When I look back at that time, it is fascinating to see what saved us. Here we were, gay men who felt nakedly visible and threatened, certain that the hostile government—probably some department of the police or Ministry of Home Affairs—was keeping close tabs on us. We didn’t realize then that we had done such a good job of hiding ourselves that we truly were invisible, both individually and as a group.
Consequently, homophobic policy makers could easily deny our existence and assert that India had no homosexuals or very few of them, that homosexuality was a Western import with no real roots in India. Thus, in an interview with Siddhartha in 1989, the director general of the Indian Council of Medical Research, Dr. A. S. Paintal, insisted that homosexuality simply didn’t exist in India because it was banned and subject to a harsh criminal penalty. However absurd that argument was, Dr. Paintal and other policy makers seemed to genuinely believe it.
And so it happened that, in those early years of the epidemic, the spread of AIDS was not blamed on gay men. Those of us who could see that gay and bisexual Indian men were indeed contracting HIV in large numbers kept quiet about the trend, knowing that drawing attention would only harm us.
But there was also a second, pivotal reason why we were spared the blame. As panic about AIDS continued to spread, it was another criminalized and reviled set of outlaws who were made the scapegoat for it: women sex workers.
In April 1986, a few months before I had returned to India from New York, I read Indian news reports about six prostitutes in a Madras reformatory who had been diagnosed with HIV. That marked the first scientific confirmation that the virus was spreading between individuals who had contracted the virus within India, rather than abroad.
I was not surprised to learn that the epidemic had spread to India—it was, after all, five years since the first known cases of AIDS had come to light in the United States and two years since Asia’s first cases had been confirmed, in Thailand. I thought with dread that India’s abysmal public health system, its largely illiterate population of 750 million, and the cultural prohibitions against discussing sexual matters would make it impossible to contain the epidemic, especially given the example of India’s scant progress in coping even with age-old infectious diseases, such as tuberculosis and cholera.
By the time I began to research the lives of those women, many years later, there was only one about whom anything much was known: Selvi. The other five women had vanished without a record, their lives and history obliterated by the fact that they were mere specks among the masses of India’s poor. Selvi, who, like many Indians, used only her given name, was the only one with a traceable history, photographs, and even surviving friends and family.
Yet only a little is known of her early years, the period that ended with her imprisonment. She came from a destitute Tamil family of landless laborers, and was educated through class five. She had left an abusive husband and was providing for her toddler son through sex work on the streets. Sometime in March 1986, this small, dark-complexioned woman, aged twenty-three or so, was arrested for prostitution in or near Madras.
The police took her to the Madras Vigilance Home, a government-run, women-only reformatory in the city’s Mylapore neighborhood. Selvi should have been produced in a local court within a day or two. This being her first arrest for prostitution, she should have been released after paying a fine of about fifty rupees. The whole saga, however harrowing, should have lasted no more than a week or so.
But the morning after Selvi’s arrest, a young medical researcher named S. Nirmala drew a syringeful of her blood—and did the same with the other women rounded up the night before. None of them dared to question or refuse her, given both the trauma of their imprisonment and the enormous chasms of class and caste that separated her from them.
The next day, Nirmala carried vials of their blood, along with those drawn from more than a hundred other prostitutes over the previous two months, to the Christian Medical College in Vellore, a three-hour journey by bus. That evening, she called her senior collaborator in Madras, the microbiologist Suniti Solomon, to say that six of the samples had tested positive for HIV.
Those results had disastrous consequences for Selvi. While the other prostitutes at the home were produced in court and subsequently either released or sentenced to long terms in the reformatory, the six who tested positive were not taken to court. The warden did not give them any explanation.
A day or two later, Dr. Solomon and Dr. Nirmala arrived at the reformatory to interview them. The director general of the Indian Council of Medical Research had instructed Dr. Solomon to find out if the prostitutes were having sex with foreigners or Indians, to learn if HIV was beginning to spread domestically. All the six said that every one of their clients had been Indian.
Only a handful of top officials in the government’s health-care system were informed about the results. The six blood samples were secretly flown to the United States for confirmatory testing at the National Institutes of Health in Maryland, a process that would take several weeks. Selvi and the other women were told nothing of that, and the reformatory authorities did not seek permission from the courts to keep them in custody.
Selvi’s parents, who knew that their daughter had been working as a prostitute after leaving her husband, somehow tracked her to the reformatory from their home in Ulundurpettai, a nondescript town thirty miles away. Though they were allowed to meet Selvi, the warden curtly told them that she could not be released because she had a “blood infection” that required treatment. They did not argue. They were impoverished and illiterate and lived in a hovel, while the warden—the ruler of the jail, with its imposing buildings and high walls—embodied the might of the Indian government.
At the end of April, the US National Institutes of Health informed the Indian Council of Medical Research that the women were definitely HIV-positive. On the morning of April 29, India’s minister of health and family welfare, Mohsina Kidwai, announced the news in Parliament, saying that six women with “promiscuous heterosexual behavior”—an elliptical but unmistakable reference to prostitutes—had been found to be infected with HIV in Tamil Nadu. There was pandemonium in the vast hall of the Parliament. The health minister reassured her colleagues that officials were monitoring the situation closely. But press reports—which inaccurately suggested that the women were suffering from AIDS (they were still asymptomatic)—fed a public frenzy.
