In the Sonagachi red-light district, where thousands of women sell their bodies along narrow, thronged lanes, it is the prostitutes themselves who have become the leading crusaders against AIDS.
Like missionaries spreading the gospel, scores go forth each morning from brothel to brothel, preaching to madams, pimps and other prostitutes about the importance of using condoms, the most effective shield against H.I.V. infection.
And they have done much more than talk. These women, despised outcasts in Indian society, have organized more than half the prostitutes of Sonagachi into a force with the influence to challenge any pimp or madam who would insist on a customer's right to sex without a condom. They call themselves a committee, but operate as a kind of labor union for the world's oldest profession.
Later this year, the Indian Government will use the Sonagachi project as its model in a large-scale battle against AIDS, waged from red-light district to red-light district, across the vastness of this country of almost a billion people.
The hope is that if India acts swiftly, while the overall infection rate is still relatively low, at less than 1 percent of the total adult population, it can avoid the horrific burden of death that afflicts Africa. Even now, because of its immense population, India already has four million people estimated to be infected with the virus.
In a line of work that spawns cut-throat competition among desperately poor women, and that regularly prompts prostitutes to risk death by H.I.V. infection for 50 cents per sex act, the Sonagachi project has knit them together to fight for their rights and their lives.
Condom use in Sonagachi has soared, from 3 percent in 1992, when the project began, to 90 percent in 1998. Researchers who have conducted random sample surveys in Sonagachi have also found that H.I.V. infection rates among prostitutes here have been held to 5 percent, a fraction of the more than 50 percent of prostitutes infected in Bombay.
Slowing the rate of infection among prostitutes and their customers is essential to protecting the general population, epidemiologists say. The truck drivers and migrant workers who go to prostitutes are the same people who are carrying the disease back to wives and lovers in villages all over the country.
These days, when 30-year-old Pushpa Das, a prostitute in Sonagachi, is confronted by a man who refuses to diminish his pleasure by wearing a condom, she tells him to go away and knows her madam will back her up. "Sometimes I have to lose a customer, but I don't want to get H.I.V.," Mrs. Das said evenly. "I just return the money."
Mrs. Das cannot afford to die. Her husband is out of work. Her $50 a month earnings keep hunger at bay for her 11-year-old daughter, Asha, and her extended family. Before she became a prostitute, she had been making $10 a month as a maid and her family was down to one meal a day.
The Sonagachi project pays 180 prostitutes about $1 a day each to spread the word about AIDS and condoms. The British Government, long the colonial power in India, pays for the project and is one of the largest foreign aid donors supporting health programs here. This year the Indian Government, with about $50 million in financial backing from the World Bank, will begin using nonprofit groups and Government agencies in a nationwide effort to mobilize prostitutes against the disease. The project in Sonagachi costs only about $210,000 a year.
"The experience from other parts of the world and from Sonagachi suggests that such efforts are the single most important thing that can be done to try to control the epidemic," said Prabat Jha, an epidemiologist at the World Bank who is team leader for its AIDS project in India.
Taking Action, Then Expanding
One recent morning a group of prostitutes sat on the balcony of their brothel overlooking a vibrant, clogged lane in Sonagachi. It was too early for customers, so the women's faces were free of any makeup. Over the jangling of hand-pulled carriages and the cries of hawkers selling papayas, they spoke of the poverty that had driven them into the sex trade.
Milan Sarkar, a 21-year-old in a loose orange shift, was married at 15 and abandoned by her husband at 16, with an infant son, Anoop, to raise. There is no government safety net here, so a year ago she went to Sonagachi. Her income now supports her parents, two siblings and her 5-year-old son. Ms. Sarkar shields Anoop from the knowledge of how she makes a living, telling him only that she has to go to work while he stays with his grandparents.
Ms. Sarkar said she refuses to have sex without a condom, but some drunken men force themselves on her, while others tear the condoms with their nails so they will peel off during sex.
"I'm very frightened about AIDS," she said. "My son and my whole family depend on me. My father is old and won't be able to continue working. I have to live here for them. And it is a terrible pressure."
The prostitutes who work in the project have used a combination of sweet talk and occasional arm-twisting to persuade madams about condom usage. Delegations of prostitutes, wearing distinctive green medical jackets over their saris, visit madams and tell them, "If you are to enjoy the fruits of the tree, you must keep the tree healthy."
