ON A CHILLY MORNING in November 2002, Chingmak Kejong, a local pastor and leader in the fight against HIV/AIDS, drove 50 kilometres through eastern Nagaland’s Tuensang district to Noklak, the district’s last outpost before Burma. The monsoon had passed the month before, and the road—if it could be called that—which followed the countless folds of the lush, coal-filled Naga hills, spotted with acres of earth scorched to prepare it for cultivation, was riddled by mudslides.
Chingmak was on his way to an executive meeting of the Baptist Church Association of the Khiamniungans—an eastern Naga tribe that makes up most of the nearly 4,500 households in Noklak town and its surrounding villages, some of which fall partly in Burma—at which he would defend his strategy for combatting HIV in the area. For about three years, Eleutheros Christian Society (ECS), an NGO he founded in 1993, had been running the only HIV testing in Tuensang, Nagaland’s hardest-hit district, through a centre he helped set up in Tuensang town’s hospital. In 2002, the rate of antenatal mothers testing positive—a figure often used by epidemiologists to extrapolate infection rates in general populations—was 8 percent. Anything over 1 percent is considered a generalised epidemic. “How do you comprehend 8 percent?” Chingmak recently said to me. “It’s a pandemic, not an epidemic.”
Puzzling over HIV data in the months before the church meeting, Chingmak had noted with concern an unmistakable fact: if 100 HIV cases were found in Tuensang, 80 of them would be Khiamniungans, one of four major tribes in the district. This was likely because of the fluidity of the border with Burma. Drugs from opium fields and chemical labs in Southeast Asia—trafficked through the Burmese uplands and bound for users in Delhi and Calcutta—would inevitably reach illiterate villagers without an education past the fourth standard, who didn’t know better than to share needles. Indian Army soldiers, Assam Riflemen and underground militants operating along the border had a reputation for sleeping their way through villages, often without condoms. Despite these risks, only one set of HIV tests had ever been done in Noklak itself. In 1998, at a temporary health camp set up by a group of doctors from Kohima, the state capital, 75 local people had tested positive for sexually transmitted infections; five of these had HIV.
There were many reasons for Chingmak to be apprehensive about the meeting in Noklak. Although Reverend Pinglang, the Khiamniungan Baptist association secretary, had personally invited Chingmak, as a member of the Chang tribe, his attendance would be unusual. The Noklak area was also heavily patrolled by underground groups, including the Federal Government of Nagaland and the National Socialist Council of Nagaland (Khaplang), who were battling the central government for the right to govern an independent Nagaland; it was difficult to do anything in Noklak without the underground’s knowledge, and they saw outsiders like Chingmak as spies. The possibility that he might be prevented from reaching Noklak—or worse—was made more real by the fact that the Chang Tribal Council had come out in support of the Khaplang faction’s main rival, the National Socialist Council of Nagaland (I-M); for that reason, Changs were particularly suspect. In addition, Chingmak’s father, an influential MLA from Tuensang town, the district administrative headquarters, had the support of the I-Ms, and this cast further suspicion on his son.
Chingmak’s agenda was also bound to be inflammatory. He wanted the church to appoint staff to walk into Burma and test Khiamniungan villagers there, to distribute condoms and sterile needles for drug users and to refer HIV-positive people to the local hospital. The crux of this plan was outreach; in a 90 percent Christian state, people hid their bad habits, and just finding drug addicts, their sexual partners, and anyone who might be sleeping around—then getting them to admit that behaviour—would be a Herculean task. Making the Church the nodal agency for HIV prevention, awareness and testing would be extremely controversial; local people associated the disease with Nagaland’s many drug users, who were widely ostracised, and with sex outside of marriage, an anathema to the sanctity of the Baptist family. A small counselling centre Chingmak and Pinglang had started in Noklak town was already an object of suspicion and ire. In Tuensang town, where ECS was running the only HIV testing in the district, Chingmak had the pastors post a bulletin in the church every week giving the numbers of new infections by tribe. Khiamniungans accounted for most of the new cases, and they were the most outraged by the brazenness of Chingmak’s tactics.
But Chingmak, though mild-mannered and extraordinarily soft-spoken, has an iron will. As the head of ECS, he had been clashing for years with militants and conservative church folk in Tuensang town. Buoyed by his own resilience, he felt ready to take on Noklak. At 33 years old, he was still young enough to be reckless.
At the meeting, held in a guesthouse next to the church, Chingmak pressed home the gravity of the AIDS epidemic in Noklak. “He told us that an entire generation of Khiamniungans would be wiped out,” Pinglang said to me. The news didn’t sit well with everyone. Here was an upstart and an outsider coming to a Khiamniungan community to warn them that they were dying of a disease that strikes the immoral, and claiming he could save them from extinction. The meeting included about 30 pastors and youth leaders from the Noklak area; Chingmak told me that they berated him for bringing badnaam (infamy) to their tribe, claimed his programmes weren’t going to help anyone, and accused him of inventing the epidemic to steal their money and blood. After a while, the din became so unbearable that Chingmak stood up and spoke again.
“I see I’ve been a huge embarrassment to you,” he told them in Nagamese, an Assamese patois that serves as a communication bridge between 16 different tribes, each with a distinct language. He said that they could refuse to take on the projects, that he couldn’t force them to conduct testing in Noklak. “But I just want a letter from you. It should say hereafter, if the epidemic becomes really loomingly large, we will not say that Chingmak never told us.”
An elderly pastor from a village in the area stood up. “Young man,” he said with an intensity that belied his measured words, “I don’t believe you’ve said this in good spirit.”
“Whether it’s in good spirit or in bad spirit, I think it’s becoming stale,” Chingmak said. “If you’re not ready to accept the fact that we have HIV, then we can just wait for a better time.” Some in the meeting were impressed by the Chang churchman’s words. Pungom, a 30-year-old pastor in the border village of Pangsha, had never heard of HIV. When Chingmak told Pungom that it was his Christian duty to help his people, Pungom believed it.
At the close of the meeting, Chingmak said that the choice was theirs, and he left. The remaining pastors debated and finally passed a resolution to implement the first in what would become a series of programmes that eventually made Noklak one of the biggest recipients of government AIDS funding in Nagaland. In 2003, Chingmak’s programme began to work in earnest in Noklak. The local Baptist association created a drop-in centre, where HIV-positive people could talk to a counsellor, discuss their antiretroviral therapy treatment and get condoms. In 2004, the community health centre started Noklak’s first HIV testing centre, which soon provided antiretroviral drugs, and, in 2010, Chingmak and the Baptist association built a hospice to serve HIV patients.
