Ashraya-New York www.ashraya-ny.org FOUNDED IN NEW YORK, 2003 Michele Leight, Founding Director, 917-655-6352 "Born Into Brothels: Calcutta's Red Light Kids", a film by Zana Briski and Ross Kaufmann, shown at The Asia Society in New York, November 18, 2004 and reviewed by Michele Leight
Five student volunteers - Brandon, Gerrit, Joey, James and Laurent - who interviewed New Yorkers Five Young Ashraya-New York Volunteers Interview New Yorkers About HIV/AIDS in the United States and Abroad "The Next AIDS Generation" symposium May 14, 2004 at the Asia Society AN INTERVIEW WITH DR. PETER PIOT, EXECUTIVE DIRECTOR, UNAIDS, & ASST. ATTORNEY GENERAL UNITED NATIONS, LAUNCHES THE WEBSITE, SEPTEMBER 2003 World AIDS Day 2003: Epidemic Outpaces Global Response Remembering Mother Teresa Helpage India Helps Tsunami Survivors
"Ashraya" means "shelter" in Sanskrit, Bengali and Hindi - the official language of India - and the word 'shelter' reflects the goals of our charity and advocacy in New York. Ashraya-NY (New York) takes its name from a very special AIDS care home in New Delhi, India, that has been the inspiration for our international and domestic focus. Wherever they reside, people living with HIV/AIDS should be able to turn to a sanctuary or shelter when the going gets tough - or when the world just does not seem to care about their problems.
In the United States, we begin our advocacy by increasing awareness of the rise in heterosexual HIV/AIDS infections, especially amongst the young, minorities and women of New York. Using the internet, we will expand to other cities across the United States.
Reaching out internationally, we extend our support and friendship to people living with HIV/AIDS in India. While we are an American organization based in New York, we are deeply committed to supporting the wonderful work being done by the team assembled by Action India's AIDS Project at Ashraya in New Delhi, inspired and founded by Nafisa Ali Sodhi, Chairperson, Action India, and a former Ms. India, movie star and social activist. Ashraya is the result of a unique partnership between the Indian government and Action India's AIDS Project.
According to the United Nations there are 42 million infected with HIV/AIDS around the globe, half of them women, and the majority of these women live in Sub-Saharan Africa. The UN estimates that without an expanded and accellerated response, an additional 45 million will become infected with H.I.V - the virus that causes AIDS - by 2010.
Secretary of State Colin Powell described these statistics as "more devastating than any weapon of mass destruction' when he spoke at the United Nations General Assembly on AIDS on September 23, 2003.
India is in the critical column of new infections, as are many Asian nations, which prompted Dr. Peter Piot, the director of the United Nations AIDS program (UNAIDS) to comment that no head of state from Asia was present among the 20 from around the world. India's Prime Minister, Atal Bahari Vajpai was present and addressed the General Assembly. Dr Piot said this is the time to act because it is much cheaper to contain an epidemic when health officials have a smaller number of infected people to deal with. As numbers explode, it becomes more difficult.
Dr. Piot's report card for the response thus far to United Nation's two-year-old commitment to conquer the HIV/AIDS epidemic is not encouraging: "The grades are barely a pass. There isn't a single A in the report card," he said at the United Nations on September 23, 2003. This evaluation is the result of information submitted by 103 governments confronting the disease.
However, Dr. Piot added that there is reason for hope because there is enormous global momentum to expand access to H.I.V./AIDS treatments in developing countries, which did not seem possible only a few years ago.
Sadly, India is one of many developing nations whose citizens are facing the immediate threat of exploding HIV/AIDS. India's population is so vast that HIV infection estimates might be higher than those currently stated, because there is barely any HIV-testing at present. With 4.58 million known to be infected, India is a close second to South Africa in the highest number of infections worldwide - and the gap is closing.
According to NACO (National AIDS Control Organization, India), only 30,000 of the infected in India are currently receiving ARV treatment - Anti-retroviral medications - which makes HIV/AIDS manageable and helps prevent full-blown AIDS from occurring. This is due to the high cost of the drugs even though India produces the cheapest generic ARVs in the world. For the poor of India, cost will determine whether they live of die from HIV/AIDS in the years ahead, because they do not have any money to pay for even the cheapest drugs. They will have to be given the medications for free - or die.
The rich and the middle class have easy and affordable access to India's abundant supply of AIDS medications, and while all people living with HIV/AIDSs deserve our attention and our concern, it is the poor in India who are our primary focus, because they are running out of time - and continuing to spread the virus through lack of knowledge about the disease.
Our focus from New York is positive and grounded in the firm belief that a combined strategy of prevention, treatment and care together with education will halt a tragedy in India. One has only to think of Africa to know that every second of every day counts when it comes to dealing with HIV/AIDS - wherever it is spreading.
For many in America, India represents the fabled land of the Taj Mahal, Mowgli, the Himalayas, snake charmers, multiple religions, languages and dialects. It is all those magical things, but it is also one of the most densely populated countries in the world with 1.2 billion citizens, and that population is now confronting a severe health threat. India has faced many trials and tribulations through the centuries, including invasions, occupations by foreign powers, poverty, hunger, disease and political upheaval. Terrorism threatens India as it also threatens the United States - and now, the spectre of AIDS casts a long shadow upon India's ancient and resilient spirit, and there is reason for grave concern and an immediate need for action.
