The HIV/AIDS (human immunodeficiency virus/acquired immune deficiency syndrome) epidemic in India is a rapidly escalating crisis. The government's estimate that about 4 million persons in the country are HIV-positive is widely thought to understate the true figure. Throughout the country, persons in traditionally high-risk groups, including women in prostitution, injecting drug users, and men who have sex with men, have been shown to have alarmingly high rates of infection. In several states of India, such as Maharashtra and Tamil Nadu, the epidemic has spread to the general population. Programs that provide information, condoms and HIV testing to persons in high-risk groups are crucial to preventing the further spread of the disease.
This report demonstrates that such programs, so essential to the fight against HIV/AIDS in India, are undermined by police harassment and abuse of HIV/AIDS outreach workers, particularly those who provide essential information and services to women in prostitution and men who have sex with men. Human Rights Watch's research on this subject, carried out in March and April 2002 in several states of India, indicates that these abuses are frequent and widespread. Police mistreatment of AIDS educators and outreach workers reflects underlying social stigmatization and discrimination faced regularly by women in prostitution and men who have sex with men.
In its official policies and statements, the Indian government has recognized the importance of reaching out to women in prostitution and men who have sex with men as a central element of its HIV/AIDS response. The national AIDS program, funded largely through a $200 million World Bank loan, invests in programs that target persons in high-risk groups. But in practice, one branch of the government-the public health service-relies on the nongovernmental sector to provide condoms and information to persons at high risk, while another branch of government-the law enforcement establishment-abuses those who provide these services.
There is widespread recognition in India, as in many other countries, that the most effective and indeed in some cases the only possible AIDS educators for women in prostitution and men who have sex with men are their peers-that is, that women in prostitution who are trained and informed about HIV/AIDS are the most effective educators for raising awareness among other women in prostitution. Unfortunately, in the absence of appropriate protections from the state, these "peer educators" face the same criminalization and marginalization as the persons their life-saving work is targeting. Since the vast majority of people living with AIDS in India have no access to antiretroviral drugs, failure to prevent the disease usually means a premature and terrible death. The disruption of HIV/AIDS work by police harassment also undermines the work the government has creditably done to raise awareness of AIDS in the general population.
Nongovernmental organizations working through peer educators with women in prostitution in India have had remarkable success in raising awareness of the basic facts of HIV transmission and AIDS care, promoting condom use, and, not least, empowering marginalized women to take into their own hands the struggle against HIV/AIDS. Thousands of cases of AIDS have been prevented by this work, some of which has been supported financially or in kind by the government. Indeed, the Indian government recognizes officially the effectiveness of peer education as a strategy, the importance of condom distribution in prevention of HIV transmission, and the need to work with women in prostitution. But harassment and abuse of these peer educators by the police and by local criminal elements whose actions are ignored or abetted by the police regularly impede this essential work.
Women in prostitution in India are treated with disdain and commonly subjected to violations of their fundamental rights by the police, both at the time of their arrest and while in detention. Peer educators providing HIV/AIDS outreach to these women frequently suffer many of the same abuses. Police have beaten peer educators, claimed without basis that HIV/AIDS outreach work promotes prostitution, and brought trumped-up criminal charges against HIV/AIDS workers. Police also extort money and sex from these workers. The very possession of condoms-a key tool in the work of HIV/AIDS peer educators-often is enough to trigger police harassment, so deterring outreach that could help prevent the spread of HIV/AIDS and save thousands of lives.
In Nippani, Karnataka State, the work of SANGRAM/VAMP, an internationally respected nongovernmental organization (NGO) that has successfully promoted condom use among sex workers and their clients, was effectively halted by police abuse in early 2002. Persistent harassment of the women in the group, especially their leader, eventually resulted in the disbanding of the organization and the eviction of most of the peer educators from their homes, interrupting work that resulted previously in the distribution of 350,000 condoms per month. "Under the garb of HIV/AIDS prevention program, these women are promoting prostitution," a local political leader claimed to the press.1 When the peer educators tried to file a police report against the persons who had attacked them, the local police chief refused to take action, saying that women in prostitution were not "normal citizens" who had the right to complain to the police. In many other ways, these women were stripped of their rights, with the disastrous consequence that HIV transmission can flourish in the absence of their work.
In Bangalore, police committed severe abuses against peer educators who work with the organization Samraksha. Police refused to recognize the identity cards issued to the peer educators in this well respected group, severely beat the women while in detention, tried to link them to false narcotics charges, and accused them of promoting prostitution. As Samraksha's director told Human Rights Watch, "Several [peer educators] have been beaten severely. . . . In some cases the police have tried to put false narcotics charges against them. They are frightened. . . . This violence disturbs our work; it prevents HIV/AIDS work from being conducted. They are targeting peer educators; they . . . accuse them of spreading prostitution. A policeman will say `I don't accept that a sex worker can be a peer educator.'"2
In Chennai, Tamil Nadu, peer educators told Human Rights Watch of similar patterns of abuse, in some cases apparently linked to the simple possession of condoms-an essential part of peer educators' work-including abuse and extortion in detention. Peer educators said the police routinely refused to believe that they were engaged in HIV/AIDS prevention efforts. In Trichy, Tamil Nadu, four peer educators were beaten severely by a police constable whom the local authorities have apparently failed to prosecute or otherwise discipline. The director of the State AIDS Control Society of Tamil Nadu, however, characterized the problem of police harassment of sex workers and peer educators as "localized and temporary."