In the decade Chingmak has been working in Noklak, the number of positive and negative people tested there each year grew from 73 people in 2007 to 737 in 2012. The prevalence among antenatal mothers dropped from 7.1 percent in 2004 to 4.3 percent in 2007. Today, Noklak has the hospice, two drop-in centres with full-time counsellors for HIV-positive people, a targeted intervention site where clean needles are disbursed to drug users, and an antiretroviral therapy department at the community health centre; 40 villages now receive HIV/AIDS care and support through the Khiamniungian Baptist association.
And yet, all is not well in Noklak. After more than 10 years of intervention supported by government and international donors, the prevalence rate among all those tested at the health centre there hasn’t noticeably declined—staying above 8 percent from 2007 to 2012. Some say this may be due to an influx of foreign migrants coming over the border with Burma, but others have insinuated that the Church is not an effective vehicle for harm reduction. Khriebu Nakhro, who runs a research-based NGO in Kohima, knows Chingmak well. He questioned whether referrals to testing centres in Tuensang are as numerous as Chingmak and his colleagues report, and said that the state AIDS-control organisation found unopened boxes of out-of-date condoms in ECS drop-in centres. “It’s very difficult to convince the Church or the general population to buy into condom promotion and needle exchange,” Khriebu said. “If you preach against premarital sex, how can you give out condoms?”
Still, Chingmak’s energy in that 2002 meeting, and his continued proselytising in Noklak over the next decade, seemed to win over a tribe now convinced that he saved them. “If it were not for Sir Chingmak,” said Nokai, the Baptist association’s HIV-programme director and Pinglang’s wife, “the Khiamniungan people would exist no more.”
THE FIRST CONFIRMED CASE OF HIV in India was a sex worker in Madras who tested positive in 1986. Ever since then, the narrative of the AIDS epidemic in India has been an inconsistent, often contradictory one. Early on, money for prevention and treatment was scarce—only $60 million per year was allocated by the central government during the late 1990s—and the incurable disease went largely unaddressed in a country suffering more immediate health challenges. (By comparison, in 1999, the United States government spent over $7 billion on its domestic prevention and care programmes for HIV/AIDS.) In 2002, 15 years after that initial patient, a US government agency estimated that India would have 20 to 25 million AIDS cases by 2010. Across India, there was something approaching the hysteria that mounted in the United States in the early 1980s, when HIV first surfaced there among gay men. Foreign funders rushed in to help stave off a global crisis; the Bill and Melinda Gates Foundation alone promised $100 million to help control the disease in India (and has since given over $300 million).
In 2006, UNAIDS estimated that 5.7 million people in the country were HIV-positive. Some observers said that the actual number was much higher—more like 10 million. The next year, however, it was discovered that the previous estimates for HIV cases in India were inaccurate. This was partly because the method used to generate the figures sampled high-risk groups, such as people at sexual health clinics, who were more likely than the general population to have HIV. As a result, the number of cases nationwide had been exaggerated by at least a factor of two. There was no general HIV epidemic in India, it was now believed; the disease was largely confined to sex workers, truckers, drug users and men who have sex with men—a relatively small section of the population. (In 2011, the prevalence rate of AIDS in the country was estimated at 0.27 percent—well below the threshold for a general epidemic.) Following the downward revisions, which were widely accepted, global funders of HIV initiatives began to wind down their projects; this included the Gates Foundation, which currently runs programmes in half of Nagaland’s districts, but will completely exit India’s HIV fight later this year.
To the extent that a larger Indian AIDS narrative does exist, however, the Northeast—and Nagaland in particular—has always defied it. The first case of HIV/AIDS in Nagaland was detected in 1990, when the Indian government tested injecting drug users at a clinic in Kohima. By the early 2000s, the region’s history of conflict and a huge concentration of drug users, along with a lack of education and development, caused the rates of HIV infection in Nagaland and Manipur to shoot up over 1 percent, the threshold for a general epidemic. Unfortunately, the population was so small, the area so remote, that it could never really claim the sort of attention given to the massive numbers of AIDS cases among sex workers in Bombay and truckers travelling out of Madras. At the same time, however, prevalence rates were so egregiously high—higher than the rest of the country—that it would have been unethical to do nothing.
Sadly, the struggle against HIV in Nagaland has often been a losing one. In 1992, the government set up the National AIDS Control Organisation, which works through state chapters to empower NGOs to tackle HIV/AIDS at the local level. Although the organisation had a presence in Nagaland from 1992, the state chapter was only set up in 1998. From its inception, it was plagued by corruption, lack of accountability for funds, and the failure of the national organisation to articulate clear policies. In districts such as Tuensang, this meant that, throughout the 1990s, there was effectively little to no government spending on HIV. By 2009, Nagaland, which has a population of just under two million, had an estimated 13,120 people living with HIV/AIDS—more than the infected population of Bangladesh.
Attempts to stem this epidemic, especially in the conflict-ridden eastern part of the state, have faced some nearly insurmountable obstacles. Mobile bands of guerrillas, difficult to reach with HIV programmes, spread the disease through sex with multiple partners. Indian Army and Assam Rifles brigades stationed in the area have spawned a sizeable local sex trade; but, because of the climate of Baptist morality, sex workers operate in secret and are therefore difficult to identify and treat. Militant groups, who with one hand extort tribute from drug traffickers in the borderlands they control, mercilessly police local addicts with the other, thereby forcing drug use underground and making HIV prevention and treatment for users nearly impossible. Guerrilla factions have also endlessly bifurcated, often along the lines of tribal rivalries, into new outfits vying to realise their own dreams of an independent Nagaland; the resulting hostilities have claimed the lives of hundreds of civilians and militants, and made it dangerous to operate health services in the region.
In addition, Eastern Nagaland’s four districts, including Tuensang, are woefully underdeveloped compared to their western neighbours. Educational institutions are subpar, literacy rates are low—in Tuensang, less than half of the population can read or write—and not one chief minister in the history of Nagaland has been from the eastern tribes. When western Nagas represent the government, many have alleged, development projects concentrate in the west; those intended for the eastern districts end up as bank notes in some government contractor’s wallet. As a result of chronic underdevelopment, two-thirds of the population in Tuensang gets its tap water from an untreated source; 70 percent live in one- or two-room homes; and almost half of the districts’ households have no latrine.
