by Michele Leight
Thanksgiving does not seem like the time to think about AIDS around the world, and yet through the joy and the laughter, the full stomachs and abundance, there lurks the reality that there are millions who are endangered, and many more millions who have already succumbed to the worst epidemic mankind has ever faced - comparable only to the plague, and that was way back in days of yore, when media did not exist, the information highway was inconcievable, and medical technology, medications and treatments for diseases were unknown.
On November 26th, 2003, the eve of Thanksgiving, a New York Times report entitled "Spread of AIDS Fast Outpacing Response" quoted Dr. Peter Piot, Director of UNAIDS:
"Measured against the scale of the global epidemic, the current pace and scope of the world's response to AIDS falls far short of what is required." Dr. Piot is right on target. None of us are doing enough - and that includes ordinary citizens everywhere the epidemic is exploding - like India and Russia.
In India, a land of 1.2 billion people, a tragedy is playing out for women of all backgrounds as denial amongst its citizens - not just its leadership - replaces immediate action to empower women against a ruthless killer virus lurking in their own bedrooms. As to political will, according to Dr. Piot, Russia has not made the political commitment other countries have made against the disease, "It budgets only a few million dollars for AIDS and still deals with it at the level of the deputy minister of health." This is in sharp contrast to Indian leaders, who were so alarmed at their HIV/AIDS statistics that they called for an unprecedented nationwide conference on HIV/AIDS this year. However, "The spread of AIDS to about 4.5 million Indians is the biggest concern is Asia" said Dr. Piot.
So why is it, in this time of medical and technological advancement and prosperity in developed nations that so many go uncared for around the globe, left to the ravages of a disease for which medications and treatments exist? Why is there this devastation by disease when we are supposedly now "civilized" and "advanced?" Why is it that this situation exists when many of us are equipped with democratic governments elected by the people who promise to work for the people who elected them - as opposed to kings and medieval despots of olden times who did not give a hoot about what happened to their citizenry as long as their coffers were full and life was filled with their own pleasure?
As Secretary of State Colin Powell said at the United Nations Special Session on HIV/AIDS after he heard the most recent global AIDS statistics: "AIDS is more devastating than any weapon of mass destruction." So why are ordinary citizens and world leaders not doing more to help the afflicted?
Panoramically observed across the globe, the HIV/AIDS statistics tell us that those of us blessed with health and wealth are greedier as individuals and more pathologically selfish as wealthy nations, less compassionate and less interested in equal rights for women than at any time in our history. With few exceptions, this pattern is repeated round the globe - even in the United States in minority communities - where we have state-of-the-art media, awareness groups, tratment and care facilities and sex education in schools. If this seems like a harsh way of looking at life, it is purely from the perspective of that segment of the world or the socio-economically deprived who must believe we have abandoned them as they languish and decay from HIV/AIDS. Theirs is a different Thanksgiving Day and a bleak holiday season. For the infected poor in developing nations the future holds little hope. Most of them will never see a plump, juicy turkey or smell an intoxicating gravy pungent with thyme and rosemary - let alone experience the mercy of anti-retroviral medications - because they are poor. Poverty kills the diseased poor faster than the diseased rich - and time marches on.
Fifty of the total global AIDS infections exist in women. In India, the total is a staggering 40 per cent, predominantly monogomous women through heterosexual transmission. Women everywhere are taking the hardest hit as HIV infects faithful wives and partners, "whose only crime was to have sex with their husbands" said Kofi Annan, Secretary General of the United Nations.
Built into the global statistics for women and new HIV/AIDS infections is the absence of laws that protect them, no control whatsoever over their own bodies as a human right and abysmally low living standards. Poverty plays its role, but upon close scrutiny, it is attitudes and customs like arranged marriages without prior HIV-testing and the absence of rights and laws protecting women that are fanning the flames of India's blazing epidemic. Age-old practices which, pre-AIDS, did not pose a health threat to women now "set women up" for the inevitability of HIV infection. For those without access to anti-retroviral medications this will progress to full-blown AIDS.
