Peer pressure saves lives

Mamta takes out a packet of tablets from her bag and shows it to Nagaratna. “These are the pills. And you need to go to the clinic for testing every three months, not every five.” She looks concerned for Nagaratna. She has travelled half way across Bangalore to meet her.  “Leave it,” says Nagaratna. “As it is I’m going to die, what difference will it make?” For the first time all morning, there is anger in Mamta’s soft eyes. “What do you mean? Are you going to give up just like that? Just because we’re sick doesn’t mean we can’t manage our illness and lead a long and healthy life.”
Nagaratna smiles sheepishly and promises to be more regular with her treatment. According to 2007 figures from the National Aids Control Organisation (NACO), Karnataka, at 5.3 per cent, has one of the highest HIV rates among female sex workers.

Quiet revolution in Karnataka
Both Mamta and Nagaratna are part of this statistic: they belong to the female sex worker community in Bangalore and both are HIV-positive. Yet this has not stopped Mamta from being part of a quiet revolution happening all across Karnataka.
She is a peer educator who works with her community of HIV-positive sex workers. As a community mobiliser, she works from nine to five, for five days a week, travelling across Bangalore’s red light districts giving vital information on HIV prevention and care to one of the city’s most vulnerable populations.
She works for Baduku, a World Bank-funded project to correct stigma and discrimination towards HIV-positive sex workers in Bangalore. As a member of the sex worker community, she is in a unique position to change and save lives. It is this ‘insider approach’ that is a vital tool for HIV prevention and treatment in the state.
Shama Karkal is senior programme manager at Swasti, a health resource centre that has played a huge role in facilitating projects like Baduku.  

Importance of peer educators
According to her, peer educators are invaluable. “You and I can’t expect to go out into the streets and reach out to this population. The reason a peer-based model works is because only a woman in sex work will be able to identify another woman in sex work and ensure she gets the services that are really important.”
So Mamta is the first point of contact for many female sex workers in the city. She gets them to register with her project, encourages them to get tested for HIV and other sexually transmitted infections (STIs), refers them to clinics, counsels them on nutrition and reproductive health and convinces them that using a condom is a matter of life and death.

And Mamta and her team have been working wonders. Helped by project Pragati, in association with a sex worker collective called the Swati Mahila Sangha, Mamta and her colleagues have been instrumental in very visible changes. According to Integrated Behavioural and Biological Assessment data, the HIV prevalence rates for female sex workers in the city have dropped from 12.7 per cent in 2006 to 8.1 per cent in 2009.
Thanks to Pragati, condom distribution has gone up from one lakh a month in 2005 to more than five and a half lakhs in 2009. Today, the peer educators reach out to between 8,000 and 10,000 sex workers each month.

Bigger success in Belgaum
The success story is even more remarkable in Belgaum, a historically high HIV-prevalence district in the state. With a long tradition of sanctioned prostitution in the devadasi system, female sex workers here have fewer options than their counterparts in Bangalore. According to Karnataka Health Promotion Trust, there are around nine and a half thousand sex workers in Belgaum. Unofficial estimates say that one in every four of these sex workers are devadasis.
But for 35-year-old Bhavani, being a peer educator has, quite literally, saved her life. She was ‘given’ to the goddess Yellamma as a devadasi when she was just ten years old by her parents. She was forced into sex work and found out she was HIV positive when she had her third child. Being a devadasi, she was not allowed to marry and at one point considered suicide. But then she met a peer educator from Shakti Sangha, a local sex workers’ collective. “They gave me the confidence to live. I became a peer educator to protect others like me from HIV.”

Recording data in Gokak taluk
Bhavani trudges daily through a slum in Gokak taluk and meets other devadasis. She is illiterate, but armed with a card that contains symbols and signs to record her daily interactions. Here she records the devadasis’ personal data, along with other details like number of condoms distributed and visits to STI clinics. In a month, she reaches out to 60 sex workers, 40 of whom are devadasis. The movement is producing telling results. According to BIRDS, the agency implementing the programme in Belgaum, condom distribution has gone up from 8,000 in 2004 to 19,000 in 2009. The number of sex workers going to clinics for testing and health check-ups has gone up from 60 in 2006 to 150 in this year alone.
According to Raghavendra T, Deputy Director, Corridors, Karnataka Health Promotion Trust, Belgaum, “Peer education has thus become the backbone of HIV prevention efforts in the state and simultaneously given positive peer educators the confidence to lead their lives.”
Says Bhavani, “All my life, I've had no choice. But today I have the choice and I'm using it to save others.”