Despite adversity and hardship, loss and terror, India has held steadfastly to the principles of democracy, and today it is the largest democracy in the world. America is probably the world's most famous democracy and shares India' democratic beliefs and principles. As we launch our charity in New York, it is somehow fitting that a statue of Mahatma Gandhi stands unobtrusively in New York City's Union Square, amidst the hustle and bustle of the world's most active - and amazing - metropolis. America - especially New York where we begin our work to help those affected by HIV/AIDS - understands the struggles ahead for India because the United States was the first country to confront the disease.
America believes in the freedom of the individual above all else - regardless of race, ideology, religion or color - and the human right of every individual to live a life of dignity and freedom from persecution for their beliefs. While things are by no means perfect in the United States, it is still the country which allows a person the highest levcl of individual freedom - especially for women.
For anyone who has seen the conditions of women in developing nations up close, there is never a day that passes when it does not feel good to be a free woman in America. We wish for the same opportunities and freedoms for women around the world who do not have the fundamental human rights we have here.
Hunger, poverty and disease rob individuals of their human rights. To have to endure disease without the mercy and relief of medications is a violation of the most fundamental human right - especially in a situation where a person has HIV/AIDS but cannot afford Anti-retroviral medications. Untreated HIV/AIDS wreaks havoc upon the infected person's body and psyche, and their suffering must be endured by helpless families, who cannot pay for the ARVs that would remove their acute discomfort and loss of dignity. The relief of their suffering is denied them when they know that the drugs exist but only for those who can afford them.
Millions of people living with HIV/AIDS in developing nations are illiterate and do not understand the gravity of their disease. Many are continuing to spread it to the people they love the most through ignorance. It is the moral obligation of those of us who do understand to inform these people and help them - because we know how devastating HIV/AIDS can be.
No one likes to discuss HIV/AIDS - in general it is an unpopular topic. For many the subject of HIV/AIDS represents forced-entry into the privacy of the bedroom and -more importantly - a scrutiny of the closest personal relationships possible in life: between husband and wife, partners, significant others or the very first sexual encounter of a young person. The advent of AIDS changed everything and people harbor resentments and scapegoat AIDS.
Most unnerving of all, HIV/AIDS turned the spotlight on trust, which lies at the very heart of our most important attachments. People want to believe that everything in the garden is rosy in their relationship, but the statistics across the globe do not lie. Whether a person chooses to acknowledge it or not, heterosexually transmitted HIV/AIDS is gaining momentum at an alarming rate globally, thereby challenging the widely held beliefs that HIV/AIDS is confined to the homosexual population and injecting drug users. This is completely untrue. Read the statistics published by UNAIDS or the Center for Disease Control for an accurate world wide perspective.
At the United Nations General Assembly session on AIDS, September 22, 2003, Dr. Peter Piot, head of UNAIDS (the coordinating body of the United Nations AIDS Agency), estimated that there would be 45 million new infections by 2010. This is in addition to the 42 million already infected. He emphasized denial was still a problem because of the diseases' transmission through sexual intercourse.
In the United States we are far more open to talking about AIDS in cities like New York, Los Angeles and San Francisco where the disease first went public and where HIV/AIDS is still most prevalent. The young have no inhibitions whatsoever in hearing and talking about HIV/AIDS, because they have been educated about it in schools and hear about it in the media. AIDS activists and advocates have had a lot to do with that openness and tolerance because they helped us all understand the nature of the disease.
Educating an unwilling public is woven into the fabric of social activism, however unpopular the cause. Gandhi did not shy away from unpopular causes; he raised awareness for the lepers in his country, who were stigmatized and marginalized in his day.
Mother Teresa, winner of the Nobel Peace Prize in 1979 and soon to be canonized as a saint for her work amongst the poor of India and the world, took on the plight of lepers at the outset of her journey to help the forgotten, the desperate and the impoverished in society. These great human beings understood the loneliness of stigma and the shame of being shunned because of disease.
America has always championed the persecuted, the strugglers, the adventurers and the freedom-lovers of the world: "Give me your poor your tired your huddled masses" (Edna St.Vincent Millais) is America's anthem, and we have our fair share of poor and ill here in the United States as well.
New York has been 'first base' to millions hoping for a chance at a new life in America - and for those who are poor when they arrive it is often a harder road than they ever expected it would be. This is not a welfare state and health care is not up for grabs. Millions of Americans do not have health insurance and many thousands of American children go to bed hungry every night- even here, in the wealthiest country in the world.
Homeless men and women walk along Madison and Fifth Avenue in New York daily, or take refuge for a few hours in the serenity of Central Park, isolated and cut off from the mainstream of abundance and plenty right in front of them. They live at the mercy of the elements, disease and poverty while we lead busy lives that do not involve any interaction whatsoever with them. We most definitely have our own poor in the United States.
It surprises many people at home in America and overseas to learn that even here in the United States injected drug use with shared needles and unprotected sex are the chief cause of the increase in new heterosexual HIV/AIDS infections - exactly the same reasons that have caused the rise in HIV/AIDS infections in developing nations - just on a smaller scale.
Socio-economics deals the same unfair hand here in the US as it does around the globe - it is a matter of where you fall on the socio-economic ladder. Take a walk in any low-income neighborhhood in New York and you will find a very different America from the glossy suburban picture postcard of the American Dream. No white picket fences, no regular trash collection. Groups of drug pushers cluster together and young men identify themselves as members of the Crips and Bloods and a other rival gangs. Not for them the secure jobs, the pension plans or the mortgages that are the divine right of mainstream America. They inhabit a very different country.
