‘AIDS has exited our consciousness. But it’s here’

Rupa (32) was diagnosed with AIDS at the age of 22 and gets her treatment at no cost, from the AIDS Health Foundation (AHF) at Kalamboli. Pic/Aishwarya Deodhar

The first time we saw Rupa, who requests that we identify her by her first name only, she is dressed in a bright green saree with gold trimmings. She has matched it with gold-green jhumkas, and stands with her back turned to us. We tap her on the shoulder, and she spins, furrowed brows sitting above a pair of bright hazel eyes. "Namaste," she says, "what exactly do you want to know?"

We have interrupted her during her chat with the staff at the AIDS Healthcare Foundation (AHF) personnel in Kalamboli, Navi Mumbai. She is answering their questions about her weight, whether she had a fever since her last visit, has she stuck to safe sex, and does she have medicine in stock. It was nine years ago that the trans woman, now 32, was diagnosed with HIV.

"I had been unwell for a couple of years, in and out of the general physician's clinic. I was a commercial sex worker at the time and one doctor told me to get tested," says the Bihar native. "AIDS is very common in the Kinner community," she says of her transgender brethren. "Many of us get into commercial sex work early because we know nothing else to survive."

Dr V Sam Prasad, country program manager for AIDS Healthcare Foundation

The Panvel resident knew it was too late for her, but she is doing her bit to educate young trans persons about the use of condoms "We talk about condom negotiation and how to cajole customers to use one. Most of these kids are under 18 and have been in the trade since they were thrown out of their homes or are runaways."

Rupa exited commercial sex work after the diagnosis, and has followed safe sex and the single partner rule since. "I usually roam the Kalamboli highway signal to collect money. And I am faithful to my partner; I am happy," she says excusing herself; she must head to the local shop owner who will convert her coin collection from the previous night to notes.

Second from left, counselor Dhanushri Deodhar, Sister Jancy Joseph from sisers for the Destitute and Dr Divya Mithel with the centre's staff. Pic/Aishwarya Deodhar

AHF has a head office in Delhi, while the Kalamboli centre operates from a space provided by the Sisters of the Destitute, a Syro-Malabar Catholic women's religious institute. Its chief medical officer Dr Divya Mithel has been working with the women of this centre since its inception in 1991, when the area was nothing more than a truck stop and a den to acquire drugs and paid sex. Dr Mithel says that the centre was initially run with government aid but in 2013, funding was stopped and the AHF stepped in. "With every passing year, the age of those getting tested and seeking treatment is dropping. We now see a lot of young people, five to 18 years old. A large chunk of these belong to the queer community and identify as gay."

Worryingly, this comes at a time when the Bombay High Court said that India must consider lowering the age of consent for sex because after the enactment of the Protection of Children from Sexual Offences (POCSO) Act, 2012, adolescents were being prosecuted for consensual relationships with minor girls.

Mihir Maher and Bismaya Kumar Raulo

In 2015, a survey conducted by online healthcare portal MediAngels.com found that among the 15,000 teenagers in six major metros, the first sexual contact for boys was at the age 13.72 years, and for girls at 14.09 years.

This is particularly rampant in the queer community. Dr V Sam Prasad, country programme manager for AHF, explains, "While the decriminalisation of Section 377 in 2018 came as a big relief to the LGBTQiA community, it meant that you could not be jailed for having sex with a person of the same gender. The community would now gather without fear. Under-age queer persons and in particular, Men who have Sex with Men (MSM) and bisexual persons also began to attend these celebratory events and gatherings with fake identity." AHF staff say that a spike in HIV cases in the queer community is being reported in centres in both Mumbai and Delhi. "Symptoms begin to show typically six months after unprotected, indiscriminate sex. The minors then used the same fake identity cards to visit our centres. We ensure that they are tested, counselled and handed medication. If we insist that they come with a guardian, they will never return. Our experience has also revealed that they are using social media to connect with adult men from the community. There is no way to verify age online; you are as old as you say you are."

A major deterrent for minors to get tested and opt for antiretroviral therapy (ART) which suppresses the HIV+ virus and prevents it from thriving is the need for them to be accompanied by an adult. This, believes Prasad, is a big reason why medical help isn't being sought. "The stigma of being an HIV+ infected person coupled with the shame of being queer makes matters worse."

AHF has tied up with Impulse, a volunteer-based organisation that works with members of the queer community on HIV and Sexually Transmitted Infections (STI), drug prevention and mental health, to host awareness and communal events. Mihir Maher, president, Impulse Mumbai, says that no minors are allowed here. "We only connect with them online. In metros like Mumbai, we see that underage persons have easy access to information and multiple dating apps. Simply entering on inaccurate birth year allows you to use Grindr, Bumble and Tinder. Many users are minors who do not know enough about safe sexual practices and end up with HIV and STI."

According to the Mumbai District Aids Control (MDACS), Mumbai has registered 1,616 HIV+ cases. Of these, approximately 50 are under 18, says an official. The total number of positive cases stood at 1,245 last year and was 1,158 for 2020-21.

Bismaya Kumar Raulo, Impulse India program manager, has been living with HIV since a few years ago. They are particular, he says, about screening minors at their events that are held three times a week across Mumbai and Delhi. "We must stop encouraging condom negotiation with those who are not in commercial sex work. The queer community must go with the no-condom-no-sex rule," says Raulo over the phone from Delhi. "One Saturday, we decided to place an HIV testing booth at one of our events in Delhi.

Of the 96 visitors who got tested that day, 12.5 per cent were HIV reactive. We cannot deny that the community is in fact, at serious risk." An HIV reactive result could be a sign of an HIV infection, but it's not the same as a positive result. "We are trying to work with members of the queer community who tend refuse to seek help from an NGO or government organisation because of the stigma of being called out as MSM and HIV infected."

At the Kalamboli centre, counsellor Dhanashri Salunke is talking to a young man who tested HIV+ the previous day. He is accompanied by a friend who whispers to him, "Everything will be alright." When we ask the friend where they are from, "Gujarat," he says.

The centre gets a large number of patients from Bihar, Rajasthan and Gujarat. "They don't want to go to centres in their villages since they fear being outed as both, gay and infected. AIDS may not be the looming monster it was in our minds some time ago, but it's very much here," says Salunke.