Volunteers stalk HIV ignorance on a trek around India

There's something timeless about the arrival of a street-theater group in the hustle-bustle bazaar of a small town like Palwal. The actors arrive, shouting, beating two-sided dholak drums, and donning kitschy costumes of golden tinsel.

A crowd naturally gathers. And then the actors pull a fast one. This is no mere entertainment. This is an educational program conducted by AIDS Walk for Life, a village to village tour by volunteers who are walking part - or all - of a more than 4,200-mile circuit around India. Their goal: to raise awareness about a disease that has already made India the country with the second-highest number of people living with HIV. The tour will conclude in Delhi Thursday, which is also World AIDS Day.

"In a country where so many people still know so little about the disease, the walk has been a dramatic and effective way to spread awareness," says Henry Alderfer of Project Concern International in India, the group sponsoring the walk.

To the surprise of the organizers, the vast majority of the walkers have been with the project from the get-go, walking mile after mile, bursting with energy each morning as they enter villages with banners and bullhorns, shouting, "Join hands together, defeat AIDS."

The walkers follow the national highway system - one of the key transmission routes for the virus. The highest concentrations of HIV cases are in the south and west of the country, in states where many working-age men travel abroad as laborers. From these states, the virus has spread along highways. Truckers and laborers pick it up from commercial sex workers, and take it to their wives, who sometimes pass it to their newborns.

"People to people, we have had a large effect," says Hemant Singh, a dance teacher from Delhi, who has been with the AIDS Walk from the start. "If you stay at home, you can't do anything about the problem."

Bharat Bhushan, logistics head from the state of Bihar, says the more powerful lessons come from teaching by example. In the state of Andhra Pradesh, they persuaded a family to welcome back an HIV positive family member. The family feared that HIV could be transmitted by touch, and worried also about the stigma of the disease. One AIDS walker solved this problem by hugging the person with HIV.

"They were afraid to touch his hands, to eat food with him," says Mr. Bhushan. "We said, 'See, I'm not infected and I'm doing this. You are their family members. When you discriminate against your own family member, then what will others do?' "

Efforts to raise awareness are just one of many ways that communities and agencies in India are meeting the challenge of the AIDS, an epidemic that has largely spread through unsafe sex, lack of hygiene, and illicit drug use. Yet there are recent signs that awareness programs like the AIDS Walk are some of the most effective methods for stopping the spread of AIDS and the HIV virus.

While the virus continues to spread in eastern Europe, Central and East Asia, and southern Africa - adding 5 million cases just this year worldwide - there have been noticeable declines in infection levels in Zimbabwe, Uganda, and Kenya, a fact that UN officials attribute to greater awareness and changes in behavior.

"In the two African countries [of Zimbabwe and Kenya] the declines in HIV rates have been due to changes in behavior," finds the AIDS Epidemic Update 2005 report, issued by the UNAIDS program. "In other words, HIV-prevention efforts are working."

Yet despite the encouraging news, UNAIDS director Peter Piot told reporters in New Delhi that the world needed to do much more, urgently. "The reality is that the AIDS epidemic continues to outstrip global and national efforts to contain it."

Here in India, AIDS is a problem that is still difficult to quantify. Unlike most nations of the developed world - and many nations of Africa - India does not test pregnant women during prenatal healthcare visits. Because of this, the Indian government counts only the most obvious cases of HIV, officially 5.13 million, leaving possibly hundreds of thousands, or even millions, uncounted.

What is certain is that AIDS is a growing problem in India, larger than more visible disasters like the Dec. 26 tsunami. (India's official tsunami death toll stands at 10,744). "The number of people affected [by HIV and AIDS in India] grew by over half a million last year," Dr. S.Y. Quraishi, former project director of the National AIDS Control Organization of India recently told reporters. "That's like having a tsunami every week."

Given the conservatism of some Indian villages, the AIDS walkers tailor their message to the crowd. At schools, they preach abstinence and the dangers of premarital sex. In markets, they are more explicit, talking about the dangers of unprotected sex, the danger of unclean syringes, the need for hygiene. They distribute condoms to any man who wants them. (Most do.)

Few women approach the marchers - who are all men - to hear such information, so the AIDS Walk reaches them in other ways, sending a mobile clinic to more remote villages, offering counseling and medical treatment, free of charge.

"If I go into a village speaking of sexually transmitted infections (STIs), people may not come because of the stigma, so we call it a health camp," says Dr. J. S. Ramchander Rao, the clinic doctor, who joined the walk from his home state of Andhra Pradesh. But even with such a random population, Dr. Rao says more than 50 percent of the cases he treats are either STIs or reproductive tract HIV infections.

Usha Rani, one of the two women accompanying the walkers by van, says she finds frightening levels of ignorance about HIV/AIDS. "In Rajasthan [a Western Indian state], people were asking us, 'What is AIDS? Is it a kind of food?'" says Ms. Rani.

Rani says she hopes she is giving women power at home by giving information. But she and nurse Apraise Joy also recognize that many Indian women live in male- dominated locales. "One woman came to our clinic and told us, privately, that her husband had given her an STI," says Ms. Joy. "Then her husband came to the clinic with his mother and started beating his wife."

In the Palwal market, the AIDS walkers are hamming it up. Their skits deal with men who visit brothels, and drug users. One skit follows a man, evidently in pain from a toothache, into the dentist's office.

"Doctor, my tooth hurts," says the man. The doctor looks inside the man's mouth, and pulls out a tooth. "Arghh, that was the wrong tooth," the man says.

The doctor pulls out a syringe - a massive plunger he has already used on several other patients - and the man cringes. "Is that for a buffalo or a man?"

At the end, an educator steps forward to give the moral. "AIDS doesn't spread only by sex, it also can spread through dirty needles at the doctor's office. Make sure that your doctor always uses a clean syringe."