MUMBAI, India — Millions once bought sex in the narrow alleys of Kamathipura, a vast red-light district here. But prostitutes with inexpensive mobile phones are luring customers elsewhere, and that is endangering the astonishing progress India has made against AIDS.
Indeed, the recent closings of hundreds of ancient brothels, while something of an economic victory for prostitutes, may one day cost them, and many others, their lives.
“The place where sex happens turns out to be an important HIV prevention point,” said Saggurti Niranjan, program associate of the Population Council. “And when we don’t know where that is, we can’t help stop the transmission.”
Dangerous trade-off
Cellphones, those tiny gateways to modernity, have recently allowed prostitutes to shed the shackles of brothel madams and strike out on their own. But that independence has made prostitutes far harder for government and safe-sex counselors to trace. And without the advice and free condoms those counselors provide, prostitutes and their customers are returning to dangerous ways.
Studies show that prostitutes who rely on cellphones are more susceptible to HIV because they are far less likely than their brothel-based peers to require their clients to wear condoms. In interviews, prostitutes said they had surrendered some control in the bedroom in exchange for far more control over their incomes.
“Now, I get the full cash in my hand before we start,” said Neelan, a prostitute with four children whose side business in sex work is unknown to her husband and neighbors. (Neelan is a professional name, not her real one.)
“Earlier, if the customer got scared and didn’t go all the way, the madam might not charge the full amount,” she said. “But if they back out now, I say that I have removed all my clothes and am going to keep the money.”
AIDS success story
India has been the world’s most surprising AIDS success story. Though infections did not appear in India until 1986, many predicted the nation would soon become the epidemic’s focal point. In 2002, the CIA’s National Intelligence Council predicted that India would have as many as 25 million AIDS cases by 2010. Instead, India now has about 1.5 million.
An important reason the disease never took extensive hold in India is that most women here have fewer sexual partners than in many other developing countries. Just as important was an intensive effort underwritten by the World Bank and the Bill and Melinda Gates Foundation to target high-risk groups like prostitutes, gay men and intravenous drug users.
But the Gates Foundation is now largely ending its oversight and support for AIDS prevention in India, just as efforts directed at prostitutes are becoming much more difficult. Experts say it is too early to identify how much HIV infections might rise.
“Nowadays, the mobility of sex workers is huge, and contacting them is very difficult,” said Ashok Alexander, the former director in India of the Gates Foundation. “It’s a totally different challenge, and the strategies will also have to change.”
A 2009 government survey found 2,000 prostitutes at Garstin Bastion Road who served about 8,000 men a day. The government estimated that if it could deliver as many as 320,000 free condoms each month and train dozens of prostitutes to counsel safe-sex practices to their peers, AIDS infections could be significantly reduced. Instead of broadcasting safe-sex messages across the country — an expensive and inefficient strategy commonly employed in much of the world — it plastered Garstin Bastion with posters with messages like “Don’t take a risk, use a condom.”
Surprising many international AIDS experts, these tactics worked. Studies showed that condom use among clients of prostitutes soared.
“To the credit of the Indian strategists, their focus on these high-risk groups paid off,” said Dr. Peter Piot, the former executive director of U.N. AIDS and now director of the London School of Hygiene and Tropical Medicine. Other countries, following India’s example, have achieved impressive results as well, according to the U.N.
But now that mobile phones are untethering prostitution from brothels, those targeted measures are threatened. At the same time, the advent of cellphones seems to be expanding the sex marketplace — luring more women into part-time sex work and persuading more men to pay for sex.