Health infrastructure in eastern Nagaland is also shoddy. In the early 1990s, the civil hospital in Tuensang offered the district’s only round-the-clock healthcare, but the facilities were extremely limited: there was no lab for urine or blood tests; to get a chest X-ray, one had to travel over 180 kilometres to Jorhat, in Assam. Today, there’s a shortage of doctors and medical staff, the roads are often impassable, and there are still few functioning rural hospitals to serve hard-to-reach villages. One primary health centre I visited, in the village of Pangsha, had been built by the Congress party in 2002 to curry votes; in 2003, the newly elected Nagaland People’s Front promptly shut it down, and it has remained closed ever since. When Pangsha villagers need care, they walk four hours—or, when too sick to walk, are carried on bamboo stretchers—to a community health centre in Noklak. And, although the HIV epidemic is a major threat, oral thrush was a more immediate concern for eastern tribespeople than AIDS, since many of them had never seen a toothbrush. Under such conditions, encouraging HIV-positive villagers who barely eke out a living in the jhum (scorched-earth) fields to take their antiretroviral therapy medications everyday—let alone getting them to supplement this drug regimen with eight glasses of water and a diet rich in nutrients—can seem a hopeless task.
Perhaps the most significant obstacles to containing HIV/AIDS in Nagaland, however, are the state’s powerful Baptist Church and the conservative mores it has helped foster. “Naga society is very puritanical,” said Father Abraham Lotha, a Catholic priest who runs St Joseph’s College in Kohima, where two-thirds of the student body is Baptist. “It was the puritanical mid-19th-century version of Baptism that came to Nagaland, and Nagas are stuck in it. Since then, the American Baptists have moved on. But we are stuck here.” Blinded by this puritanism, many Church leaders simply denied that there was an epidemic; in Tuensang during the early 2000s, few in the largely Christian community believed or were willing to admit that HIV existed, even though the district had the worst antenatal infection rate in Nagaland—almost eight times as bad as in Kohima. Across the state, the Church continues to resist the harm-reduction approach used by government AIDS-control organisations, which seeks to minimise the negative health effects of criminal activities such as drug use and prostitution, without attempting rehabilitation.
The impact of the Church’s HIV-denial and its antipathy to harm-reduction methods cannot be overestimated. In a state crippled by decades of home-grown militancy, political corruption, tribal violence and a lack of material development, the Church is the most stable, pervasive force. For many Nagas, it is the only institution in their lives. It has replaced older structures in a society that has in other ways modernised in the span of a generation. Just decades ago, some local tribes were headhunting and their boys were segregated, until they came of age, in thatched-roof communal dormitories called morungs. Today, Naga youth profess Christianity, listen to rock music, watch a few of their most privileged peers leave home to study in Delhi and Bangalore, and have a surfeit of drugs at their doorstep. Because of its conservatism, the Church is almost entirely unequipped to handle the AIDS epidemic that has occurred alongside this social upheaval. At the same time, however, no other social institutions exist to fill the vacuum of care, and the Church has quashed almost all attempts by outside groups to curb HIV.
The ongoing guerrilla conflict, the lack of local development and the Church’s obstructionism have all been compounded by an older strain in Naga culture—inveterate mutual antagonism. “Nagas thrive on rivalry,” Pastor Ricky Medom told me, recalling the headhunting days of Naga tribes, which persisted in Tuensang into at least the 1970s. “We get our identity through enmity. We are still grappling with Christianity. The Christian view of ‘love thy neighbour’ is so different.” Such animus has not only exacerbated the state’s destabilising internecine political violence, but has also made collaboration between the various stakeholders in the campaign against HIV/AIDS extraordinarily difficult.
IN THIS CONTEXT, if Chingmak is believed by some to be the saviour of a conglomeration of tribes that fit into the imprecise ethnic category of eastern Naga—if indeed he casts himself as, and even believes himself to be, such a deliverer—perhaps it is not without reason. When Chingmak was born in the wee hours of Christmas Day, 1968, five years after the creation of the state of Nagaland, his father, then a local administrative leader who drank and gambled away his nights in defiance of Baptist orthodoxies, stumbled home, leaned over his new son and pronounced, smiling: “This one will be in the Church.” Not long after returning to Tuensang from a seminary in Pune, in the early 1990s, Chingmak, along with his doughty wife, Phutoli, began fulfilling that paternal prophecy in an unexpected and radical way by ministering to the infected—mostly addicts and prostitutes on the margins of Baptist society.
During Chingmak’s pastorate, the HIV situation in Tuensang has dramatically changed. Many people, including Chingmak himself, claim that to the extent there exists in the district today a health infrastructure capable of treating this chronic, flesh-wasting, immunity-destroying virus, it’s because of his efforts. When he moved back to Tuensang, healthcare for HIV-positive people was non-existent; no one in the district even wanted to acknowledge the disease. The local hospital refused to treat HIV patients, Church leaders refused to recognise their existence—and young men and women were dying in what should have been their prime. Since Chingmak and Phutoli began spearheading the local battle against HIV/AIDS, however, prevalence rates among the district’s many injecting drug users have sharply declined; the most recent data show a drop from nearly 24 percent in 2003 to just 2 percent in 2008.
People who have seen the evolution of Chingmak’s work in Tuensang swear he is capable of miracles. Through ECS, his NGO, Chingmak succeeded in linking AIDS-control funding from Delhi to the district’s existing hospitals, and helped lobby for a special centre in the Tuensang Civil Hospital to counsel patients on antiretroviral therapy. When he arrived, the Civil Hospital didn’t even have a gas stove, but he provided one, along with a washing machine and sensitivity training for staff. He also built up the hospice in Noklak, which, though humble, was—at least on my visit—better stocked and attended than the local government hospital. Since then, he has founded another hospice, in Longpang village, that has 15 beds for HIV patients and 10 for general patients; it is known locally as the House of Hope. He has also started four drop-in centres for HIV patients, three targeted intervention centres for drug addicts, and two antiretroviral therapy centres. He has secured funding to provide nutritional supplements to patients taking antiretroviral therapies; he is using a Rs 30 million grant from the Navajbai Ratan Tata Trust to implement water and sanitation projects in the district; he just inaugurated the cultivation of over 200 acres of baby orange trees meant to create a viable livelihood for villagers and rejuvenate the land following decades of jhum cultivation; and, at the height of his projects, he employed a staff of 200, including part-time outreach workers. “It is a role model for all of us,” Dr Limaakum Jamir, a joint programme manager for the state AIDS-control organisation in Kohima, said of Chingmak’s work. “Development, public health, all the programmes are converged. We have to try to replicate that.”
