Women's and Girls' Health in South Asia: Challenges for Global Policy

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A woman suffering from HIV/AIDS uses a stick to walk back to her bed in hospital. Cambodia. (© Masaru Goto / World Bank)

But she had the support and the strength of those girls and through this program, she had also begun to learn about her body, about menstruation, and when she goes into this marriage, at least, as Dr. Bista was saying, she won't be like so many millions of others, who go into a marriage as a child, who know nothing and often are married to a much older man. So there are programs that do reach out and that's what we need to do: to support young people, as Kati was saying and as Lucy and all of us have said, regardless of the fact there are those who say well, we can't do that, it's culturally sensitive, or what have you. It can be done. I think we should move to other questions and concerns from the floor.

Question: I am a returned Peace Corp volunteer from the Philippines and am currently studying to be a midwife at Columbia University and hope to work internationally with some kind of organization like one of these. My question is twofold: having been in the Philippines, I spent a lot of time working with women who were either formerly prostitutes or currently prostitutes. Part of the problem was the influx of foreigners coming in and the lack of control they had in dealing with those foreigners. And again, the prostitutes could be 12 years old. The other problem was the health aspect of it: they were not properly screened, and although the government tried to screen, they could easily pay off the health officials who screened them so that the number of reported cases of HIV/AIDS is much less than it is in actuality. I am wondering in South Asia, India and Nepal, whether it is like that as well.

Ms. Marton: Well, I am afraid it is very similar in India. I think Thailand is the role model for what we are hoping will be the next stage for India as pressure begins to mount on the government to apply some sort of central control over brothels, which clearly needs to be done, not only enforcing condom use but also testing the sex workers. But India is such an enormously disparate and multi-layered country, where the states really are almost semi-autonomous, it is very difficult for central control. That is why I was emphasizing the need for pressure to be applied from every quarter.

One of the things we did while we were there is we participated in a conference organized by Indian corporations and they are now stepping up to the challenge of doing what the government is clearly not doing because they realize that so much is at stake for India's economy. So there really is room for hope there because they seem to be stirring from their slumber. And as you mentioned, the sex workers are very important and they are a fact of Indian life, an unavoidable and inescapable fact and they are an extraordinarily dangerous fact. The only way to go is to have some sort of regulation there. Adrienne, you may want to say a few words about your experience with sex workers in Calcutta.

Ms. Germain: Yes, one of the things about India is that whatever one might hope to find in the world, one can find there. I spent the most amazing day with unionized sex workers in Calcutta. We don't have time tonight to tell their entire story but they organized themselves, and they did it for three reasons. One was to ensure that all of them would use condoms, would demand their clients did, because if not all sex workers in a district demand it, the clients will just go to the ones that don't demand condom use.