A STUDY ON THE DIFFERENT CULTURAL APPROACH TO HIV/AIDS

IGNOU STUDY CENTRE, NEW DELHI

BY

INDIRA GANDHI NATIONAL OPEN UNIVERSITY

MAIDAN GARHI, NEW DELHI 100068

ENROLEMENT NO:

Acknowledgement

Without good health, life would not be possible, and even if it were, it would not be worth living.With
utmost humility, we would like to thank and praise almighty god. The merciful and compassionate, we
bestowed us with health, sense and courage.
The present study has been accomplished under the expert and constant guidance and supervision of
revered teacher, ---------------------- New Delhi.
The investigator wish to express their sincere gratitude and indebt thanks for her expert guidance,
valuable suggestions and keen interest in planning and execution of studying.
We are equally indebted and grateful to the ---------------------for facilitating permission and support for
conducting the study.
We would like to extent our sincere thanks to all the experts who contributed time and efforts towards
validating and modifying the tools.

Table of Contents
ACKNOWLEDGEMENT......................................................................................2
ABSTRACT .....................................................................................................4
DIFFERENT CULTURAL APPROACH TO HIV/AIDS.................................................5
INTRODUCTION TO CULTURE...........................................................................5
INTRODUCTION TO HIV AND AIDS.....................................................................8
EPIDEMIOLOGY OF HIV/AIDS............................................................................9
INTRODUCTION TO HIV/AIDS IN INDIA...............................................................9
STIGMA AND DISCRIMINATION IN INDIA..........................................................15
CULTURAL FACTS OF HIV INFECTION...............................................................20
CULTURE AND SEXUALITY...............................................................................23
EDUCATION AND LITERACY: WOMENS INEQUITABLE SITUATION.......................29
THE ROLE OF CULTURE IN THE FIGHT AGAINST HIV/AIDS..................................34
LAWS REGARDING PROSTITUTION.................................................................41
REVIEW OF LITERATURE................................................................................66
OBJECTIVES OF THE STUDY............................................................................76
FINDINGS AND ANALYSIS ON DIFFERENT CULTURAL APPROACH TO HIV
78
RECOMMENDATIONS......................................................................................94
IMPLICATIONS FOR POLICY, PROGRAMMING AND FUTURE RESEARCH..............100
CONCLUSIONS.............................................................................................102
BIBLIOGRAPHY............................................................................................105

Abstract

Problem statement: The objective of this study was to determine Strengthen the different socio-cultural
approach in projects planning and evaluating of HIV/AIDS in three regions of the country. The study
seeks to understand the different cultural approach of HIV/AIDS within the different vulnerable groups
and diverse cultural contexts. Further explore the cultural factors, values, traditions and practices
associated with the HIV/AIDS.

Present guidelines for the development of research on vulnerable

groups. Implement methodologies for intervention projects in vulnerable groups. Approach: the study
covered 50 permanent residents and the migrants labour in Delhi. Using structured questionnaires,
primary data were collected in the cultural approach to HIV/AIDs. Conclusion: Widespread of cultural
practices and attitudes in the context of HIV/AIDS prevention and care , and focuses on some groups
and communities that show focused and specific manifestations of Indian culture. It also broadly covers
the sociocultural background of Indian society in the context of HIV/AIDS, and depicts an enormous
variety of cultural practices and beliefs all over the country. Such a discussion highlights the importance
of adopting a culturally specific and culturally appropriate HIV/AIDS intervention strategy in this
country. A common general strategy can be developed at the broader level, but for specific cultures and
communities, the intervention programmes should follow an appropriate culturally sensitive policy.

DIFFERENT CULTURAL APPROACH TO HIV/AIDS

Introduction
It is said that in India language changes every five miles. There are eighteen official languages and
hundreds of dialects. India is a largely rural country and its economy is still primarily agricultural.
Approximately 75 per cent of the population of one billion resides in rural areas. The political entity is
divided into 35 states and union territories that are further divided into districts. Some of these states are
larger than many European countries. Each state has a different language and script, and includes
numerous dialects. The people belong to diverse ethnic groups. India is sprawling landscape ranges from
mountains and extended plains to deserts and the peninsular coasts. In addition, India has had a long
history of successive waves of settlers and invaders, with an impact on this vast and culturally diverse
subcontinent.

A cultural approach to HIV/AIDS (Human Immunodeficiency Virus/Acquired Immune Deficiency

Syndrome) care and prevention has to deal with a set of complex issues. It has to take into account the
diversity in religion, language, values and social laws that are part of people's lives in India. This study
aims at different issues that are comprised in the cultural matrix and are relevant to the HIV/AIDS
epidemic.

