For AIDS prevention education to be
successful, powerful gender-sensitive
messages must replace the nebulous ‘moral framework’, argues Anita
01 February 2003 –
The South Asian region has about 4.1 million HIV infected people, of which
3.97 million are in India. And, by the year 2010, it is estimated that
another 5 million will contract AIDS. These figures were disclosed at a
high level conference held in Nepal last week on HIV/AIDS in South Asia.
Experts agreed that while the numbers are important, governments in the
region need to show political will to arrest the disease from taking a
greater hold by focusing on prevention education.
Dr Nafis Sadik, special envoy of the UN Secretary General for HIV/AIDS in
Asia, says it has been hard to get leaders in the region to talk about
AIDS, as they have always found it uncomfortable. She should know. A
medical doctor and Pakistani by birth, Dr Sadik was the first woman to
head the UN Fund for Population Activities (UNFPA), and the prime mover
and shaker of the UN’s ground-breaking International Conference Population
and Development, in Cairo (Egypt) in 1994. Here, the notion of
reproductive health or a lifecycle approach to men and women’s health was
recognised and accepted.
In India, the progress of AIDS prevention is one step forward and several
steps back. Despite government policies and programmes, some ministries,
states and bureaucrats are doing an about-face on the issue of AIDS
In December 2002, select NGOs working on the issues of community health
and awareness were told by government bureaucrats that their campaigns had
to be discontinued, altered, or were under review. Of these, some
campaigns had been designed in collaboration with central and state
government bodies. At least one NGO had a memorandum of understanding
(MoU) with two government agencies. The campaigns – as hoardings and TV
advertisements – had to do with consciousness raising about using condoms
to prevent AIDS and sexually transmitted diseases (STDs).
The hoardings campaign in Maharashtra and the TV commercials on
Doordarshan are set in situations where men talk to men about AIDS and
safe sex. They are based in the workplace, street, in the community and in
the home. And yes, they talk about using condoms. Some ads also feature
women: at a ladies’ sangeet (customary get-together before a wedding),
where women advise each other on condom usage as a contraceptive and
preventive against STDs.
The campaigns of both NGOs were based on intensive research. The hoardings
campaign in Maharashtra – aimed at high impact – was selective and
targeted to reach young men in lower socio-economic groups, a priority
audience for HIV/AIDS prevention. Heterosexual men constitute about 80 per
cent of the total HIV positive population in India. TV ad campaigns were
targeted to low prevalent Hindi-belt states based on a major baseline
survey of knowledge, attitudes and behaviour.
A few women’s groups and health groups in the capital (Delhi) and
Maharashtra protested that the campaigns were ‘condom-centric’ and ‘not
culturally sensitive’. They suggested an approach that ‘primarily promotes
a moral framework with gender sensitivity’. Their objections and approach
to central and state authorities have put the campaigns at risk. A moral
framework implies conformity to ideals of right human conduct. Those
proposing this framework and opposing the ‘condom-centric’ approach want
more stress on abstinence and sexual faithfulness to a partner. They are
less emphatic about what gender sensitivity means in these campaigns.
And, I suspect that cultural sensitivity means not using the word ‘sex’ or
‘condom’ or targeting youth and unmarried adults.
It is not important who the NGOs are. What is important is the fact that
despite NGOs and the government working in family planning for over half a
century, there is little to show for their efforts. The birth rate is
still high and condom use is low. The current targeted and to-the-point
campaigns are more explicit with the goal of behaviour change, reduction
in high-risk sexual behaviour and a healthier society. In this context, is
morality more important than information on how to save your life?
Gender sensitivity means ensuring that both women and men’s socialisation
is taken into consideration. I believe that the condom promotion approach
is highly gender-sensitive in that it asks men to examine their sexual
behaviour and move from the irresponsible to the more responsible. And the
condom, next to abstinence, is the only thing that protects both women and
men from STDs, and women from unwanted pregnancies.
Girls and women still bear the consequences of government and NGO
reproductive health services that keep them ignorant and do not help them
to protect themselves from unwanted pregnancies, reproductive tract
infections and STDs. Their reality is exposure to rape, incest and
non-consensual sex – in and outside marriage. Boys and men also have
anxieties about their sexuality and are equally ignorant about how to
avoid risky behaviour.
The personal morality of some citizens and government
ministers is tying the hands of bureaucrats and setting the work of some
critical NGOs back.
The government needs to follow its own reproductive health policy and
honour its international commitments. Will the government have the
political will to focus on prevention education? And, will it allow NGOs
who are doing this to do their work? Will it be wise about AIDS and
condoms? At the moment, the private morality of some citizens and
government ministers is tying the hands of bureaucrats and setting the
work of some critical NGOs back by years, if not decades. If this
continues, NGOs will have to censor themselves and tiptoe around the words
and concepts that are essential to prevention education – something they
have been doing for a long time. And, they will continue to waste time and
money on messages that will be ignored and have no impact.
Confucius is known to have said, “When the wise man points at the moon,
the idiot looks at the finger.” Is the government going to look at the
moon or the finger?
Anita Anand is a Delhi based writer who writes on development and
women issues. She is also the author of The Beauty Game