Documentary Film Discussion "The Day My God Died": Child Sex Trafficking in Nepal

In Nepal, a small country in South Asia, hundreds of children are trafficked into work as sexual slaves each year. While nonprofits like Maiti Nepal have emerged to fight, prevent, and assist victims of sex trafficking, political, social, and economic circumstances in and around Nepal have created conditions where child slavery and trafficking persist.

A film that documents the personal, social and human rights abuses of child trafficking, "The Day My God Died" was recently screened at Harvard University (I found the video via the Geo Blog). A panel discussed the film following the screening and was hosted by the Carr Center for Human Rights Policy at the Harvard Kennedy School of Government.



Anuradha Koirala, Founder and Executive Director of Maiti Nepal, was among the panelists.

In attendance were academics, journalists, and anti-trafficking/slavery activists. One of my favorite questions was: "What do you think needs to happen in the Nepal, India and the US to change the social mindset so that...you can not buy another human being, that it will not be tolerated." The question was asked by a woman working to curb the commercial sex trade through reducing demand for commercial sex among men.

Koirala responded without hesitation: "Education. Education. Education. Awareness."

Watch this short video - or find a way to view the film. I'll be looking for an opportunity to see it, as well!

Since 2001 the US government has supported anti-trafficking programs in Nepal. For more information on the U.S. anti-trafficking policy in Asia read this November 2009 USAID Trafficking in Persons report.

Lead Poisoning - A true global health problem

Around the world children are dying from lead poisoning and many more suffering from the neurological and physical health problems associated with lead exposure. In one region of Nigeria, lead poisoning has caused an estimated 163 deaths, mostly among children.

CNN ran a lead story on the tragic developments this week, even though it seems that the problem was first recognized back in January. Lead is a toxin that can cause serious neurological problems and even death in young children, as well as adults. The most commonly cited consequences of lead poisoning in the US are learning disabilities and behavior problems.

I am mostly familiar with the problem of lead poisoning affecting children and families through inadequate housing that contains lead-based paint. However, in the Zamfara State of Nigeria, the region where these recent lead-related deaths are concentrated, the source of lead exposure appears to be the minerals brought home by workers from the mines.

Gates Pledges $1.5b for Maternal & Child Health

The Bill & Melinda Gates Foundation has pledged $1.5 billion over 5 years to improve systems that will reduce maternal and newborn deaths and illness in the developing world. The announcement came yesterday during the Women Deliver conference.

I heard the story first on NPR  - you can access their brief interview with Melinda Gates here. But this story peppers papers from the Wall Street Journal to USA Today and has now made headlines on Politico and the Kaiser Family Foundation websites. Melinda Gates wrote her own article, 'A New Vision for the Health of Women & Children' in the Huffington Post.

The Gates Foundation sees this clearly as an area that requires public-private partnerships. In other words, they recognize that in the case of maternal & child health private organizations and nonprofits cannot have meaningful, sustainable change without the support of local and national governments.

Improving consistent access to contraceptives to prevent unwanted pregnancy clearly appears to be a major focus of the Foundation's efforts.

This investment is great news for the field of maternal and child health -- and will hopefully raise these issues to greater prominence both here in the US and abroad. In addition to raising awareness, effective use of $1.5 billion ought to have considerable impact on the health of women and children - and I hope to see and read about these improvements.

Leisure Time in Bavaria -- Germany, that is.

Snow capped mountains and miles of farmland lined the streets and highways on my way through the Bavarian Alps last week. I was on a vacation with my family in southern Germany where we spent a few days in Stuttgart and a few more in Garmisch with family who have lived there for the past six years.

What struck me most during my days was not least the cold but that despite the cold if you walked anywhere you saw at least a dozen Germans walking outside, as well.

Political Will & The Fight Against Human Trafficking

The political will to combat trafficking and sexual exploitation could not be more different in Nicaragua and Costa Rica. As you may be aware, the US Department of State released its 2009 Trafficking in Persons Report where it demoted Nicaragua to the Tier 2 Watch List, a warning of sorts that Nicaragua is not doing enough to combat this problem. Costa Rica, on the other hand, remained ranked at Tier 2.