More rewarding work must be found for these Amercans, even if that work is to improve their own neighborhoods with government funding. Planting trees, beautifying, painting run down dwellings - anything but drug pushing.
Here in New York and America we seek to increase vigilance in informing America's young, minorities and women of the increase in new HIV/AIDS infections within the heterosexual population. The young especially have let down their guard. We need to raise the bar dramatically about warning the young of all socio-economic backgrounds of the risks of unprotected sex. Our goal is to to prevent further escalation of new infections in their age group.
Dr. Peter Piot, head of UNAIDS, observed in my recent interview with him:
"The young think they are invincible." The statistics show alarmingly that they are not.
As our international focus, Ashraya-NY are committed to raising funds for Ashraya AIDS Care Center in New Delhi, so that people living with HIV/AIDS in the community will have somewhere to turn for help. The AIDS Care Center was founded by Nafisa Ali Sodhi, Chairperson of Action India, a Citizens Motivated Trust, which was inaugurated on December 17th, 2002 by Chief Minister of New Delhi, Ms. Sheila Dixit, in the village of Rajokri, New Delhi.
Ms. Ali resides permanently in India, but recently visited New York - a city she loves - and the United States. She especially wanted the support charity to be based in New York, a city rich in multiple nationalities, diverse religious and a concentration of the most tolerant and compatible ethnic and cultural groups in the world.
Ashraya is a pilot project between the Government of Delhi and Action India under the "Bhagidari" (citizen-government) scheme. Amongst those who attended the inauguration were Ms. Meenakshi Dutta Gupta, Head of NACO (National AIDS Control Organization) and David Miller, Country Director for UNAIDS.
Michele Leight, Founder and Director of Ashraya-New York, resides permanently in New York but spent her entire childhood in India, a country she deeply loves. Ms. Leight was made a Patron of Action India in 2003.
Two years ago Nafisa Ali Sodhi invited Ms. Leight to visit an empty building and land in New Delhi which she hoped would one day become a "shelter" for people living with HIV/AIDS in India. At the time, Delhi had no such place. Now, that same empty building is buzzing with activity and is called Ashraya.
Ms. Ali and Ms. Leight have been lifelong friends.
As a confirmed New Yorker, Ms. Leight has chosen to include the youth, minorities and women of her home city in the advocacy of Ashraya-New York. She has no more enthusiastic supporter than Ms. Ali and already several representatives in New York and other American states have agreed to volunteer their time. Their efforts are deeply appreciated and their effect will be felt in the months and years ahead.
(Please see related stories and detailed reports on India & AIDS and the realization of Ashraya at LINKS).
Given New York's history of caring for its own, it is important to reach out to the young, minorities and women because the statistics show that we have many in our own city who are continually vulnerable to the dangers and risks of HIV/AIDS. Awareness, together with HIV-testing is crucial, because unlike developing nations, the United States is equipped with the infrastructure that makes HIV/AIDS manageable and offers prolonged life to those who discover they are infected. Full-blown AIDS can be prevented if HIV is detected early and treated.
The statistics clearly show that young Americans in particular have become careless. The most recent CDC (Center for Disease Control) message to young heterosexual people is a wake-up call:
"Between 1990 and 1995, AIDS incidence among people 13 (yes that is correct) to 25 years old rose nearly 20%. While AIDS incidence among both young gay and bisexual men and young injecting drug users was relatively constant during this time period, AIDS incidence among young heterosexual men and women rose more than 130%." (www.cdc.gov/hiv/pubs/facts/compyout.html)
145,750 male and 55,576 female Americans became infected with AIDS through injecting drug use. Heroin addicts inject drugs and share needles - it takes only one infected member of the group to spread HIV/AIDS to all those who use the same needle.
It is essential to consistently remind the young about the risks they incurr if they do not use protection during intercourse - or abstain from sex till they are more knowledgeable about their partner. Promiscuousness with multiple partners without using a condom is deadly with HIV/AIDS so prevalent.
Injecting drug users must be offered the chance to understand that they risk the lifelong health of themselves and their families once they find themselves in the orbit of heroin users and pushers. Warning the young of the risks of selling "gateway" drugs (Marijuana etc) is a good starting point because many young people think that marijuana is harmless compared to 'hard' drugs like crack, cocaine and heroin.
Statistics show that many users and sellers of the less addictive drugs "graduate" to the more addictive and lucrative drugs - like heroin - once they sign up with the drug pushers. Pushers have a vested interest in getting sellers hooked and holding on to them for life. Selling more expensive drugs for more profit is the lure and many sellers end up addicted to heroin in the process.
For a scary 'take' on heroin use and abuse, rent the movie 'Trainspotting,' starring a very young Ewan McGregor. The unstoppable roller-coaster of substance abuse at its most corrossive has been captured in this movie. It is unbearable to watch at times, mainly because the victims are deliberately targeted for their inexperience, their need for money and their youth.
Pregnant mothers who are HIV-positive transmit the virus to their unborn and newborn babies. In Africa, a tragic 58% of HIV/AIDS infections exist in women, who have become infected by having intercourse with their spouses or partners.
In India the same pattern is emerging: 40% of the total number of infections are in women, through heterosexual transmission. The numbers are rising in the United States in the monogomous, heterosexual female population as well - and the pattern is repeating around the globe as the HIV/AIDS pandemic spreads.
