Imagine you are a 12-year-old boy. You live in India, on the outskirts of a town called Vijayawada. Your name is Yesu Babu.
Your home is a tiny two-room concrete block, approximately 200 square feet, in a slum known as the Vambay Colony. Imagine that you share this small home with your grandmother, Durgamma, and your 9-year-old brother. You live with your grandmother because your parents died of AIDS â€“ first your father, who brought the infection home, in 2001; then your mother followed in 2004. There was no one left to take care of you and your brother except your elderly grandmother, who never expected to be raising two more children at this age.
Soon you learn that although you are HIV-negative, your young brother is HIV-positive. He begins to grow ill. He battles many infections. He cries in the night when heâ€™s sick and calls for his mother.
Almost crippled with severe joint pain, your grandmother can barely walk and cannot physically work; even if she could, someone has to care for your brother. So you let your brother go to school, although for what future is painfully unclear, while you go to work. You leave home for a week at a time to travel for migrant construction or agricultural jobs. You are paid 30 to 50 rupees per day on a good day â€“ roughly a dollar or less.
You are 12 years old. You know you should be in school, like other children you see around you. You should have a childhood, but it has been traded in far too soon for adult work and worries, for hardships that no 12 year old should ever have to face. But what can you do? There is no one else. There is no other way. From a normal life with a mother and father, school, a childhood, possibilities â€“ to this previously unimagined reality.
This is your new normal. Imagine.
I met Yesuâ€™s family when I traveled to the state of Andhra Pradesh in March 2007, on my third trip to India. Abraham Mutluri, Programme Coordinator with the womenâ€™s and childrenâ€™s development organization Vasavya Mahila Mandali (VMM), explained how Vambay Colony sprung up two and a half years ago, almost overnight, as thousands of people from the surrounding rural villages migrated to Vijayawada for work and began setting up camps along the canals. Soon the government built 8,000 of the small concrete boxes like the one Durgamma and her two grandsons live in, right up next to each other in row after endless row.
There seemed no such thing as sanitation or hygiene in Vambay. Children squatted by the side of the road to defecate. Other children played with simple things on the front stoops or in the small lanes â€“ a dirty ball, two or three jacks. The homes were dark and poorly ventilated, no more than concrete lockers, each an armâ€™s length from the next. In front of each doorway ran an open sewer which one must step over to enter the house. The flies were incredible, swarms of them everywhere, an incessant presence. Bowls of food and open bags of grain sat around, with no refrigeration and very little storage space. I thought of the flies and how they must land on both the sewers and the food.
Sitting together in her small house, Grandmother Durgamma spoke to me about her life.
â€œIt is very hard taking care of my two grandchildren. I have leg pains, I cannot run with them. I want to take care of them but it is hard. I am only one. I am always thinking about their futures. If something happens to me, when I die, what will happen to them? I donâ€™t need anything for myself. I am living only for my grandsons.â€
Her plight is an all-too-common legacy of Indiaâ€™s exploding AIDS epidemic and a familiar story in Andhra Pradesh, the epicenter of the crisis with the highest infection rates in the country. The pandemic has created a secondary human rights crisis â€“ the orphaning of children on a massive scale. The leading cause of death worldwide for people ages 15 to 49 â€“ the very ages at which many people are raising families â€“ AIDS is an epidemic that wipes out the middle-aged population, leaving hundreds of thousands of children in its wake. As it devastates this generation, the very old are left to take care of the very young â€“ as well as the other way around.
In Vambay I visited many homes and talked to family after family affected by AIDS. Like Durgamma, they were all dry-eyed and matter of fact about their situations, unemotionally recounting their lives. Tears are an indulgence these elders have neither the time nor the luxury for. In their daily scrabble for existence they cannot afford to keep accounts of regret.
Ramulamma is another grandmother caring for an HIV-positive grandchild, Krishna. Krishna was so tiny I would have guessed him to be a boy of four or five years old; when I inquired I was told that he is nine. It is a family with three generations affected by HIV: Krishnaâ€™s father died two years ago, and his grandfather died just the month before my visit, both from AIDS.
VMM provides doctor care and medicine every month for Krishna, as well as a local physician who is available for immediate needs, but he is not on ART therapy currently because he is not deemed sick enough. In India, CD4 blood count levels must be 200 or below to qualify for ART drugs â€“ the level at which HIV is medically considered to have become full-blown AIDS. Only 7% of HIV-positive people were receiving any Anti-Retroviral Treatment in 2005. In the United States, ART is started well before this time to prevent AIDS, generally at CD4 levels of 300 to 350. Krishna continues to have regular blood tests so that ART drug treatment can be started as soon as his condition qualifies.
Krishna and his grandmother gazed at me listlessly as we spoke, both with the same vacant eyes. In those two pairs of eyes lay a world of despair, devoid of any hopes or dreams. In Vambay it seemed death was not a feared stranger but a constant, familiar companion. They waited patiently for my next inquiry. Abraham waited, looking at me expectantly. I knew that I was supposed to ask more questions, but I could think of no more words.
Silence seemed to demand all the space between us.