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Mainstream, VOL LI, No 24, June 1, 2013

Exposing Vested Interests Behind National AIDS Control Programme

Saturday 1 June 2013

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BOOK REVIEW

by Sujata Madhok

Breaking Ground—Journey into the Media ... and Out by Rami Chhabra; National Book Trust; pp. 469; Rs 305.

A ringside view of the circus that is New Delhi, its circles of power and privilege and the mega changes it has witnessed in recent decades, marks Rami Chhabra’s 500-odd page magnum opus. This is both an insider and an outsider’s recollection of the challenges of professional and public life in post-independence India.

As a journalist and feminist who become a development communications expert, then joined a family planning NGO, spent some years in government and moved on to international consultancies with UN organisations, the WHO and World Bank, Chhabra, in her retirement years, is ideally placed to tell us many insider’s tales.

A feisty woman who broke into the largely male profession of journalism in the 1950s, Chhabra spent several years establishing herself before she pushed for and was granted the privilege of writing a column of her own. The column, titled ‘A Feminist Viewpoint’, carved out space for women’s issues in the late 1970s when these concerns were barely beginning to be addressed in the international and national media. It was carried for three years in the Indian Express. Another column, ‘Woman About Town’, appeared regularly in The Statesman (then a leading national daily). Together these provide valuable documentation of the early years of the contemporary women’s movement in India.

A recap of the concerns of these years alone makes interesting reading as it reflects how far and yet how little Indian society has changed in its treatment of women. But Chhabra’s professional autobiography has much more on offer, ranging from vignettes of the suffocating Emergency years and the anti-Sikh riots of 1984 to a trip through post-war Vietnam, work visits to several small African nations, travel on a peace bus to Pakistan as well as later political battles on issues of public broadcasting policy, HIV/AIDS, prostitution, pornography, and women’s reservation in the legislatures. In fact the sheer size of the book and the range of issues it covers render it an interesting but unwieldy work.

From print journalism Chhabra made forays into the newly opening television media, anchoring and producing programmes for what was then All India Radio’s first TV station. Her interest in women’s issues led her to work with a family planning NGO and a deepening under-standing of survival issues such as female and child mortality, early marriage and its consequences, abortion, malnutrition, poverty and discrimination that affected the majority of Indian women.

Handpicked for the job of a development communications expert in the Ministry of Health and Family Planning by then Prime Minister Rajiv Gandhi, she brought a feminist perspective to the work. Her skills as a TV journalist came in handy, as did networking with bureaucrats and top professionals in the television, advertising and cultural worlds, enabling her to produce public interest TV spots that aired nightly on DD, carrying vital health messages which reached out to the entire country. Her work in these and later years brought her into contact with men like J.R.D. Tata, Narasimha Rao, Atal Behari Vajpayee, I.K. Gujral, K.R. Narayanan, Mani Shankar Aiyer, Sam Pitroda, Jairam Ramesh, Nikhil Chakravartty, demo-grapher Asok Mitra, Congress MP Satpaul Mittal, Dr M.S. Swaminathan, adman Gerson da Cunha, Alok Mukhopadhyay of VHAI, Dr Zafrullah Chowdhary of GSK in Bangladesh and many other public persons.

It was difficult for an outsider to work in the bureaucracy. Chhabra recounts both her successes and her struggles during this period including run-ins with politicians and other policy-makers. She recalls her opposition to Pitroda’s Child Immunisation Mission, as she argued for a more holistic safe motherhood and child survival continuum-of-care approach. “The grim consequences of diverting from, and thus distorting, the already weak health delivery system are now only too evident in the still marginally changed statistics of maternal and child mortality/morbidity as we complete the first decade of the 21st century,” she points out.

When her three-year contract expired Chhabra, relieved of a job that had already become a burden, moved on to consultancies with the World Bank, WHO and other bodies. Her early exposure to the HIV/AIDS issue during her travels to several African countries made her a vocal critic of the methods adopted by Western agencies. The latter half of this book is largely an insightful critique of the NACP and its fallout beyond the health sphere into the arena of social and cultural values.

Challenging the condom-centric approach she argued for promoting safer lifestyles, using the “age-old Asian cultural and social values: sexual abstinence for the young unmarried and a life-long monogamous relationship within marriage”. Such moral values are unpopular in a world dominated by Western culture and obsessed with individual sexual freedom at the expense of family and community. Predictably, given the huge funds at the disposal of the HIV/AIDS lobby, critics like Chhabra were soon sidelined. She herself opted out of working for the lucrative HIV/AIDS programmes mush-rooming in many countries and later strongly opposed the start of the National AIDS Control Programme (NACP) in India.

Tracing the history of the NACP she recalls how in the early 1990s the World Bank dangled before a cash-strapped Indian Government what was then a large sum of 84 million dollars to start the NACP. The author writes: “A financially discomfited government gasping for breathing space lapped up the offer without questioning. And so, the once-iron-backed finance bureau-cracy not only extended open arms to accept a huge debt for what was not a key national health priority in the country, it tamely accepted World Bank’s strict conditionalities to get it. These conditionalities were to bring into existence yet another silo in the health field.” Instead of improving basic health infrastructure the NACP meant “a colossal frittering of scarce resources on a very narrow agenda”.

The book provides an extremely detailed critique of the NACP in its several phases, citing various research studies and a CAG report on the many shortcomings and failures of this hugely funded programme. International experts too now question the falsified, hyped up figures of the incidence of HIV/AIDS in the country that have been used to siphon off huge funds. While it provides very vital insights, the average reader may find the technical evaluation too tedious to go through.