In the United States and around the globe, mothers who inject heroin and share needles with an infected person - or who have intercourse with an IDU who is infected - transmits HIV/AIDS to their unborn and newborn babies if they are infected. National and international HIV/AIDS statistics are available at www.cdc.gov and www.unaids.org (and see LINKS).
Unprotected sex with an infected person is the chief cause of women getting HIV/AIDS, wherever they live. In developing nations most of the women do not know they are infected because the only man they have ever had intercourse with has been their husband.
A recent study by SAMHSA (Substance Abuse and Mental Health Services Administration) found that 19.5 million Americans used illicit drugs in 2002. America's jails are jammed with impoverished American men - predominantly African American - who have been sentenced to long jail terms for drug pushing, drug possession or drug use. Some are barely older than boys and the mandatory minimum sentences they receive place them in the same cellblocks as murderers and rapists in the most notoriously unsafe prisons in this country. It is the harshest possible fate for a young man - and they receive no mercy, no parole.
Socio-economics plays a big part in this fate: almost none of those convicted on drug charges are from middle or upper-middle class backgrounds, and many wound up selling drugs because there were no legitimate jobs available to them. For an insight into the drug laws and how they affect minorities and the disadvantaged read "Reefer Madness" by Eric Schlosser. Individuals like Mr. Schlosser have their finger on the pulse of what is wrong in America - and they seek justice for those who are wronged because they love their country - and all their countrymen - not because they are critics.
In Russia, injected drug use - heroin - within prisons has contributed significantly to the proliferation of HIV/AIDS. As the prisoners are released back into mainstream society they spread the virus they acquired in jail.
A recent news item draws attention to the issue of breach of trust between partners and documents the first AIDS related indictment in the United States:
"Man Charged With Exposing Lover to HIV" was a breaking news headline in The Kansas City Star:
"San Francisco - A former city health commissioner who allegedly lied to an ex-boyfriend about his HIV status is the first person charged under a state law against intentionally exposing another person to the virus, prosecutors said."
The attorney for the boyfriend said the health official had been dating his client for 5 months and the couple were taking an Alaskan cruise together in July 2000 when he discovered medical records indicating he was taking medications for HIV: "I think it took him a while to compute that this guy had lied to him in such a fundamental way," the attorney said, adding that eight months ago his client was still healthy and free of the HIV/AIDS virus. (www.kansascity.com/mid/kansascity/news/breaking_news/6801336.htm).
While news headlines like this are alarming, we are committed to focusing on positive solutions: blaming and judging are counter-productive and statistics show clearly that a moralistic approach does not lower the prevalence of HIV/AIDS cases amongst young Americans - or the young anywhere.
Greater focus needs to be placed on public health - especially for those whose socio-economic circumstances 'set them up' for HIV/AIDS - which translates to individual health for everyone. It is threatening for society as a whole to have a disease like HIV/AIDS increasing instead of decreasing.
New York City has the highest number of people living with HIV/AIDS in the United States, (126,237), followed by Los Angeles, (43,488).We also have more AIDS activists and advocates per square foot than anywhere in the world.
Cumulatively, 816,149 Americans currently live with HIV/AIDS. This is with state-of-the art infrastructure, health and sex education, ARVs - and prevention, treatment and care facilities.
Imagine what it is like for people living with HIV/AIDS in developing nations - with none of these advantages.
There is at present no mandatory sex education in schools in India and sex is generally a taboo subject at home between parent and child. For the infected poor, most of whom are illiterate and have never been to school, the disease is largely ignored, and they are left to the ravages of the AIDS virus without the stabilizing anti-retroviral medications and humanizing care that make the disease manageable in the west. Those in developing nations who can afford treatment and care have the same chance of managing their disease as their counterparts in the west.
The poor in India are at present utterly alone except for places like Ashraya, who seek them out and extend them a warm and helping hand.
A staggering 50% of the global total of HIV/AIDS infected persons are women, and India's total is 40% - most of them monogomous and increasingly middle-class. Their only error was to have sex with their husbands.
Raising the standards of women in developing nations like India is vital to preventing the spread of the virus: it is no coincidence that the nations with the highest number of women infected with the AIDS virus are also the nations with virtually no laws that protect women's rights. This is across the board in developing nations and by no means exclusive to India.
The world is finally waking up to the horrific plight of millions in developing nations as women like Amina Lawal await her sentence for adultery in Nigeria. The Sharia Appeals Court in Lawal's home state will decide if she will be stoned to death for the crime of giving birth to her baby who was born 10 months after a divorce - evidence of sex out of wedlock. According to Reuters "President Olusegun Obasanjo, a Christian who has struggled for four years to deal with Christian-Muslim clashes over sharia in which thousands of people have been killed, has pledged that no stoning sentence will be carried out."
The barbarism inherent in the concept of stoning a woman to death is finally being absorbed into global consciousness, but for those of us who are familiar with the treatment of women in developing nations, this is the tip of the iceberg. Most domestic and international outrage has focused on what many critics say is the discriminatory nature of sharia's stand on adultery: the male partner usually escapes punishment.
According to Reuters "Muslim communities in South Africa called for Lawal to be pardoned and raised questions about the whereabouts of the child's father. 'We join many people around the world asking: Where is the man in this case?' the Muslim Youth Movement said in a statement.
Nigeria's northern-based Civil Rights Congress launched a hunger strike in sympathy with Lawal and will pursue other protests if her appeal fails. According to Sharia law, if convicted of adultery, a woman will be buried up to her neck in sand and stoned to death.
