Aanchal Sharma, 18, is young, educated and well-groomed. At 18, she is aware of the financial constraints of her large family comprising two siblings, parents and a grandmother. Living in one of the 12 refugee camps for displaced Kashmiris in Jammu and Kashmir (J&K), Aanchal knows that the dole the family gets just cannot make ends meet.
But Anchal has found a quick solution to her financial crisis: she is now a sex worker. The young woman is one of the estimated 2,000 migrant women of the relief camps, home to the victims of the wave of terrorism and ethnic cleansing of the 1990s, that have poor healthcare facilities and few livelihood options. While reports of sex scams occasionally turn the spotlight on these settlements, the residents are in need of more sustained attention in the form of health awareness campaigns and better facilities.
Malini Raina, 38, has been living in the Muthi camp in Jammu for some years now and has come to the conclusion that the women of the camps are victims of financial crisis, mental trauma, social stigma and the flesh trade. "Sex scams are reported to create a sensation but if you go a little deeper... it may be the family's needs that pushes young girls into them. Health, education and marriages need money and how much do rehabilitation packages offer, anyway?" asks Malini. In the settlements, opportunities to earn a living and information about better healthcare are hard to come by, despite the prevalence of high-risk behaviour among some of the inhabitants.
The conspicuous absence of any awareness and intervention campaigns in the camps only makes people like Aanchal more vulnerable. Quiz Aanchal about HIV/AIDS and her unperturbed expression is rather telling. "Have heard of it but isn't it curable?" she asks, rather innocently.
Dr K.L. Chowdhury, a social activist associated with the Shiriya Bhatt Mission hospital in Jammu, says, "Over the last 18 years no NGO has bothered to come and sensitise the community on various health issues."
Neerja Mattoo and Dr Shakti Bhan of 'Daughters of Vitasta', the women's wing of Panun Kashmir add, "These camps are unsafe for women. Women have been raped and killed and many girls have committed suicide."
(Panun Kashmir meaning 'Our Own Kashmir' in Kashmiri is an organisation of displaced Kashmiri Pandits founded in December 1990 in Jammu.)
Ironically, even as the threat of HIV/AIDS looms large over the camps, and even as the state has its share of AIDS cases and mortalities - last year the government reported 42 AIDS deaths and between 2006 and 2007 there was an approximate six-fold increase in the number of cases - residents of the camps are still victims of ignorance and neglect.
While Maharashtra has its share of Ashley Judds and Bollywood stars sporting the red ribbon; West Bengal has the inspirational 'Bula Di' (elder sister) awareness campaign; and Chennai benefits from the red ribbon express steering into villages. J&K, in contrast, witnesses no initiatives of this kind, although it possibly needs them more than any other state, given that many in the state are extremely vulnerable to the disease.
There are several reasons for this vulnerability and high-risk behaviour in the camps is just one. According to Survival International sources, a human rights organisation headquartered in London, HIV/AIDS spreads among displaced migrants due to increased contact with outsiders and dramatic social change. The growing number of intravenous drug users and sex workers, low literacy levels, the ongoing militancy, a variety of local languages - Kashmiri, Urdu, Dogri, Punjabi, Ladakhi, Pahari and Gujjari - and the constant demand for blood transfusions only add to the problem and underline the need for concerted health awareness.
In a region marked by difficult terrain that limits accessibility to existing healthcare, there are just a few hospitals - SMHS, Lal Ded, Sher-e-Kashmir Institute of Medical science, Bone and Joint Hospital, Government Medical College, SMGS Hospital, Batras and G.B. Pant - which test blood for HIV. Unfortunately, all of them are in Srinagar and Jammu. None of the district and sub-district hospitals leave alone the camps have this facility.
Given this scenario counselling and awareness are the need of the hour. Dr M.A. Wani, Project Director, Jammu and Kashmir Aids Preventive Control Society (JKAPCS), says, "Mass awareness must be generated about the disease and its preventive measures, which is the best strategy to tackle the menace."
He adds, "Even though the state lies in the low prevalence zone, it does not mean that the threat of HIV/AIDS is any less here."
Contrary to government complacency, an independent study conducted by Jammu-based clinical immunologist, Anil Mahajan, states that HIV/AIDS is no longer a low-prevalence disease in the state. The study reveals that paramilitary forces, truck drivers, housewives, and camp inmates are the groups most affected.
Given the topography and numerous local dialects and languages, Mahajan acknowledges that it is challenging to conduct even minor awareness campaigns like showing films and staging cultural programmes.
There's another hurdle too. "Existing NACO (National AIDS Control Organisation) guidelines do not provide costing and implementation of the Targeted Intervention (TI) programme for migrant labourers in a systematic manner. They constitute the second highest risk group in J&K," explains Wani.
Even though Panabaaka Lakshmi, J&K's Minister of State for Health & Family Welfare, had said that Phase III of the National AIDS Control Programme has been formulated to control the spread of HIV by up-scaling TI among the high risk groups, there is not much evidence of this in the camps.
Tragically, the region has not benefited from international assistance either. The much-publicised visit of French Countess Albina du Boisrouvray of the charity, Francois Xavier Bagnoud (FBX), as part of the French President Nicolas Sarkozy's delegation to India, has also failed to benefit the state, even while West Bengal, Andhra Pradesh, Mizoram and Manipur have been assisted. A lack of funds could not have been the reason for this, considering that FXB's India budget for the 2008 calendar year amounts to US$1.3 million.
According to Dr Chowdhury, the man behind Shriya Bhatt Mission Hospital and Research Centre at Jammu, which addresses the health problems of displaced Kashmiris, HIV/AIDS cases in the camps, if any, could go unreported because of the fear of stigma and discrimination.
The health department in Kashmir needs to do more than just put the burden on the religious scholars, as it tends to do. Sikh religious leaders and Imams (Muslim priests) in the Valley still don't know the exact causes of HIV/AIDS nor indeed the difference between the two.
Perhaps the government could learn a lesson or two from the army, which has taken the initiative to conduct workshops on HIV/AIDS at the basic unit level as well as higher up, at the Northern Command level, to educate its officers and their families about the disease. The government now needs to get its act together on the issue in the interest of the vulnerable women in the camps.