The author argues that half the initial donor loan for the NACP was used on communication, turning into a bonanza for sections of the media and also funding new NGOs that created a new thinking on sexual issues. Sex, she says, tumbled out of the closet and was turned into “a roaring legitimate engine of media-commerce” by a “commercially savvy neo-liberal media....very different from the mission-mode media post-independence India knew and which had bulwarked the nation’s intrinsic cultural values”.

Funding was also used to do research in red-light areas in the cities, beginning with Sonagachi in Kolkata. Over the years hundreds of international consultants have visited this small group of prostituted women, pimps and brothel keepers organised into a ‘collective’ trumpeted as “a powerful model of woman power”. Chhabra recalls an early visit to the area, with a big air-conditioned NGO office in the midst of squalid brothels occupied by “garishly painted, tuberculosis-thin, sad-eyed young women living in visible filth and squalor”. She argues passionately against the propping up of commercial sex by huge international grants. For instance, she says in 1977 Sonagachi, which houses 5000-7000 women, received over Rs 3 crores in funding at a time when the Social Welfare Department of West Bengal had no funds for rehabilitation of women in prostitution and the Women and Child Department of the Government of India had less than Rs 3 crores for the entire country! Most of these funds came from Britain’s Overseas Development Agency.

The book documents at length the writer’s prolonged decade-plus long battle to question the legitimisation of commercial sex and the false rhetoric of sex as work with workers who have labour rights. Chhabra regrets that the women’s movement itself has become divided on the issue. She also points to the successful Swedish model of criminalising demand for commercial sex while decriminalising the women who provide it, as the best way forward. Unfortunately India today continues to debate this issue, with powerful forces pushing for legitimisation of bar dancers, prostitutes and pornography, even as rape and sex trafficking grows apace.

Chhabra’s book throws light on another vital area: the erosion of public broadcasting and the entry of foreign media into India. She recalls, for instance, that the first uplinking of a satellite news channel was in 1992-93 from the residence garden of Prime Minister Narasimha Rao himself! She also recalls how there was internal sabotage from men like top bureaucrat Rathikant Basu who, flouting all rules, “kicked the government in its teeth, walked out to open the competitor’s shop (Star TV)... and clean got away”! She also recalls how a PIL and subsequent Supreme Court judgement (in a case where BCCI challenged Doordarshan’s attempt to restrain it from giving telecast rights over cricket matches to foreign bodies) was used to break the government monopoly of the air-waves. However, the Supreme Court’s advice for the setting up of a powerful regulatory authority to calibrate the invasion from the skies was ignored by the government of the day. Today, Chhabra realistically acknowledges, it may be too late to do so, as “the satellite media calls the shots and it is far too powerfully entrenched to be reined in by a weak govern-ment”.

The numerous issues raised in this voluminous work deserve serious attention by both policy makers and social activists in these extremely fractured times. We need to hear many more passionate challenging voices like that of Rami Chhabra as India goes through a new churning and rebuilds itself afresh in this millennium.

The reviewer, who is the President of the Delhi Union of Journalists (DUJ), is a senior journalist and activist.

Experts and activists, including over 100 field organisations, have written several times to the Prime Minister who also heads the National Aids Council—but with no acknowledgement, much less response. The authorities’ attention has been repeatedly drawn to the enormous problems with NACO, NACP-I and II, the increasing distortion of the Primary Health Systems and the social set-up through its narrow, verticalised and socially-insensitive vision. A review and reformatting of HIV/AIDs policies and strategies through the prism of a holistic-ethical and wholesome paradigm has been urged.

Low-risk lifestyles remain universally applauded and overwhelmingly followed in India as yet, although they are now facing breakdown by onslaughts from varied forces, including ill-conceived NACO-originating communication. (Chalo-condom ke sath!) Low-risk lifestyles need appreciation and reinforcement, not challenge.

A holistic-ethical and wholesome paradigm is the crying need of the hour. What does this entail? First and foremost, a reorientation of the policy-perspective: the primary focus being accorded to the general population; policies, programmes (allocations accordingly) that reinforce/reward traditional behaviour-values of abstinence for the young, monogamy /fidelity/committed-relationships of human-intimacy as continuing cherished norms of Indian society: the “social-vaccine”. Massive mass-media communication campaigns to reinforce this perspective—not to promote condoms. Pro-grammes devised to reduce and geared to monitor reduction in high-risk sex activity, not the numbers of condoms used, STDs treated. The media also needs persuasion from the highest levels to uphold these values as internalised social responsibility, or face the consequences of external regulation. All social/economic laws reviewed/refor-mulated/strengthened to ensure implementation of a socially-responsible paradigm. 

The “wholesome perspective” needs mainstrea-ming as the multi-sectoral responsibility of all sectors/ programmes. Holistic thinking requires HIV/AIDS care and treatment to be integrated into primary health systems, improving the same to ensure across-the-board functioning efficient services.Further, every sector/programme needs to be mandated to self-examine and identify every available opportunity within its purview to create circumstances/enabling environment that, first and foremost, rein-forces primary prevention measures, while addi-tionally creating effective linkages to secondary prevention.....

How we tackle HIV/AIDS is a metaphor of India’s soul and unique spirit and of her ability to show balanced pathways to a happier tomorrow in this globalised world. If external funds are available earmarked only for a narrowly conceptualised high-risk sex dominated paradigm this must be rejected. The National Aids Control Programme cannot be allowed to become a conduit for an extraordinary legitimisation of the sex and pornography industries under cover of warding off a dreaded disease! These are remedies worse than the malady they seek to cure—and the consequences of engineering such sociological shifts will be very far-flung. Therefore, this madness must be halted before it lumpenises vast sections of society. Is anyone listening?

[Excerpts from “National AIDS Control Programme- Phase II : A Socio-Political Disaster in the Making” by Rami Chhabra, Mainstream, Annual 2007]

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