Sex, lies and HIV
|Dr. Paul Sachdev
By the end of 2002, it is estimated that the number of HIV-infected individuals in India will have grown to approximately 35 million, outpacing the transmission rate in any other country in the world. Of these cases, an increasingly large number will be women.
According to Dr. Paul Sachdev, Social Work, this explosive growth rate is due to a cultural gender bias, the focus of his survey, Sex, Lies, and HIV/AIDS in India, conducted among 1,272 Indian graduate students in social work, nursing/medicine and the humanities.
Dr. Sachdev's study is the first ever conducted in India on the attitudes towards sex and HIV transmission. It was sparked by his desire to understand how students' attitudes can affect their ability to counsel clients or treat patients.
"This (gender bias) is very important when counsellors and social workers go to work with women and men. The gender component is also important for other reasons. If government officials don't support gender equality, then government policy is going to be skewed in favor of men and neglect women in terms of access to reproductive health care, education and counselling," said Dr. Sachdev.
In 1994, eight years after the first AIDS case was diagnosed, the incumbent health minister still publicly dismissed the problem of HIV transmission in India: "We are a traditional society and this western type of sexual promiscuity does not exist in India and so it has no chance of spreading."
This attitude explains why married women who showed up at clinics with symptoms of AIDS were not tested for the HIV virus. Many doctors considered it impossible that such "morally pure" women could contract the virus.
"There was a massive denial among politicians and the medical community. It was just a disease of the (female) sex workers." said Dr. Sachdev. "Because of this inaction, the virus spread from prostitutes to migrant workers and into the bedrooms of girlfriends and wives."
Dr. Sachdev's study attacks a series of what he candidly refers to as "lies" about sex and AIDS in India.
One such lie - men's sexual needs are stronger than those of women - rationalizes the belief that men are, in fact, victims of the HIV virus because their promiscuity is driven by a natural urge. Dr. Sachdev's study refutes this notion, finding that women also have a healthy sex drive. Nearly 70 per cent of women agreed it would be better to express their sexual desires with as much initiative and aggressiveness as men.
Further evidence of gender bias is evident in attitudes towards condoms: 48.2 per cent of men placed the responsibility for choosing a condom with women.
Dr. Sachdev points out that nearly all respondents exhibited good to excellent understanding of HIV transmission, but that their behavior was not altered correspondingly. Both men and women expressed a reluctance to use condoms despite their awareness of the health risks of unprotected sex.
"Education is not enough to change behaviour. We must also change attitudes. Men need to be more sensitive and women need to be empowered," said Dr. Sachdev. "We have to infuse in them (men) the idea that they have equal responsibility if they want to engage in mutual sexual pleasure. It's not a one-way street.
"Women need to learn the art of negotiating. A woman should be assertive and secure enough in her relationship that she should be able to put this very strongly. `Look if you don't want to take responsibility, if you don't want to use a condom. Then no sex'. This is what I call empowerment for women."
Dr. Sachdev recently conducted a seminar in India sponsored by the Delhi State Aids Control Society. The seminar was attended by 300 people, including the health minister, government officials, members of the medical community and the general public. While there, he stressed that the attitudes and behaviors studied in his survey reflect the best-case scenario as he had surveyed a well educated cross-section of Indian society.
"It's one thing to change attitudes among educated, literate Indians, but how do you reach the poor, illiterate living in the villages? It's an enormous task to educate these people. With its growing population and inadequate health system, India is sitting on a time bomb."
Dr. Sachdev has been invited back to India in October to conduct another seminar to students in various medical fields.