Thursday, March 30, 2015
As our field visits draw to an end, I realize that they provide only a glimpse into the underground world I am attempting to unravel. The sheer complexity of the environments, and the subsequent advocacy efforts, leaves me wondering for days on end.
Most are clean 2 ½’s apartments; clad in various maps of the districts and hand-drawn prevention posters, spread over 600-800sqft. Some are more far more colourful or convoluted than others.
It really depends on where the doctor’s office is.
As we take our seats in the now familiar plastic patio chairs, I notice the drift from the bathrooms down the hall. I gag. The project manager from this office was voted MVP of the NGO this year. I try to breathe through my mouth as much as possible, because we should be here for a while.
The site has been operating since 2009, swept into the National Aids Control Organization’s administrative review in 2011. The staff is comprised of twenty peer-outreach workers, 6 outreach workers, a project manager, a doctor, a counsellor, and a doctor.
Sameer has been working as an outreach worker in Aarambh II for the last 6 years. The drop-in center services 6 different cruising sites, including Grant Road and Churchgate station. It is the best place to find “office boys” because the district of Colaba is the commercial hub of the city. These areas are also the ones that see most of the daily traffic.
It also happens to be one of the only areas in Mumbai where I come across other foreigners with regularity. Sometimes there is an awkward dance, where I look at them, and they look at me, and usually, we just move on. These are the office’s “star locations” because they see most of the daily traffic.
I am told that these sites are the original stomping grounds for Humsafar Trust’s initial outreach programs. Pallav, Santosh, Ashok and Vivek – who all work with me, are among the original few who were activists in the 90’s.
Sameer says most of the groundwork he does consists of relationship-building and good networking. Because avoidance is such a big part of Indian society, you have to be, at the very least clever or very handsome, to be able to approach educated people and try to inform them about things issues they don’t feel like addressing.
I’m told that some clients are reluctant to take the government-issued condoms because of the perception that nothing good can possibly be free in this country. And so, Sameer tells us, HST decided to team up with another brand, marketed by DKT India, that has better packaging.
Government-issued FREE condom
Fancy packaging condom.
When I get home, I check the expiration date on the goods. (Of course, they gave us free condoms.) April 2015. I think of the five or six big boxes I’ve spotted sitting under the desk. Are condoms like food? Still good for a couple of days after the expy date?
There are 1,500 MSMs registered at Aarambh II. They are generally given 3-4 condoms a week.
Pallavi asks about STD prevention, and about how NACO labels sexual activities. The problem is that India’s National Agency on AIDS management has decided that anal sex is the only sexual activity relevant in their guidelines.
Sex is such a taboo in India. There is no sex-ed in school. Women find out about their menstrual cycle from their mothers, aunts and friends, and the information is often a mix of facts and absurdity. So this incomplete discourse, with some much left to an active imagination, does a great deal of disservice to the cause.
The counsellors get around this lapse of judgement through a generous redistribution; a few extra here and there, just to be safe.
In response to Pallavi’s questions about STD-prevention, we are shown a flipchart booklet. It is dubiously illustrated and comprised of several pages with short topical paragraphs (I am told). From my understanding, the booklet also includes information about potential symptomatic effects on pregnant women.
Most new clients are invited to register with the counselling office after an initial assessment period of 1-2 months. His clients include a lot of migrant workers, and not everyone sticks around.
Sameer stresses that how you approach clients should vary according to who your target is. He says that high-class clients usually respond relatively well, but that they aren’t necessarily interested in hearing about sex education. So an indirect approach, like using social networks or friends to bring them around to the subject, has yielded better results. For the lower-class clients, the main concern is generally maintaining anonymity. They don’t necessarily have the social savvy to stand up to cops or the tools to mitigate any backlash that might accompany gender/sexual identity issues in India.
Of all the counsellors I’ve spoken with, Sameer is definitely the most in-tune with the bigger picture.
When we ask him how he feels about the drawbacks from NACO’s guidelines, like the age group dead zones (under 18 and over 50 age). He tells us Pallav, at HQ, is working on targeted interventions for these groups.
Despite the fact that the 50+ demographic is perhaps the least sexually active, they are the biggest clients for commercial sex. Because sex has become a commercial transaction, protection is rarely part of the equation. Studies have shown that the older demographic (in most societies) if far less likely to consult a physician, or seek out help or support. The reasons vary, of course, from not wanting to be a bother people to concerns over being recognized, but the consequences are often the same: isolation, depression, and a protracted stigma.
For Sameer, the point of leverage for change is educating youth. He recounts how complicated it is just to get admitted into the school. On one occasion, it took him over 3 months to set up an appointment. He has to use subterfuges and mind games just to get a foot into the door: he often doesn’t mention what organization he works for, at first, and usually prefers the premise of doing youth engagement.
He also cites media disinformation as a recurring problem. He mentions a newspaper article, printed last week in the Times of India, which ascribes to homosexuals a lion share of the blame for the propagation of HIV in India. We discuss the viability of a web-based video campaign to promote safe sex, and demystify a number of key subjects, from masturbation to menstruation, that are currently being completely distorted via official channels.
Mental health issues are the second biggest problem. He says at least 50% of the HIV+ patients he sees are bitter about being infected and consciously pass it on to various partners, as a means of social reprisal. It is a vindication for their despair because it becomes shared, generalized. It is a way to control a situation where perhaps you feel you have none, because this disease has taken over your life.
Substance abuse is also prevalent among youths. I am told that some TG’s and Khotis think using drugs will make them thinner, and more attractive. They haven’t seen the “Don’t Do Drugs” campaigns of the 80’s; the hollowed faces, the broken families, the unsightly veins… because no one talks about these things publicly here. When it is discussed it is very “Hush! Hush!” and “What would the neighbours think!”. And this has a compounding effect, because these kinds of social ills fester and grow in these conditions.
I should not forget to mention, in passing, the teasing and sexual exploitation these group faces. “Sugar factory” is a common pet name for the more effeminate types on the low-end of the sex-trade pay, which averages to about 20-50 rupees (less than a dollar CAD) for a hand job.
We ask if it is possible to visit Mumbai’s biggest Red Light District, Kamathipura, but the transgender office worker tells us that she is concerned about negative backlash if she brings us without testing the waters first.
The talks wind down and we head out for a visit of one of the outreach sites: the Oval Garden, in Colaba. It is a huge fenced in park, in the heart of South Mumbai, where people play cricket and take leisurely strolls by day, and wander in search of some warmth at night.
The park is divided between MSMs, Transgender and Female Sex Workers. As we meander through, it is easy to spot couples sitting on the ground or groups of 2-3 people sitting on benches and by the packs of shrubs. The peer-outreach worker interrupts two TG’s who are talking with a gentleman, so we may ask them some questions. I feel awkward for disturbing them. It’s like a freak show tour. We hang around another half-hour or so, roaming around in the dark grass, and Pallavi graciously puts my on my train home. It’s great for the ego to need to be mothered by a twenty-something.
Meet Pallavi.