When government health workers gave Thenmozhi and her friends condoms, they would blow them up and bat them back and forth in the streets of their slum in Chennai, giggling. It didn't really occur to her that she ought to use the condoms with her clients, the neighbourhood men who paid her for sex, to protect herself from AIDS.
That was a disease of other people, other countries. Thenmozhi (who like many in her community uses only one name) had many problems – a drinking, philandering husband who once set her on fire when he got angry, and feeding her children with no job and a Grade 3 education – but AIDS was not one of them.
And then five years ago, a different kind of health worker dropped by her two-room flat – a woman Thenmozhi knew, who made about $50 a month selling sex like she did. She sat on the cement floor, helped Thenmozhi pick through some rice and told her there was AIDS in India – in fact, right there in their crowded fishermen's slum in the capital of the southern Tamil Nadu province. It had recently killed a man they both knew.
She invited Thenmozhi to a community centre, where she heard informal lectures about the virus and how sex workers must band together to insist clients use protection. When she left, her handbag was full of condoms and the results of her free HIV test: negative.
Thenmozhi went on to do a most remarkable thing: “After that, I always used a condom. With every man who paid.” And when she passed the age of 40 last year and transitioned into the role of madam – renting her bedroom to younger women and their clients – she handed each of them a condom, too.
Although her actions may seem logical and obvious, AIDS-education programs around the world have found that people rarely do the logical, obvious thing and use condoms once they learn about the risk of HIV. They may use condoms sometimes, in some cases. They almost never use them with the zealousness of Thenmozhi.
And yet she is no aberration. She is simply one example of the way the country has cut its rate of AIDS infection in half in the last decade, moved away from the brink of catastrophe and quietly achieved a great but unheralded public-health victory.
I married at 13, and had two children, but my husband left us two years later. That year I married again – but my second husband was not a good man. He set me on fire in an argument. I was going to go to the police, but he pleaded for forgiveness. I thought it was a question of my prestige in society, so I stayed, but then he left us. My children never went to school because I could not afford proper clothes for them. I started in sex work when I was 18 – I needed to pay the bills. Now I rent my room to friends who need a place to work discreetly. I want an income for myself. If a woman charges 500 rupees [$11] for a half hour, I get 200 [$4.50] rupees of that for the room. Now that we have learned about AIDS, even if someone gives us more money for sex without a condom, we refuse. A woman who is very desperate might be tempted – but in case we indulge in that, we go immediately after for a blood test. – Thenmozhi, 40, in Chennai, India
In southern India, HIV incidence (the rate of new infections) was 2 per cent per year in 2000; by 2007 it was just below 1 per cent. In the north, where HIV is far less prevalent, there was no large decline, but also no increase.
Only much-smaller Thailand, which implemented a mandatory-condom campaign in its sex industry in the 1990s, has ever posted similar declines.
