” Thrice a week at least they came to me with vague health problems that on further investigation turned out to be AIDS. Four of five of them would come together – it was easy to differentiate them from my regular patients who came with pregnancy related issues since I was running a Maternity home. My hospital was based then on Central
Avenue, very close to the infamous Ganga Jamuna red light area of Nagpur.
It broke my heart to see the condition of the women. Ranging in age from 16 to 60, some were just HIV positive, some had full blown AIDS but they had no recourse to medical treatment and no respite from their trade, which they HAD to continue with since their families depended on them; they had young kids they were trying to educate and
bring up… the scary thought was how many of their ‘clients’ were going to be infected and would then be passing on the deadly infection to their wives,”
A leading Gynecologist of Nagpur Dr. Swati Barad, reminisces with a shudder.
No one knows exactly how many sex workers ply their ‘trade’ from Nagpur’s red light areas – the figures for Mumbai vary from 2 lakhs to 3 lakhs, Pune is next closely followed by Nagpur. A conservative guess is that Ganga Jamuna has between 500 to 800 sex workers but now other areas and other category of females have also come up in competition, More on this later…
When the De. Barad had tried to educate them and caution them she was shocked to realize that many of them were not aware of the disease and the precautions they could take – like get screened medically and insist on use of condoms by their customers. They did agree that some Health workers belonging to Govt. Medical services or NGOs come by once in a while and hand over condoms but they are rarely used.
The women confessed that many customers turn away when asked to use condoms. They either threaten the women with physical abuse or offer double money if they agree to not insist on taking precautions. It is too easy to give in since financial necessity is
the reason most of these women are in this trade in the first place.
Many of the customers are migrant labour from outside who are lonely since they are away from their families and their homes. They either bring the infections with them or carry it back to their native place when they go on their annual visits. And so AIDS spreads across the nation.
The state Health department either doesn’t care or turns a blind eye. There are no campaigns to spread awareness of the problem or educate these hapless women about safe sex.
The repercussions are already being experienced across all stratas of society. Dr. Sandeep Mogre, a pediatrician recounts a case where a seven year old girl came to him with severe anemia. After screening her for many conditions that could be causing it and not finding the cause he finally tested her for HIV and to his shock found her positive. He then screened her siblings – two sisters. They also turned out to be positive. So the whole family was called for scrutiny – parents and grandfather. Both parents were HIV positive, so the whole family was affected except the grandfather. Shortly after, the parents developed AIDS and died leaving the three girls with their grandfather. In normal circumstances too it would be a herculean task for an old, single man to look after three little girls, but to expect him to get them screened regularly for AIDS or manage other complications that could occur is inhuman.
The irony is recounts Dr. Barad, while she was dealing with prostitutes with AIDS her own Nurse/ Sister was diagnosed with the problem too and died at the age of just forty!
“When a patient tests HIV +ve, his health can still be managed as long as AIDS does not develop. But once it does, the patient deteriorates rapidly and can die within months.
With the kind of health care they can afford I doubt that many of the affected prostitutes will give beyond the age of 35 to 40” says Dr. Swati.
On the other hand, one can see patients, like the 67 year old man who came in for surgery to an orthopedist after an accident who had been HIV +ve for twenty years. But soon after the surgery he developed AIDS and passed away.
‘What do you do in the case of expectant mothers who test positive?’ We asked some Gynecologists of the city. They all opined that if the pregnancy is in the first trimester, abortion is the most advised option.
In case, it is not safe to abort the fetus since pregnancy has advanced, we monitor the mother very closely and go in for Cesarian section rather than wait for normal delivery explains Dr. Barad.
Once the baby is removed by C section a Cord Clamp is immediately applied so that mother’s blood does not enter child’s blood stream. She is also not allowed to breast feed her baby. But still 4 – 5 ml of contamination will always occur when baby is in the uterus and even though the placenta is filtering the blood. So the baby developing AIDS further on can’t be ruled out, she explained.
There are treatments now for such babies – a drug administered immediately after birth and then regularly after the baby is one and a half years old.
Dr. Mogre says he has treated two babies only like this in the last few years.
But on the other hand if the mother is healthy but the baby is already HIV +ve due to the father, the mother will definitely be affected after child birth, And there is no way of treating her – it is mostly fatal for the new mother.
The prostitution situation could be more alarming for Nagpur since a casual browsing on the net will show that there are many more in “the trade” who are from unorthodox backgrounds like the student community and even ‘respected housewives’. Girls who come to study here from mofussil villages and towns often get lured into prostitution to earn extra money of fall prey to ‘pimps’ who may masquerade as boy friends.
An NGO and some Service organizations working with these kind of women say the number could be 8000 and rising. These girls are in their late teens and early twenties and depending on their looks could earn Rs. 30,000 and above per month “working” 2 to 3 times a week. Easy money to be lavished on self or sent home to needy families.
Do you see such students coming in with AIDS? We asked Dr. Barad.
“It is difficult to tell. Some young girls do come in with their young male friends who are hardly in their twenties with the problem of unwanted pregnancies. If they are within the first trimester, we give them pills which will help them abort at home. Such girls never get tested for HIV”.
Another scary factor is that alcohol and drug abuse is rampant too among such students with ‘extra curricular’ activities. Given Nagpur’s dhaba culture where one can openly carry alcohol bottles to be consumed in eateries that dont have liquor permits it is no wonder that sale of alcohol is rapidly rising in the city.
If this continues will one see an epidemic of HIV and other sexually transmitted diseases?