Smarajit Jana

Abstract

Physician and public health specialist who championed HIV prevention. Born on July 21, 1952, in rural West Bengal, India, he died from COVID-19 on May 8, 2021, in Kolkata, India, aged 68 years old. In 1992, Smarajit Jana was tapped to lead the first population-based HIV survey among sex workers in Kolkata's Sonagachi neighbourhood. He was an unusual choice, colleagues said, as a physician who had been teaching occupational health and epidemiology at Kolkata's All India Institute of Hygiene and Public Health (AIIH&PH). “He started going to the red-light area and began engaging with sex workers and others”, said Sushena Reza-Paul, an Assistant Professor in the Department of Community Health Sciences at the University of Manitoba, Canada. Jana began to reframe “sex work as work, looking at it from a workers' rights perspective, with HIV as an occupational hazard”, she said. Those early efforts, which became known as the Sonagachi Project, were the start of Jana's decades-long involvement with the community. “He started discussions with the sex workers to understand them and the power structures that govern their lives”, Reza-Paul said, and sought collectivised responses. That work included the formation of the Durbar Mahila Samanwaya Committee (DMSC) in 1995. DMSC is now a collective of more than 65 000 sex workers in West Bengal. “He really did change the nature of how communities can organise themselves and agitate and advocate for their own health and welfare”, said Kevin O'Reilly, formerly with WHO's Department of HIV/AIDS and now an Affiliate Associate Clinical Professor at the Department of Psychiatry and Behavioral Science at the Medical University of South Carolina in Charleston, USA. Jana received a bachelor of medicine and bachelor of surgery from the University of Calcutta in 1978, and his doctor of medicine degree from AIIH&PH in 1984. After working briefly as a physician, he returned to AIIH&PH to teach and would remain on the faculty as a field epidemiologist even as he began to develop the Sonagachi Project and DMSC. His early efforts in Sonagachi involved innovative approaches to HIV prevention that saw sex workers take responsibility for educating their colleagues and distributing condoms. “He understood that if people have access to services in their preferred way, they will do everything that is needed to protect their own health”, said Swarup Sarkar, a former adviser to several UN organisations and the Indian Government. Between 1992 and 1999, condom use among sex workers in Kolkata increased substantially and HIV seroprevalence never climbed above 10%. Those achievements were only possible, Reza-Paul said, because of Jana's efforts to empower the people he worked with. “He used to always tell me, we cannot just prevent HIV by promoting condoms or doing check-ups”, she said. “People need to have control over their lives.” Jana helped DMSC strategise and secure funding to address the myriad problems the sex workers faced. They were able to build nurseries and boarding schools for their children and to establish an independent cooperative bank so they would have access to accounts and affordable loans. Literacy increased and violence declined. Jana “showed us the path of light, a life of dignity like any other in the country”, said Bharati Dey, DMSC's Mentor. Jana made sure the sex workers and their children “are recognised as being integral to the society and he devoted his life to that”, said Dey. Jana stepped down from a leadership position in the DMSC in the late 1990s but remained an adviser. “His model really shifted the whole strategy for HIV/AIDS in India, in terms of getting them collectivised and able to negotiate their terms of survival”, said K Sujatha Rao, the former Union Secretary of India's Ministry of Health and Family Welfare and the former Director General of the National AIDS Control Organization. “His work has shaped international thinking about working with very marginalised, very disempowered groups, including sex workers, but many other groups as well”, said Isabelle de Zoysa, the former Senior HIV/AIDS Adviser to the WHO Assistant Director-General for Family and Community Health. Jana also exported the lessons from Sonagachi. In his work for the humanitarian organisation CARE Bangladesh from 1999 to 2003, he helped expand HIV interventions to sex workers and also to people who inject drugs and truck drivers. He returned to India to take over as CARE India's Assistant Country Director and was based in the country, moving between government and international advisory positions and teaching roles. Jana is survived by his wife, Madhulina, daughter, Samaita, and son, Sambit.