Sympathy for the 31 year old illiterate Amina Lawal has put pressure on Obansanjo's government to curb sharia law, which is used in Muslim countries like Saudi Arabia and Pakistan which still prescribes amputations for theft - including the amputation of tiny hands of children who are hungry and steal food.
Thus far there has been no stoning sentence in Nigeria, but the practice continues in other countries. The fact that there is even debate over whether or not stoning should take place shows how urgently new laws must be implemented to protect women in societies that put such a low price on their women's lives - let alone their health.
How can such women ever receive a fair shake in the scenario where even if HIV/AIDS is known to be present in their spouses, wives have no rights to refuse them intercourse when they do not agree to use a condom, citing 'husband's conjugal rights?' There is at present no cure for HIV/AIDS and the woman is unlikely to receive treatment - but these endangered women do not know this. The woman will be blamed if she gets HIV/AIDS, not the husband.
Mercifully, Amina Lawal will not be stoned to death. The defense attorney Hauwa Ibrahim, elated by the acquittal verdict on September 25, 2003, argued that the court should reject Lawal's confession of adultery because no lawyers were present when she made it. He said a poor, uneducated woman from a rural family did not understand the charges against her at the time. Lawal identified her alleged sexual partner, Yahaya Mohammed, saying he promised to marry her. Mohammed, who would also have faced death by stoning, denied any wrongdoing and was acquitted for lack of evidence.
With injustices like this, it is easy to see how HIV/AIDS is spreading in the heterosexual populations of developing nations. For the happy ending of Amina Lawal and her baby, it is haunting to think of those who are not so fortunate - because these practices continue.
Laws must change and standards raised to protect women in developing nations instead of sacrificing them to indignity, horrific punishments and disease.
In many developing nations women without job prospects turn in desperation to prostitution to feed their children, sometimes when they are barely older than children themselves. Children from poor families end up in the sex or drug trade in a pattern of abuse that can be traced with chilling clarity from Cambodia, Vietnam and Thailand and onward to other developing countries like India.
The abuse of women must stop if the spread of AIDS is to be curbed. Sex with minors in developing nations should be the same criminal offence it is in the West - that means anyone under the age of 18.
For those who have visited Cambodia and Thailand, and many other developing nations, children in the sex trade are considerably younger than 18. Without required condom use they will get - and spread - AIDS. Many are so desperate at their fate they are offered the solace of injected drugs like heroin by their employers to improve their mental state and their willingness to 'work.'. This 'treat' which is offered to ensure that they bring money to their employers, seals their fate when they share needles and inevitably they become infected with the AIDS virus.
Prostitutes, or 'sex-workers,' and injecting drug users are the"high-risk" groups contributing to the spread of HIV/AIDS in India. The first reported case of AIDS in India was found in a prostitute and according to some health care professionals this contributes to the stigma surrounding the disease. If the first AIDS case had been a heterosexual professional doctor, perhaps things would be perceived differently in India today.
(See LINKS for www.pbs.org NcNeil Lehrer Newshour report on AIDS in India, including commentary by Nafisa Ali)
HIV/AIDS is transmitted from mother to unborn child - or newborns - without the block of the anti-retroviral called Nevipirene (United States) or Nevimune (India). If administered, this "block" is 99% effective in preventing a baby from getting HIV/AIDS.
HIV-testing is essential to ensure that a baby is kept safe if a mother has become infected. Above all, we are committed to preventing babies from acquiring HIV/AIDS, whether in rural India or in the drug havens of New York where heroin addicted women share needles with their partners.
Africa has thousands upon thousands of tiny babies lined up in hospitals destined to die within a few miserable years - without the comfort of easing medications. It is a sight that skewers the concept of morality and justice on the viewers conscience and demands an accounting - because the anti-retroviral medications exist. They are just not reaching the babies or their mothers because of poverty and lack of infrastructure. No country is blameless in this. We need to get relief to them faster.
It is not enough to prevent the baby from getting HIV/AIDS. The mother must be kept well so that she can take care of her children. The AIDS virus has left 16 million orphans around the globe, and according to a New York Times report (9/23/03) more than one third of heavily affected countries have no strategies to deal with them.
In the West it is considered a moral obligation to protect the young - the most vulnerable in society - with information about sexually transmitted diseases (STDs) including HIV/AIDS. While promiscuity is certainly not encouraged, children learn by 7th or 8th grade that they must either abstain from sex or protect themselves through condom use when they become sexually active.
Even with this information, the young in this country are becoming infected, as the rising statistics show. It is vital to increase innovative health and sex education strategies to ensure that the young are kept safer in the years ahead - the young yawn at moralizing. There is too much coming at them in the media and in their free time for us to think for a moment that they are not constantly being tempted by lifestyles that are potentially dangerous. It is critical that countries like India do more to warn their young.
Participants in clinical trials, AIDS advocates and activists and clinicians in the United States have been awesome in their dedication and openness in dealing with HIV/AIDS. It is the only way to improve the quality of life for those living with the virus and eventually these 'can do' attitudes and practices will contribute to the cure.
While there is as yet no cure for HIV/AIDS, sceintists and researchers pursue that goal every day. Till then, we will be guilty of exposing our young to an incurable virus if we are not open with them about the routes of HIV/AIDS infection.
