NACP III: HIV Prevention amongst the general population

[Guest guest]

Dear Forum,

The explanation to the above topic of e-consultation in the mailer sent out by

Dr. Quraishi goes as follows:

" PREVENTION OF HIV IN GENERAL POPULATION: Efforts directed at reducing HIV

infections through increasing knowledge about HIV and promoting behaviours that

protect against the risk of contracting HIV. Supporting enabling environments to

sustain such behaviors. This also includes counselling and testing, safe blood

transfusion practices, treatment of STIs, prevention of mother to child

transmission etc. "

I have taken the liberty of highlighting some of the key words in the

explanation, because I feel that it is these very things that need to be focused

on, shorn of all ambiguous moral or impractical posturing, which all in the end

lead to a situation where we all pat our backs as having achieved a lot, when in

fact our refusal to look facts straight in the eyes, our penchant of deriving

satisfaction from ostrich syndromes, leads to impediments on the path of the

very things that we are seeking to achieve.

In this regard I shall hereafter try and pick on these very key words or phrases

and pose a few questions, whose honest answers, if we do get around to seeking

them shall really and truly enable prevention of HIV amongst the general

population.

1] Increasing Knowledge: The question is what do we mean by knowledge? We have

had campaigns where the modes of spread of HIV infection and the means to

prevent it have been discussed, albeit in a heterosexual context, often in a

marital setup being projected as the ideal, and a sex worker playing the vamp in

the story that brings in the specter of infection.

If this is knowledge, we have given out a billion leaflets on it, have sprayed

millions of walls with slogans, and plastered enough billboards and wall-faces

with posters to make at least the whole literate 54% of the population

knowledgeable.

But I am sure every expert on every committee would agree

that that is not the case, else NACP-3 itself would not be necessary. May I

venture that in future when we say " Knowledge " we include the following in it:

* That sex is not just heterosexual; it could be homosexual, or solitary.

That sex is not just peno-vaginal; it could also be anal or oral.

That sex is not just within the context of marriage; it could be outside of

marriage.

And that there are varying degrees of risk that is associated with each of these

forms of sex, for contracting STIs as well as HIV. And most importantly that the

responsibility of prevention needs to be a part of each of these sex acts.

* That we respect the fact that the population has knowledge of the fact that

" Most people have sex, of varying types " and therefore not attribute any moral

judgement to it. We just inform of all the various types of risks involved in

all the various types of sexual acts. In other words we also stop targeting

specific sexually active groups as deviant or criminals or amoral beings.

That we do not give out messages that a sex worker is amoral person or that a

homosexual is a deviant criminal. More importantly we

actually start acknowledging the fact that thing like homosexuality, anal sex,

oral sex, and multiple sexual partners are a reality. We acknowledge all these

honestly and give all necessary prevention information from that position of

honesty.

* That condoms are preventive tools for all types of penetrative/ejaculative

sexual acts, irrespective of whether such acts are the dominant social more or

not, and that honest information about this, no matter how uncomfortable or

difficult, is part of all our campaign strategies with the general population.

2] General Population: The question is whether the general population is

inclusive or exclusive? In other words, the MSM from the cruising area when he

goes back home to a wife and kids, would he be 'general population'?

Would the non-brothel based mobile sex worker who after a days work goes back to

a husband and family be 'general population'? Would the IDU who hides his habit

from his wife or other sexual partner be 'general population'? Would the trucker

who is not trucking at the moment be 'general population'?

I personally believe that they all are. One of our follies thus

far has been to think of the general population as this idealized moral monolith

where there is a husband and a wife and two kids and sex only happens

peno-vaginally in the 'missionary position' within their marriage.

We have believed, and wrongly I think, that this moral monolith is exclusive of

the so called high risk groups, who are relegated to a sort of amoral

underclass. Re-educating ourselves on this count is an extremely urgent

requirement.

While I am personally an advocate for targeted interventions with all the high

risk groups, I also realize that all our resources are

just not enough to reach every one within the high risk groups.

Those that we cannot reach, those that fall within the cracks of our targeted

interventions are the ones that are enmeshed with the 'general population'.

Therefore when we talk of prevention work amongst the general population, we

have to include the high risk groups as well, otherwise they shall continue to

be excluded, to feel excluded, and therefore also continue to be a bridge and

vector of infection amongst the " general population " . AND the only way I see

that happening is if we actually honestly see knowledge to include all

of the things I have mentioned above.

3] Enabling environments to sustain such behaviors: The question is whether an

enabling environment can exist in a situation of intellectual dishonesty?