Heterosexual transmission between partners or from husband to wife is now the primary cause of the proliferation of the disease in India. Many believe that India, with 4.5 million infected, now has the highest HIV/AIDS infection rate in the world, though officially India lags half a million behind South Africa. Estimates by American, British and other global healthcare agencies have put the number of infected Indians at nearer 8 to 10 million in recent weeks, depending on which paper you read. Reading the global statistics for HIV/AIDS today, sex might be viewed as a potentially lethal commodity even within the home nowadays - everywhere in the world - not just in developing nations.
On November 19th, 2003, Maxine Frith reported from Madras, India (http://www. news.independent.co.uk/science_medical):
"When she was 21, Kosulya Periasamy was forced into marriage with a man she did not like. She was told she had to marry him because his family owned land that supplied water to her father's factory. What Kosulya was not told was that her husband was HIV/positive. He knew he was positive and his family knew too. I think my father suspected because he knew what my husband was like, but the marriage was all to do with money.'"
Kosulya inevitably became HIV/positive and her story is tragically common in India. One must ask where are the laws for women like Kosulya requiring a mandatory blood test for STDS and HIV of a proposed spouse prior to marriage? Without such laws, backed up by the right of the woman to the denial of marriage if the man is HIV/positive, these women are facing a death sentence on a daily basis.
AIDS is at present an incurable disease and anti-retrovirals are not likely to reach poor women in developing nations like India anytime soon. It is not rocket science to conclude that it is criminal for accomplices to force the Kosulya's of this world to marry when they know the proposed husband is HIV/positive. Murder is a harsh word, but murder it is by any other name if the marriage is knowingly and wilfully enforced when HIV is present in the man - no matter what "spin" is put on it.
Similar practices go on in many nations in different disguises; in Africa, for example, boys have been initiated to become men by bedding a virgin. Many communities did not have information about the dangers of HIV/AIDS, or the inclination in their menfolk, to change such behaviors. One has only to look at Africa for a reason to act. A continent is being decimated by a deadly virus and most of the beautiful, smiling men, women and children cannot afford the anti-retorviral meds that will turn their suffering around and offer them dignity and a prolonged life. A recent New York Times article reported that families are having to choose who shall live and who shall die because of the high cost of the drugs. South Africa has begun dispensing AIDS medications to their infected citizens after years of denial - during which time millions have died tragically. Wealthy nations have the drugs: we need to ensure that those who need them most get the drugs without delays and red-tape, stone-walling and an eye on profit margins.
While Kosulya might be an Indian woman who acquired the AIDS virus unknowingly from her husband, her plight is not uncommon in other countries around the world. In Latin America, women have few rights and remain unequal with men within their society. Rape within marriage is legal in India, as in many developing nations, even if the husband is HIV/positive, and domestic violence is largely yawned at.
"Pandemic/Facing AIDS" by Rory Kennedy, sponsored by the Bill and Melinda Gates Foundation, features the impact of the AIDS epidemic in Russia, Brazil, India, Africa and Thailand and exists as a feature-length film (113 minutes), a 5-part series (aired on HBO) in the US this past June: each episode is 1/2 hour long), a 42-minute educational version, with accompanying educational materials (classroom workbooks, a teacher's guide, and a poster), 5 PSAs, and a 20-minute policymakers' version. Additionally, there is a traveling photo exhibition, a photography book and a website for the "Pandemic Project." If you are interested in any of these additional materials and versions of the film, please email: cpotenza@moxiefirecracker.com. or call Moxie Firecracker Films at 212-620-7727. There is a moving illustrated book published by Umbrage Books, with essays by Kofi Annan, Rory Kennedy, Nadine Gordimer, Nan Richardson and Jeffrey Sachs. The accompanying CD "Pandemic: Music for a World Without AIDS" is a wonderful compilation of world music featuring such varied and beautiful artists as Orcestra Marrabenta Star de Mozambique, our own "Giant Leap,"Ravi Shankar and Phillip Glass,Gilberto Gil, Caetano Veloso and Euge Groove - amongst other wonderful artists. It is a great gift for the ones you love. Detailed information may be obtained at their website: www.moxiefirecracker.com. Educators, this is a brilliant piece of work by Ms. Kennedy, whose work is well-known - and much needed out in the world. The Moxiefirecraker Film Company is based in New York City.