We vaccinate our children against measels, mumps and rubella - known lethal viruses - yet as parents and caregivers we pull back from discussing HIV/AIDS because it involves the subject of sexual intercourse. Across the world, children are far more sexually aware at a younger age than at any other time in history. To be fair to them, wherever they live, we must arm them with information.
Using the internet - and Tim Berners-Lee's wonderful World Wide Web - we are committed to working with educators and educational institutions in India to ensure that India's youth are given the opportunity to gain more knowledge about the circumstances and practices that result in HIV/AIDS infection. While Indian children in private and government schools are gradually becoming educated about the potential risks and dangers associated with STDs and HIV/AIDS, (but too slowly for the momentum of new HIV infections), for the most part condoms, injected drug use and sex education remain a taboo subject in India's rural areas, which hold the bulk of the population. We hope that the children and educators with whom we exchange information will work hard to inform those in their country who are illiterate and who have not been fortunate enough to go to school.
As we involve our schools and colleges in the United States in communicating with their counterparts overseas, our young will also understand that they are no longer as safe as they thought they were. Hopefully they will acknowledge the rising statistics in their age group and practice safer lifestyles.
Many young girls in India are married off before they are old enough to understand the risks they may face if their partner is HIV/positive, and there is no mandatory testing for STDs or HIV prior to marriage. Parents who are poor are quicker to make arrangements for their girl children to live elsewhere. The lucky ones end up married but many go into servitute or, sadly, the sex trade. However, marriage no longer protects women, as the dire statistics show. 40% of infected Indians are women, most of them monogomous. They get AIDS from their husbands who do not use protection when they see other women or prostitutes.
Many marriages are arranged in rural areas and in most cases the husbands and partners are not aware that they are infected due to lack of education about HIV/AIDS. Infected Indian women infect their unborn and newborn children without anti-retroviral medications. It will be challenging to reach the rural communities, many of whom speak regional dialects, but in focusing immediately on these communities, educators will participate in saving millions from HIV/AIDS, which has a domino effect within families - from father to mother to infant.
It is imperative that, whatever the routes of infection, education about HIV/AIDS accompanies treatment and care if and when such public health strategies are implemented in the years ahead. Educators can play a vital role in saving their uneducated fellow citizens from a terrible fate.
In the months ahead we will include a section devoted to networking with schools and colleges so that the young may communicate with each other around the globe. The young discuss everything in the United States, and in many ways they are the best educators of each other on the issues of sex and drugs. We have to ensure, however, that they have accurate information about STDs and HIV/AIDS and injected drug use.
It will become a matter of conscience to inform those who are illiterate in India of the terrible risk of HIV/AIDS. Communication in rural areas is complicated and prejudices entrenched: but in developing nations like Africa and Brazil it has been proven that poor, illiterate people can and do respond as well to taking their AIDS medications as their educated counterparts in the west once they are informed.s.
Religious leaders and educators can play an invaluable role in reducing the prejudices and ignorant attitudes surrounding HIV/AIDS in India and developing nations. Small rural communities look to their elders for guidance and information. Most cannot read, so the advice they hear from their holy men, priests, sadhus, Zilla Prasads, imams, monks or nuns are their guidelines - and in the case of HIV/AIDS, what they hear will be their saving grace in the years ahead. If religious leaders do not come forward, knowing the consequences, the years ahead will be tragic and painful for India as AIDS decimates the populations.
According to Dr. Peter Piot, Executive Director of UNAIDS, stigma is the chief cause of the spread of HIV/AIDS in India today. (See Interview with Dr. Piot at LINKS)
Without the balancing effect of anti-retroviral medications, AIDS is ruthless. A single photograph shown to Michele Leight by Nafisa Ali is the reason for the creation of this support charity in New York. The physical deterioration of the woman depicted was beyond belief. How she must have suffered is haunting to those who have seen photographs of her condition, let alone imagine her lonely struggle to hold on to life as she battled unmedicated full-blown AIDS. Yet, despite the ordeal of her daily existence, she revered life and wanted to live.
Love of life and a will to live against all odds is a common emotion in those whose lives are constantly threatened by poverty, hunger and disease in developing nations. The poor and ill in India have a heart-wrenching longing to live a normal life and they do not give up hope until they die. Walk into any slum or shanty town in India and you will see children turn stones into imaginary cricket balls and sticks into bats, and they laugh and smile and play in the dust like any children at a Little League game in the United States. Joy is free and they grab it.
The stricken woman in the photograph taken by Ms. Ali lived in Delhi and her sole caregiver was her sister, who was a nurse, but she could not afford the medications that would have eased her sisters daily agony. The woman died shunned by the community around her, mainly because she had been a prostitute and the disease was viewed as a deserved punishment.
The sex trade at that time did not allow a prostitute to require that clients use condoms. AIDS advocates in India have worked hard to change this, but many prostitutes are so wretchedly poor they agree to sex without a condom when the client offers more money - they agree because they have to feed their children or watch them starve. The prostitute asked Ms. Ali to photograph her physical condition to help others, as a warning "so this does not happen to them," she said.
In the past year, despite all efforts to introduce condom use, condom sales in India have dropped according to manufacturers.
The prostitute died a few days after the photograph was taken and she did not have any bitterness towards those who had contributed to her suffering by stigmatizing her. Stigma killed this woman and denied her the most fundamental human right: to die with dignity in a community that acknowledged her human right to dwell among them, even if she had been a prostitute and had HIV/AIDS.