Chingmak’s biggest success, however, was to win over the Baptist Church. He has persuaded local congregations not to openly oppose his outreach work and to allow him to lobby church staff to go door to door to pass out information on the disease. He has even convinced local parishes in Tuensang to permit condom promotion out of church basements, something that has not been attempted in any other Nagaland district. And he has gotten local pastors, from the district’s many tribes and political affiliations, to collaborate. Today, Tuensang is the only district in Nagaland in which the Church is substantively involved in addressing HIV and ministering to the afflicted. By contrast, in Dimapur and Kohima, which are now the two highest-prevalence HIV districts in the state, the Church has almost nothing to do with HIV treatment or harm reduction.
“Chingmak has several advantages,” Chenithung Humtsoe, who runs a federation of HIV NGOs called N-NagaDAO, told me. “Basically, he’s from a Church background. And then his political influence is also there, because of his father, though Chingmak may deny that. Later on, Chingmak became the executive secretary of the entire Chang Baptist association. So because the leader himself had taken a keen interest, he’s done a very good job.” (Chingmak’s 84-year-old father was first elected an MLA in 1997, and has won three consecutive terms, due partly, Chigmak said, to considerable support from the powerful I-M.)
“I call him the Prince of Tuensang,” added Chenithung. “ECS is everything in Tuensang, and other NGOs aren’t coming forward.”
In such a remote, underdeveloped district, Chingmak cuts a striking figure. He wakes up at five—“just to check if I’m still alive”, he told me—eats just two meals a day, and imbibes a steady stream of warm beverages from which he apparently derives enough energy to broker endless deals on his omnipresent BlackBerry. Everyone knows and trusts him, from government employees to addicts, and he is constantly in motion—building sanitation here, establishing water projects there, then flying to Dimapur or Delhi to meet with government AIDS-control organisations. He’s also the only person in Nagaland who advises the Supreme Court. (He was appointed to make recommendations to a two-man commission on a case against the Union Government over the Food and Civil Supplies Bill.) But if a villager calls him to say a landslide has blocked the road and people can’t leave, he’ll put everything on hold and shake up the district administration to do something. In a sense, his mutability is a source of power: he can speak the harm-reduction lingo of NGOs in Delhi conference rooms and then turn on his heel and speak in folksy parables to villagers raised on oral histories. He’s everywhere and nowhere at once.
“If anyone controls Tuensang, it would be him,” Father Joseph Namgkhuchung, a Catholic priest who gave up the cloth to run HIV programmes in Dimapur, told me. “He’s very soft-spoken—you would never suspect it—he’s very nice, smiling, but his influence is wide. He has brought in the president of India to Tuensang. The president has come, which no government of Nagaland has succeeded in doing.”
“You may not be wielding a gun,” Father Joseph said of Chingmak, “but your image and your word goes far.”
Indeed, it’s difficult to see Chingmak’s health empire and imagine anyone else on his throne. Perhaps because he’s devoted his life to Tuensang when he had the education and ingenuity to do so many other things—a fact he eagerly pointed out to me—he is distrustful of anyone who poses a real or imagined challenge to his authority. In the Northeast, such a challenge is now emerging from another school of NGO leaders—those from within the affected populations of HIV-positive people and at-risk addicts, who wish to administer their own care. But in Tuensang, where Chingmak reigns, these individuals have almost no control over health programming; Chingmak, some say, has actually disempowered the people he purports to help. Chingmak rejected such criticisms, pointing to all he has accomplished in Tuensang. If it wasn’t for him, he told me, “there would be no one walking the streets in this town.”
But despite the health infrastructure Chingmak has set up, and although prevalence rates among injecting drug users have steeply declined, the prevalence of HIV among antenatal mothers in Tuensang has remained alarmingly high, hovering around 3 to 5 percent between 2003 and 2008. In 2009, the district was one of just six sites in India that had antenatal mothers testing positive at a rate greater than 3 percent. These figures suggest the AIDS epidemic may still be ravaging Tuensang. (At the same time, there has been a general improvement in HIV prevalence across the state, which by 2009 was no longer considered to be in the grips of a general epidemic.) Now, as the government AIDS-control organisation begins to wind down funding to some projects, these numbers may rise even higher.
Chingmak’s control over HIV programming in Tuensang is seen by some community members as a part of the problem. “There is no big enough leader to question him,” said Father Joseph. “There may be people murmuring here and there. But nobody will talk loudly.” This may soon be compounded: although Chingmak denies it, some locals believe he is flirting with a move into formal politics—a perhaps natural step given his unrivalled authority in the district. “Once you get in this position,” Father Joseph continued, “the risk is that you take arbitrary decisions without consultation. And arbitrary decisions could go very wrong.”
TUENSANG TOWN IS A SERIES of government offices, public grounds, a single understaffed public university and one private one, and bamboo and timber homes on stilts, scattered over two adjacent hillsides. The lighthouses of the landscape are the churches of each of the four major tribes of the district—the white tower of the Sangtam; the multi-windowed façade of the Khiamniungan; the great, austere cross of the Chang; and the tall, green steeple of the Yimchunger gather together most of the 30,000 town residents every Sunday.
Across the vale from Chingmak’s house rises a series of three green ridges; from his balcony, even the most distant hills appear close. “That one,” Chingmak said, pointing to the last range, which was partially shrouded by low-hanging, post-monsoon clouds, “is Burma.”
If a single cause for the outbreak of HIV in Nagaland can be identified, it is the heroin that leaked over these hills in the early 1980s, when Burma was the biggest opium producer in the world. As sea routes for heroin shipment dried up, and Thailand, Singapore and Malaysia tightened their drug control policies, a significant portion of the Burmese drug trade was channelled through Moreh, in Manipur. Kilos of heroin wrapped in woven bags were smuggled over the porous border and trickled into Tuensang district. Overnight, it seemed, the state was transformed.
