Blow to anti-AIDS campaign as condom turns taboo subject

The paanwallah-doubling-up-as-a-condom-vendor ad has been taken off the air. Instead, Doordarshan will show a village council member warning women about aids and exhorting them to be faithful. The shift in focus heralds a drastic change in India's aids prevention policy. No longer condom-centric. Harping on abstinence and fidelity. But also glossing over certain facts: like heterosexual transmission being responsible for more than 82 per cent of the country's nearly 4 million HIV positive cases, and the experiment having failed elsewhere in the world

 
By Vibha Varshney, Ritu Gupta
Published: Saturday 04 July 2015

The paanwallah -doubling-up-as-a-condom-vendor ad has been taken off the air. Instead, Doordarshan (dd) will show a village council member warning women about aids and exhorting them to be faithful. The shift in focus heralds a drastic change in India's aids prevention policy. No longer condom-centric. Harping on abstinence and fidelity. But also glossing over certain facts: like heterosexual transmission being responsible for more than 82 per cent of the country's nearly 4 million hiv positive cases, and the experiment having failed elsewhere in the world (today, Texas is one of the most aids-prone areas in the us despite President George Bush delivering similar sermons in the state when he was its governor).

India's strategy to combat the dreaded disease was given a prudish slant at the behest of Union health minister Sushma Swaraj. When she held the information and broadcasting portfolio, some television spots were discontinued for a while because the minister felt they promoted prurience and portrayed contraception as a male preserve. Now, in her new avatar, Swaraj is pushing ahead with her agenda and has banned the advertisements again.

Among those who have had to fall in line as a result of the morality policing is the New Delhi-based National aids Control Organisation (naco), established by the Union ministry of health and family welfare (mohfw) to combat the disease. "A change of guard spawns policy amendments. If our new minister wants a shift in stance, so be it," says R K Kalia, deputy secretary, naco, matter-of-factly. But J V R Prasada Rao, secretary, department of health, mohfw, categorically denies a change in outlook. "Only those ads which were socially unacceptable have been banned," he states.

On her part, Swaraj has lost no time in sanctioning new tv ads that largely centre on women but are said to be too subtle to drive home the message. "Ads which do not highlight the role of condoms defeat the campaign's purpose," opines Peter Gill, executive producer of bbc World Service Trust, a non-governmental organisation (ngo) based in New Delhi. The ngo is working in collaboration with dd and naco to develop the various series of tv ads on aids prevention in India. "Moreover, what's the point of raising awareness among women when it is men who are to be blamed for the situation coming to such a pass?" adds Gill.

Indeed, the baseline general population behavioural surveillance survey carried out by naco in 2001 shows that 11.8 per cent of India's male population reported having sex with non-regular partners as against 2 per cent women. Another significant finding pertains to the weak impact of educational messages. It was seen that 74.5 per cent of men in India know the link between condoms and safe sex, but only 51.2 per cent actually use the contraceptive device while having sex with non-regular partners. "If people are not convinced about using condoms, how can one persuade them about the merits of abstinence? After all, India is not the epitome of morality," asserts Carol Squire of Population Services International (psi), a Mumbai-based civil society group. Zooming in
P L Joshi, additional project director of naco, raises the target group issue to justify the new line of thinking. He claims that the shift "is a mere change in packaging", and puts a poser: "By hard-selling condoms in anti-aids tv campaigns, weren't we unwittingly promoting condoms among children too?" Considering that hiv is mainly transmitted in India through sexual activity between 30-44 year-olds, informing children about contraception would, on the face of it, seem rather unjustifiable.

But experts put the issue into perspective. "Kids today are already aware about these issues through other mediums -- especially movies and the Internet -- which provide explicit information about sexual behaviour. Why single out the ads and ban them?" asks Anjali Gopalan, executive director of naz Foundation (India) Trust, New Delhi, an ngo. "The fact is that children need to be educated about these matters, as studies show that more and more of them are having sex at an early age," avers Gopalan.

Even among sex workers -- projected as a high-risk group -- it makes sense to promote condom use more aggressively. Kolkata's red-light district of Sonagachi is a case in point. As condom use increased in the area from 3 per cent in 1992 to 90 per cent in 1998, the hiv infection rate among sex workers was contained at 5 per cent. In stark contrast, the prevalence level among Mumbai's sex workers was an alarming 50 per cent in 1998. A study by the us Agency for International Development (usaid) found that only 13 per cent of Mumbai's brothels stocked condoms.

According to unaids, a joint United Nations programme on hiv/aids, us $26,613 should be spent per 1,000 sex workers to prevent the spread of the disease in India. Out of this, us $ 2,890 must be utilised for condoms. Appallingly, nobody in the country knows how much is spent on the contraceptive. K K Gupta, assistant director (finance), naco, trivialises the matter: "The skeleton staff does not make it possible for us to keep track of minor details."

Funding rider
In the us, the Bush administration is increasingly resorting to using financial aid as an arm-twisting tool to propagate abstinence. It recently ordered a San Francisco group -- stop aids Project -- to either halt its "explicit programmes that promote sexual activity", or risk losing us $0.5 million in annual federal grants. The us spends us $10.8 billion on aids annually. While us $0.9 billion is for preventive measures, us $3.2 billion is spent on research. In effect, the stress is on cure rather than prevention.

Experts fear that the ripples of the shift in us policy are being felt by ngos promoting condoms in India, too. "We cannot do what we really believe in," laments an official of psi, which is funded by us organisations. Debabar Banerji, emeritus professor, Centre for Social Medicine and Community Health (csmch), Jawaharlal Nehru University, New Delhi, attributes India's new anti-condom stance to its toeing the us line: "The wb is completely controlled by the us.

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