Niram Sharma is 28, jobless and dying. He says he is lucky.
For, unlike Niram, most of the new friends he has made at HIV/AIDS support groups in this bustling Indian trading town can’t afford the medicine that could give them 10 to 15 more years of life.
The cost? Just 1,300 rupees ($29.85) a month - less than one cup of coffee every two days in London or New York.
“I come from a good family, so I can afford this medicine, but my heart cries for the other people,” he says, speaking rapidly in his passion. “Many are dying because they are too poor. Poverty is a big problem up here.”
With India’s five-million-plus HIV/AIDS patients rivalling the world’s AIDS capital, South Africa, its cheap drug industry has pioneered low-cost treatment, bringing the price down from $200-$300 a month a decade ago.
But it is still too much for many sufferers here, some living on less than a dollar a day - if they are lucky and their employer has not found out they are infected and thrown them out.
The official infection rate in the world’s second most populous country is less than 0.1 percent, compared with 30 percent in some African countries.
But India’s poor healthcare and rampant disease mean many die of other causes without them or anyone else ever knowing they are infected.
Many shy away from government hospitals, where reporting new infections is compulsory. But then that leaves them prey to blackmail, with many clinics faking results or demanding money not to mention real positive results.
It has been two years since Niram found out he was HIV-positive during a routine physical for a job at a hotel in Dubai. He most likely got the virus from homosexual sex a decade ago.
“I had gone with a dream to make my fortune,” he says. “When I found out, I felt I would die the next day.”
Now he spends his time supporting other sufferers and trying to make people listen to their plight.
“We have been asking for help from the government, but our voice does not carry,” he says. “We are doing a lot of the work ourselves.”
Two of those he helps are “Rupak” and “Rupa” who don’t want their real names used because they don’t want neighbours in their small rice-growing village to find out what is really wrong with them.
Even their four children, aged 11 to 22, don’t know.
“It’s a very social thing,” says Rupak. “You never know how they would react, what they would think of us.
“The disease is there, but the problem is when someone knows, then their behaviour is quite bad. What have we done? Don’t we deserve a normal life as well?”
Indian officials say the government’s awareness campaign is paying off with a big drop in the number of new infections. But AIDS activists say numbers are actually increasing. And rapidly.
In Siliguri’s Khalpara red light district, a squalid slum where excrement floats thickly in the open drains, most customers still refuse to use a condom.
On top of the dollar or two for the sex, they throw in 10-15 rupees (23-34 cents) to go without. A condom costs just two rupees.
WAITING TO DIE
This is a place where the handful of near-empty laneway stalls do not sell food or lollies, just some basic beauty essentials, such as hairbands and shampoo.
Workers from the local group Durbar hand out 10,000 free condoms a month and sell another 11,000 at subsidised prices.
Still, the girls boost their income by selling many of the free ones at the local market rather than using them.
Doctor D. Rudra, who has been working with HIV/AIDS patients in this narrow part of India between Nepal, Bhutan and Bangladesh for more than a decade, says the most common form of transmission is still unprotected sex.
He is pessimistic and says parts of India will soon lose an entire generation, leaving only grandparents and orphans. He believes AIDS will one day destroy the country’s economic boom.
“If this continues, then in one decade India’s economy will be nowhere,” he says. “The hospitals will be full of AIDS patients.
“The youth are being infected. Once they are infected the country is doomed. And this is going to happen.”
Millions of Indians leave home every year in search of work. Many become infected and, once they are, poverty means they can do nothing but wait to die.
“Poverty is rampant,” he explains. “Out of 100 patients, maybe 10 can afford medicine.”
Without drugs, Rupak and Rupika have no idea how much longer they will live. But they are determined not to go back to hospital, where even the doctors and nurses want nothing to do with them.
“If I have to die, I would rather die here,” says Rupika under the mango tree outside her spotlessly neat home.
Revision date: June 20, 2011
Last revised: by Sebastian Scheller, MD, ScD