Gita Das, a 50-year-old madam, manages five prostitutes who commute to Sonagachi daily to work in two small, dingy rooms. Mrs. Das, who wears a bindi, the red dot on a woman's forehead that signifies her status as a married woman, inherited the role of madam from her mother-in-law 25 years ago.
She has become a convert to condoms out of her own self-interest. "I argue with the customers, 'You should use condoms,' " she said. "If they refuse I send them away. If the girls use condoms and stay healthy, that helps keep them loyal to me."
Not every expert is sure the Sonagachi approach will work outside the state of West Bengal. Calcutta, its capital, has India's strongest tradition of labor unionism, an inspiration for the Sonagachi project. In contrast, Bombay, the epicenter of the epidemic, has a brutal and powerful mafia that runs the sex trade. Gangsters are likely to resist efforts to organize prostitutes.
Nonetheless, even the skeptics agree that India must act. "If you don't try to take these efforts to scale, you'll have little wonderful corners, but you won't address the big issues that India poses by its sheer size," said Gordon Alexander, who heads the United Nations AIDS program in India.
This nation is only now awakening to the dangers the epidemic poses. Last month, for the first time, an Indian Prime Minister spoke publicly and at length about the disease. Prime Minister Atal Behari Vajpayee declared H.I.V. and AIDS to be the country's most serious public health challenge.
"When H.I.V. appeared in India in 1986, everybody thought that it is a Western disease that will be contracted only by sex workers in red-light areas, gay men and injecting drug users," Mr. Vajpayee said. "The consequences of that myopic view are now upon us."
The first prostitutes who ventured into Sonagachi and other red-light districts in Calcutta to talk about the prevention of AIDS were chased off with brooms, drenched with buckets of water and spat on. Prostitutes and madams feared that an insistence on condoms would drive customers away.
Sadhana Mukherjee, 40, remembers hoodlums threatening to strip her naked, beat her up and throw her out of the red-light district unless she stopped proselytizing for condoms. But she and her supervisor politely explained their strategy: If the district became known for AIDS, that would really drive customers away. They were not trying to destroy the sex trade, only to insure the health of prostitutes.
Like many of the other prostitutes working in the project, Ms. Mukherjee keenly felt the sting of society's contempt, but she was proud that she had survived by her wits.
When she was 12 her family was duped into giving her up to a woman who promised to find her work in a plastics factory in Calcutta. Instead, Ms. Mukherjee said, the woman sold her to a brothel for $10.
"I was beaten on the cheeks, tugged by my hair, forced to drink alcohol, strangled so I couldn't swallow for two weeks," she said. "The rage I felt about being tortured so mercilessly has burned within me from the first day."
It is those memories of her first terrible years in the sex trade that have made her a passionate and untiring worker for the rights of prostitutes in Sonagachi.
And the respect with which she and the other prostitutes have been treated in the project has strengthened their bond. They all speak with affection of Smarajit Jana, the slight, mustachioed epidemiologist who was assigned to run the Sonagachi project by the nation's All India Institute of Hygiene and Public Health, part of the Indian Government's Ministry of Health.
"He's like a father and a mother to us," said Minu Adhikari, one of the first prostitutes hired by the project. "We were stigmatized by everyone around us. He showered us with love and affection."
Dr. Jana said he quickly realized that reaching the prostitutes would require much more than a narrow focus on AIDS. In his first week on the job, the courteous but rather formal researcher visited a brothel. He was introduced, he said, as "the big doctor from the big hospital," and found the prostitutes reluctant to talk.
But by the third day, they began asking him for medical advice. To his astonishment, the first nine women wanted help with infertility problems, common among prostitutes who have had repeated bouts of sexually transmitted diseases.
"That opened my eyes," he said. "They're like any other women. They want a child. They have the same heart, the same minds and feelings."
Organizing To Make Changes
The health clinic that opened in Sonagachi to treat syphilis and gonorrhea wound up treating women and children. It was the first time most prostitutes had an alternative to quack doctors who practice in the red-light district.
Just a year and a half after the project began, the percentage of prostitutes who said they used condoms had risen from almost nothing to 70 percent.
Something less tangible had also begun to happen. The prostitutes hired by the project were turning into a force to be reckoned with in the power structure of the red-light district -- a place where madams, pimps, hoodlums, money lenders and quacks once reigned supreme.
The literate prostitutes in the project began teaching the others to read in makeshift daily classes held on plastic sheeting spread on the bare ground in the clinic's courtyard -- classes that continue even now.