Introduction to Culture
In simple terms, culture refers to the traditions and customs upheld by societies and communities
because of their belief systems and values. Culture is defined as the learned, shared and transmitted
values, beliefs, norms and life ways carried by groups of people, which guides their decisions, thinking

and actions in patterned ways. The individual in society is bound by rules of his/her culture. Cultures are
different in that the same events that may be fear inducing in one culture may be anger inducing in
another. A more comprehensive definition of culture is the pattern of human activity and the symbols
that give signifi cance to these activities. Culture manifests itself in terms of the art, literature, costumes,
customs, language, religion and religious rituals. The people and their pattern of life make up the culture
of a region. Cultures vary in different parts of the world. They are different across
land boundaries and the diversity in cultures results in the diversity in people around the world.

Culture also consists of a system of beliefs held by the people of a region, their principles of life and
their moral values. The patterns of behaviour of people of a particular region also forms a part of that
regions culture. The word culture hails from the Latin word cultura, derived from colere, means, to
cultivate. Hence, the way in which the minds of the masses inhabiting a particular region are cultivated,
in some way determines the culture of a region. Gender roles and relations also constitute some aspect
of culture. These roles and relations arise out of a process of socialisation, where young boys and girls
are taught their respective roles in society as well as in relation to one other. Culture, the male figure has
always held the dominant position in the household. Men in precolonial times were hunters and have
always been the providers and breadwinners for their families.
Women ploughed the fields and took care of the household duties that involved cooking, cleaning and
washing clothes, etc. It can be said that men have always maintained a superior status over their wives
to some degree. India boys are taught from a young age that they are to provide for their families and are
to also be the heads of their households. Young Indian girls, on the other hand, are socialised to
become nurturers and caregivers to their children and husbands. They are to take care of their families
and taught to be humble, as well as respectful to their husbands. This is common knowledge among

Indian and these patterns of socialisation are not only taught, but learned through daily observation
within ones family and other black African families. As a result, the gender roles learned and adopted
by young boys and girls influence the ways in which they relate to one another later in life. Men are
Labeled provider/head and women caregiver/subordinate and, as a result, begin to internalise and
Assume these respective roles.

It can be argued that these gender differences/ inequalities contribute to the spread of sexually
transmitted diseases, such as HIV/AIDS, in that unequal power relations also come to exist when it
comes to sexual intercourse. Sex in some traditional cultures has mainly been for the pleasure of the
man. This idea was further emphasised during the Apartheid era when men migrated to the urban
centres in search of employment in the mines. Men in the mines felt that they worked very hard and
constantly faced the risk of death because of working in highly adverse and dangerous conditions.
This, they felt, entitled them to various sexual partners, ultimately creating an opportunity in which to
relieve, sexually, the stress and tension they experienced on a daily basis, thus simultaneously providing
an avenue in which to express their masculinities. Masculinity has been cited as a place in gender
relations, the practices through which men and women engage that place in gender, and the effects of
these practices in bodily experience, personality and culture. It has been posited that power
imbalance[s] pervade all social relationships between men and women. To contextualize this even more,
there is an unequal balance of power between men and their sexual partners an imbalance whose
detrimental effects have resulted in women becoming the face of HIV/AIDS, both in India

Lack of power women in relationships means that they have very limited decision-making abilities in

the relationship and are unable to negotiate safer sex and, therefore, risk infection to please the man.
This is particularly the case if the womans husband/partner is the sole breadwinner of the household, or
if the woman has a low educational background.

INTRODUCTION TO HIV AND AIDS

HIV stands for Human Immunodeficiency Virus. HIV is a retrovirus infecting cells of the human
immune system and it destroys or impairs their function. An infection leads to a progressive depletion of
the immune system and finally immune deficiency. Immuno deficient people have an increased
vulnerability to a wide range of infections, which are mostly rare among people without immune
deficiency. No symptoms develop immediately after the infection and hence most people infected with
HIV do not know that they infected. An HIV-infected person, even without any symptoms, is however
highly infectious and can transmit the virus to another person. HIV infection leads to AIDS which stands
for Acquired Immunodeficiency Syndrome (UNAIDS 2004a, 2005a).

According to UNAIDS the first cases of AIDS were discovered in the United States in 1981.4 Then a
number of unusual immune system failures were identified among gay men and in 1982 AIDS was first
defined. Blood transfusions, sexual intercourse, injecting drug use and mother-to-child transmission
were identified as modes of transmission5 and in 1983/84 the Human Immunodeficiency Virus was
identified as the source of AIDS (UNAIDS 2004a).

EPIDEMIOLOGY OF HIV/AIDS

Globally the number of people living with HIV keeps growing. The estimate for 2001 was 35 million
while it in 2003 had grown to 38 million. This included almost 5 million people infected in 2003, a
higher number of new infections than any previous year. In 2004 nearly 40 million people were
estimated to be living with HIV. 30 million people have already died of AIDS (UNAIDS 2004c, 2004d,
2005b).