HIV/AIDS outreach workers who target men who have sex with men3 suffer widespread and serious abuses. The taboo in Indian society against men who have sex with men and the denial at all levels of their existence create an environment of moralistic judgmentalism against which AIDS educators battle constantly. The criminalization of homosexual practices under the pre-colonial section 377 of the Indian Penal Code on "unnatural offences" contributes to the impunity with which police harass these men and those who work with them. Organizations that conduct AIDS education activities in Lucknow, Mumbai, Chennai, Sangli, Bangalore, and New Delhi described serious incidents of police abuse that had sometimes prevented them from providing information and condoms to men who have sex with men. Common to all these accounts was the practice of police extortion of money or sex directed against a group of persons who are so marginalized in society that they have nowhere to turn for redress.
An important case of harassment of outreach workers in the MSM community involved the arrest of HIV/AIDS workers from Bharosa Trust and Naz Foundation International (NFI) in Lucknow in 2001. The police at first accused both groups of running a "sex racket" and of showing pornographic films in their offices, though eventually these allegations were dropped from the official charges. In this case, workers were detained for forty-seven days, part of that time without access to potable water, clean food, or sanitation facilities. The Lucknow case is still pending in the courts.
Advocates for men who have sex with men reported that the police regularly use section 377 to justify their ill treatment of HIV/AIDS outreach workers but rarely bring up formal charges under that provision. As a result, they say, the government can claim that section 377 is a benign and rarely used law. Police also accuse those doing AIDS outreach of promoting homosexuality, another kind of threat related to section 377, and have at times attempted to link them to national security offenses, narcotics offenses, or other criminal acts.
Men who have sex with men and women in prostitution are easy targets for police extortion and physical abuse. Discriminatory police practices that keep them from filing complaints or seeking redress, combined with the financial difficulties of making bail, typically mean long periods in detention facilities where they are subject to further abuse. Moreover, crackdowns on particular nongovernmental organizations engaged in HIV prevention and awareness among high-risk persons has had a chilling effect on the activities of others seeking to assist these vulnerable populations. In the case of the jailing of the NFI and Bharosa workers in Lucknow, for instance, several groups working with men who have sex with men reported that attendance at support group meetings dropped and vulnerable men were harder to reach for AIDS prevention work as word of the Lucknow incident spread and many men feared similar abuse.
In addition to arrest and detention justified by section 377, AIDS outreach workers have also been accused by police of being "threats to national security" and in one case charged under the National Security Act of 1980. The Lucknow defendants were publicly accused of spreading ideas said to be "against Indian culture" and charged with promoting homosexuality under various parts of the Indian Penal Code that have to do with abetting crimes.
Various social factors have contributed to the spread of HIV from high-risk groups in India to the general population. Societal pressures lead many men who are gay or bisexual to get married. A survey of 120 male sex workers in Mumbai (formerly Bombay) in November 2001 found, for example, that 43 percent of these men were married. Women married to men who frequent male or female sex workers are also at high risk of HIV infection, which in turn can be passed from mothers to their children in utero, in childbirth or during breastfeeding. Government and nongovernmental programs that work effectively and compassionately with persons in marginalized high-risk groups are essential if there is a hope of stemming the country's HIV crisis.
The leadership of India's national AIDS program has recognized harassment of HIV/AIDS outreach workers as a problem and said sensitization of the police would remain the government's principal strategy for dealing with it. National AIDS Control Organisation (NACO) officials also told Human Rights Watch that the country's NGOs need to give more attention to improving community relations and sensitization of the police. To the government's credit, 20 percent of the current national AIDS program budget is spent on "targeted interventions" among high-risk populations. NACO is named as an official respondent in the petition to repeal section 377 of the Indian Penal Code currently before the Delhi High Court.
Police abuse of HIV outreach workers parallels police abuse of other marginalized or minority populations in India. Human Rights Watch has extensively documented police abuse of Dalits or so-called untouchables, religious minorities, women, and street children, among others.4 The need for extensive police reform has also been documented by numerous Indian human rights groups and India's official National Human Rights Commission. The criminalization of social activism-using laws that allow for extensive periods of preventive detention in violation of international due process norms-has also been well documented.5
3 "Men who have sex with men" is a term that includes men who may not identify themselves as "gay" or homosexual, who may also have sex with women or have regular women partners. See, e.g., Joint United Nations Programme on HIV/AIDS, "AIDS and Men who Have Sex with Men" (Geneva, 1998), pp. 2-3.
4 See generally Human Rights Watch, Broken People: Caste Violence Against India's "Untouchables" (New York: Human Rights Watch, 1999); Human Rights Watch, `"We Have No Orders to Save You' - State Participation and Complicity in Communal Violence in Gujarat," A Human Rights Watch Report, vol. 14, no. 3, April 2002; Human Rights Watch, Police Abuse and Killings of Street Children in India (New York: Human Rights Watch, 1996); Human Rights Watch, "India: Communal Violence and the Denial of Justice," A Human Rights Watch Report, vol. 8, no. 2, April 1996.
5 See, for example, Asia Watch, "Before the Deluge: Human Rights Abuses at India's Narmada Dam," A Human Rights Watch Report, vol. 4, no. 15, June 1992; Human Rights Watch/Asia, "Memorandum to World Bank President James Wolfensohn from Human Rights Watch/Asia concerning World Bank projects in the Singrauli region of India," April 16, 1998, and Broken People, Human Rights Watch, chapter VIII.