(February 2003) Shruti Sharma is a student at the fashionable Bhawanipur Gujarati Education Society College in Calcutta. She dresses in designer jeans and stylish tank tops. Ask her where, if at all, she learned the facts of life, and she replies, “My elder sister told me, but many of my friends don’t know much. They ask me. We can’t discuss these things at home, you see.”

At a telephone help service called “Askline,” boys from middle-class homes call up to ask the counselors if masturbation is harmful and can lead to impotency, and girls ask if kissing could lead to pregnancy.

These young people share a lack of knowledge about sex and their own sexuality. In a conservative society where the subject is taboo in many homes, young people have limited sources of reliable reproductive health information. Thus, in urban India today, the scene can be confusing for the youth: While movies, cable television, the Internet, and other media have introduced them to Western images and lifestyles, they lack the social infrastructure to cope with even the most basic questions about their own bodies. Sharma rues that even at school, when teachers of life science come to a chapter on reproduction and the human body, they “ask us to read it up at home, because they are embarrassed to explain to us.”

Reasearch Shows Widespread Ignorance About Safe Sex

Yet among India’s 300 million young people ages 10 to 24, recent studies show that premarital sex is increasingly common. A 2001 study conducted in Delhi and the Lucknow (capital of India’s most populous state, Uttar Pradesh) by the National Institute of Health and Family Welfare shows that some 15 percent of young people engage in premarital sex, even though Indian society regards sex before marriage as deviant behavior. The study, which included grade school and college students, also revealed that despite a growing HIV/AIDS epidemic, many young people have unprotected sex. Two common reasons given by youth for not using condoms are that they are hesitant to obtain them (39.3 percent) and fear side effects (34.3 percent), according to the study “Premarital Sexuality and Unmet Need of Contraception.”

Ironically, even the veneer of modernity among the better-educated middle- and upper-class youth can be misleading. In her 2001 research work “Youth and HIV/AIDS in India,” Allison Drynan observes that a worry commonly expressed by sexuality educators in New Delhi is that “middle-upper-class youth” are less receptive to information than “middle-lower-class youth.”

Drynan, who gathered information on youth issues as part of a program sponsored by the Canadian International Development Agency (CIDA), attributed this widespread ignorance to an absence of uniformly established sexual and reproductive health education in schools. Educators she surveyed also pointed out that middle/upper-class youths falsely perceived their awareness of “Western sexual behaviors” — gained through the media — as awareness of their own sexuality.

This lack of access to reliable information is especially alarming given the high number of HIV/AIDS cases in India. With a population of more than 1 billion, even a comparatively low adult HIV prevalence rate (0.8 percent) translates into large numbers of infections. Thus, at the end of 2001, an estimated 3.97 million adults and children were living with the virus, according to the National AIDS Control Organization (NACO). This number exceeds that of any other country except South Africa, where some 5.0 million people had HIV/AIDS at the end of 2001.

The first case in India was detected in 1986 in Chennai (Madras), the capital of Tamil Nadu in south India, but it was dismissed as an aberration and a “Western” disease. Today, the mistake of that illusion is well accepted and Prime Minister Atal Behari Vajpayee, in his Independence Day speech two years ago, declared HIV/AIDS as one of the main concerns of the country and one that has to be tackled from all fronts. The high incidence of illiteracy, poverty, and migrant labor has added to the rapid rise in the number of HIV cases.

In its 2002 assessment of the epidemic in India, the Joint United Nations Programme on HIV/AIDS (UNAIDS) notes that although infections have been reported across India, an overwhelming 98 percent of AIDS cases are concentrated in just 10 of the country’s 31 states. In addition to Maharashtra in the west, the 10 are mainly in the south. NACO says the majority of infections are heterosexually transmitted. Infections are also concentrated among needle-sharing injecting drug users and their partners in the northeastern state of Manipur. This area is close to the Golden Triangle — the border region of Myanmar, Laos, and Thailand known for its trade in heroin and opium.

Indian Government Considering School-Based Sex Education Program

Faced with the warnings that India’s infected people could outnumber South Africa’s in the next decade unless urgent measures are taken, the government is looking into school-based programs. Until recently, parents, educators, and bureaucrats had resisted the introduction of sex education for teenagers at school. Some argued that such programs would only encourage promiscuity. However, the centrally funded National Council of Educational Research and Training (NCERT) prepared a School AIDS Education module in 1999, drawing on the experiences of scattered programs in operation since 1995 under the umbrella of extra-curricular school activities. Some states are now gradually introducing these programs in senior classes. One of NACO’s objectives is to attain an awareness level at least 90 percent among those in the reproductive age group.