In Rory Kennedy's heart-wrenching movie, "Pandemic/Facing AIDS," which tracks stories of people living with HIV/AIDS in five different countries experiencing AIDS epidemics, the couple featured in the Indian segment of the film are in love, young and subject to all the pressures ascribed to rural community life in India - including arranged marriages. Their marriage was arranged and they thought nothing of it - this was the way it had been for centuries and neither partner questioned it.
Unfortunately, Navaraj, the husband featured in the film, had seen prostitutes before and even while married and in love with his wife, and had become infected with HIV/AIDS. Unlike may men who are secretive, the moment Navaraj knew of his infection, he told his doctor and his wife. He did not want unsafe sex with her and in fact abstained from sex at the peak of his infection until his wife insisted they have a baby together - even if he was sick and might infect her. What is life without a child to pass on to the world was how his young wife saw it? Navaraj gained all the information he could from his doctor and everyone agreed that the risk of transmitting HIV/AIDS to the baby would be reduced by caesarean section at the time of birth should his wife also be infected with the virus - which was not known at the time. What was apparent throughout the filming of the couple was how little control the young wife had over most of the decisions that involved her own body - except the one to have a child. She said a childless woman in rural India had no status and is looked down upon. Clearly this young wife had no conception of how lethal the HIV/AIDS virus is.
The baby was born beautiful and healthy, and all the while the camera panned to Navaraj's anxious, doomed eyes and gaunt face and body. The viewer was left with a feeling of hope as the Indian segment ended with grandparents cradling the newborn, and glimpses of an idyllic thatched hut and palms in the beautiful village - like the thousands of villages that dot India - where the small family had made their home.
Navaraj died shortly after the film was made; it is not known where his wife and child are because she has moved from the idyllic hut since her husband's death - but mother and child were last heard of doing well. The whereabouts of the good doctor are also unknown as she has been out of contact. If anyone knows of here whereabouts, please contact Moxie Firecracker Films, thecityreview.com, or ashraya-ny.org.
In a recent story in The New York Times Magazine, it was revealed that homosexuals and bisexuals in some of America's large cities lead double lives on the "low down" as husbands and partners, but harbor secret male relationships from their wives and parents because they risk ostracization within their own families and communities. These men are proudly "macho" and do not wish to be confused with the stereotypical effeminate gay male. They are a far more lethal commodity to women, however, as many of these men do not practice safe-sex with their male or female partners. The statistics for new HIV/AIDS infections in the United States have increased alarmingly in recent years, especially in black and hispanic communities. Most of the men on the "low down" are supposedly black, but the sharp rise in homosexual hispanic infections (26 percent) points to the same trend. TV series on gay relationships abound in the media, but as yet no one has tackled the thorny topic of the men who lead double-lives. Women need to know more about this.
Meera Nair's brilliant film "Monsoon Wedding" highlights pedophilia and incest within an Indian family - a brave and welcome move from a film maker who does not flinch from subtly exposing the often family-generated violation of women and girls perpetrated in her beloved country - and around the world. It is no coincidence that "Monsoon Wedding" resonated to great acclaim around the world. Women from California and Kentucky, London and South Africa how told me how much they loved the movie - because they had similar stories to tell within their own communities or families. Similarly, Clint Eastwood's film "Mystic River," (adapted from the book by Dennis Lehane) gets inside the tortured mind of a grown man (played brilliantly by Tim Robbins) who was raped by pedophiles as a young boy. The experience marked him for life, and unlike other films on the subject of sex with minors, this film and story chases the legacy of pedophilia and rape to the bitter end, concluding that for the very young victim the damage is irreparable - except for the lucky ones who have access to therapy. It is a "must-see" film for all parents.