“It was the whole of Nagaland,” said Sentimoa Tzudir, a former heroin addict who now works in Dimapur for a harm-reduction initiative funded by Avahan, the Gates Foundation’s programme for HIV in India. “It was like almost every second family had a drug user. It was so visible.” People shot up in outhouses and bamboo latrines, barely concealed by curtains. Heroin with an 87 percent purity level was shockingly cheap; if supplies ever ran out, people took SP, or Spasmo Proxyvon, an opioid painkiller described by one addict as causing “a sparkle in your head, like a bomb”.
Although drug use was at first relatively conspicuous, users were soon targeted by local militias. If you were caught using in Tuensang, the guerrillas, known as undergrounders, or UGs, would come to your house with a shard of bamboo, pierce your ear, insert a small padlock and take the key—that is, if you were lucky. If you weren’t, the UGs would snatch you from your home and hold you for ransom—or just shoot you, point-blank, in the head. (Ironically, UG commanders were simultaneously profiting by levying hefty taxes on smugglers.) Meanwhile, pastors confiscated needles from chemist shops and excommunicated users, refusing to bury them when they died. Parents burned syringes and sent their children to prayer centres—sort of sleep-away Bible camps where they fasted, sang songs to Jesus, and prayed to overcome their sins. Unable to inject in any other way, addicts in Tuensang fashioned makeshift syringes out of ink droppers and sewing needles. HIV flourished in the resulting climate of secrecy, shame and contamination. “In Tuensang it was very bad,” Tzudir told me. “Some of my friends there had crazy stories. They had a glass syringe, and they had seven, ten friends come over and share. That’s why Tuensang was so badly hit.”
Though they did not acknowledge it, the drugs were burning through Chingmak’s family as well. When he was at Union Biblical Seminary in Pune, his younger brother Sanglee went to nearby Fergusson College. Sanglee never seemed to have any money, and only wore a single pair of jeans, which were badly ripped, although his parents bought him new clothes often. Chingmak and his family didn’t piece things together until 1988, when Sanglee collapsed from heart failure. When the doctor told him that his brother had admitted to injecting heroin, Chingmak was forced to confront the problem. “I just brought him back home,” Chingmak told me. “We had to put him in treatment. Then it was literally from one hospital to the other, one treatment centre to the other.”
Chingmak continued to care for him, but the next year Sanglee died of another heart failure. He was 23. Chingmak was devastated, not only because of his attachment to his brother, but because he had spent the past three years of his life trying to save him. Worse, Chingmak’s youngest brother, Chuba, the baby of the family, had dropped out of school after the 10th standard, and was now using heavily as well. “It just simultaneously happened one after another,” Chingmak said. “The question within myself was, ‘Why? Why is this happening?’ I wasn’t aware that there was this larger environment that was affecting it. It was only later that I realised that unless I work on the environment, if I’m only dealing with my brother, it’s going to have no effect.”
Chingmak and Phutoli, who met at Union Biblical Seminary and married in 1992, started informally counselling HIV-positive people—mostly drug users who could afford the trip to Kohima to get tested. Because of the duty of confidentiality, individuals’ statuses were never disclosed, and no one in Tuensang suspected the HIV outbreak. When Phutoli tried to lobby doctors in the area to provide testing and treatment, she was rebuffed. One doctor “flat out told me there was no HIV in our district,” Phutoli recalled.
By the late 1990s, however, HIV in Tuensang was impossible to ignore. In 1993, Chuba had joined 32 other boys at a de-addiction camp that Chingmak ran in an abandoned building, once meant to be an isolation ward, behind the district hospital. According to Chingmak, two researchers from the Indian Council of Medical Research came and tested all the boys for HIV, but the tests didn’t come back until four years later, when he received a copy of the results from the medical officer in Tuensang. Twenty-five of the boys, including his youngest brother, who died in 1995, had tested positive. (The medical officer, the health department, and the state AIDS-control organisation have no official record of these tests. Chingmak insists they were performed, and keeps a typed-up copy of the names in his house.)
Using their knowledge of local users and community gossip, Chingmak told me, Phutoli and he attempted to estimate how far HIV might have spread from the 25 addicts who had tested positive in 1993. “We mapped the people and it was like 300 of them at least—drug partners, sex partners,” Chingmak recalled. “We said, it makes no sense that we live in this beautiful setting where we sing songs every night whereas HIV is spreading all over.” “Families who had three or four sons who were HIV positive weren’t admitting to the problem,” said Phutoli. By that time, Chingmak had become the pastor at the Chang Baptist Church, and his father, recently elected as an MLA, had a great deal of respect in the community; Chingmak decided to use this privileged position to draw attention to the proliferating disease. In 1998, in front of hundreds of people at the Chang tribe’s annual convocation, he disclosed his dead brother Chuba’s status. “It had to start with me,” he recalled. “Because there was so much denial, I had to say look, I have a brother who is found HIV positive.”
AT THAT TIME, Chingmak told me, he was terrified about what he saw as the coming obliteration of his race. Growing alarm in Kohima and Delhi added to the panic. A doctor from the state AIDS-control organisation had called him to Kohima to encourage Chingmak to set up a five-bed HIV hospice. But the community’s level of prejudice, Chingmak and Phutoli realised, would never support such an endeavour: no one would come forward for care; even if they did, they would be ostracised. Chingmak and Phutoli were themselves growing more isolated; though Chingmak was the Chang pastor, he would avoid funerals so that people wouldn’t think that the deceased was a user or had HIV.
That was when Chingmak and Phutoli decided they had to involve the Church. In February 2000, they convened a meeting of pastors from the various congregations in Tuensang; Reverend Pinglang came down from Noklak. “If as a church we don’t do something,” Phutoli recalled saying to the pastors, “Nagas will kill themselves off on HIV.”
“One of them said, ‘you people do it, we can’t deal with it,’” she told me. “I said, ‘Help your own tribe. We’re not asking you to help other tribes.’ The tribal feelings work well, and we really played that card.” But the pastor of the Tuensang Khiamniungan church remained vehemently opposed. He loudly declared that HIV didn’t exist; he was unaware that his nephew, Mongstua, an apple-cheeked, dimpled young man of about 30, was an HIV-positive former addict whom Chingmak and Phutoli helped to counsel. “His nephew was dying of HIV and he was making so much noise,” Phutoli told me. Mongstua also had a number of other infections and had been hospitalised for tuberculosis; without access to antiretroviral therapy in Tuensang, his condition was worsening. “He was shitting black,” she recalled.