While I admit that I have not met the leader of the Nicaraguan National Coalition Against Trafficking in Persons in the Ministry of Government, I feel that I have a adequate perception of him through my various meetings with international organizations, local NGOs, and US state department affiliates. And to be frank, it was pretty clear that it would not be worth my time (...should I not have said that?).

There is a clear lack of government leadership in Nicaragua to prevent trafficking and assist victims, which is absolutely essential for any national effort to eliminate this 'modern day slavery'. There are no clear objectives for the Coalition, there is no action being taken by the government to address trafficking, and the NGOs and international organizations are left picking up the pieces and doing their best to work with (and around) the governments' inadequacies. (...here's a good article on this in El Nuevo Diario if you don't just want to take my word for it...)

On the other hand, while Costa Rica is by no means a perfect example of 'best practices' in the area of trafficking prevention and assistance they are light-years ahead of many other countries in the region. This is no doubt a result of substantial government efforts to prevent and combat trafficking in coordination with local, national, and international NGOs.

I met on Monday morning with the Costa Rican Viceminister of Internal Affairs and Police, Ana Durán, who also heads the National Coalition against Illegal Migration and Trafficking in Persons. She has a strong record of leadership and commitment to this issue, as evidenced by the high regard for her of local NGOs that work in this issue. It was clear from our conversation that her team is working hard to 'institutionalize' the improvements they have made, so that future administrations can easily continue the work that they are doing.

Training and education/awareness are essential tasks of the coalition (among others...). And it is clear that Lic. Durán takes the education and training of police and immigration forces seriously. She mentioned that one factor that may make the Costa Rican Coalition more effective other coalitions in the region is the orientation of the police within the same ministry as the anti-trafficking leadership. This means that there is one less beaurocratic/political hurdle in getting the police to take trafficking seriously. In Costa Rica, for example, all officers must be trained in best practices to investigate possible cases of trafficking and sexual exploitation in order to pass through the police academy. Nonetheless, she concedes that the police have a way to go and hopes one day of a police force specialized in trafficking cases.

There are so many other examples of the strengths and weaknesses of the two government approaches to trafficking. For example, Nicaragua still only recognizes trafficking of women and children for sexual exploitation in their Penal Code. Therefore, those trafficked into domestic servitude or children and men trafficked into forced labor are not protected under Nicaragua law. It was only in February 2009 that Costa Rica revised the Penal code to include pubnishment for labor trafficking, as well. However, there is still little protection or assistance for men who are identified as victims of human trafficking. Until 2005 they didn't even consider internal trafficking a crime!

While Nicaragua relies exclusively on NGOs to provide victim assitance and to lead prevention efforts, Costa Rica also relies heavily on the provision of serivces by local and international NGOs. The difficulty is in the provision of funding for these services which waxes and wanes. Currently, I would expect funding for trafficking to be flowing pretty freely. However, who is to tell when the international interest in this issue will decline? In fact, the NGOs that seemed to be most effective and growing were the ones receiving funding from the US State Department G/TIP office -- go figure!

These past three weeks have given me an incredible education on the politics and governance around trafficking issues. The strategies needed are complex and require extreme cooperation and collaboration between the civil and government sectors.

I am thankful that our current administration takes this topic so seriously. Especially as we hear more and more about trafficking and sexual exploitation taking place in cities all across the US. Hopefully we have an eye to the problem at home, as well as abroad.

Families and Sexual Exploitation

(This picture of 'family' demonstrates that the definition goes far beyond that of blood relatives at Casa Esperanza. This woman lives with and cares for these girls and have become family to one another.)

One thing that really struck me was the presence of families at House of Hope and of women I met on the streets. Any sociology class on Central America will teach that family is one of the most important, if not the most important cultural value.