"Mystic River" deals with rape between adult pedophile strangers and a young child - but stop just for a moment and imagine the legacy and damage if the violater is a member of your own family? Pedophilia is prevalent in all cultures, as is incest and rape within and outside families - and more common in the United States than one would think. Just watch Oprah from time to time to get a dose of reality. Than heaven for Oprah. She had done more to spread the word on pedophilia, rape and incest than anyone in America. Information like this saves lives because it sends out a flare to those who are most at risk - a warning to be vigiliant. Programs like Oprah's should be available to citizens of all nations as a public service so they can defend themselves. In "Mystic River" the victim is a young male - a reminder that sex abuse is perpetrated on boys as well.
What is even more threatening today about rape, incest and sex with minors is that they carry with them the possible threat of HIV infection. In situations where women and children have no access to anti-retroviral medications due to poverty or global location, it is tantamount to a death sentence. Even with AIDS medications, the treatment takes its toll and is no joy ride."Mystic River" portrays the effect of the crime of rape against a young boy within the context of small-town America, where townsfolk knew one another on a first-name basis. The boy who was violated started out on the lowest rung of the emotional and socio-economic ladder in his community because he did not appear to have a "traditional" family comprised of a mother or father - just "many uncles." Imagine what is going on in our own cities in the United States, where there are more and more young children and teens facing split homes and divorced parents, and fewer adults to care for and supervise them because they all must work? No one is immune to the threat of HIV/AIDS - not even in the United States. Defeating the AIDS virus will require a major change in attitude in males especially, and it does not seem to matter which hemisphere or country they inhabit. In many developing nations, sex with minors or young women of poor or low-caste backgrounds is not even considered immoral, let alone a criminal offence. But it violates them and should be unlawful.
In a case reported in the New York media this year, a Bronx man sodomized several young neighborhood boys and was charged with murder - not rape - because he infected the youths with HIV. He was taking HIV medications at the time of the rapes and therefore knew he was most likely infecting the boys. It was a wilfull and deliberate act that threatened their lives - no different to the injustice perpetrated upon Kosulya in India by her husband and her in-laws or men in developing nations who know they are HIV positive but have paid sex with minors or their wives without using protection. The Bronx boys will receive anti-retroviral medications, but those who are sexually violated in developing nations may not be so fortunate. Low-caste women in India are often forced into prostitution, and seeking health care is difficult when a married woman is not allowed to leave home unescorted.
It gets even worse for women in developing nations, if that is possible. According to a recent (British) Voluntary Services Overseas report, called "Gendering AIDS," women's low status and lack of rights have left them vulnerable to infection regardless of their own behavior. Married men openly visit prostitutes, putting their wives at risk for infection. Even if a woman knows her husband is infected, it can be impossible to insist he practices safe sex. If they leave their husbands, women in effect forfeit their rights to the marital home and the dowry they brought with them. As increasing numbers of HIV/positive men are dying in India, young widows are finding themselves forced out of their homes by their husband's relatives.
The VSO report concludes that while the Indian government has begun to respond to the AIDS epidemic, it has done little to improve women's rights. Discussions about condoms are banned in schools and colleges, despite the fact that many young girls are married by the time they are sixteen. Girls are traditionally not supposed to know anything about sex or contraception before they marry. How can any nation hope to conquer HIV/AIDS in this scenario? It will be utterly impossible to do so.
There is good news as well. Kosulya took action and fought back because she was so disgusted and outraged at the predicament in which she found herself. She set up her own support group, the Positive Women's Network, and became the first woman in India to go public about having the virus. From India, Maxine Frith writes:
"Three years ago she (Kosulya) was critically ill with HIV-related infections. Thanks to AIDS drugs, she is now healthy and will travel to London for the launch of the VSO report.'When I first got ill, I was very angry at my husband. I thought I was going to die because AIDS meant death, and life had no meaning,' she said. 'Now I can look forward to the future. I like to look after my nieces. I want India to change for them," said Kosulya, now empowered by action.
Information saves lives, so for all those out there who have the power to inform women like Kosulya who are endangered on a daily basis, please do all you can to get information about the HIV virus to them as fast as possible.
