Wednesday, November 30, 2005

India's highways major HIV routes

Associated Press:

Zalisz Ahmed paid $1 and lost his virginity on the side of the road to one of India's countless young truck-stop prostitutes. He's had unprotected sex with many others since and says he's never heard of AIDS.

Ahmed, 20, is one of an estimated 5 million to 8 million truck drivers who supply the country with everything from apples to air conditioners along long-haul routes that have become deadly HIV highways.

The crowded ribbons crisscross the nation of more than 1 billion people and facilitate one of India's high-risk AIDS groups: men far from home who are always on the move.

Just as in Africa two decades ago, truckers and the sex they buy have helped fuel India's spread of a disease that revolves mainly around sex and injecting drugs. With an estimated 5.1 million people living with AIDS and the virus that causes it, India currently ranks just after South Africa in logging the world's highest number of infections. However, the number of Indian cases per capita remains relatively low, with an estimated 0.4 percent to 1.3 percent of adults infected so far.

Local truck stops, called dhabas, litter India's highways. They provide warm food and bodies for truckers with no questions asked. The prostitutes are poor and uneducated -- forced to sell themselves for pennies inside trucks, parking lots or even outside in the bushes. Negotiating condom use simply isn't an option for most who work alone instead of in more organized brothels.

Out of the 20-25 truckers tested each month at Babu Jagjivan Ram Memorial Hospital, near the Sanjay Gandhi truck depot in New Delhi, about one-fourth come back positive.

"They tell us they have many sex partners at red-light areas and then they have sex with their wives," said Nirmal Khatri, a counselor at the hospital whose job it is to inform patients of their HIV status. "We can't press them. It is their own decision. It is a problem -- it is a big problem."

The cycle is often vicious. Out of the handful of positive truckers who come back for follow-up visits, some report still having unprotected sex with prostitutes or sleeping with their unsuspecting wives who sometimes then become pregnant and pass the disease on to their babies.

Outreach workers have for years visited dhabas and depots. Safe sex messages are plastered across billboards and are handed out in brochures at these roadside venues-- they're even painted on the sides of cars that pass big rigs to remind drivers of the risks.

But the message isn't always loud -- or clear -- enough.

The government, trucking industry, unions and the drivers themselves must take responsibility to keep history from repeating itself in India, said S. Sundararaman, an AIDS consultant. He's devoted the past 15 years to working with truckers and has spent many long nights talking safe sex at dhabas that never close.

"In Africa, it was exactly the same because wherever the roads did not take people, the epidemic did not reach there," he said. "The epidemic is invading."

Sundararaman said Indian truckers can have anywhere from 40 to 400 sex partners a year, depending on how much time and money they have on their hands. India's growing economy is also pushing more traffic -- and disease -- into new areas, he said.

"The truckers actually have a very, very important and crucial role to play in containment," he said. "We have characterized them as a bridge population because they are bridging the population across geography."

No numbers are available for how many truckers may be infected, but in the northeastern state of Assam, a survey found one-quarter tested were HIV-positive, said Denis Broun, country coordinator for UNAIDS in India.

He added that fewer than 20 percent of truckers nationwide are getting prevention messages and condoms, and none of the nation's driving schools includes AIDS education in their curriculum.

But the men are being tempted everywhere by sex. Some dhabas use it as their top money maker, and long waits for paperwork between states also fuel boredom relieved by countless women who approach the trucks in parking lots, restaurants or anywhere else drivers congregate.

"The highways are very slow so people, when they start on long hauls, start on trips which are over a month," Broun said. "What we have found in some cases, the food was free (at the dhabas), provided they have sex."

Veteran trucker Satnam Singh, 55, has seen firsthand how the virus can ravage healthy drivers. He watched a father and son from his village die grueling deaths a few years back. They wasted away to skeletons without money for treatment. Their trucking company simply replaced them. For every trucker who falls ill, there's a pool of thousands waiting in line for the job.

"I've seen everything and I know it's worse than leprosy," Singh said in a loud, husky voice that's as rough as his face, worn from years on the road. "This is a family killer."

Singh, who used to fool around with prostitutes 25 years ago, says he frequently warns other truckers like young Ahmed that they're playing Russian roulette today by having unprotected sex at the dhabas.

But Ahmed, whose dark eyes shine beneath ruffled tufts of black hair, says he will continue running apples and bananas on the 15-day drive between the state of Bihar and New Delhi. Someday he will marry the woman he loves back in his home village in the state of Uttar Pradesh, but he has no plans to get tested for HIV and says he has nothing to worry about -- at least for now.

More Married Women In India Are Getting Infected By HIV

India's HIV cases higher than official numbers

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