If such attitudes and practices contine they will undoubtedly result in the rampant spread of a ruthless virus throughout Indian society and it will destabilize it as it is doing in Africa. Stigmatizing people with HIV/AIDS must stop if the virus is to be conquered in India. Stigma kills as effectively as bullets - and stigma helps HIV/AIDS.
One of the toughest realities to swallow for those of us who want to help people like this woman is that the anti-retroviral medications exist - but not for everyone. In the years ahead there is going to be a prolonged battle to ensure that the poor get their anti-retroviral medications in India and around the globe. Prevention is taking precedence at present, and funds are being allocated to raising awareness. But for those who are HIV infected, immediate ARV treatment is required to prevent full-blown AIDS. Those already living with AIDS need urgent ARVs and care.
India's pharmaceutical industry, the public and private sector and the government will need to act immediately to avoid further delays while their country continues to experience a steady stream of deaths due to AIDS. The international community and world health agencies will be crucial partners in the monumental task ahead.
On 21st September, it was encouraging to read in the Times of India "Fighting AIDS: CII Chief (Confederation of Indian Industry) to Share Dais with Annan."
Mr. Tarun Das, Chairman of CII, addressed a United Nations panel discussion during the 58th General Assembly session in New York on 23rd, September 2003. It will be interesting to see what such powerful Indian organizations will be able to do to combat AIDS in their country, and we hope to make available comments from Mr. Das in the near future.
Also present at the United Nations was India's Prime Minister, Atal Bahari Vajpai, who addressed the delegates. Richard Feachem, head of the Global Fund said: "The epidemic in India is going to be huge and there is nothing in place to prevent it from happening."
We sincerely hope that America's leaders and AIDS activists and advocates will help India in the months ahead. We are committed to doing so at Ashraya-New York.
AIDS charities, non-profits, AIDS advocates and activists in New York and the United States have been crucial players in the dedication with which they have campaigned for a reduction in the price of AIDS medications for people in developing nations living with HIV/AIDS who cannot afford them. These meds are now available for $1 a day - yet still this is an impossible sum of money for the poor in developing nations. In addition, millions of dollars for AIDS research has been raised in the US.
As we continue to seek treatment and care for the infected poor around the globe, the amazing scientists, clinicians and researchers chase the cure for HIV/AIDS every day. They are under great pressure as the hopes of millions rests with them. We admire and cherish their efforts on behalf of people living with HIV/AIDS and we wish them "Godspeed."
In the United States we need to pay special attention to the number of hours our children spend alone or in peer groups that are unknown to us. It is the ideal breeding ground for drug and heroin pushers, casual sex and sexual predators. We cannot leave the burden of raising our children - to our children. We must work to put food on the table but we must also strive to plan our joint working life-styles so that children are not alone so much: and we must talk to them openly and repeatedly about sex and drugs - without moralizing. Wanting to protect them and their health is the message they need to hear from us. Statistically, moralistic attitudes do not lower the infection rate anywhere in the world today.
Children cannot learn everything from watching TV, playing video games or by managing their own young lives alone or in peer groups: true, many teenagers are like prickly pear cacti (!) but "My son is so independent" or "She knows how to take care of herself, she's ok," are a cop-out and irresponsible parenting.
Children of the well-to-do and middle classes in developing nations mimic and draw inspiration from their counterparts in the west. They want to 'be like them," dress in clingy spandex, apply glitter nail varnish to fingers and toenails and eat McDonald's chicken nuggetts and Domino's pizza. As the world becomes more homogeneous they move away from their own cultural heritage. This is unstoppable with the world's young who are now able to view each other through the fish bowl of the international media, music television and Hollywood.
As the world's wealthiest and most powerful nation we are also the most influential - for better or for worse - around the globe. Those of us in the United States who have the greatest responsibility for what we "sell" and make available to our youth through our media and our actions, must become more aware that people around the globe are watching us.
Children know only what they see - words do not work if the facts don't back them up. Our news is constantly about rapes, arsons, murders, gang warfare and drug heists, and our video games and movies send the same messages.
We need to balance all this negativity with prettier images and experiences - the park, bike rides or family occassions where even the most pesky and wierd aunt is included. Above all, we need to keep the door of our home open to our children's friends, so we know who they are. That includes inconveniences like opening the refrigerator on a Sunday morning to find that the teenagers picked it clean in the wee hours of the morning and there is no milk left for coffee.
"Young plants need someone to help them grow," said Chauncey Gardner (Peter Sellars) in the endearing movie, 'Being There.'
(Of course, we have to pretend we are invisible while we do so, because our children claim they know it all by the time they are 10, and we are just fusty old bores who have spent our entire lives in the distant past with the dinosaurs).
All is not doom and gloom. In his 2003 State of the Union address to American citizens, President Bush spoke of an African doctor who told AIDS patients that he could not help them due to lack of funds: "In an age of miraculous medicines, no person should have to hear those words," he said.
The President helped focus the world's attention on the global AIDS epidemic in a very powerful way - as the leader of the wealthiest and most powerful nation in the world, he broke the silence on AIDS at the highest possible level. Atal Bahari Vajpai did the same at India's first Parliamentary Conference on HIV/AIDS: "Indian Premier Urges Major Push on AIDS" was a welcome headline in The New York Times on July 27th, 2003.