On the home front, the AIDS situation in the United States is not too good either. On Thursday, November 27th, 2003, Thanksgiving Day in America, the following headline appeared in The New York Times:
"H.I.V. Infections (in the US) Continue to Rise: Troubling data on the AIDS virus for Hispanics and Gays."(by Anahad O'Connor).
A CDC (Center for Disease Control) Study looked at data from 29 states - not including New York and California - that included a confidential system that was started in 1999. The study found that the number of new HIV cases diagnosed in the United States is continuing to climb: the most significant rise has been among Hispanics (up 26 percent) and gay and bisexual men (up 17 percent).
The other statistics are interesting as well: for example, exposure to infection through heterosexual contact is 35.2 percent (that is transmission between men and women), and injected drug use at 17.1 percent.
As to race and ethnicity: blacks (non-hispanics), still make up the largest portion of new cases at 55.4 percent; white (non-hispanic) 31.3 percent (up 8 percent), and as mentioned before hispanic at 11.5 percent (up a staggering 26 percent). Men represent 70.5 percent of total US infections, and women 29.5 percent - not a comforting statistic. The report indicated that HIV infections may be even worse than the data indicates because states with the highest populations and possibly the highest rates of infection, like New York and California, were not included in the study.
Why, one wonders, were these two states omitted from the study, as they have always had the highest prevalence of HIV/AIDS? According to CDC statistics posted on their website, New York has the highest number of people living with HIV/AIDS than in any other American city.
"From 1999 through 2002, the number of new HIV cases soared by 26 percent among Hispanics and by 17 percent among men who have sex with men, while the increase in new cases over all for that period was 5.1 percent," according to the study: "Because more effective treatments are available, there seems to be a perception, particularly in the gay community that HIV is a manageable disease." said Dr.Robert Janssen, director of the division of HIV and AIDS prevention at the centers. "Most of the increase in the Latino community is due to men having sex with men. I think the disease just doesn't have the fear that it once carried."
According to the report by Anahad O 'Connor, other groups also showed increases in the rate of diagnosis:
"African Americans still make up the largest portion of new cases, at 55 percent, while whites accounted for 8 percent of the new cases, the study found. The numbers for men in general went up 7 percent. Whether the study's findings reflect higher rates of HIV infection is difficult to say because some cases are not diagnosed immediately. But if that was a factor, Dr. Janssen said, the study would have detected more cases that had progressed to AIDS. Instead, rates of testing have stayed about the same and many of the recently detected HIV infections were caught in the earlier stages. "We're seeing an increase in people with HIV but not necessarily an increase in simultaneous diagnoses of HIV and AIDS," he said.
According to Mr. O'Connor, the new findings reinforce the notion that there is a growing sense of complacency among groups at the highest risk of contracting the disease. Some experts say advances in AIDS treatments in recent years could be undermining efforts to promote safe sex. The latest figures might therefore reflect a more widespread willingness to engage in risky behaviors.
Dr. Jeffrey Laurence, program consultant of the American Foundation for AIDS Research in New York (www.amFAR.org) said: "Even among populations targeted for outreach, it's as if people think they can become infected because there is a pill to take care of them. There needs to be a stronger message that it's not a picnic to be on these drugs and that even when you're being treated you can still transmit this disease."
Experts say that efforts to promote AIDS prevention to convey the gravity of the disease have not reached Hispanics and other minorities. According to Dr. Laurence: "Too often AIDS education programs rely on blanket messages that are too weak to combat the widespread images of healthy, resilient AIDS patients in drug advertisements.There is such a striking disparity among Hispanics and blacks that we're obviously not doing a good enough job of targeting them and conveying the right idea. Here's a population that is not responding to the messages we're sending. Perhaps it's because the message is getting stale."
Or, in the humble opinion of this writer, perhaps not honest enough about the ravages of HIV AIDS? Maybe less placating, comforting images of people with HIV/AIDS would help raise the fear factor in the young especially. "The young think they are invincible" said Dr. Piot, Executive Director of UNAIDS, in a recent interview, and the statistics back him up. The young think they are invincible and immune to diseases like HIV/AIDS and other STDs because we are not strident enough in our messages to them.
