Jana would apply this insight in 1991, when an official from the World Health Organization asked him to survey the brothels of Sonagachi for HIV. By then, Jana had found his niche in occupational medicine, establishing precedents for compensating factory workers and protecting tea-garden laborers from pesticides. Jana agreed to the WHO request only after the official used the phrase "sex worker": the concept intrigued him. He opened a clinic in the area, and when patients finally trickled in, he treated and listened. The prostitutes' lives turned out to revolve around their children, which suggested how to make HIV relevant. Jana in turn explained to the women that he saw them simply as workers earning a living: "I sell services, so do you." To the prostitutes, who despised themselves no less than everyone else did, the idea was mind-boggling. "Many others came to ask if I had indeed said this. It had a ripple effect," Jana remembers. Gaining a measure of self-respect became the first step in a long process of empowerment.

Following the survey, Jana undertook to ensure that the women protected themselves against HIV. He trained a few sex workers to go around the brothels talking about the virus and distributing condoms, and he sent researchers along to take notes on everything. It transpired that if a prostitute insisted on condom use, her customer just went to someone else. Unlike AIDS, starvation posed an immediate threat, and the program seemed doomed. "Counseling, educating--it just doesn't work," Jana states. "Higher up in the social hierarchy, people are able to act on the information given to them. Not so in the lower levels."

Thinking of HIV as an occupational hazard gave him the solution: a workers' collective. "The outcome of a negotiation depends on the relative power between the two parties," Jana explains. "When an individual sex worker deals with a client, she is weak. To change the power equation, she needs the support of other sex workers."

That was not enough, however: Jana also had to loosen several layers of coercion that perpetuated unsafe sex. He persuaded the brothel madams that keeping HIV down was in their interest. To reduce the depredations of gangsters, he invited their bosses--often local politicians--to tour the area and converted them to the cause. He lobbied the police to stop raiding brothels, because if a prostitute lost a day's earnings she was less likely to insist on condom use. He argued with syndicate leaders who controlled the pimps and who ultimately conceded to his economic logic. And finally, because society's revulsion left the sex workers feeling worthless and therefore less able to protect themselves, Jana pitted them against Kolkata's intellectuals in impassioned, face-to-face debates about morality. As the women grew in confidence, he removed himself from the scene: Jana's greatest achievement is his planned obsolescence.

Jana has added community empowerment to the known spectrum of structural interventions--that is, programs that seek to alter the forces that maintain harmful behavior, explains public health scientist Michael Merson of Yale University. The United Nations's AIDS effort holds the Sonagachi project up as a "best practice" model. Still, how well it can be reproduced remains to be seen. Meanwhile the collective has hosted three conferences, attended by sex workers from around the world (including the U.S.) who hope to learn its secret. And while I interview Jana during one of his visits to Kolkata, hundreds of women wait patiently outside, each for her turn to meet him. In their eyes, this man who reached down to help them up wears the halo of a modern-day savior.

   
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ABOUT THE AUTHOR(S)
Madhusree Mukerjee, a former editor at Scientific American, is researching the origins of Indian poverty for a book.