The panic was most intense in Madras, after a leading newspaper, The Hindu, ran a front-page article on April 30, having tracked the “AIDS cases” to the reformatory. Selvi and the other five women paid the price for the panic.
They were immediately separated from the others at the reformatory and imprisoned in a barred room at a distance from the main building. Food was pushed in through a small window. The women were forced to do everything in that small room—eat, sleep, go to the toilet, wash their clothes. It was “like an isolation cell for the condemned,” Selvi later told a friend. Of their fearsome, unknown affliction, they knew only that it was so deadly that no one would come near them or speak to them with compassion.
But within weeks, as the focus of the panic shifted to the scores of other prostitutes and individuals across India now being discovered to be HIV-positive, Selvi and the five other HIV-positive women in the reformatory were entirely forgotten, left imprisoned in those terrible conditions. Neither Indian nor international women’s groups, human rights organizations, or the medical establishment, including Dr. Solomon and Dr. Nirmala, challenged their imprisonment or its punitive conditions. Indeed, the state government continued to summarily imprison every prostitute found to be HIV-positive, often in the same Mylapore reformatory. It showed that the outcast and downtrodden, even in a democracy that prided itself on its enlightened judiciary, could be locked away even indefinitely, without due process.
Forever after in India, AIDS was thought of as a disease of women prostitutes, merely because the first indigenous cases were detected among them. T
hey were accused of spreading the sexual infection to hapless men, who then spread it to their innocent wives and babies. They had always faced persecution, but now—as the epidemic worsened across India—it intensified to an unprecedented scale.
Unlike us gay men, they were often easy to locate—in brothels or on particular street corners. They were impoverished. And they were “sexual” women, which singled them out for vindictive scorn and abuse in India, where misogyny is at its most brutal in crushing women who do not adhere to the cultural diktat that they be chaste virgins until marriage and then devout wives until death. The trauma Tandavan and I faced at the police station was nothing compared to the ordeals that Dominic had to go through. His suffering, in turn, paled in comparison with the calamities heaped on Selvi and countless others like her.
NINE
A PERFECT STORM
Late in the summer of 1990, a few months before my twenty-ninth birthday, Tandavan and I left Delhi. I had been awarded a scholarship by the Harvard School of Public Health to study global health policy. Tandavan was moving back to Paris for the nine months that my course work would take. We then hoped to figure out some way of living together in the United States or France, however improbable it seemed, since the immigration laws of neither nation recognized gay relationships. We avoided any mention of the eventuality that we wouldn’t be able to live together somewhere in the West and that moving back together to India might be our only option for staying together.
At Harvard, it was a joy to study again. I had researched such diverse things as a journalist in India that I longed to make sense of how they fitted together and what they said about India’s prospects. My years as a journalist reporting on everything from automobile pollution to rural hunger had also led me to decide to specialize in public policy. Journalism was not an ideal fit for me, given the strength of my interests in social justice issues. The profession’s unrelenting focus on breaking news kept me from digging deeply into the issues of deprivation and justice that I cared about. But with graduate-level training in an aspect of public policy, I could work as a researcher and policy maker as well as use my journalism experience to be an insightful commentator.
I was drawn to public health as it was one of the few aspects of deprivation in which it was realistically possible to achieve remarkable gains fairly quickly, the recent examples ranging from the global eradication of smallpox achieved in 1980 to the across-the-board gains made in Sri Lanka and the Communist-ruled Indian state of Kerala despite their relative poverty. In contrast, I had already seen that the process of realizing progress in other vital aspects of human well-being such as incomes, ownership of productive assets, education, and sociopolitical emancipation often took decades of effort and battles against groups that opposed equitable progress. Though I realized that progress was needed on every front of well-being if people were to move out of poverty and that providing better health in isolation could be helpful only to a finite degree, I needed a promising front to keep alive my hope that the burden of poverty in India and globally was not insurmountable. At a personal level, too, health was the aspect of human well-being I had felt most deeply about ever since I could remember, from watching my brother Pratap struggle to cope with the lifelong impact of the polio that had ravaged his legs.
I cared about everything I studied in those nine months of intensive course work at Harvard, whether it was infectious diseases, malnutrition, or epidemiology. But from the outset, one issue was my special focus: AIDS.
In every way, this was a disease about me—this virus that was intertwined with our essential human longing for sex and love, and with being outlawed, shamed, and persecuted because societies invariably seemed unable to address sexual matters rationally or humanely. For all I knew, I could have been infected with HIV by now. And the unhinged hatred of gay men spotlighted by our association with AIDS—the Reverend Jerry Falwell claiming that our deaths were “God’s punishment for homosexuals” and Senator Jesse Helms attempting to slash AIDS funding on the grounds that we contracted the disease through “deliberate, disgusting, revolting conduct”—triggered my fighting spirit.
