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An Indian wealthy engineer or a transgender - who is most vulnerable?

It was already past midnight, but I thought it was time for a SALT visit 30,000 feet above sea level on my way to Kolkata. The Indian guy next to me was an engineer working on ships around the world for 6 months/ year. The other 6 months he spends with his family in Kolkata. After some small talk about work and his fear of losing his job in the economic crisis, he asked about my work. His questions came up: ‘If there are 10 Indians and 1 has HIV, can you see the difference? Can you get it through oral sex? How many years can a person with HIV still live?

We had a good chat and after some reassuring answers, he started sharing about the lives of the boat crews that travel around the world. “Most of the big ports have beautiful sex workers. Especially Brazil, Thailand, Indonesia and the Philippines. The Brazilian girls are amazing. It’s difficult to resist the lovely girls especially as you are with a group of men”. We had a good conversation about condoms and the reliability of them. I learned a lot about the lives of such men. I acknowledged the vulnerabilities that many of these men must go through.

I expressed to my Indian friend: “It must not be easy to be away from home 6 months/ year”. He started talking about his family and how proud he was about his children. After an hour of ‘SALT’, I explained him the self-assessment of AIDS Competence. “Perhaps boat crews can do their self-assessment, stimulated by the big shipping firms they work for?” He smiled and I saw him reflecting. Then we continued our airplane meals.

This experience reminded me of some of the vulnerabilities that long-haul truck drivers in GLIA expressed or even wealthy men that travel a lot for work. For me, the ‘MMM’, Mobile Men with Money are not any less vulnerable to HIV. This is not only my view. I was struck by the following video: Hans Roling used UNAIDS data and presented it in a remarkably simple way. Besides other very interesting data, it shows how income is positively related to HIV prevalence both on a macro-level as well as within one country like Tanzania (see 6min11). So I am wondering: Who is really at risk and who is striving to become AIDS Competent?

During my recent trip in India I have seen communities of Sex Workers and MSM (in Mysore) or Transgender communities (in Krishnagiri) that were certainly more AIDS Competent on most of the practices than the wealthy engineer sitting next to me or even than myself. I experienced a group that is certainly level five on ‘acknowledgement and recognition’. Every time, I am struck by how much I learn from these community groups. All it needs is a pinch of SALT.

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Comment by Gaston on June 1, 2009 at 4:58am
Thanks Rituu for the comment. I just want to say that in my view ACP does not 'score over' targeted intervention. I think it is not either-or nor 'what is better'. The essence is how we target any group and with what mindset? In Africa, we do facilitate ACP among truck driver communities, but not with the mindset that they are the transporters of risk etc, but to transform them into agents of change for themselves and others. In Papua New Guinea, we do work amongst the vulnerable groups in settlements with much crime and rape, but we don't look at them as such. We see the potential of these people. Sometimes, I think targeting on specific groups is very useful. The question is with what intention.....

What do you think?
Comment by Moses M.Bull on May 31, 2009 at 11:13pm
Thanks for raising such question,the most vulnerable people are women and those that do not adhere to health advices.
Comment by Rituu B. Nanda on May 30, 2009 at 7:06pm
Dear Gaston and Caca,

Thanks for raising these thought-provoking issues. Gaston, your blog takes me back to a similar exchange nearly two years ago. The mode of transport was different though, I was in the choo choo train. My co-passenger was a well read, globe trotter MD of a large company. This knowledgeable lady knew all about the then raging controversy on HIV estimates in India. However, she was shocked to hear that mother-to-child HIV transmission was possible before, during and after labour. This information was new for her. Caca, yes even in my experience, MARP (Most at risk population) rate higher in area of acknowlegement and recognition due to overload of prevention information. Here ACP with its geographical community approach scores over targeted intervention.

Gaston, wonderful blog with a striking title.


Comment by Caca Carillo on May 27, 2009 at 9:06am
Hi Gaston,
I have been working with the ACP in the Philippines too, and I am a transgender and weve done work on HIV and AIDS prevention among sexual minorities and sex workers. Your blog caught my attention, because yes, bieng branded vulnerable to HIV, its sexual minorities who are targeted for prevention information and thus the community generally rate high in the areas of acknowledgement and recognition.
The painful reality in the philippines is that while efforst on prevention is going on strong, we are missing the target. and those targeted( Sexual minorities are so having information over load)
So here is the picture:
The (targeted sexual minorities) sex workers and transgenders though getting the information are not those that access the services (VCST) and those that are not targeted ( Bi-sexual men, discreet men blah,blah) dont get information and also dont get tested.
thus the philippine epidemic is really moving towatds the MSM population more that any other "target" group.
In fact this focused prevention is also driving me nuts, since with being a focused/targeted group also comes stigma and discrimination associated with being targeted because of behaviors, which is exactly the way I get your point in you blog. Thank you for seeing this, and pointing it out. Because this is not at all helping.

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