Some say this targeted approach should yield results.

“In a country where sex and sexuality are taboo, mass awareness drives have obviously failed,” says Dr. D.K. Neogi, head of the virology department of the Calcutta-based School of Tropical Medicine. “The only way to make people more conscious is through one-to-one counseling.”

Despite doubts expressed by some experts, nongovernmental organizations (NGOs) have taken the lead in the campaign to spread awareness. As they tailor their programs to cater to local needs, their success stories have attracted the attention of government agencies and national and international bodies. With as many as 18 officially recognized languages, numerous dialects, and the use of English confined to urban areas, health workers who design the programs must keep in mind India’s social and cultural diversity. They must also take into account the fact that the roughly 70 percent of Indians who live in villages have little in common with their urban counterparts, particularly those who grew up watching the television channel MTV.

The need for diverse approaches is evident everywhere. For example, though girls are generally less informed than boys about the dangers of infection, a 1998 study on HIV/AIDS awareness levels among adolescents at St. Xavier’s College in Mumbai (Bombay) found that female students were “significantly better informed about the disease and its manifestations than their male counterparts.” The study also found that “students in the Arts stream and those in the younger age group (15 to 20 years) were more knowledgeable about AIDS than those studying science or commerce who are over 20.”

A preliminary analysis of the data collected by the college’s counseling center revealed that students were fairly well aware of the basics of HIV transmission through unprotected, penetrative sexual contact. However, they were less informed about transmission through anal and oral sex.

“We took on this research because we realized that if we need to educate students on HIV and AIDS, then we need to figure out their levels of awareness and ignorance before taking any focused and appropriate action,” says Terence Quadros, director of the counseling center.

Others stress that the one-approach-fits-all concept has no place in India. “As we’ve found with this study, different groups — based on gender, education levels, or age — have differing knowledge levels and need to be informed accordingly,” says Dr. Rajesh Parikh, honorary consulting psychiatrist and neuropsychiatrist at Jaslok Hospital and Research Centre, who helped design the survey.

Both NGOs and government agencies have discovered the need for carefully tailored approaches to promoting awareness.

Learning ‘Life Skills’

The West Bengal Voluntary Health Association (WBVHA), one of the first NGOs to make forays into rural Bengal, has been working on HIV/AIDS awareness programs since 1991. In 1995, they began developing youth-oriented programs. The organization found through their needs-based survey that in the more conservative rural milieu, the word “sex” immediately puts people on the defensive and makes them reluctant to take part in the programs.

“Instead of sex education, we call it ‘life skills,’ emphasizing family values and health care, which also includes HIV/AIDS awareness,” says Tarun Kumar Maiti, manager of Adolescent Health, a program whose slogan is “Listen, learn, live.”

Operative in 1,500 schools, the program involves peer educators chosen by students. Often the brightest students in their classes, their leadership qualities influence their fellow students, organizers say. Many of the earlier batches of peer educators now either work with NGOs or are involved in youth clubs. (In villages, these clubs of young men have considerable influence.) The increased employment opportunities are also an incentive for others.

Working closely with UNICEF and government agencies, WBVHA takes approaches that might appear to be conservative. According to Maiti, people in the community identify with the traditional mores the program emphasizes: “study now; don’t get over-occupied with sex; you must build a career.” There is also no sex segregation during the classes. Most rural schools are coeducational, unlike in Calcutta and other areas where same-sex schools, a legacy of British colonial rule, are more common.

Taking Advantage of Radio’s Wide Reach

Some of the approaches include the use of radio programs, since radio has a better reach than television in villages. The following programs have specifically targeted young people:

  • The Thoughtshop Foundation in Calcutta, which manages Askline, produced a Bengali language radio program on HIV/AIDS in 2001. Gyaner Alo Zindabad (roughly translated, Hooray for Knowledge) ran on the government broadcasting channel All India Radio (AIR) with quiz and call-in facilities.
  • The Ministry of Information & Broadcasting through its Directorate of Audiovisual Publicity, the Song & Drama Division, AIR, and the national television service Doordarshan, extend time and forums for the dissemination of public service programming and messages on HIV/AIDS prevention and care.
  • One of the world’s largest broadcasting campaigns for increasing HIV/AIDS awareness was launched in July 2002 by the BBC World Service Trust in partnership with NACO as well as the national television service and AIR and supported by the British government’s Department for International Development. While NACO estimates that 83 percent of HIV cases in India are spread through heterosexual contact, a recent BBC Trust survey found that only 5 percent of people surveyed had ever discussed sexual matters.

