Dr. Lloyd Cunningham is Care and Support Specialist for Orphans and Vulnerable Children in India, where EngenderHealth improves care, support, and treatment for people living with HIV through the SAMASTHA Project.
What motivated you to start working with vulnerable populations?
Seeing how female sex workers with HIV were treated by so-called medical professionals in India had a huge impact on my career, and my life. While studying medicine, I worked at an HIV prevention project reaching sex workers, migrant laborers, and truck drivers. Spending time with these groups, it began to dawn on me that they were the least informed and the most at risk. Those who had contracted HIV were stigmatized, marginalized, and denied access to medical care.
One day, a 19-year-old woman was brought into the clinic where I was training; she was a sex worker and in the final stages of AIDS. I tried to get her emergency medical treatment, but every single hospital that I approached refused to treat her. Finally, after several days, I was able to get her into an HIV care and support center. But it was too late; she died a week later. It was this experience that inspired me to help people living with HIV—even though everyone around me discouraged it. But I continued because this was my passion—I wanted to make a difference.
What are your thoughts on the issue of sex trafficking in India and the dangers these women and girls face?
In India, the law does not permit sex work, and anyone involved in such activities can be arrested and imprisoned. Thus, sex work is looked down upon, and the women are arrested and beaten. But sex trafficking happens on a large scale, and an increasing and alarming number of children are trafficked. There has been a particularly sharp rise in the southern states of Karnataka and Andhra Pradesh and in Maharashtra.
Why are women and girls especially vulnerable?
They are often exploited by the sex trade market or by the devadasi tradition, in which girls are dedicated and “married to” to temple deities and taken out of the conventional marriage system. This Hindu custom has increasingly become aligned with the commercial sex trade. Year after year, the age of the sex workers has come down, and very young girls are being introduced into the system. This has also coincided with the rise of HIV. Having worked for 10 years in the field, I have witnessed the changing face of HIV in India and have seen it evolve from an illness affecting a few men to one that involves women and children.
Can you tell me more about your work with this community?
Watch a video about EngenderHealth's SAMASTHA Project in India,
working with orphans and other vulnerable people with HIV.
I oversee EngenderHealth’s work with orphans and children in rural areas in Karnataka, where approximately half of the state’s sex workers live. The children of sex workers, those living with HIV, or those who have lost one or both parents to AIDS carry the greatest burden and are often isolated from support and care systems. We help them get lifesaving treatment, help them go to school, and put them on a different path. Overall, EngenderHealth is improving the quality of care and treatment that people living with HIV receive. We’re helping to eliminate the stigma and discrimination that women and men living with HIV face from clinic staff—like the young woman I encountered as a student—and make sure we reach those most vulnerable.
This work is done as part of the SAMASTHA Project, which offers support to sex workers to help them prevent or reduce their risk of HIV infection—not only by making condoms more accessible, but also by helping the women learn to negotiate condom use by their clients.
What approaches appear to be effective?
SAMASTHA is at a midway point, and our preliminary data suggest that helping women to form collectives has an impact; with each other’s support, they have newfound confidence and can fight for their own rights. This can significantly improve their safety and health—and opens the possibility that they will find a way out. Also essential is working with the police, to change the way the officers treat sex workers. We have to recognize the situations under which these women enter the system and struggle within it. We also need to keep working with the next generation—that’s why my current work focuses on the children and orphans most vulnerable and at risk.