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Getting AIDS Education on Track in India
In a Country Where the Topic Is Taboo, Government Delivers Message by Train

By Rama Lakshmi
Washington Post Foreign Service
Friday, December 7, 2007

ALWAR, India -- Seventeen-year-old Ravindri Chaudhury and some classmates lined up Sunday morning to board an unusual train called the Red Ribbon Express, which had pulled into their dusty town. Chaudhury had a lot of questions about AIDS but did not know whom to ask. So she hoped the colorfully painted train, with its traveling AIDS exhibition and counseling center, would give her some answers.

"Will I get AIDS from mosquito bites? From sharing a soda?" she asked, then whispered her next question shyly. "Will I get AIDS from kissing?" Her friends giggled, covering their mouths with their palms.

Chaudhury, an arts undergraduate, said that her parents often shoo her from the room when condom ads and AIDS announcements appear on television.

"We had a session on AIDS in school once, but it was sketchy. I still do not know the difference between HIV and AIDS. We could not ask any questions, because the boys in our class would tease us later," she said as her friends nodded in agreement. "At home, my mother knows even less, and my father would not allow such a conversation."

Chaudhury and her friends illustrate the daunting challenge of communicating AIDS information to young people in a society that regards discussion of the disease as taboo.

So the Indian government has launched the Red Ribbon Express, hoping to hold the line on growth of an HIV-positive population that now numbers about 2.5 million people, according to a recent U.N. report, one-third of them in the 15-24 age group.

About 80 percent of Indians ages 15 to 24 have heard of HIV and AIDS, the Health Ministry reports, but only 57 percent of them can correctly identify prevention methods.

Fifteen years after India began a national anti-AIDS program, officials say the Red Ribbon Express represents an admission that the general population remains woefully ignorant about the disease.

Some progress has been reported, however, among high-risk groups such as sex workers, truckers and intravenous drug users.

"We hope the train will carry the message to a wider population beyond the high-risk groups," said Sujata Rao, head of the government-run National AIDS Control Organization, which coordinates all prevention programs in India.

Last Saturday, on World AIDS Day, senior political leaders in New Delhi saw the train off on its first mission -- a 17,000-mile, year-long journey to deliver information on AIDS to about 60,000 villages.

Assisted by UNICEF, the train project aims to attract millions of people to 180 train station stops. Those in remote villages will be visited by a band of cyclists distributing pamphlets and by buses carrying folk entertainers and exhibits.

"The train will force people to face the issue head-on," Rao said. "There is still a lot of denial about AIDS in our society."

This year, protests erupted in several parts of the country over adolescent sex education manuals for schoolteachers. Critics said the flip charts in the manual contained explicit images of male and female reproductive systems, conception and contraception. They said the training program was irresponsible, encouraging sex in the guise of spreading AIDS awareness and promoting condom use.

Condom promotion has always been a difficult issue in India. AIDS officials tread cautiously by offering the ABC strategy -- "abstinence," "being faithful" and "condom use."

The government withdrew the teacher training program and ordered a review. Rao said a new manual that addresses "cultural sensitivities" will be out in January.

"You start talking about HIV, and it is the quickest way to lose an audience in India," said Ashok Alexander, director of Avahan, founded by the Bill & Melinda Gates Foundation. Avahan works with 6 million people from high-risk groups. "We pretend to be more moral than others, even though studies show the high prevalence of concurrent sexual relationships," Alexander said, speaking of Indian society in general. "We act as if our morality is an invisible condom."

The national AIDS organization has pledged the equivalent of almost $3 billion over the next five years for programs such as public education, blood safety, condom promotion and antiretroviral therapy.

On Day 2 of its journey, the train pulled into Alwar, about 85 miles south of New Delhi, where folk performers in colorful turbans sang about AIDS, calling it a "new danger in the country."

People pushed into the train to examine an array of interactive push-button exhibits, touch-screen information monitors and films. One rail car had been transformed into a counseling center, where visitors asked questions in curtained privacy.

Dhuli Chand, a 40-year-old mason, turned up on his bicycle out of curiosity.

"I heard there was a disease called AIDS only two years ago, when I bought a TV for my home. But I do not know anything else," said Chand, who left school after the 10th grade. He lives with his wife and son and says he has never used a condom.

After hearing the singers and spending an hour looking at the exhibits, he slipped into the counseling room and asked about causes, testing and treatment. He also got a demonstration of condom use.

After he disembarked, Chand pondered what he'd heard. "I think I will get myself tested soon," he said. "Just to be safe."

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