There are two (nearly contradictory) ways in which I saw the role of family intersecting with the presence of sexual exploitation: 1) promotion of sexual exploitation, and 2) healing and restoration.

The Pain:

For the young girls I met at House of Hope, it was often neglect by mothers or outright insistence on entering sex work that brought the girls to live there. I say 'mothers' because fathers are a rarity here. Usually when the girls asked about my family I would tell them about my husband. Then they would ask if my parents were alive and then they would ask "And you have a dad, too?". It was a heartbreaking question.

Most of the girls mothers worked as prostitutes in the streets of Managua, so that lifestyle is all that they have grown up knowing. However, that doesn't mean that they wanted to start joining them on the streets at the age of 11 or 13. Some of the girls would run away in protest, but this could lead to physical abuse and violence from others (usually stepfathers or mothers' boyfriends) in their household.

For those who were abused in their own household, prositution became a legitimate source of income when they found themselves on their own and having to care for an infant by themself. For example, an 18 year-old living at House of Hope (she looked so much older to me...) not only cared for her 3 year old daughter, but also an 8 year old! ...sigh... It is almost no surprise that sex work becomes a way of life with so much pain and violation in one's past.

Even older brothers and sisters are at fault and have faciliated sexual exploitation of these women and girls. In one case a girl was sold to a trafficker/brothel for $7 US by her sister.

The stories of how family members violate the dignity and rights of these girls and young women are endless. Nonetheless, the stories out of House of Hope also reveal a healing and restoration that can happen when transformation takes place. The transformation is not limited to residents or those that attend the Tuesday meetings -- it can renew entire families.

Healing:

I think it would be impossible to do work with sex workers in Nicaragua and not address their families. Most who come to House of Hope have a child by the age of 14 or 15. I would expect that most sex workers have children early into their careers. Abortion is not an option for those that do get pregnant, or if it is it is a very dangerous one, because it is completely illegal and any one caught giving abortions will find themself "disappeared" quickly and quietly.

So in the midst of a history of abuse, pain, rejection, and violence...how does healing take place? At House of Hope it is by the power of the Holy Spirit and belief in and obedience to Jesus Christ that helps women be healed from past sufferings.

For one family, the mother was currently working on the streets and had two daughters. The oldest daughter also worked on the streets with her mother. The youngest did not want to follow that same path and had been (or was close to being...) a victim of sexual abuse. The mother began coming to House of Hope on Tuesdays and felt that the youngest daughter would be safer living there. Some time passed with the young girl at House of Hope and the mother and daughter coming on Tuesday mornings. Slowly transformation took hold and the mother decided to leave sex work. The eldest daughter went back to school and graduated. Both are now confident in their abilities to make a living in something other than prostitution. And the youngest daughter is on the path to graduate from high school as well!

(Women part of the Nueva Imagen Ministry in Managua)

At Nueva Imagen, another Christian ministry for women working on the streets of Managua, the transformation of the family by the grace of God was evident. Broken families are the norm among sex workers. However, women spoke there of how God was able to change their marriages and to heal that brokenness. Restoration took time, but it is possible. And their lives are a living testimony to that.

The Point:

Hope is a necessary part of this work. I was asked by a group of short-term mission leaders who were staying with me at the Quinta Primavera when I left House of Hope if I really saw possibility of prevention and elimination of sexual exploitation. How could I say, "No!"? While the challenges are great and overwhelming I saw and heard enough stories of hope and healing that I believe there is reason to believe we can and should help women who are victims of exploitation. Moreso, we must commit to do everything possible to prevent the spread of the "culture of exploitation" and to tackle the root of the problem.

Family.

House of Hope: Las Niñas

It is the ~25 kids at House of Hope that give it such life. Some of the children live in bodegas with their mom, while 9 girls live in the 'dormitory' with Brittany, a young American woman who took the position as dorm 'mom' just a few months ago.

The girls living in the dorm cooked me breakfast and dinner almost every day that I was staying with them (I ate whatever they were having that day). I was struck by how 'normal' the girls were when I first met them. They they joked, they did homework, they fought, and they made up, and they were excited to meet a new person -- me!