The Bill and Melinda Gates Foundation have pledged millions of dollars in grants to help countries around the world, including India, experiencing AIDS and other epidemics and their commitment is especially important because Bill Gates is the wealthiest man in the world - and hugely intelligent. He could just as easily spend all his time developing even more amazing computer software programs to amuse affluent children and business technologies that make the rich even richer. Instead he and his wife are choosing to focus on one of the gravest health threats mankind has ever faced. They know that help in this area is urgently needed and they are bringing their wealth to the cause of HIV/AIDS and other global epidemics like malaria and tubercolosis. Their contribution is invaluable to people living with HIV/AIDS.
Just as the closing lines of this website were being written, there was heartening news from the WTO (World Trade Organization) which has been barraged with criticism in the past over its rules governing international drug patent laws:
"Poor Nations Can Purchase Cheap Drugs Under Accord," jumped off the page of The New York Times on 9/31/03.
"Under the accord, poor countries will be able to import generic versions of expensive patented medicines, buying them from countries like India and Brazil without running afoul of trade laws protecting patent rights....'This will absolutely save millions of lives that would be lost without it,' said Faizel Ismail, South Africa's permanent representative at the World Trade Organization, in an interview from Geneva.'"
According to the editorial, the breakthrough came when the United States agreed to the original proposal it had rejected in December 2002:
"Backed by the the powerful American pharmaceutical lobby, the Bush administration had prevented the trade organization from adopting the measure, saying it should be restricted to a handful of diseases and limited to certain countries....This week the United States accepted the original proposal, but included the demand that such generic medications could be imported to cure any life-threatening disease, so long as it is a public health emergency: 'It proves once and for all that the organization can handle humanitarian as well as trade concerns,'" said Supachai Panitchpakdi, director general of the trade organization.
"The countries most affected by the agreement were in the forefront of the lobbying effort this week. India and Brazil, which manufacture cheap generic medicines, and South Africa and Kenya, nations that need them, pleaded with delegates late into the night..."
On September 22, 2003 a New York Times headline confirmed the need for urgency in getting ARVs more speedily to the infected: "W.H.O., Declaring Crisis, Plans a Big Push With AIDS Drugs." The editorial included the following information:
"Saying that the failure to deliver AIDS drugs to impoverished people is so grave that it has become a global health emergency, the World Health Organization plans to provide such drugs to three million people, most of them in sub-Saharan Africa, by the end of 2005."
"W.H.O. has long held a high reputation for the quality of its scientific experience in making recommendations that many countries, particularly those in the third world, follow closely to control diseases. But it had seldom been an action agency like the United States Centers for Disease Control and Prevention, until W.H.O. coordinated the response to the SARS epidemic and declared it a global health emergency. That experience taught W.H.O. the importance of acting quickly." (NY Times, 9/22/03)
The editorial continued: "Dr. Barry R. Bloom, the Dean of the Harvard School of Public Health, said that 'anytime health workers every Friday can analyze what went right ann what went wrong so they can improve performance, it will benefit not only HIV/AIDS but also improve health care for everyone. Addressing HIV/AIDS in resource-poor countries will be the defining issue for W.H.O. and its new leadership, Dr. Bloom said."
What remains to be seen is what will happen within India's own borders, because India may be resource poor but it manufactures AIDS medications in abundance and does not have to import them
Our modern medicines are miraculous inventions, and they need to reach those who need miracles the most. Time is running out for India's poor.
As for US involvement in India's and the world's HIV/AIDS pandemic: it is our firm belief at Ashraya-New York that despite economic woes and major international financial commitments, America's kindness, generosity and enormous heart will prevail. People living with HIV/AIDS around the globe will be able to count on America in the years ahead.
And that goes for those who cannot afford treatment in the United States as well. We will find you, be sure of that.
To commemorate the launch of "Friends of Action India/Aids Projects" in New York it is a great honor to interview Dr. Peter Piot, Executive Director, UNAIDS, and Assistant Secretary General of the UN, who recently visited "Ashraya" in New Delhi and addressed the first National Convention of Elected Representatives on HIV/AIDS in India on July 26, 2003.
The National Convention was opened by India's Prime Minister, Atal Bihari Vajpayee, who asked for "openness and complete absence of prejudice towards affected persons." Kofi Annan, Secretary General of the United Nations, addressed the New Delhi gathering via video message: "As elected representatives of the world's largest democracy, you can show leadership in many ways. By making laws, by passing budgets, by deciding policies," he said.
In his address to India's Parliamentary Convention on HIV/AIDS Dr. Peter Piot said: "Never before, in any nation in the world, has there been such a large and committed gathering of leaders from every level of decision-making, dedicated to the common cause of fighting HIV/AIDS." He gave a positive message:
"India already has the resources available to turn the epidemic back, because the most important resource is leadership."
For a the full report on India's Parliamentary Convention on HIV/AIDS and Dr. Piots visit to "Ashraya" see LINKS
For Nafisa Ali's (Chairperson of Action India) commentary on the McNeil/Lehrer Newshour on August 6th, 2003, see LINKS.
The content of the website "www.Ashraya-NY,org" has been compiled and written by Michele Leight, Director, Ashraya-New York. (See CONTACT US).
WITH SPECIAL THANKS TO:
Nafisa Ali Sodhi for her inspiration and her humanity, and thanks to all at Action India and Ashraya in New Delhi who help her and people in India living with HIV/AIDS.
Flyness69@aol.com for the design and implementation of the 'Ashraya-New York' website
Carter B. Horsley for his invaluable support, advice and vision of the World Wide Web as a connector and educator of people around the globe.
To Ashraya-NY's friends, representatives and consultants in New York and the United States - heartfelt thanks.