in Asia that houses about 20,000 sex workers, 20 per cent are below the age of 18. After the city's known brothel was demolished, the police in Shillong have had to contend with an unidentifiable "high risk" population that now operates out of hotels. Fact: empowering and educating sex workers in Thailand has led to a drop in HIV infection by 75 per cent. At another level, the Delhi government, is, for example, in a fix after being asked by the high court, which is considering a public-interest petition filed by the Naaz foundation, its stand on homosexuality. In Guwahati, a college teacher recently appealed to the city's superintendent of police that a park where gays were meeting needed to be "cleaned up". Recently, an article in the 'Assam Tribune' spoke of the ills of cyber sex, the latest in a country that has blocked all phone-sex telephone lines, and disallows the sale of pornographic material. Fact: cyber and phone sex, and porn do not infect people with HIV; also, gays are human and have rights. According to the WHO, it could take the world anything up to 10 years before it sees an effective HIV vaccine. If that figure were to be true, there would be 5,78,16,000 infected people in the world, the largest section of them being Indian.

That Indians are as sexually active as anybody else isn't going to change. Yet the only solution that the country seems to have worked out so far is victimising the victim. Jahnobis are a part of us. Question is are we willing to see this? More than HIV its ignorance and hypocrisy that costs lives.

By Pranab Bora (with additional inputs from Dr SI Ahmed in Barcelona, Dipankar Bosumatary and Kh Priyalaxmi Singh in Guwahati, Kuntil Baruwa in Mumbai, Namrata N. Diengdoh in Shillong)