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The Rediff Special/ Shobha Warrier

'Unless they see somebody dying from AIDS, they won't understand'

The shocking story of how mentally unstable women in Tamil Nadu are being infected by the dreaded AIDS virus.

Part I: 'I am scared. Please don't leave me here'

Poor Vanaja didn't know anything about the HIV virus or about AIDS for that matter. She gave her body to anyone who was kind to her and gave her something to drink when she was thirsty and something to eat when she was hungry. Men found women like Vanaja easy to please, as they did not demand money or insist on the men using condoms like the commercial sex workers do. Nobody knows when Vanaja contracted the virus or how many she has passed on the virus to. Those at CHES now know that she had travelled from Andhra Pradesh to many north Indian states before reaching Kerala.

When stories of AIDS first broke out in the West, Indians sat pretty claiming that this 'dirty' disease would not ever come anywhere near India as it was not believed to afflict the 'morally right' and Indians considered themselves to be 'morally right'. The first case of AIDS in India was reported in 1986 from Madras. Since then there has been an increase in the number of HIV infections over the years. As reported to NACO, by December 31, 1999, out of a population of 3.5 million, 92312 people are HIV positive. But experts working in the field feel that the statistics as to how many people carry the HIV virus is not available.

Now, India has the largest number of AIDS patients in the world. CHES gets references from the TTK Hospital, from Banyan, an NGO that works with mentally ill, destitute women, and also from Bombay. From the TTK Hospital, CHES gets mainly HIV+ve drug users, from Banyan, mentally ill women who are HIV+ve are referred and from Bombay, women who were in the sex trade are sent to CHES.

Vidyakar is not really concerned about the "cruel animals" who use mentally unstable women to satisfy themselves. What worries him is the fate that awaits the innocent wives of these men and the babies who will be born with the virus in their blood. Why should these innocent lives be burdened with a sin that was committed by someone else? "I feel a major crisis is going to arise because of this. It may get unnoticed now because many don't see this as a problem at all. People are under the impression that only commercial sex workers spread AIDS. They do spread it but they are mentally normal, they are aware and they use precautions. But what about the women who are mentally unstable? One of them may have sex with at least 50 men.

"What about the life partners of those 50 men? That makes a hundred potential HIV affected people. Then, at least ten per cent of such women give birth to babies. If the life partner also has multiple sex partners, the net becomes wider. This is a matter of great concern. When I talk about this, people say it is only a negligible problem. But it is not. There are hundreds of mentally ill women wandering the streets. Such women are a danger to society and whatever you do about AIDS prevention is going to be a wasted effort if this continues," says Vidyakar.

According to Dr Dhanikachalam of the Tamil Nadu AIDS Control Society, this is not a problem at all. "More than 85 per cent of the HIV+ve persons in Tamil Nadu contract the virus through sexual contact while in the northeast, through injections as drugs are widely used there. It is not only the mentally ill who are vulnerable to this dreaded disease but also the highly educated and so-called normal people. So, the chances of being infected by the HIV virus are equal to all. How many of those who are HIV+ve are mentally ill and how many of them are women? The number is very small."

Vidyakar, however, refutes this argument. "I have been picking up a number of women patients who require psychiatric help. We give priority to such women as they are highly victimised. A man can walk naked on the streets but if a woman does this, she becomes an object of ridicule and any number of men will try to exploit her. I have found that at least 70 per cent of the mentally unstable women whom I pick up from the streets suffer from sexually transmitted diseases and 40 per cent of them are HIV+ve. Ten per cent of them are pregnant. We have picked up at least 300 people last year alone and all of them were highly exposed, exploited and sexually abused. We have not found a single HIV+ve male patient who requires psychiatric help!"

Anyone who gets admitted at Udavum Karangal, whether he is a child, male or female, is made to undergo HIV investigation. This is done to identify the HIV+ve cases and give them proper care. It is also to protect the other patients who are free of the disease that they do the test. But many inmates like Mini and Mariamma find the Home atmosphere stifling and some even try to jump over the eight-feet high wall, which also is topped with barbed wire. But is it right to send them out of the Home after diagnosing them as being HIV+ve?

"For example, a woman like Mariamma enjoys her freedom like all people. And they also get beedis, drugs, alchohol, etc when they are out in the open. Once they are inside a Home, all these things are denied to them, which they find unbearable. How can I let a mentally ill woman who is also suffering from AIDS out in the open? She could transmit the disease to many. At the same time, somebody can question me about human rights. What right do I have to hold someone who wants to be let out of this place? Somebody may even question why I tested her for the HIV virus without her consent. This is a very, very tricky issue."

Dr Manorama of CHES also feels the same way. "If such people are let out of the Home, their life is under threat and they are also a danger to society. Sometimes, they run out into the streets and we have to drag them back. If they become violent, we may have to even give them a small dose of tranquilisers at night to calm them down. So, I feel there is nothing wrong in keeping them in a Home even if it is against their consent."

