On track: A sex worker hits the streets of Mysore, but for a vastly different reason this time around

MYSORE, KARNATAKA
Wednesday, May 31, 2006

Hidden behind a noisy auto stand and flanked by an assortment of petty stores, the office of Karnataka Health Promotion Trust (KHPT) doesn't seem like a place where one might find innovative solutions to one of India's most pressing problems: The HIV epidemic. Yet, up a narrow flight of stairs on the first floor of an unremarkable white building, Susheena RezaPaul and her team have come up with a quiet, yet path-breaking, answer to the human immuno deficiency virus (HIV) scourge. As the Director of KHPT, a joint venture between Bill & Melinda Gates Foundation's Avahan and Canada's University of Manitoba, RezaPaul is leading a novel initiative to keep tabs on the health of the most HIV-prone segment of our population: Sex workers.

On May 26 this year, KHPT distributed smart cards to 500 sex workers spread across Mysore and nearby Mandya in a pilot project intended to better understand their lives. RezaPaul, a physician by training, says these cards will act as loyalty cards with a select group of five stores frequented by sex workers for items such as food, clothing and, most importantly, medicines and condoms. Purchases are logged using a Simputer handheld computer and the reward points on purchases can be redeemed on subsequent visits.

"The use of smart cards has given the sex workers a sense of pride and belonging" DR SUSHEENA REZAPAUL Director/KHPT	"We need a more structured fight against this illness, since it is looked on as something that can be managed" DR SUNDAR SUNDARAMAN Advisor/ Bill & Melinda Gates Foundation

The real benefit of the smart card is, however, much bigger. The smart cards issued to these sex workers are valid for just three months. To renew it, the card holder must visit a health centre, where she can also get a medical check up. In other words, the smart cards are being used to keep track of a dynamic, HIV-prone population. Explains RezaPaul: "Prostitution in Mysore is not organised like the brothels of Sona Gachi in Kolkata (the red light district houses 60,000 to 70,000 sex workers) and they work primarily by soliciting on the city streets and then in city lodges."

Before zeroing in on smart cards, KHPT tried using ordinary cards with a special id number. But the experiment failed because most of the sex workers were illiterate, besides which, KHPT discovered, many of them had the same name (there are dozens of Ratnas, for instance) and that led to problems in tracking their individual health and follow-ups. The use of smart cards, says RezaPaul, has given the sex workers a sense of pride and belonging. "It's about creating a place where they feel welcome and uninhibited," she says, as we walk around a vast recreation room, where sex workers catch up on gossip, eat lunch and catch a quick nap before hitting the streets once more.

Team talk: Representatives of Ashodaya, an association of sex workers, regularly meets to discuss issues

Having got a taste of the smart technology, Mysore's sex workers want more from it. "We make about Rs 500 a day and need more features to be added to the card if it is to be effective," says Ratnamma, a sex worker of 10 years and President of Ashodaya, a community body. (Ashodaya, which means a ray of light in English, has given the sex workers voice against low-level policemen and anti-socials, besides certain minimum working conditions. Members, for example, are required to insist on use of condoms by customers and report any cases of child trafficking to a 10-person supervisory board.) In response to such demands, KHPT is considering integrating an ATM option with the card so that the users can immediately deposit their earnings before they are hassled by cops and/or the local toughs.

Help at hand: A sex worker in Mysore with the smart card

With just five vendors aboard at the moment and the initiative only a few days old, much more needs to be done before this smart card solution can be rolled out statewide. "We are yet to finalise which shops we need to focus on and what goods sex workers find most essential. We also need to consider if requirements vary for, say, those operating in Bangalore compared to Mysore," says RezaPaul. Despite these chinks, administrators and advocates remain confident that this initiative can be scaled up to, one day, reach all of the two million sex workers across the country. "The various components of the fight against aids are disjointed in India and across the globe. We need a more structured fight against this illness, since it is increasingly looked upon as something that can be managed," says Sundar Sundaraman, an advisor to the Bill & Melinda Gates Foundation in India.

Mysore's smart card experiment, then, looks like a good beginning.