CHENNAI: Most of India is very proud of its traditional, conservative and closed-cultural upbringing. The country which gave birth to the Kamasutra is also the same place where the justice system equates piety to celibacy, and claims that peacocks don’t have sex. There is a thin latex line between health and sickness, awareness and hypocritical disregard, and it’s about time the society acknowledges it.
The prevailing stigma on the topic of sex has shrouded the need for discussions about safe sex, use of condoms and the prevention of sexually transmitted infections (STI), most importantly, HIV.
According to statistics from the UNAIDS Gap report, India has the third largest HIV epidemic in the world with adult HIV prevalence estimated at 0.26%. The number seems small, but considering India’s population of 1.3 billion, that accounts to 21 lakh people living with HIV.
According to the National AIDS Control Organisation (NACO), about 86% of HIV infections occur because of unprotected sex. “Condoms have been proved to be the most effective tool to prevent STIs and unwanted pregnancies. There is no question of the efficacy and efficiency of condoms in prevention,” says Dr V Sam Prasad, country manager, AIDS Healthcare Foundation (AHF).
Accessibility
Yet, the taboo of talking about sex has created a widely unhealthy practice. Throw in judgemental shopkeepers and pharmacists and you’ve got a gaping hole in HIV/STI prevention net. “Shaming of sexuality is based on the premise that pursuit of sex for pleasure is degrading. It’s funny to see the reactions when we ask for condoms. They’re confused and don’t know how to answer as they’re not used to customers asking for it! Supermarkets display alcohol and cigarettes proudly, yet condoms are not seen anywhere,” rues Delfina, a gender activist in the city.
But the problem doesn’t lie in accessibility alone; more often than not, men do not want to use condoms. “Women do not have a say in asking their partners to use a condom. If they do insist, it’s not taken positively by the partner. In some cases, men use violence because they believe they’ve been asked to do something that interferes with their pleasure,” says Prasanna Gettu, managing trustee, International Foundation for Crime Prevention and Victim Care (PCVC). “This kind of neglect is prevalent everywhere irrespective of socio-economic strata.”
The most vulnerable populations that are more susceptible to HIV infections, namely female sex workers, men having sex with men, transgenders as well as the bridge populations — migrant labourers and long-distance trucker drivers — used to have less awareness and access to condoms.
The National AIDS Control Programme (NACP) involves targeted interventions (TIs) towards these key populations, by promoting the demand and sales of condoms through its condom-promotion programme. Implemented as NGO/community-based organisation-led peer outreach model, these interventions involve condom promotion as part of their package.
Change is possible
“The important thing is to teach sex workers about condom negotiation. For cases where the clients refuse to accept, we provide female condoms. We also teach them additional skills, like driving and catering, so that they can reduce their dependence on sex-work and get out of it,” says AJ Hariharan, founder secretary, Indian Community Welfare Organisation (ICWO), which has been promoting well-being of sex workers since 1994.
Baby, an outreach worker with ICWO, recalls her early days as a sex-worker. “I came to Chennai when I was 25. My husband abandoned me in a hotel, where I eventually had to get into sex trade to pay the bills and take care of my children. I didn’t even know what a condom was then. A broker initiated me into attending a meeting by an NGO, where they taught us about condoms, gave us counselling, and urged us to get tested frequent for HIV. We were also given free condoms,” she says.
Eventually, she joined as a peer educator to teach other women, and is now an outreach worker for four areas in Chennai, heading a team of four peer educators and working with 50-60 female sex workers.
Dhanalakshmi, another sex-worker-turned-outreach worker with ICWO, adds that they distribute condoms to sex workers through peer educators, and also counsel sex workers to always have condoms with them. “It takes around a month to get someone comfortable with us and listen to us. But we feel good to talk to women about safety precautions,” she adds.
Challenges
Despite the efforts of the NACO programme, there are still many logistical challenges that are stunting the reach of condom awareness. “According to the NACP-IV mid-term appraisal report, only 16.9% of the condom distribution target was achieved. This prompted us to initiate a free condom store to complement and step up their operations. We wanted to generate discussions around it and remove the stigma,” says Dr Sam.
The AHF’s free condom store works on the principle of anonymity, to eradicate stigma involved in purchasing condoms, and since their inception on April 25, 2017, they have shipped over 4.21 lakh condoms. Orders can be placed via e-mail or phone, and they deliver across India for free.
Raising awareness to de-stigmatise the topic is a challenge, and the only way to do it is to talk more and discuss about it. “We use street plays and local folklore to get more people to listen to us. For instance, there is the famous Tamil ad ‘Puli raja ku AIDS varuma?’. Modified punch dialogues and magic shows get the message across as well,” smiles Dr Sam.
The rising accessibility and availability of condoms for the population in general, and specific vulnerable communities in particular, has decreased the number of new HIV cases over the years — 86,000 new cases in 2015, a 32% decline from 2007 — boosting more such organisations to bring condoms as the core HIV prevention strategy.