By 1994 they began demanding things that went way beyond the project's mandate. They wanted police protection from hoodlums. They wanted police raids to stop and a place to borrow money at fair rates.
Dr. Jana said he also realized that the prostitutes needed more than information and condoms to prevent the spread of H.I.V.
"They must enforce condom use by the clients, for which they need skill, confidence and power," he said.
With his encouragement, the prostitutes organized the Women's Collaborative Committee in 1995. The committee now has about 30,000 members in West Bengal, each paying dues of about 50 cents a year.
They have since formed their own financial cooperative to escape the clutches of money lenders who charge interest rates of at least 1,000 percent a year. To do so, committee members persuade the state government to dissolve a requirement that members of a cooperative have legal standing as people of "good moral character."
Hundreds of prostitutes have repeatedly encircled police stations to demand action against criminals. In one case, men who had tortured two prostitutes with blades and cigarette butts had gone unpunished. After the prostitutes held their noisy protest, the police arrested the men and beat them up, the gratified prostitutes said.
The women have also intervened to rescue child prostitutes sold or duped into the trade. The committee members' motives are altruistic yet self-interested. The under-age girls are tough competition in a market that prizes youth, and they also attract police raids that disrupt business.
In 1997, on a routine visit to a brothel, Ms. Adhikari, one of the prostitutes working in the project, said she discovered a 13-year-old girl from Bangladesh who had been sold to a madam. Ms. Adhikari said she simply walked out with the girl and the committee later returned her to her family.
"The committee explains to the madam that this is not done," Ms. Adhikari said. "She doesn't have the muscle to fight us. We're too big for her. She can't go to the police. And now that we're so organized, she can't go to the hoodlums either."
The percentage of prostitutes 19 or younger in Sonagachi dropped from about 1 in 5 in 1995 to about 1 in 30 in 1998, according to project surveys.
Taking a Message To Ground Zero
In recent years the project has expanded beyond the confines of Sonagachi, home to about 6,000 prostitutes, into other red-light districts in Calcutta and nearby areas, where about 21,000 prostitutes work. It employs 180 prostitutes and 100 other workers and operates 12 health clinics.
The Government's All India Institute of Hygiene and Public Health runs the project in collaboration with three nonprofit groups and the prostitutes' committee.
They have managed to do the work at low cost. The main office is a windowless basement. The project has cut back on distribution of free condoms and sells many of them through the cooperative at bulk rates. The staff is paid very little by Western standards. Medicines in India are inexpensive.
Bharati Dey, a 38-year-old prostitute, joined the project in 1997 to work in Talpukur, a red-light district in a northern suburb. She recently visited a defiant madam who refused to require customers visiting her brothel to wear a condom.
Ms. Dey said she took the nine prostitutes in the brothel aside and suggested they disappear for a few days. "Less than an hour after they left, the madam gave in," Ms. Dey said. "But they did not return for three days."
It was a message of strength that quickly spread to other madams.
Dr. Jana and the prostitutes who work in the Sonagachi project will soon become missionaries far beyond the confines of Calcutta. Dr. Jana, 45, will leave his post in Sonagachi and plans to advise the Indian Government in its efforts to expand the model nationwide.
J. V. R. Prasada Rao, director of India's National AIDS Control Organization, said he would tap the expertise of the prostitutes and of Dr. Jana. "We're going to take the Sonagachi girls to Bombay and ask them to talk to the madams and sex workers," he said.
Bombay is ground zero for AIDS in India. Almost half the people infected with the H.I.V. virus live in the state of Maharastra and its capital, Bombay. And rates of H.I.V. infection among prostitutes in its sprawling sex industry are already very high.
The prostitutes in Bombay are powerless against the gangsters who run the trade. There are several small programs there that employ prostitutes to spread the word about condoms and that provide prostitutes with health care, and they have had success with the women they have reached, but none of them have attempted to organize the women.
The difference in the moods of the red-light districts of Calcutta and Bombay can be sensed immediately. In Calcutta, many prostitutes talk openly in front of their madams. In Bombay, the speak quietly, glancing furtively over their shoulders to make sure no one hears.
In Calcutta, many of the prostitutes wear decorous saris in muted colors and look a lot like office workers waiting impassively at a bus stop.
In Bombay, they are tarted up in shiny red lip gloss, midriff-bearing halters, skin-tight velvet pants and gaudy saris. They pose aggressively and their faces are set in a sulky come-on. They stand in the lurid light of Falkland Road like Broadway actresses on a gritty stage, inviting death to come knocking.