I was immensely fortunate that Jonathan Mann, the architect of the international response to the pandemic, who had resigned just a few months earlier from leading the World Health Organization’s Global Programme on AIDS in Geneva, had joined the faculty of the public health school. Mann had taken a disease that political leaders and officials invariably sought to ignore because of its sordid association with sex and turned it into an international health priority in just the four years between 1986 and 1990 that he led the global AIDS program.
Mann agreed to be one of my two academic advisers. In my second semester, I enrolled in his seminar course on AIDS.
His course was held in a small room in a modern high-rise in the busy downtown portion of Boston that housed Harvard’s medical campus, including the public health school. Mann—an odd, compelling figure, frizzy hair standing atop an unending forehead, nattily dressed in a sports coat and bow tie—never sat at his desk. Instead, he would launch into his lectures as soon as he entered, almost as if he couldn’t hold himself back, pacing the breadth of the room and stopping only when he wanted to challenge one of his two dozen students, drawn from every corner of the world, in debate.
He gave us students unforgettable insights into the pandemic. Mann was an epidemiologist by training, and one of his first efforts at the Global Programme on AIDS was to collate more accurate worldwide data on the epidemic. The results showed that AIDS was spreading exponentially—12 million people around the globe had contracted HIV by 1991, WHO estimated, of whom 2.5 million had died. In the United States alone, the worst-hit rich nation, one million people were estimated to be HIV-positive, and more than 150,000 had died.
Strikingly, the data now showed that the epidemic was spreading even more fiercely in developing countries than in the wealthy Western nations where it had first drawn attention a decade earlier. Eighteen of the world’s twenty most severe national AIDS epidemics were in poor countries, mainly in Africa and the Caribbean. The “gay plague” was also the poor man’s plague.
It was astounding: a disease that had come to scientific attention as a killer of five gay men in California had—by its tenth anniversary—morphed into a pandemic of millions of men and women around the globe, a vast majority of them heterosexual. Those millions were going to suffer unimaginably and die essentially because their leaders had inexcusably ignored this killer disease, out of discomfort with the sexual matters it raised or the hate-filled prejudice that these immoral people were reaping the wages of their own sin.
Even worse lay ahead, WHO warned. The number of people cumulatively infected worldwide was likely to soar to 30 million to 40 million by the year 2000. Though those estimates were disparaged at the time for being alarmist, they eventually proved to fall many millions short of the reality.
The epidemic was taking its greatest toll in sub-Saharan Africa. African leaders had so far dismissed AIDS as a Western affliction caused by promiscuity, saying that their traditional societies were immune to such a disease. But by now, in some parts of central Africa, as many as one in three of all urban adults were estimated to be HIV-positive, in comparison to an estimated one in thirty-five adults in New York City, the worst-affected American city. (Retroactive studies showed that HIV had probably begun to spread unnoticed in Africa since the 1970s or even earlier; by the time AIDS was “discovered” in the United States in 1981, more than 100,000 people in sub-Saharan Africa were probably already infected.) Deaths and funerals had become a daily occurrence, with countless men and women dying in the prime of their lives, leaving behind orphans and aging parents, ghost towns and untended fields.
The crisis was a warning of things to come in other developing regions. Asia, with more than half the world’s population, was emerging as a new epicenter of HIV, Mann told us, because of a similarly incendiary mix of poverty and illiteracy, youthful populations, th
e barriers women faced in negotiating as equals in sexual relations, and high rates of the ulcerative sexually transmitted infections that enhance the spread of HIV.
That painstakingly gathered evidence belatedly convinced government leaders that the world faced an “unprecedented global crisis.” By the time Mann resigned from WHO in early 1990—after clashes with the body’s autocratic new director general, Hiroshi Nakajima—almost every developing country had begun national AIDS programs, nearly a billion dollars had been mobilized to finance their efforts, and the UN General Assembly had discussed the epidemic several times, the first instances of a disease being taken up for consideration by that body.
Of course, however crucial, those were just the preparatory first steps. Whether they would be translated into the right kind of action, and at the massive scale required, was another matter altogether. The history of public health was a depressing record of epidemics that could have been far more easily tackled than AIDS and yet weren’t. AIDS had all the elements of a perfect storm—and that, too, a worldwide storm.
Policy makers, including conventional public health experts, had little understanding of sex and balked at grappling with the role of sexual behaviors in the spread of the disease. The role that public health efforts could play was also unclear, given that there was no treatment, cure, or vaccine in sight. It seemed plausible that more could be achieved by urgent societywide efforts to tackle inequality between the sexes, illiteracy, the lack of knowledge about how to negotiate condom use, the near-universal ignorance and discomfort about sexual matters, those being the basic factors that left so many millions ill equipped to keep from contracting HIV.
Given those unique challenges, Mann’s other achievement at WHO was arguably even more historic. That was to push governments into agreeing to AIDS control strategies that respected human rights rather than relied on compulsion. The odds were heavily against him.
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