Phutoli made a dangerous but—she felt—necessary decision that night, after the pastors left, to disclose Mongstua’s status to his uncle. She had gotten so tired of hiding the conditions of their clients, while she and Chingmak were publicly scorned and treated as false prophets for trying to talk about HIV. Later, Chingmak and Phutoli approached the Khiamniungan pastor. “I just told him, ‘Look, Mongstua is your nephew, and he’s positive,’” Chingmak recalled. “And he didn’t know. It may not be very ethical. But we were so desperate and people were so adamant to deny it.”
That was the turning point with the pastors. They soon formed an NGO called the Church’s Alliance, and won a Rs 600,000 grant from the state AIDS-control organisation for raising awareness and outreach. In each of the churches, the pastor was appointed as a counsellor, and two outreach workers brought in at-risk townspeople to speak with them about the spiritual and bodily dimensions of HIV; the pastors referred individuals to ECS for testing, and—at least theoretically—distributed condoms to those diagnosed with the disease.
Even with the pastors on board, however, congregations and the general public were intransigent and abusive. Church meetings became a chance to excoriate pastors for neglecting their duties to righteous folk in favour of lost women and addicts. “We went through shit,” said Phutoli. “Once, a lady actually spat on me.” Other women shunned Phutoli because she wore jeans, kept her hair short and wasn’t from a local tribe. “I was working for a community that wanted me to fit in a box,” Phutoli told me. One person blamed Chingmak for bringing the drugs to Nagaland; others accused them of harvesting cadavers for heroin. “People said we buried drug users to take the bones and sell them,” Phutoli told me. “They thought the drugs used to be in the bones of an addict.” Some townsfolk called Chingmak the Antichrist.
Then there was the underground. Chingmak started training the boys he had rehabilitated to volunteer as vigilante-informers, reporting back on drug trafficking from villages along the border. But one day a Chang guerrilla came to Chingmak’s home, sent—so the guerrilla claimed—“by people in the East”. He told Chingmak to help addicts if he must, but never to pass beyond Tuensang town. “Then I didn’t know the tie up” between the underground and the drug trade, Chingmak recalled. “We thought the community would support us because we were catching the peddlers.” According to both Chingmak and the state AIDS-control deputy director, on a 2003 trip to Noklak, they were detained for five hours and interrogated by UGs. Another day, Chingmak received an envelope containing two raja mircha (tiny, bright red, scorchingly hot Naga chillies), a bullet and a pencil-written letter in excellent English; the letter warned him off his “antinational” activities and accused him of putting up bogus statistics for funding. (He never found out who sent it.) Meanwhile, outreach workers were dragged out of their offices by local militants, who destroyed condom boxes and stole financial records.
Despite the environment of hostility, Phutoli, Chingmak and his fellow pastors were slowly setting an example in Tuensang town. At the local hospital, because of the ignorance of medical staff, HIV patients were being neglected. After one client died, the nurses burned her mattress. “And they did not even wrap her body in a sheet,” Phutoli told me. “I went down and I wrapped her body, and I and two staff carried her to the van.” The pastors convened that night to hold a makeshift funeral outside the Chang church. After her last rites, staff dug the dead woman a grave in the cemetery. Congregants, however, continued to inveigh against the work their church leaders were doing on behalf of the addicted and diseased; the Khiamniungan pastor almost had to resign as a result. But people were at least finally talking about HIV, and some infected people were becoming ready to speak out. On December 1, 2003, the Chang church held a special evening service for World AIDS Day. Mongstua and a young woman named Lepla, who had been dropped off at Chingmak and Phutoli’s door one day by her father after he discovered she had HIV, joined the gathering. That night, they became the first people in Tuensang to publicly declare they had HIV.
SINCE HE DISCLOSED HIS STATUS IN 2003, Mongstua has become something of an HIV poster boy in Tuensang. (Lepla, however, fell ill soon after the AIDS Day gathering, and the Church took her in. When she died a few months later, the pastors built her coffin.) The week I visited the town, there were two government-supported HIV/AIDS events: a football match that didn’t seem to have much to do with the issue, and an awareness-raising rock concert at the dilapidated town hall. In between sets of Christian metal and rock, Mongstua got up and, in halting English, shared his HIV story. Many of the young people, who had just come to see their friends play, walked out.
I met Mongstua on my last day in Tuensang at Chingmak’s home. The location was Mongstua’s choice, because, he confessed, he didn’t want me to see where he lived. We sat on the balcony of Chingmak’s guest quarters, before the hills reaching up into Burma.
Mongstua, who is 42, told me that he was born to paddy farmers in Pathsonoking, a village in the Noklak area, and that his father died when he was three. At 13, he moved alone to Noklak town and rented a small, mud-walled hut, so he could go to school and occasionally work in the jhum fields for a few rupees a day. When he was 16, he started using heroin with older boys who fed him in exchange for a place to hide out from the UGs. There were about eight of them, and they all shared a needle. He discovered his status in 2000, when he was tested by ECS after working with them to help identify drug users.
Soon after his AIDS Day declaration, Mongstua went a bit rogue from ECS. In the previous years, as global programming for HIV/AIDS developed, counselling groups run by HIV-positive people sprang up all over the world. Such groups, known internationally as “networks”, are meant to empower people living with HIV by giving them authority over their own treatment, involving them in the process of administering needed services, and allowing them to be a source of support and positive identification for other people with the illness; it’s an evolution from older, top-down forms of care provided by NGOs and government agencies. Mongstua joined the Network for Positive People in Kohima, and then helped to start Tuensang’s own patient-led support group. “The Church’s Alliance is monitored by the elders,” Mongstua said. “They know the right information about HIV, but they don’t know the life of HIV/AIDS because they’re not infected.”
