A Catch 66?

3 Different Entities Have Tough Decisions to Make

When the government run National AIDS Control Organization (NACO) implemented its new Phase III initiative it did not take into account its own country's laws. Sounds confusing right? Let me try to explain.

Well, the issue arose when NACO decided to change the targeted groups for its programs of intervention and awareness from the "high risk" population to the "core" population. This switch namely means from truckers and migrant workers to commercial sex workers and men who have sex with men. The switch seems logical - after all one sex worker can be responsible for infecting a good deal of men. Also targeting the "core" is agreed to be the best way to address the increasing prevalence rate in some of India's hardest hit states. To accomplish such feats, NACO has asked its state and district subsidiaries and reputable non-governmental organizations to choose a local commercial sex worker and homosexual man to receive proper training by NACO. These two individuals can lead the outreach work through their personal experience and connections to the different target groups. Part of this plan is to register the individuals to make sure they get the attention and help they deserve.

Now here comes the rub. While this all seems pretty logical, the grassroots people responsible to implement the Phase III initiative are walking on egg shells. According to Indian law it is illegal to be a commercial sex worker and, interesting enough, it is not illegal to be a homosexual but it is a jailable offense to engage in homosexual acts of intercourse.

So now we have three entities entangled in Joseph Heller's famous "Catch 22": the government, the NGOs, and the core group representatives. The government needs to further address the growing HIV issue and engaging the core group is the most effective approach of doing so. Including members of the core group as part of the solution will greatly increase the success rate and efficiency because they have invaluable insider knowledge. However, current laws will surely hamper the new program and any attempt by the government to alter these laws in the slightest will cause chaos with the heavy religious and conservative voices in the country.

The NGOs float in the same lake but are in a different boat. If they do not support the decisions of NACO or reject the projects as illogical, they run the risk of biting the hand that feeds them; after all, NACO provides a great deal of the funding for HIV NGOs. If they do support the measures then they run the risk of exposing their core group workers to arrest or some other potential trouble. The same is true if they are required to register the people who they are trying to help at their facilities.

Lastly, the individual core group workers that NACO demands spearhead the projects at the local level are stuck between the proverbial rock and a hard place. If they do choose to accept the position, they get a chance at a paying job, helping people who they know, and saving some from what they understand is a difficult and sometimes lonely future. However, aside from the potential of being arrested now or later, coming out and saying you are a homosexual or a commercial sex worker is not going to make anyone's life any easier anywhere, especially in India. Both face great amounts of discrimination and they also run the risk of "disgracing their families" (a one way ticket to horrible karma in Indian culture and Hindu religion). For example, I have met homosexual men who would rather say they are HIV positive than admit they are homosexual. Hopefully this shows how hard it is to take such a bold step as this job requires.

All three of these parties have a lot to think about before the Phase III initiative can be as effective, efficient, and successful as possible. NACO has forged ahead hoping that volunteers will not fear any type of repercussions. However, after talking to some of the organizations it appears that involved people, especially homosexual males, are not exactly lining up for the positions. Also another consideration that NACO may have overlooked is the education level of the commercial sex workers. For instance, one NGO is teaching their representative how to write before she goes to the training session. Decisions have certainly been made and only time will tell if they are on the right path or if phase III is already set for failure - stuck in a triple “catch 22”.