The dorm girls were aged 9-14, and with anyone that age you can expect a lot of cliques forming and in-fighting. Put a history of violence, abuse, and neglect on top of that and you can imagine how difficult it would be to parent and discipline these kids who have never had any structure in their lives. My heart goes out to Brittany and the overwhelming task she has courageously taken on.

April was open with me about the history of exploitation and abuse in the girls' lives. Many of the girls have been victimized in multiple ways - through neglect, sexual abuse, incest, forced prostitution, and physical abuse. Each has her own story wrought with pain and suffering and many have not communicated the full extent of their victimization to anyone at House of Hope, including April.

The emotional, mental, and physical health effects are clear when the stories are told. Besides the nightmares, depression, and aggression, at least one of the girls now suffers infertility caused by cervical cancer resulting from infection with a cancer-causing strain of HPV (surgery succesfully got rid of the cancer).

Sometimes the structure of House of Hope is too much for the girls. They run away.

The girls are able to see their families on the weekends. I saw one mom bring a lunch and have a picnic in the ranchón with one of the girls and their siblings. Some of the girls see their mom on Tuesdays after the card-making sessions and when school lets out. I think this is a great way to keep families intact; yet, I think it creates some challenges for the structure and discipline needed to help these girls develop the skills and behaviors necessary to rise above the pain of their past.

Some moms never visit, which results in yet another layer of rejection that must be acknowledged, grieved, and overcome by these girls.

What a priviledge to spend a week with these girls! I am glad that they have April, Brittany, and other volunteers investing in their lives and creating an environment of support and love. It is my hope that they will finish school, find their talent and passions, and pursue it in a career that brings them much satisfaction.

Is it too much to hope for?

House of Hope: Activities

A side note: I can't believe that I haven't had access to a computer for the last week...and I apologize that these posts are so delayed. I will add pictures to all my posts as soon as I can. I hope to write one post a day for the next week to catch you all up on what I have seen and heard while in Nicaragua.

I had an exciting week at House of Hope and learned a great deal about the work of this organization (see last week's post). They have many activities throughout the week ranging from bible studies and card making at House of Hope to outreach and small groups with women in the various barrios of Managua. Because I lived at House of Hope during my first week in Managua, in a bodega that is home to a missionary couple most of the year, I had a front-row view of the various aspects of the organization.

While the children attend the school nearby, the women at House of Hope clean and do various activities in the morning hours. On Tuesdays, they host a group of ~220 women for a bible study and card/jewelry-making. They bring in 4 buses and 1 truck full of women (young and old) who are former or current sex workers. Some of the women work on the street and others in brothels. These appear to be the two major environments for sex work in Managua. Tuesday mornings represent an opportunity to earn additional income by doing these crafts (the women get paid a certain amount per card or earring).

It was interesting to see how the women worked together. At some tables they had an assembly line going where one person stamped, another glued, and another cut out paper. This seemed to work well, but the interest of these groups was certainly speed -- quantity not quality. April Havlin, the founder and director of House of Hope, mentioned that the women began working together and stopped quarreling as much once they started praying together in their table groups. That's a great transformation!

A couple times a week there is an afternoon group meeting that discusses topics relevant to residents' lives as former victims of sexual exploitation and abuse (some of the girls living there were not involved directly in sex work, but had suffered sexual abuse). I was able to sit on one sexual abuse counseling session that happened in a large group the topic was honesty. April talked about how important it is to be honest with yourself and with others about the sufferings that took place in their past. The youngest girls (10-15) met together and then the older women with children met together to discuss the lesson and pray. The women were pretty open about the victimization that took place in their lives prior to coming to House of Hope -- but it was just the tip of the iceberg. Many of the women not only suffered sexual abuse, but are deeply scarred from the rejection and betrayal of parents or siblings. For some of them, it is the betrayal and rejection that is more of a present pain than the physical abuse.

