When the news of Ram Pravesh's death in Mumbai reached his family members in Allari in the district of Azamgarh in eastern Uttar Pradesh, the people there were saddened but not surprised. Ram Pravesh had been sick for some time. The villagers remembered that the last time he had come home a year ago he had become as thin as a stick. He was due back again but his health deteriorated and so his wife had gone to look after him a month ago. Now he was dead. He was the eighth person to die of what is now called Bambaiwallah bimari (Mumbai's sickness) in the village in the last three years.

A widow of an AIDS victim was given a job at a local anganwadi (pre-school centre) on compassionate grounds. This is in complete contrast to the ignominy that widows of positive people have had to face in other parts of the country.
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Currently, national authorities cross swords with international organizations over the number of HIV/AIDS affected persons in the country and the focus remains clearly on the high prevalence states. Uttar Pradesh does not figure on this list. But the disease has quietly started making its presence felt in the rural settlements of Eastern U.P., one of the poorest regions in the country.

Consider the case of Allari, it's a large village with about 400 households. Here one person from every second household has left the village in search of livelihood elsewhere. Many have gone to Mumbai, others to Surat or to Chandigarh. In the first six months of 2005 two others also died, one in the village and one in Mumbai, of the Bambaiwallah bimari -- HIV/AIDS.

Rajesh Chaturvedi of Grameen Punarnirman Sansthan, an NGO which works in the village says that there is one HIV/AIDS person living in the village now, but not every one knows about his status. Fortunately even when the HIV status is known, there is no discrimination or stigma attached to the condition as yet. Two persons who died in the last year came home, people knew that they were positive and they were cared for till the end. One of the surviving wives has even been given a job in the local anganwadi (pre-school centre) on compassionate grounds. This is in complete contrast to the ignominy that widows of positive people have to face in other parts of the country.

It can be argued that the villagers are unaware of the disease and so are not yet reacting in an inhuman manner. But this did not seem to be the case here. In Behrwa, a small market next to Allari, 6 people have died of HIV/AIDS and two are still alive. In Maghaipurva on the other side 5 people have died, and this is common knowledge. Once someone dies of this condition the family members immediately take his wife for tests to a local private nursing home in Azamgarh. In all cases that I enquired about, the women tested negative. However it was not possible to cross-check whether this nursing home did indeed conduct HIV testing.

In two cases the women had returned to their natal home. One of these women, who is still very young, was married for a second time. She was lucky to get married a second time, but ironically she was again married to a person who works in Mumbai, Chaturvedi notes wryly. Chaturvedi has been working on a reproductive and sexual health awareness project among youth for awareness and protection. He feels this is one way in which he can prepare the youth, because migration (especially to Mumbai) is seen as the only viable economic option.

Holes in surveillance

U.P. is not yet on the HIV/AIDS map, and yet is well known as having some of the worst health related indicators in the country. According to the official figures, with less than one percent prevalence among ANC clients and less than 5 percent prevalence in high-risk groups, Uttar Pradesh is firmly one of India's low prevalence states. This, despite stories from village after village in eastern U.P. providing evidence. But now that HIV/AIDS is making its way into the state, U.P. appears ill prepared to deal with it.

The one early connection U.P. had with HIV/AIDS was the attack that government authorities had launched on workers involved in HIV/AIDS awareness programmes, in 2000 and 2001. The government had framed charges of pornography and promoting homosexuality on the workers.