The Gigi Mela's song is but one example of how nongovernmental organizations in India are struggling to stanch the epidemic by broadening their HIV prevention messages. Discarding approaches that narrowly associate HIV with high-risk populations and permit the larger society to ignore its own vulnerability, these organizations now strive to include entire communities in their AIDS awareness programs.

One example of such an inclusive HIV prevention program is in Belgaum, a largely agricultural district in the southern Indian state of Karnataka. The highway that wends through Belgaum's farmlands brings trade from Bangalore and Bombay. It also brings truck drivers, sex workers, and HIV.

When the virus arrived in Belgaum, it exposed the vulnerability of the local devadasis, women who belong to a Hindu sect that dedicates their lives to the worship of the goddess Yellamma. Over the years, however, the religious role of these women has diminished. Forbidden to marry and take other employment, devadasis rely on sex work, concubinage, or alms-seeking for survival. In 1993, MYRADA, a nongovernmental organization that had been working to improve these women's lives through economic self-help groups, made an alarming discovery: among the devadasis voluntarily tested in Belgaum, more than 9 percent were infected with HIV.

Through a partner agency, PLAN International, MYRADA then sought funding to launch an HIV prevention program in Belgaum. Although they began working with devadasis, a single group at high-risk, they quickly expanded the scope of their program to include the population as a whole.

"There was the concern that targeting devadasis would marginalize them further and not enhance their risk reduction behavior," says Wendy Githins Benazerga, senior program officer at AIDSCAP, which funds the MYRADA-PLAN program. "These women don't have a lot of power. You've got to work with men and get them to change behaviors."

"We soon saw that we'd need to reach everyone," says Vidya Ramachandran, who oversees MYRADA's AIDS program. "Anyone who had anything to do with sex or blood."

Recruiting a Variety of Educators
For its prevention program, the MYRADA team targeted four taluks, or administrative areas, in Belgaum whose total population numbered one million. Through focus groups, the team learned of the critical need for HIV education. Less than half of the sex workers and less than a quarter of all women interviewed had even heard of AIDS. Only one-fifth of the respondents could correctly name a single means of contracting HIV. While some named "sex with many people" and "illegal sex" as risk factors, other mentioned such habits as chewing betel leaves or tobacco.

Based on its findings, MYRADA directed its attention toward training specific groups--such as volunteer health workers, traditional midwives, and government employees with extensive public contact--to act as HIV educators. In the process, MYRADA learned that each of these groups had its own attitudes and myths about AIDS--and its own potential for spreading the word.

"You are learning from day one in a project like this," says Sudha Sivaram, who manages the MYRADA-PLAN project. "For instance, no one thought of barbers as a target, but we soon learned that many people thought their practices might be a mode of transmitting the virus." Barbers had a large stake in learning the facts and adopting safe methods. They became effective HIV educators and later proved to be reliable condom vendors as well.

Along with training HIV educators, MYRADA employs a range of approaches--such as village meetings, folk and popular music, billboards, and newspaper advertisements--to communicate its prevention messages. MYRADA also interjects AIDS messages into traveling programs of movies and music videos. To reach the half of the population that is illiterate, MYRADA has redesigned print materials to carry fewer words and more pictures.

Street theater has become an especially successful vehicle for HIV prevention, with performances drawing audiences of 500 to 1,000 people nightly. With license to tackle normally forbidden topics with sly humor, both men's and women's drama groups denounce the devadasi tradition and other practices that exploit women. The drama troupes--which have visited nearly 500 Belgaum villages--are careful to avoid blaming specific groups for transmitting HIV. No matter the medium, the message remains the same: HIV draws no distinctions; everyone is vulnerable.

Expanding the Range of Voices
Few people in MYRADA's focus groups believed that HIV was a direct or immediate threat; other sexually transmitted diseases (STDs) were a much greater concern. MYRADA therefore decided to introduce HIV within the context of STDs and general reproductive health.

Once aware of their own HIV risks, the people of Belgaum needed access to condoms as an important means of protecting themselves against sexual transmission of HIV. Years of family planning education efforts by the government had familiarized most people with condoms; MYRADA built on this foundation by focusing its condom sales pitch on family planning and health, and by portraying protection against STDs and HIV as an added advantage. In addition, a small profit built into condom sales has helped to recruit diverse groups as distributors, including some sex workers who have begun to educate their peers.

Today, MYRADA is close to its goal of ensuring that no one in the area needs to walk more than ten minutes to buy a condom. Following its efforts to generate awareness and demand, commercial firms are now investing in rural condom marketing in Belgaum. Auto-rickshaws filled with condoms navigate crowded marketplaces as vendors shout slogans for Zaroor, a local brand: "Are you a smart person? Smart people use Zaroor. If you want a satisfactory sexual experience, a healthy family and life, then use Zaroor. It can prevent AIDS and promote family planning."

Through voices as diverse and powerful as those of the Gigi Mela singers, traditional midwives, and condom vendors, organizations such as MYRADA are seeking to ensure that people throughout India will hear--and heed--HIV prevention messages. By expanding the range of voices, the organizations hope to draw entire communities into sustained conversations that may save lives.