In a district where Chingmak and Phutoli received absolute fealty from most of the positive people they helped, Mongstua had the gall to question the Church’s Alliance model. “The church members don’t allow us to speak in the church about HIV/AIDS,” Mongstua told me; I heard similar complaints from several other HIV-positive people in Tuensang. “The public still thinks that HIV is a curse,” he said. “It’s high discrimination we are facing in church. Some people won’t sit by me when I go.” Sure, in Noklak and Tuensang town, people are somewhat open about HIV, Mongstua said. But in his home village, the elders tell people to stay away from the 40 or so positive people. And in Patso village, where ECS tried to start a targeted intervention centre for drug users, the elders drove them out.
Chingmak’s line, however, is that the Church has virtually done away with stigma in the region—and that it saved Mongstua’s life. “Here in Tuensang we’ve come to a point where HIV has become a very normal disease,” said Chingmak, who seemed to take Mongstua’s move toward networks personally. “If Mongstua wasn’t grateful, then I’m sorry, because today he’s walking around because we literally took care of him. When he was sick, the Church took care of him for months. They took him to the hospital. He did not have anyone to help him. It was Church that dealt with the stigma. And if he’s breathing normally, I think it’s because of the Church.”
Chingmak stridently opposes the networks in Nagaland. He believes they have become pretexts to chase government funding, and that they self-segregate positive people for no good reason. In addition, he doubts whether addicts and former addicts can be trusted to regulate their own treatment and responsibly use funds. “This is the problem with the whole HIV world,” Chingmak told me. “To identify drug users, you need to use drug users. You can’t expect HIV positive people to—.” He paused, then went on. “In places like Nagaland and Manipur, the old habits come out.”
THE PROFILE OF DRUG USE has changed in Nagaland. Shooting up was once inevitable, even fashionable—a rite of passage into adulthood, like drinking in college. After a decade of drug-related deaths and some efforts at outreach, the people who still shoot up do it because there is simply nothing else to do. Acutely aware of the lack of career opportunities in a place such as Tuensang, some young men just spend their days scheming on how to buy drugs.
On a recent afternoon, Chingmak arranged for me to meet a few members of the new generation of Tuensang drug users: young men who frequent a targeted-intervention centre run by an ECS-mentored NGO that keeps them in clean needles. In a two-room shack, I watched as five friends, all in their twenties, unscrewed 10 bright blue tablets of SP and dumped the contents out onto a photograph. SP is not as easy to get in Tuensang as it once was: it has been banned in Nagaland for almost a decade, and the UGs still don’t look kindly on users. Many local dealers head to Bokajan in Assam to buy in bulk, then make the hours-long journey back. But the state AIDS-control organisation estimates that there are still 27,000 injecting drug users in Nagaland.
The process of injecting SP is involved, because the powder itself doesn’t easily dissolve into water; any missteps can lead to abscesses. Sao, an unemployed 23-year-old, painstakingly mixed the solution, and filled one of the 10 fresh syringes he’d gotten from the local NGO. He then filtered the solution with a piece of cotton to keep out the powder that hadn’t dissolved. When he finished, Sao licked some residual powder off the faded photo, a snapshot of him and some friends horsing around by a rocky embankment next to the Dikhu River. Phillip—at 26, the eldest of the crew and a former member of the Nagaland Police who is now unemployed—unceremoniously dropped his jeans and injected into a vein in his groin, then reeled and sucked in his breath as the high hit him. Most of his friends, he told me, dropped out of high school by 10th class. Later, he said that even as he’s injecting, he’s thinking about his next fix.
Later that evening, after watching the young men shoot up, I sat with Chingmak in his warm, spacious living room. A local boy had lit a fire in the hearth, and a young Adivasi girl brought Chingmak black tea, then warm milk—a nightly ritual. Chingmak and I spoke about the addicts, and his connection with them. He built the NGO that they go to for needles, and their counsellor, a Nepali former addict who now lives in Tuensang, was once an ECS employee. I told Chingmak that the boys were pretty high when I saw them.
“Well, you got them high,” he said, laughing. “How do you get 200 a day when you don’t work? And how do you sustain that habit? So for them it was a feast day, because they were given 500 worth.” He explained that the project coordinator from the targeted intervention centre, a former employee of his, had bought them the drugs. Chingmak said he thought the photographer travelling with me just wanted a quick picture of a needle. “See, but it’s OK,” he assured me. “The other way of looking at it is, we presume that Tuensang has been a hidden story and I for one haven’t been very connected with the media. So this story is definitely going to make an issue, whoever reads it. The effects of it are going to be definitely positive.”
We both fell silent. I was shocked that a man who made his career on harm reduction would buy drugs for young people in the district he purported to save. His admission, so blithely delivered, made me wonder if he had exploited other people in his quest to reshape the district—and how anyone could possibly measure the costs of those choices when Chingmak is the only person speaking for Tuensang.
Chingmak broke the silence after some time. “They would have fixed anyway,” he said.
MONGSTUA’S NETWORK IS NOW virtually defunct, a fact that is not unrelated to Chingmak’s power in the district. In some senses, the very vulnerability of the population in Tuensang, and Chingmak’s own relative authority, made this inevitable. The sick, impoverished population of Tuensang was so desperate for aid, and it was so easy for Chingmak to pay Mongstua’s rent, to give money to clients, and to employ local people. He was able to use his political connections and his personal eloquence to talk to the government, and to use his deep understanding of Naga culture to appeal to people in Hakchung, Noklak, and all the villages in between.
“The advantage of having Chingmak control everything is that the government of Nagaland, the government of India, big donors, they all listen to him,” said Abou Mere, a former addict and NGO leader in Kohima. “But if he dies or anything happens, there is a danger. It’s too dependent on him.” A social activist I met with in Dimapur, who wished to remain unnamed, also said Chingmak operates with a problematic level of control, although for different reasons. “In the end, who owns these programmes?” the activist said. “It’s not the positive people. Is that a power with the people or a power over the people paradigm?”
