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 recognized and accepted.
In India, the progress of AIDS prevention is one step forward and several steps back. Despite government policies and programs, some ministries, states and bureaucrats are doing an about-face on the issue of AIDS prevention.
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 behavior.
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. The 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 behavior change, reduction in high-risk sexual behavior 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 socialization is taken into consideration. I believe that the condom promotion approach is highly gender-sensitive in that it asks men to examine their sexual behavior 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 behavior.
The government needs to follow its own reproductive health policy and honor 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?