It's often said that the first step in solving a problem is to truly understand it.

240 pages. New York: Anchor Books, 2008. $12.95 (paperback)

No one is sure how many people in India are living with AIDS; initial estimates of five million cases have been scaled down to two or three million, but that's still a huge total for a single country. Even worse, many of those suffering from AIDS in India are unlikely, for reasons including poverty and social stigma, to receive adequate treatment which could ease their suffering and prolong their lives.

No public health issue exists in a vacuum: social, historical and cultural forces must be considered equally alongside medical and scientific concerns. The sheer size of India, both in terms of geography and of population, and the number of different cultures contained within it, means that no single book could possibly cover all aspects of AIDS, or for that matter any other significant health or social issue, for the entire country.

AIDS Sutra: Untold Stories From India, an Anchor Books paperback original published in collaboration with Avahan, an HIV prevention project funded by the Bill and Melinda Gates Foundation, facilitates understanding of the AIDS epidemic in India by looking closely at particular factors germane to the disease and its spread, rather than focusing on facts and statistics at the national or state level. This perspective is presented through 16 essays by noted Indian writers which focus on individual stories and specific situations within Indian culture, thus beginning the work of creating a broader context for understanding the AIDS epidemic within India.

The variety of authors included, and the topics they choose to focus on, is remarkable. Salman Rushdie writes about the hijras of Bombay: these are men who consider themselves to be members of a third sex and are at high risk for HIV infection because they often work as prostitutes. Siddharth Dhanvant Shanghvi writes about Murad, a young filmmaker from a wealthy family who lived an openly gay lifestyle despite the legal risk; homosexual acts are banned by a law dating from 1860, which specifies penalties up to life imprisonment for "carnal intercourse against the order of nature."

Sonia Faleiro describes the police harassment faced by sex workers. Although prostitution itself is not illegal (indeed, it has a long history in India), solicitation and indecent public behavior are against the law. Since both are open to broad interpretation, the result is that those in the sex trade always vulnerable to arrest, and are often forced to "pay" their fines with sexual favors (and creating a route by which the policeman's wife and future children may be infected). The indecency laws are also used against those performing outreach such as distributing condoms to sex workers, creating another obstacle for those trying to limit the spread of the disease. William Dalrymple writes about the devadasis, temple prostitutes often sold into that life by their parents whose face almost inevitable HIV infection. Much as they hate the life of prostitution, due to economic desperation many devadasis often find themselves forcing their own daughters into the sex trade, as well.

AIDS Sutra includes these and 12 more essays on topics ranging from the role played by highways in spreading AIDS throughout India, to the experiences of AIDS orphans (who are estimated to number one and a half to two million in India, possibly the largest such population of any country). The introduction by Amartya Sen places the epidemic in context and discusses some social, legal and economic considerations which affect the spread of HIV within India.

It's often said that the first step in solving a problem is to truly understand it. In the case of AIDS in India, understanding the problem requires knowledge of the social and historical context of Indian society, with particular awareness of the vastness of the land not only in the geographic but also in the cultural sense. The essays in AIDS Sutra are a good starting place for anyone who wants to understand the many factors which affect the transmission of HIV in India, and the consequences for those who become infected. | Sarah Boslaugh

---