I use the strong word dishonest very consciously. For we have been dishonest in

defining knowledge to not-include all forms of risky sex, just because we had a

moral agenda to protect, at the cost of many lives if I may so add.

For we have been dishonest in not including everyone without passing

judgements on them based on their lifestyle, their gender orientation, their

choice of vocation, or their addiction. For we have dishonestly allowed

ourselves to be cowed down by extraneous factors and have refused to stand up to

our professed convictions.

For we have dishonestly allowed one set of morality to prevail at the cost of

lives of those that do not fall within its ambit. For we have been dishonest in

not standing up to what we know is right, and have therefore rendered ourselves

cowards on the face of the supposed moral majority.

And finally because we have been dishonest in our intentions in using words like

'enabling environment' when our own lack of

courage and conviction renders such terms into mere rhetoric.

I believe that an enabling environment begins with enabling an individual to

live his/her life as a human being with dignity, free of fear, free of violence,

and in control of his or her destiny. In this regard please ponder over the

following points:

*Of the three high risk groups that we target, in our country, all three are

criminals. Sex workers are criminals. Drug Users are criminals. And males who

have sex with other males are criminals.

Either this criminalization is totally unnecessary as in the case of MSM, or is

a distortion of the existing law to suit the venal ends of an extortionist

police force, as in the case of sex workers.

*Simply because of criminalization, sex workers, MSM, or IDUs, live in an

environment of fear where they often cannot access those services and

informations that are crucial to protecting them.

*Criminalisation opens up Sex workers to organized extortion from the

police. Also every episode of violence has to be hidden, as exposing the

violence or seeking justice is a way of exposing the sex worker him/herself to

retribution of the law. The voluntary sex work is often targeted as trafficking,

where the agency of the individual to choose a vocation out of adult free will

is subverted to the moral agenda of 'preventing prostitution'.

Entire colonies of sex workers that have existed for decades

in places like Goa, and Surat, and Kerela have been bulldozed to pander to this

moral agenda and we have stood by and watched. Some of these had existed as red

light areas for decades, if not centuries. Maybe it was our way of rendering a

target population into a general one.

*Crusing areas where MSM congregate are happy hunting grounds for the

police force to extort money, indulge in long term blackmail, extract sexual

favors, or indulge in wanton, unnecessary, and unconstitutional violence, often

sexual violence.

Like sex workers, MSM too cannot seek justice as they would render themselves

criminals. All this is because of the anti sodomy section 377 of the Indian

Penal Code. The monetary stakes by itself are high

enough for the police to be at the forefront of opposing any change to the law.

This when every scientific understanding of homosexuality today

considers homosexuality as neither unnatural, nor a disease, nor a criminal

deviance.

*All of the above are examples of our dishonesty. But more importantly the fact

that we have allowed Surat, Goa, Sangli, Lucknow, or Sahyog to happen is proof

of our lack of courage. The fact that after 12 reminders from the Delhi High

Court, the National AIDS Control Organisation failed to file an affidavit

clarifying its stand on homosexuality is a proof of our lack of conviction in

our own rhetoric and of our cowardice.

I do not believe that we can have our enabling environment if we continue to be

cowards and continue to lack conviction. WE can have it only by truth and

honesty. This entails that we do away with bad laws where they are unnecessary.

This means that we do not try and shield the morality of the 'general

population' by refusing to talk of all the aspects of knowledge that I have

described above. This means we do not consider certain parts of the population

as being other than 'general'. This means we not only talk of, but actually take

concrete steps to ensure that every one has their human dignity and their

environment lacking in fear.

This finally also means that our action and intentions are not confined to only

NACO and the HIV/AIDS NGOs, but are extended to all of those who are at the

vanguard of denying an enabling environment fro happening, like police, armed

forces, paramilitary, doctors in public/private hospitals, employment agencies,

schools and colleges etc.

4] Promoting behaviors that protect against the risk of contracting HIV:

This incidentally is at the end because the question here is a trick

question. The question is why is it tricky? It is tricky because in fact if we

do all that is described above, namely accept knowledge to include all aspects

of sex and sexuality shorn of moral impositions or judgements, if we include

everyone as equals without judging them, if we create a true enabling

environment, if we really give the power to the most vulnerable to be in control

of their destiny and have the capability to negotiate safer options to protect

themselves, then we do not have to do anything extra to

promote behaviors that protect against HIV. Creating these positive

possibilities with conviction and courage is all the promotion work we really

need to do.

Best regards

Aditya Bondyopadhyay

E-mail: <adit@...>