Public health expert Dr. Lloyd Cunningham reflects on the importance of working with India's most vulnerable populations.
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Breaking the Cycle
In ancient times, as a devadasi, Sunitha* might have been treated with respect. She could have been a dancer, a singer, or even a political advisor. But these days, being a devadasi means that one is no different from an average sex worker.
Originally, devadasis were girls dedicated as “wives” of temple deities, as part of ancient Hindu tradition. Aside from taking care of the temple, the women undertook a wide range of activities and lived independently. But since colonial times, many devadasis have been exploited, as the practice has become increasingly associated with commercial sex. Now they are “married” not to a temple god, but to the men in their community. While this tradition has been outlawed, it is still active in Karnataka and Andhra Pradesh, two Indian states with high rates of HIV.
Sunitha’s family drafted her into the devadasi system when she was 13; they were desperate for money and felt they had few alternatives. And somewhere along the way, during many years of unsafe sex and unbeknownst to her, Sunitha contracted HIV. During this time, she also had three children: a girl and two boys.
Twenty-one years after becoming a devadasi, Sunitha died from AIDS. Soon after, her children were tested and her daughter and one son were positive for HIV; they had become infected during childbirth.
Impoverished themselves, both Sunitha’s sister and brother-in-law were reluctant to take on the responsibility for the three children. With nowhere to go and an aunt and uncle struggling to take care of their own family, Sunitha’s children were left in a very precarious position and were highly vulnerable. This is where EngenderHealth, through the SAMASTHA Project, intervened. The initiative provides foster care services for orphaned and vulnerable children affected by HIV, placing them in more stable homes or giving out small grants to their guardians to improve their living conditions. This is a central component of the multifaceted project, which provides integrated HIV and AIDS prevention, care, and treatment in Karnataka and Andhra Pradesh.
For Sunitha’s children, field workers encouraged the sister and her husband to become guardians, providing counseling, support, and a stipend. The project has also funded the children’s education and raised money from the community for their continued care.
While providing support, SAMASTHA has been working with the family and monitoring the children’s progress. The two children living with HIV are now on an antiretroviral treatment regimen, and their health is monitored and evaluated regularly. They participate in a weekly child support group meeting, and their aunt and uncle attend regular caregiver trainings.
According to their SAMASTHA field worker, the children are in school and are more positive about their future. Sunitha’s daughter is now 13 and seems destined for a life different from her mother’s.
* Name changed for anonymity.