In 2005, Chingmak began Grace Chapel, which is the closest thing to a functioning network that exists in Tuensang today. Although he vociferously denied that it’s a network at all, Grace Chapel is essentially a church for people living with HIV. It meets on Sundays, and in addition to prayer and Bible readings, someone often comes to give a talk on nutrition or antiretroviral therapy. Many of the members are in some way indebted to Chingmak. Chukamakom, a former guerrilla who gave up his gun to live a restful life, took out a Rs 25,000 loan from Chingmak to set up a paan shop, which is chronically empty; Chingmak worked his connections with the district administration to get another member’s infected husband a job at the local power station after his previous commute became too much for his health. Chingmak’s services also spill over into matchmaking; he recently spoke with the other Chang pastors about setting up one client, an HIV-positive woman whose husband was a guerrilla who died of AIDS, with Mongstua. “A lot of marriages happen,” Chingmak said. “That’s the beauty of this Grace Chapel. They come there and meet there. ‘I know I’m positive, you know you’re positive, so we’re not harming anyone.’” (Mongstua, however, told me privately that he wanted to marry an uninfected woman, because he feared that there would be a greater chance of a positive woman bearing positive children.)
Though he built it up with his wife, Chingmak now runs his fiefdom alone. Phutoli, depressed by the isolation of Tuensang and the perception that people never really accepted her, moved to Guwahati in 2008 to work for the national AIDS-control organisation, and is now studying towards a law degree at University College London. Chingmak’s eldest daughter received a scholarship to an art school in Los Angeles, and his two younger children were sent away to boarding school in Mussoorie.
But Chingmak stays, for his work is by no means done. As part of the latest phase in its AIDS-control programme, which began last year, the government plans to downsize local hospices and direct patient traffic back to district hospitals, even though many of them are inadequately staffed and provisioned. And, as global donors funding HIV/AIDS programmes wind down their work across India, the epidemic in backwoods districts such as Tuensang will inevitably fall into a more tenebrous period of neglect. An important element of Chingmak’s success was that he leveraged government HIV funding to build up the health infrastructure, the Church, and tribal institutions in the district; once the government AIDS-control programme shuts off funding, he’ll have to devise a workaround.
Chingmak has been hustling hard to pre-empt the impending ebb of resources from Tuensang; he spent the past few months flying back and forth to Delhi to make a case for rural districts and to protest their chronic lack of access to healthcare. “There is just no end of problems in this district,” he told me. Even though things look bleak, he still has the iron will that served him so well in Noklak a decade ago. “This will continue,” he said of his work in the district. “Even if the ECS has to shoulder entire responsibility, we’ll do that.”
In many respects, it seems that Chingmak is already bearing much of the burden of maintaining the health infrastructure—and many of the other forms of infrastructure—in Tuensang, which lacks robust official leadership. He is perhaps the only person who has successfully built a coalition around four tribes in a remote corner of Nagaland, pacifying at least two different UG groups. (Not only does he not pay taxes to the militants, he proudly told me, he is also the happy recipient of their generous donations.) All this makes Chingmak an obvious candidate for political office.
One of the groups that has courted Chingmak’s political participation is the Eastern Nagaland People’s Organisation (ENPO), a political faction that has been advocating for a separate state called Frontier Nagaland (which would comprise Nagaland’s four easternmost districts), partly in an attempt to secure government funds that they feel have been diverted to the west. But Chingmak himself is cagey about his political future; when the ENPO nominated him to be part of the organisation’s steering committee, Chingmak texted the secretary immediately: “I’m in Delhi and I heard I’m a steering committee member for which I am honored. However my engagement with SC does not permit me since I officially represent Nagaland in the court. Pl explain my position to the ENPO officers. My full support to the movement otherwise.”
Over the years, Chingmak told me, he’s grown disgusted with the Naga political system. “There was a time where you needed money to win elections,” he said. “Later on it matured and it graduated into a situation where you needed money and the clan. Because politics became very dirty, tribal and clannish. Now today it’s come to a point where you need your clan, you need your tribe, you need money, and you need UG.” Seeing his father, Kejong Chang, win four elections has shaped this view. Kejong, who this February narrowly defended his incumbency in the 20,000-voter Tuensang Sadar-II constituency, is a controversial figure. According to his most recent declaration of net assets, he was worth almost Rs 10 million in 2012—an increase of nearly 700 percent since 2008, when he declared net assets of less than Rs 1.4 million. Kejong and Chingmak’s respective goals for Nagaland appear diametrically opposed: while Chingmak wants to foster democratic systems, Kejong, who has no formal education, seems to thrive on old modes of patronage. According to Chingmak, Kejong pays off tribal councils for votes and benefits from guerrilla support. In 2011, father and son were pitted against each other after a number of ministers had embezzled funds from the National Rural Employment Guarantee Act scheme. Chingmak convened a protest in Tuensang town with the women from his self-help groups. A few ministers, including his father, gave back the money they had stolen.
ALTHOUGH CHINGMAK SWEARS that he won’t get into politics—he described himself to me as a rube who, when the community finally takes over all his projects, will retire to the hills where he’ll raise pigs and grow pumpkins—he also boasted that initiatives such as Grace Chapel and self-help groups he has started across the district mean that if he wanted to run for office, the ballot would be his for the taking. “In three constituencies, 80 percent of the women are in my self-help groups,” he told me. “So I just feel that everything is just set, if one is to be tempted. Eighty percent of women who are in self-help groups cut across the three constituencies and you can actually dictate how the votes shift.” His friend Chenithung—the one who christened him the Prince of Tuensang—said that whether Chingmak likes it or not, he has taken up a mantle it would be difficult to discard. “If the ENPO got its aim and Eastern Nagaland became a state,” Chenithung said, “who else would be its CM?”
At dawn on the morning I left Tuensang, Chingmak and I sat in his kitchen over mugs of black tea, waiting for the car that would take me on the 10-hour drive back to Dimapur. The conversation once again turned to politics, and I expressed disbelief that he wouldn’t even consider running for office some time down the line. He has clan, tribe, and UG-backing, I pointed out, and could probably get his hands on the money.
He laughed and then, shifting easily into his other identity, that bumpkin from eastern Nagaland, told me a story. Once, he said, there was a villager who lived near a stream that was full of fish, and every day he would catch one and feed his family. One day, an outsider happened to be passing by, and saw this stream full of fish, and walked down to it. He exclaimed at the bounty of the stream, and praised the villager’s luck for living so close to it. The outsider advised the villager to capitalise on his blessings and catch more than just one each day. The villager asked the outsider what would happen if he caught more fish than he needed for his own family.
“Why, then you’ll be rich,” the outsider responded.
“And then what will happen?” asked the villager.
“Well, then you’ll be happy,” he replied.
The villager paused a moment—and here Chingmak paused as well, for effect. “But I am happy,” he said.