On Friday, I joined Oscar and Vilma (the directors who work and live with the women at House of Hope) during their outreach and small group meetings. Each of the major communities where women come from on Tuesday morning for card making are represented with a 'cell group'. These cell groups were created in order to continue having a time of more personal contact with the women as the Tuesday morning meetings grew. We began in Ciudad Sandino and moved all around the city. The place that made the biggest impression on me was our visit to the Mercardo Oriental.

The Mercado Oriental is a notorious place of crime, violence, and prostitution. The people who live there are extremely poor. I saw many drug addicts (glue sniffing is the drug of choice there...I assume it is quite cheap). I heard the MO is the largest market in Central America. Everything -- everything -- is bought and sold there. In the heat of Managua there is an unforgettable stench of rotting tomatoes and cabbage and people swarm everywhere. I can only compare it to the Haymarket x1000. Not only did a large group of women gather for our cell group meeting, but Oscar and a former sex worker, Marlen, did some evangelism with women who were waiting for clients in a few of the brothel areas.

I was surprised by the look of 'sex work' in the Mercado. Two of the stops we made were to women who were just sitting, hanging out, in an alley way. There was what looked like a house in the back of the alley, and I assume that was where they went with clients. Some of the women were more 'dressed up' than others...but it was 11:00 in the morning!

Then we went to a real brothel. When we stepped up to the sala where the women were sitting the dueña (madame) moved into the restaurant/bar which was behind the sala. Oscar began talking and suddenly pop music came on loud overhead. The dueña had turned on music to make us leave. We stayed, Oscar and Marlen speaking loudly with some of the women who seemed most engaged and interested, and then we left. The whole time Vilma was holding her 2 year old daughter with me close by. I couldn't help but wonder what it will be like for little Emily as she grows up seeing so clearly the exploitation and sexual victimization of women all around her.

That was the jist of the activities that I saw. They also have some mentoring for the girls who are living in the dormitory by a really nice young Christian woman who has a heart for children and discipleship. April's son and his wife have started a children's ministry that works with vulnerable youth (including the children of sex workers) that is attended by women who come on Tuesday mornings and to the cell groups, as well as the residents of House of Hope.

A medical team came last week to provide some assistance to the women and children who are at House of Hope. These short-term teams are seen as an integral part of helping House of Hope carry out its mission.

More on other thoughts about House of Hope tomorrow!!

Managua: House of Hope - An Introduction

I arrived on Sunday to House of Hope. A residential and day program for victims of sexual exploitation and a place of spiritual healing for women desiring to leave prostitution. Already I have thrown out a lot of words that carry loaded meaning. For example, who are ¨victims of sexual exploitation¨? And does my use of the word ¨prostitution¨ carry a value judgement?

Well, I use prostitution because this is the word and the approach of HoH. It is a Christian organization that operates under the strong conviction that true healing from the abuse of women´s pasts can only happen with God´s grace and strength through spiritual renewal. Prostitution for them is a life that is not desired by God under any circumstance and for this they hope that any women who desire a change in their lives will turn towards Jesus Christ for healing and for a better way to make a living.

I use sexual exploitation because some of the girls (as well as many of the former prostitutes) living at HoH may not have been prostitutes, but are victims of sexual abuse or incest. Sexual exploitation refers to the force or coercion of women and girls to engage in sexual activity that is not within their will. For anyone under age 14, almost all sexual activity is beyond their will -- particularly when it includes much older men.

While one post is not enough to describe all of HoH´s work and more will be forthcoming in future posts (and with pictures!) I hope to provide an adequate account of the time spent there and the stories of the women that I met during the next few days.

There are currently about 10 women and their young children living at HoH and 9 girls in the residential program whose mothers live elsewhere. Some of the girls were victims of trafficking and others are children of women who are currently working in prostitution and do not want to care for them in those circumstances.

