Preventing HIV/AIDS in India: Points to Ponder

These notes were prepared on the occasion of the International Conference of South Asian Parliamentarians (SAARC) meeting on the “Advocacy Role of Elected Representatives in Prevention of HIV/AIDS”, August 1-2, 2003, Ashok Hotel, New Delhi (India).

The person writing this letter has some experience gained in prevention activities against the spread of HIV/AIDS in India during the last eight years. Initially the Government and funding agencies came along in a big way addressing the issue of HIV through prevention projects. During the course of implementing these top down projects, myself and my organization felt some severe inadequacies starting with the conceptualization, to the implementation and down to preparations on the ground. In short, in project lingo, these are lessens learned.

Targeted intervention among “high-risk groups”

This is a highly effective intervention strategy. Since HIV is transmitted through blood and sexual intercourse, to address the high-risk groups (sex workers; injecting drug addicts; mobile work force, such as truck drivers, construction workers etc.) on a war footing before HIV percolates into the general public would seem effective. But we failed miserably in preparing the ground for intervention. Take for example, the case of sex workers; we never addressed the laws criminalizing sex work and its premises, stigma attached to sex work, human rights violations both by the public and police, gender-power relations in sexuality and differences among the different segments of sex workers. No project can work effectively in a criminalized atmosphere. The projects existed in India as clandestine activity just like contrabands. There never developed a co-ordination between the law making/implementing authorities and the health departments.

The projects were designed in the context of brothels in Europe or U.S., where there is relative freedom for the inmates in deciding their personal matters. But here the situation was of slave trade and there is no organization of sex workers for collective bargaining either with the brothel owners or with the clients. Without a sex worker’s organization they can never bargain with clients; if one denies, another should not cater. Except perhaps in few pockets like Sonagachi in Kolkata, or in some fifty-odd sites in West Bengal, Sangli in Maharashtra, sex worker’s organizations are non-existent in India. Here again, we could see the relative freedom of sex workers running the brothels to decide the matters. But the Government’s policy is still against the sex worker’s rights and organizations.

Again, the projects drawn in the situation of brothels are used to address the situation of street-based sex workers, for example in Kerala, where there is no red-light area or permanent brothel. All the parameters and monitoring systems are for brothels, which makes it ridiculous. (For example, in a brothel situation, condom tracking with a waste basket outside a room can provide some information, but in the street, this exercise is a joke — still the project reports will be full of condom tracking.) In the absence of brothels, drop-in-centers are a must for executing the projects. But as there was no ground preparation from the part of Government in supporting the drop-in-centers, it vanished from the projects in the course of implementation. This means there is no collectivity and hence no bargaining in condom use. There is only a nascent organization in Kerala, but projects go on in papers.

In the absence of collective bargaining the only alternative is using condoms oneself. But the condoms supplied to the female sex workers are male condoms, which means they have to ask the clients, under harrying conditions, to wear them. The power relations in sexuality are against the women; all they could do is wear something themselves. If the Government promoted female condoms in targeted interventions it would have succeeded immensely. They will cite the prohibitive cost but mass production and subsidy could have brought down the cost. In a study, it is shown that tampons can reduce the rate of infection in women. So the Government should also provide these along with female condoms in the projects and ensure their availability in the market.

There is still no concept of Male Sex Workers (MSW) but only of Men Seeking Men or Men having Sex with Men (MSM). This stems from the assumption that sex workers are only women; again no one sees it as sex work but only as exploitation of women, because if you admit the reality of sex work, then the strategy and policy will have to change. So the authorities just shut their eyes conveniently against the reality. But those who are involved in sex work, whether they are male or female, know it as work. So we should understand that there is a distinct category of male sex workers, who should be addressed independently. (We are not talking of gigolos, a minuscule category, which caters to rich independent women.) We should also know that we can’t address all gay men as sex workers or vice versa. Right now there is confusion in these MSM projects.

Again, archaic criminalizing laws coined in the name of “unnatural offences” hinder all activities among the male sex workers as well as within the gay community. There are instances of health activists getting arrested on these charges. The concept of needle exchange among IV drug users is still being debated. With the existing laws, as in the case of sex workers, no project can be implemented with effectiveness. Change of law is a must in these situations.

Condom promotion

The concept of A (Abstinence) B (Be faithful to one partner) C (then use Condoms if you can’t stick to the other two) in prevention projects ran high. All the IEC (information, education and communication) materials produced by the State Aids Control Societies (SACS) had this moral overtone in it. I must say they created fear and shame in people on the whole. Now it is backfiring. People are rejecting their kith and kin and in the case of strangers they even go to the extent of lynching them. The presumed “Indian Culture” and morals are actually fallout of our colonial past. The Indians, and for that matter people of other countries also, have a rich tradition in sexuality and a practice quite diverse. But the prudish postures our administrators take make them fit enough to be living in 19th Century Victorian England. Because of this “right” moral approach, people hide their sexuality and pretend otherwise. The existence of several million female sex workers along with millions of all other varieties in India show that we have a highly promiscuous way of life. We all pretend that we have the barest minimum of sexual life and only the “westerners” are indulging in sex. If it is true, then how come we Asians have two-thirds of the world population? We should know that we are more active in sex and for that matter, more in penetrative sex, and for that matter, more active in unsafe sex than all the people in the world. So it is imperative to promote condoms in every way possible and also to teach non-penetrative sex. Think about promoting kissing in the movies and tell people to indulge in non-penetrative sex. Make sexuality a pleasurable act, which could be safely practiced instead of keeping it as an act of procreation. Keeping sex as an act of procreation, as religion preaches, is keeping people in the animal state. Because, Westerners were able to conceive sex as pleasure in their culture they have brought the burgeoning population in their countries under control. Here, even after thirty years of condom promotion in the family welfare scenario, condoms have failed to click because of the opposite understanding. For us sex first means procreation and penetrative sex. Just think about all the literature like Kamasutra and all the temples of Khajooraho and Konark, what a fall! A real fall from heaven. What we call now Western is Indian and what we call Indian is Western.

When we talk of condoms, we have to think about varieties. We should invent different varieties, especially different colors to suit the Asians. We can do away with the white variety altogether, or maybe keep a few for the pale skin people. We must immediately produce flavored condoms and thus promote oral sex, another safe sex activity. As I said earlier, we must produce female condoms and tampons to give our women a defense against the penetrative sex culture of the males. This will remain as a viable alternative for the meek and submissive “wives” and “girl friends”.

Look at the varieties now available in the market, ribbed condoms, spotted condoms, dotted condoms etc. The idea of friction inside the vagina is behind all this, which the male thinks is a necessity for women. Poor women have to bear all this thrusting and just burn inside. Can’t these fellows who design these condoms, just ask the women? Haven’t they heard about a protuberance called clitoris in women? Didn’t they know about the Grafenberg spot (G-spot) in women’s vagina? Ignorance of women’s sexuality is the principal input in the designs of men’s condoms now. We have to consult women when designing male condoms. Similarly, we should consult men when designing female condoms!

Foundation for Integrated Research in Mental Health (FIRM), Kerala, India
Email: maitreya@asianetindia.com

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GM170705

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