    The plan is to have more than 1,000 broadcasts that will aim to reach more than half the Indian population. Also, 3,500 video screenings of the program will be targeted at villages that have limited access to TV and radio. The campaign also includes a detective drama, Jasoos Vijay (Detective Vijay), three times a week; a weekly “reality” youth show called Haath se Haath Milaa (Let’s Join Hands); Chat Chowk, a weekly radio phone-in program on personal health issues; and advertising spots running three times daily on both TV and radio for the 10-month duration of the campaign.

Reaching the Young, Educated Sector

  • The Ministry of Human Resource Development’s Department of Youth and Sports is involved in a Universities Talk AIDS (UTA) program of the National Service Scheme, covering 158 universities, 5,000 colleges, and 2,000 senior secondary schools throughout the country. UTA encourages young people to talk about their sexuality, particularly in relation to issues surrounding HIV/AIDS. The program trains peer educators to increase the awareness of the causes, consequences, and prevention strategies among the country’s students.
  • The Nehru Yuvak Kendra (NYK), an autonomous body under the Department of Youth Affairs and Sports, is implementing an AIDS awareness program through its national volunteer network. The volunteers fan out to villages for outreach programs that have adopted a nonformal educational approach.
  • In the high-incidence state of Andhra Pradesh, UNICEF supports a College AIDS Awareness Programme (CAAP).

Targeting Young Workers and Street Children

India has a high number of children who have never been to school, who live on the streets, or who work. A study conducted by the United Nations International Drug Control Programme (UNDCP) and UNAIDS in 1996 showed a pattern of high-risk behavior among street and working children in different parts of the country in the area of HIV/AIDS and other sexually transmitted infections (STIs) and drug abuse.

Some programs target street children. Dr. Bitra George of the Salaam Baalak Trust, an NGO in Delhi, found that among 100 street children at the New Delhi Railway Station, 86 percent of the older boys (14-20 years) were sexually active, had no knowledge of proper condom use, and had never used a condom while having sex, even though 25 percent had heard something about condoms.

To reduce risk-taking behavior, the Trust’s strategies involved teaching peer educators about issues related to health, hygiene, STIs, HIV/AIDS, and drug abuse. At the same time, empowerment has been an important ingredient through vocational programs, placement opportunities, and income generation, where older children at the New Delhi Railway Station are given loans to start small business enterprises. The UNDCP, UNAIDS, and NACO have helped develop information and educational, and communicative material, including posters, games, kites, flip charts, and coloring boards. Today, the Trust works in the area with five other NGOs under the aegis of the NGO AIDS Forum.

While working on the HIV/AIDS prevention programs with street girls, the Trust found that unless support services such as shelter facilities are provided, the programs would have limited success and that trained peer educators are the best vehicles for spreading information to other girls.

Among its lessons learned, the Trust observes that “focus should shift from the concept of behavioral change to behavioral development.” Changing behavioral patterns would include regular and proper use of condoms, reducing drug-seeking habits, and the inculcation of safe sexual habits — “a long-term gradual process which can be achieved only by a multi-pronged, peer group-driven program and supported by adequate support services and empowerment programs.”


References

National Institute of Health and Family Welfare (NIHFW), “Premarital Sexuality and Unmet Need of Contraception” (New Delhi: NIHFW, 2001).

Allison Drynan, “Youth and HIV/AIDS in India,” research conducted under a program implemented for the Canadian International Development Agency (CIDA) by the International Health Youth Internship Program of the Canadian Society for International Health (CSIH) (Ottawa: CSIH, October 2001).

National Council of Educational Research (NCERT), Learning for Life: A Guide to Family Health and Life Skills Education for Teachers and Students, accessed online at www.unicef.org/programme/lifeskills/reference/

India/pdfs/19_LFL.pdf, on Feb. 4, 2003.

West Bengal Voluntary Health Association, Adolescent Health Care program, accessed online at www.wbvha.org/Index%20Page/NEW%20WEB/

Adolescence/adol.htm, on Feb. 4, 2003.


Ranjita Biswas is a freelance writer based in Calcutta, India. 


For More Information

UNAIDS Epidemiological Fact Sheets on HIV/AIDS and Sexually Transmitted Infections, India: http://www.unaids.org/en/

BBC World Service Trust: www.bbc.co.uk/worldservice/trust

Thoughtshop Foundation: http://www.thoughtshopfoundation.org/

National AIDS Control Organization: www.naco.nic.in/