Two incredible Nicaraguans - Oscar and Vilma - also live at HoH with their family (a boy and two girls - one 17 and one 2). They are at HoH nearly 24-7 and care deeply for the women there. They also conduct weekly small group sessions with about 6 groups of current and former prostitutes throughout the city (there will be more on this later...). Additionally, there is a young American lady living there as a dorm mom who takes care of the girls who are in the residential program. They make breakfast and lunch together each day, paint eachother´s nails and go on walks together. It is a taxing job -- and it is one that requires substantial courage and grace.

For me -- I stayed in the house of two missionaries who are currently on vacation. I have my own bathroom and share the couple rooms with some ants, mosquitos, flying things, and beetles. So far I have managed to keep the flies out.

Now for the health aspect of my initial introduction to HoH. Health is not the focus of HoH activities but it is woven into their life in unavoidable ways and even into their devotions! One day Vilma spoke to the women about the dangers of drinking soda and eating fatty foods! She used biblical and spiritual reasons -- but all the same, it was public health. Also, the kids have to show that their hands are clean before eating their meals. All hands are checked at the door. This was to help stop the spread of germs. Still -- the families don't really seem to understand germs and how they are spread very well and they often share cups and pick food off of the ground.

I can't wait to write more about my experience going to the cell groups and visiting the brothels yesterday. Stay tuned!

Series on Sex Trafficking in Central America

Many of you know that most of my latest research has been in the area of victimization and sexual health of victims of sex trafficking across the globe. I have the privilege of working with brilliant team of researchers at the Harvard School of Public Health that have started this work in Indian (Mumbai) and have expanded to include projects in Southeast Asia and now, Latin America.

On Sunday I leave for a 3.5 week trip to Central America to meet with several non-governmental and government organizations that are providing counseling services, medical care, or housing to victims of sex trafficking or trying to prevent this awful practice through social marketing campaigns or policymaking.

The majority of my time will be spent in Managua, Nicaragua. Arguably the poorest country in Central America and a source country for many trafficking victims. Then I will travel to San Jose, Costa Rica. I expect there to be quite a contrast in terms of resources, services, and trafficking awareness in the two countries.

I will be returning June 30th.

Stay tuned for my posts from the field. I will try and update you as to my whereabouts and observations as I travel. (Subscribe to the RSS feed or become a 'follower' to get my latest posts).

Outrage Over Afghan Law

A law pending in Afghanistan appears to limit women's rights by actually legalizing marital rape and leaving the house without a male's permission was illegal. The wording is what struck me most, that it is the right of the man to have sex with his wife every fourth night (shown on CNN tonight). The idea of sexual and reproductive rights is one that warrants strong consideration. For example, the 1995 Beijing Conference (cited here) produced a Platform for Action stating

[t]the human rights of women include their right to have control over and decide freely and responsibly on matters related to their sexuality, including sexual and reproductive health, free of coercion, discrimination, and violence.

International human rights language makes clear that a woman has the right to decide when and how to use her body, not a man and not a relative. Furthermore,  it acknowledges "shared responsibility for sexual behaviors and its consequences." 

The Afghan law makes explicit that the desire of a husband to have sex trumps the rights of a wife to not want to have sex, this has enormous implications for legitimizing trauma and sexual violence (yes -- rape does happen within marriage -- no always means no), as well as has long term implications for family planning.

This case illustrates the enormous variability in conceptualization of sexual and reproductive rights and decision-making in different contexts. An essay on intimate partner violence (IPV) from the Peaceful Families Project highlights that in Muslim culture 'marital rape' is considered a contradiction in terms.  And while this Afghan law aims to politically legitimize the practice, it is important to note that many women and girls experience sexual violence and will continue to regardless of this legislation. It will take a social movement to eliminate these horrid practices. Much like the women's movement in the US served to overturn laws in US states that  exempted spousal rape as a crime until the 1970s.

More must be done to empower girls and to oppose those who impose barriers. Obama and other international actors have spoken out against this legislation that comes with the signature of our Afghan ally (he signed it at the end of last month). The result of this international pressure is yet to be decided.