How well is a social worker equipped to treat mentally ill women? "Their mental state is like that of a child. How do you manage a child? You cajole him first but if he still continues to throw tantrums, you raise your voice and calm him down. The same way we handle these women too. When we raise our voice, they start sobbing and then we console them. You cannot segregate them and isolate them but you cannot leave them outside at all. We can only take care of them with kindness. When a normal person gets AIDS, at least he is emotionally normal to think about it but these people are not emotionally stable," explains Dr Manorama.

Ignorance, however, still rules the roost. The attitude of many is, so what if I get AIDS? Jancy, a 25-year-old HIV+ve woman told me how she used to warn people about the virus. Jancy's story was no different from that of many other young women who found themselves in brothels against their will. She was sold to a brothel by her lover and when they discovered that she was HIV+ve, she was driven out.

"I reached Madras as I had no other place to go to. The convent where I lived as an orphan refused to take me in. So, for a year or so, I stayed on the Marina Beach. These men will not let you sleep in peace there. I was very hungry too. So, there was no option for me but sell my body for a meal! I used to tell everyone that I was HIV+ve. They said they didn't care. I was worried about their wives and children but they were not," Jancy says.

Many men in India are still ignorant about how dangerous AIDS is. They believe that it is like TB or at worst cancer and cure will come soon. Vidyakar tried publishing the photographs of the final days of AIDS patients so that others would understand how terrifying the experience is. But many human rights activists objected to this, calling it unethical. "We look at everything from a Western point of view. The problem here is, unless people know how much an AIDS patient suffers in the end, they will not be scared. Many tell me, `It is not a big thing at all'. Such an attitude doesn't help," Vidyakar says, sadly.

Dr Manorama was fuming when she spoke about the men who use mentally ill women. "I cannot understand this whole thing about men and sexuality. All they need is a female body! I have a 45-year-old sex worker here as a patient and she looks so sick. Still people go to her! All men want is sex. Mentally ill women who roam around the streets don't take a bath, don't dress properly, still men have sex with them. The worst part is, men have group sex with these women. I must tell you, you cannot change men's behavior at all. Unless they see somebody in their family suffering from AIDS and dying, they won't understand the gravity of the situation. The sex circuit is so bizarre that men will have sex with a woman at any place."

Dr Manorama, like Vidyakar, feels only if they see people in the final stages of AIDS will people understand how bad life with AIDS can be. So, she asks her AIDS patients whether they would like to be resource persons to educate others. Some agree, but some do not.

Another dilemma a social worker faces concerns the disclosure of the truth. Vidyakar narrated the story of a law college student who had an affair with an advocate and gave birth to his child. The child was passed on to Udavum Karangal by her parents. When the baby became sick, the hospital where it was admitted found out that it was HIV+ve.

Vidyakar called the mother and tested her and found out that she was also mildly positive. After the first failed affair, the girl had again had an affair with another man for some time and then the man had married another woman. The student's father was planning to marry her off. She could have passed on the virus to the second man and he, in turn to his wife. Now she would give it to the man she was going to marry.

"I haven't told the girl that she is HIV+ve. What if she commits suicide on hearing the news? On the other hand, I feel I should tell her about it and advise her to be careful. As a social worker, I cannot hide facts. I know a truck driver from Kerala who got married although he knew he was HIV +ve. He died here a few years ago. It is a sin. It is betrayal. What about AIDS orphans? As a social worker, where do I stand? WHO says you should not test for HIV virus without the person's consent."

A boy from a normal middle class family was admitted in Dr Manorama's hospital some time back for severe diarrhoea. When the boy was not responding to any medicine, she had a doubt that the boy was HIV+ve. "This child was from a good family and how could I tell them that I wanted to test the child for the HIV virus? It is very difficult. So, generally what I do is, I keep a list of all the reasons for chronic diarrhoea and I tell them that I have tested this, I have tested that and I have only these left over and then I test for HIV. It is very difficult to break the news to such families. When I tested this boy, I found that he was HIV+ve. The poor child might have picked it up from a blood transfusion!"

According to Dr Manorama, "Problems arise only when I test someone and let the whole world know that he or she is HIV +ve. Then, they will be discriminated against in society. Otherwise, we are not doing anything wrong. I am sure nobody can object to testing the mentally ill. It is necessary for their own benefit. There is nothing wrong in testing them. You can test them in a government center. I don't consider it a violation of human rights at all because only if you test them will you be able to put them at the right place and give them the right kind of care. They need people who are sympathetic to them and who can understand them."

Dr Manorama feels the government is not concerned about the mentally ill, destitute women. Unless you have low cost care homes, life is going to be very difficult for these mentally unstable women. "Only if the government, the non-government organisations and the society work together will we be able to tackle this problem. A directory of all care homes should be displayed at all places and it should be made available with the telephone directory, free of cost. I shouldn't pay money to have CHES's name in the directory and all these names should be in the special category so that any member of the society can alert a NGO when she or he sees somebody abandoned on the streets.

"I also believe that besides us NGOs, everybody else in society should also feel responsible. If every individual who earns some money gives at least ten rupees a month for a social cause, things will be different. It is immaterial to which organisation he donates the money; what is important is that every member of society should make caring for other a habit."

The Rediff Specials

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