The Hindu Business Line : Is the message loud and clear?

Safe sex was an alien concept even though many of the men admitted to having more than one partner; awareness about condoms as a means of preventing HIV was woefully inadequate.

If a certain kind of mosquito bites you at 5 a.m., you get AIDS. — Shivamma (38), a pourakarmika (municipal corporation sweeper).

You get AIDS if you eat with or touch someone who has it. — Ranganatha (19), an auto-rickshaw driver.

AIDS is spread by `second-hand women'. — Mukesh (25), a laundryman.

Shivamma, Ranganatha and Mukesh are just three of the many people one met while seeking to assess levels of awareness on HIV/AIDS among the general public. All of them (from urban and rural Karnataka) belonged to lower economic groups, and were either illiterate or semi-literate.

One did expect low awareness levels among them owing to their illiteracy; what one also encountered was a morass of confusion, misconceptions and a strong imagery that associated AIDS with mosquitoes and barber's blades.

In Karnataka, which has the third largest incidence of HIV-positive people in India, huge amounts of money are spent every year on awareness generation. According to G.B. Meti, Deputy Director - Information Education and Communication (IEC), the Karnataka State AIDS Prevention Society (KSAPS) has spent Rs 6.47 crore on IEC activities in the last four years. This is in addition to what other national and international agencies have spent to spread awareness on HIV/AIDS.

Have the efforts worked? Does the general population, particularly the very poor and the illiterate, possess accurate information on HIV/AIDS? Attempts to do a reality check on this produced interesting, but largely worrying, results.

A peek at reality

Most of the men Iquestioned had at least heard about AIDS, but there were many women who were completely unaware of such a condition. Awareness on HIV was completely absent. Safe sex was an alien concept even though many of the men admitted to having more than one partner; awareness about condoms as a means of preventing HIV was woefully inadequate. Some responses:

Renukamba (30), wife of the watchman at a construction site, looked blank when asked if she had heard of AIDS and said, "I don't know what you are talking about."

"AIDS gets into the blood when we get bitten by dotted mosquitoes," Katamaiya, a pourakarmika, said firmly.

Lakshmi (25), a housemaid, said, "I know about AIDS. It is a bad and dreadful disease. But if I speak about it my husband will say I am characterless."

Ganesh (22) was stubborn about his belief that only women could spread AIDS. When asked "What if you got it from a woman and gave it to another," he had no reply. He also believed he could get it by sitting on bedclothes that an infected person had used.

Muniyamma, a flower-seller, refused to talk about it saying, "I don't want to discuss that dreadful disease. My sister's son, who was a bad boy, died of it."

I visited the primary health centre (PHC) in Ashoka Nagar in Khanapur taluk, about 40 km from Belgaum city, to talk to rural groups.

Awareness among them was poor, and even the few who had heard about it only knew that AIDS was a killer disease associated with `bad character'.

Kalavva also struck a note of apathy as she said, "So many of us are already dying of TB, malaria and other illnesses. What difference will it make to anyone if we die of AIDS?"

Sambhaji (35) owns a petty shop in Khanapur near the highway. I asked him if he sold condoms. He looked innocently at me and revealed that he sold three or four condoms a month to lorry drivers who used them to repair leaky diesel pipes.

Laxman Chougule, a lorry driver, claimed that he had no other use for a condom.

Imet young, sexually-active slum dwellers in Belgaum city who admitted to having sex outside their marriage. When asked about safe sex, they said, "We use `helmets' (the colloquial term for condoms) sometimes when we go to other women, but not with our wives."

The wives of men who admitted to having multi-partners naively asked, "We are faithful, what if our husbands are not? Will we get AIDS?"

The fight against HIV

It is two decades after the first case of HIV in India was detected in Chennai. Twenty years in which we have had the time to tackle the problem, but have actually allowed the infection to touch more than 5.2 million people, with the number increasing every day. Twenty years in which we have subjected the HIV infected to stigma and discriminatory treatment. Above all, 20 years spent largely in denial that our culture and values would protect us from HIV.

We have at last woken up to the fact that HIV does not discriminate between sex, class and caste. It has also become an expensive proposition for the government to bear.

"It is estimated that more than 25,000 people will require treatment with anti retroviral therapy (ART) in Karnataka in the coming years. At a conservative estimate of Rs 8,000 per person per year, it will put an enormous burden on the exchequer, as the government is committed to providing free ART for those who need it. This will be a long-term commitment, as ART once begun cannot be discontinued," says Meti.

What can we do?

"The crux of our fight against HIV lies in how we can effectively promote prevention, the only tool we have against it. We have to get correct information out on time, and to everybody, not just the literate," says P.R. Dasgupta, first Project Director (1992-95), National AIDS Control Organisation, New Delhi.

As Meti says, "While we have achieved some success with the literate groups, taking messages right down to the grassroots and changing behaviour patterns that have been established over the years require intensive efforts at the community level. Unless there is convergence and integration between KSAPS and other departments such as health, women and child welfare, education, gram panchayats and village-level organisations, awareness cannot percolate effectively into the general population."

The challenge is huge, and reaching out to the grassroots effectively is never easy. Dr Prashanth N.S., Coordinator, Health, Karuna Trust (a Bangalore-based NGO that runs 26 PHCs in a public-private partnership with the Karnataka Government), says, "It is probably time to devise innovative measures to achieve large-scale awareness, in both urban and rural areas. In Karnataka, for instance, there are 1,683 PHCs. In terms of sheer economics, it makes more sense to place trained health workers to impart awareness on HIV/AIDS in each PHC. This would be more cost effective than providing care and support to people who could have avoided the problem in the first place."

It is evident we have a long way to go before we are able to demystify HIV/AIDS. The messaging for the future should focus strongly on the fact that anybody can be vulnerable to HIV. There is also an acute need to dispel misconceptions about mosquitoes and barber's blades.

Responsibility on the part of men who indulge in high-risk behaviour, complete and accurate information among the general population, and empowered women who can enforce the use of condoms for safe sex are vital needs for a HIV-free India.

This article was made possible by a financial grant from The EU-India Media Initiative on HIV/AIDS implemented by The Thomson Foundation.