This week I saw an anti-fur advertisement plastered on a wall in Downtown New York that I will never forget as long as I live. A beautiful celebrity held a skinned, dead baby fox in her hands and the caption read: "HERE IS THE REST OF YOUR FUR COAT?" The image was horrible beyond belief but it worked. I have since vowed never to wear fur. The Siberian fox is about to face extinction because we turn the other way and want our fox coats. One wonders if women in certain countries will be on the verge of extinction before their governments and citizens decide to act. "Nice," comforting, confident messages about HIV/AIDS designed not to upset anyone will not do the job in preventing the spread of the HIV virus: unfortunately, "shock-tactics" like the fur advertisement seem to have more effect. Whatever works is the answer.
According to the CDC, 40,000 Americans are infected with HIV every year. More than 850,000 Americans are currently infected with HIV, the highest number since the AIDS epidemic began in the 1980s. For American women out there, these numbers are not good. 850,000 may not sound like a large number unless you or a member of your family become a part of the data charts. The statistics for heterosexual and bisexual infections in the United States should make us twice as vigilant for ourselves and for our children and families as HIV/AIDS works its way through our society - and that means both heterosexual and homosexual society. Most men do not infect their wives deliberately - but, with all the love in the world, it turns into a horror story all the same.
As I walked past the Metropolitan Museum the day before Thanksgiving I found myself stunned by a conversation with a woman I had just met. I had been telling her about the plight of women in developing nations who were terribly at risk for HIV/AIDS because of their husband's promiscuity and unsafe sex.
Suddenly I felt her hand on my arm and she told me with deep sadness of a college friend who had become unknowingly infected with HIV/AIDS through her husband, even though she had always been faithful to him. All three of them went to Harvard, where her friend had met her husband, and their future looked as rosy and as loving and bright as it was possible to be back then in the glow of youth.
The friend has since died of HIV/AIDS. Her husband had physically abused her and her daughter, who moved away from her father after the death of her mother. She too went to Harvard, and made a new life for herself. She is successfull, has a great job and is, God willing, happy. The daughter saw her mother's demise and took control of her life. She defeated the odds and did not repeat the pattern - which can happen in situations of domestic abuse. It must bring joy to her mother wherever her spirit dwells that her daughter is a survivor.
It was amazing to me that such a story should come my way at the very time I was writing about the dangers confronting women in India and developing nations. I still feel the urgency of the woman's hand gripping my arm. She wanted me to know this story to warn women in the United States, so they keep up their guard. She is a film maker and I urged her to remember the power of film and to use it to inform those she wishes to protect. Efforts to get the word out helps dispel sadness and brings hope to the disenfranchised - wherever they are.They need to know we are there for them, thousands of miles away, or just down the block in our own neighborhoods. It is so scary to be alone, threatened with abuse and a deadly disease, and for most women, it requires enormous courage to get out of such situations.
Like Kosulya and the young daughter whose mother died at the hands of her father's HIV infection, hopefully women around the world will take action from the seeds of information they receive and change the status of women in their countries - for future generations of sons and daughters. It is no picnic for a young son to sit by and watch a mother or sister victimized. It causes life-long damage.
On a positive note, there is encouraging news from two nations facing exploding HIV/AIDS epidemics:
The governments of China and South Africa have begun giving free medications to their poor citizens infected with HIV/AIDS after years of denial. This is momentous and incredibly heartening.The power of the media to save lives and the power of activism and the vote are immeasurable - but we have to keep up the pressure everywhere.
India must surely follow China and South Africa because India has a "king size problem" according to Dr. Peter Piot - but he also believes India has the means in the commitment of it's leaders to solve the problem. India manufactures anti-retroviral medications and does not have to import them and must surely be allowed to dispense these meds to their infected poor without further delay. Otherwise, the situation will very likely mirror Africa in a few years.
Finally, we must work hard to educate and nurture our sons so that they and their future wives or partners inhabit a brighter universe - free of HIV/AIDS and abuse.