Gender-based Violence in Darfur - New Website

Physicians for Human Rights recently announced the launch of a new website, DarfuriWomen.org. The website will be used to share stories and images of Darfuri refugee women and discuss how their lives have been affected by violence. 

Life in the camps has been anything but easy. The website's homepage describes how in June 2008 seven women in the Farchana camp were publicly tied-up, beaten, whipped, and humiliated after being accused of engaging in sex outside of marriage. A video entitled "Life in the Camps" can be found here. Check out this website. 

If you are interested in learning more about the violence in Darfur visit the Save Darfur website.

Mobile Phones for Health Surveillance

An article in the Yale Journal of Public Health recently reported on the use of mobile technology to improve public health surveillance activities. Advances in technology are not always quick to be adopted in public health, though the computer and Internet have exponentially increased the efficiency and productivity of information management and risk communication. How else could one so quickly be informed about a SARS outbreak or the current state of Avian flu?

My husband, after returning from a 2-week trip to Kenya, told me stories about the widespread use of mobile phones, even in the most rural and poor regions of the country. He noted that he never saw them actually talking on the phone, it was a device used for text messaging. "Minutes" are just too expensive.

Given the penetration of mobile technology - how might cell phones be used solve pressing public health issues? This article describes two CDC activities; one aimed at using PDAs to collect surveillance information for its "Household Morbidity Surveillance Survey" in Kibera, the other is to use text messaging to improve inter-governmental communication about disease outbreaks. 

There is certainly an irony on the use of PDAs to collect information from some of the poorest people in the world. However, if it is able to collect better data, more quickly, and to improve the delivery of health services and prevention information I am in full support! 

How else might mobile phones be used to collect or communicate health information?

If interested, check out the following websites

• Texting4Health - A conference held at Stanford University, February 2008
• MobileActive.org - Blogs, information, and a directory for activists using mobile technology worldwide

AIDS Sutra: Untold Stories from India

When you see the word AIDS what comes to mind?

Africa? Disease? Death?

Sex? Drugs? Prostitution?

Mothers? Orphans?

Treatment?

We know so much more today about the etiology of HIV/AIDS than when the epidemic began in the early 1980s. In some parts of the world, the stigma of having AIDS or being HIV positive has begun to weaken. We now have effective (albeit expensive and complex) treatment for the disease, more people are more aware of how the disease is spread, and today we know that if certain conditions are met women who are HIV+ can even give birth to babies unaffected by HIV/AIDS. In this day, in this place, one need not equate AIDS with death.

In India 2.5-3 million people are infected with HIV/AIDS. India has the 3rd largest number of HIV+ people in the world, behind sub-Saharan Africa, and the spread of HIV among women is increasing. (click here for more facts -- published 2006)

In many other countries, however, there is still great denial about just how widespread are the effects of AIDS. The Bill & Melinda Gates Foundation's Avahan India AIDS Initiative just released a book entitled "AIDS Sutra: Untold Stories from India". It is a collection of essays that brilliantly portrays the lives of people dealing with AIDS and facing its stigma in India. The stories uncover the brutallity and fear that come with social margnizalization, violation of privacy, and discrimination. 

Two authors, Nikita Lalwani and Sonia Faleiro, and an editor from Avahan visited the Harvard School of Public Health today to discuss the book. It was a fantastic event, with about 30 people in attendance. The stories told by the authors were heart wrenching.

Many Harvard affiliates, such as Jay Silverman and Felton Earls, are committed to preventing the spread of HIV/AIDS as well as serving populations who already have the disease. Though, I want to note that the work of my colleagues really seeks to inform the broader picture of how poverty, gender relations, family violence, and sex trafficking perpetuate the spread of HIV/AIDS beyond what service provision in "high risk" communities can provide. It is fascinating work and its implications are great, as the stories "AIDS Sutra" tell. Not only will understanding AIDS in India help those who are currently suffering, but it will provide a basis for future prevention efforts and cultural change that can halt the epidemic, save lives, and restore hope.