INTRODUCTION TO HIV/AIDS IN INDIA

India is one of the largest and most populated countries in the world, with over one billion inhabitants.
Of this number, it's estimated that around 2.4 million people are currently living with HIV. HIV emerged
later in India than it did in many other countries. Infection rates soared throughout the 1990s, and today
the epidemic affects all sectors of Indian society, not just the groups such as sex workers and truck
drivers with which it was originally associated. In a country where poverty, illiteracy and poor health
are rife, the spread of HIV presents a daunting challenge.
The History of HIV/AIDS in India
At the beginning of 1986, despite over 20,000 reported AIDS cases worldwide, India had no reported
cases of HIV or AIDS. There was recognition, though, that this would not be the case for long, and
concerns rose about how India would cope once HIV and AIDS cases started to emerge. One report,
published in a medical journal in January 1986, stated:

Later in the year, Indias first cases of HIV diagnosed among sex workers in Chennai, Tamil Nadu. It
noted that contact with foreign visitors had played a role in initial infections among sex workers, and as
HIV, screening centers were set up across the country calls for visitors to screened for HIV. Gradually,
these calls subsided as more attention were paid to ensuring that HIV screening was carried out in blood
banks.

In 1987, a National AIDS Control Programme launched to co-ordinate national responses. Its activities
covered surveillance, blood screening, and health education. By the end of 1987, about 52,907 who
tested, around 135 people found to be HIV positive and 14 had AIDS. Most of these initial cases had
occurred through heterosexual sex, but at the end of the 1980s, a rapid spread of HIV observed
among injecting drug users (IDUs) in Manipur, Mizoram and Nagaland - three northeastern states of
India bordering Myanmar (Burma).

At the beginning of the 1990s, as infection rates continued to rise, responses strengthened. In 1992 the
government set up NACO (the National AIDS Control Organisation), to oversee the formulation of
policies, prevention work and control programmes relating to HIV and AIDS. In the same year, the
government launched a Strategic Plan, the National AIDS Control Programme (NACP) for HIV
prevention. This plan established the administrative and technical basis for programme management and
also set up State AIDS Control Societies (SACS) in 25 states and 7 union territories. It was able to make
a number of important improvements in HIV prevention such as improving blood safety.

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By this stage, cases of HIV infection reported in every state of the country. Throughout the 1990s, it was
clear that although individual states and cities had separate epidemics, HIV had spread to the general
population. Increasingly, cases of infection observed among people that previously seen as low-risk,
such as homemakers and richer members of society. In 1998, one author wrote:

In 1999, the second phase of the National AIDS Control Programme (NACP II) came into effect with the
stated aim of reducing the spread of HIV through promoting behaviour change. During this time, the
prevention of mother-to-child transmission (PMTCT) programme and the provision of free antiretroviral
treatment implemented for the first time. In 2001, the government adopted the National AIDS
Prevention and Control Policy and former Prime Minister Atal Bihari Vajpayee referred to HIV/AIDS as
one of the most serious health challenges facing the country when he addressed parliament. Vajpayee
also met the chief ministers of the six high-prevalence states to plan the implementation of strategies for
HIV/AIDS prevention.

The third phase (NACP III) began in 2006, with the highest priority placed on reaching 80 percent of
high-risk groups including sex workers, men who have sex with men, and injecting drug users with
targeted interventions. Targeted interventions generally carried out by civil society or community
organisations in partnership with the State AIDS Control Societies. They include outreach programmes
focused on behaviour change through peer education, distribution of condoms and other risk reduction
materials, treatment of sexually transmitted diseases, linkages to health services, as well as advocacy
and training of local groups. The NACP III also seeks to decentralise the HIV effort to the local level,
i.e. districts, and engage more non-governmental organisations in providing welfare services to those
living with HIV/AIDS.

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CURRENT ESTIMATES HIV IN INDIA

In 2006 UNAIDS estimated that there were 5.6 million people living with HIV in India, which indicated
that there were more people with HIV in India than in any other country in the world. In 2007, following
the first survey of HIV among the general population, UNAIDS and NACO agreed on a new estimate
between 2 million and 3.1 million people living with HIV. In 2008 the figure was estimated to be 2.31
million. In 2009 it was estimated that 2.4 million people were living with HIV in India, which equates to
a prevalence of 0.3%. While this may seem low, because India's population is so large, it is third in the
world in terms of greatest number of people living with HIV. With a population of around a billion, a
mere 0.1% increase in HIV prevalence would increase the estimated number of people living with HIV
by over half a million.

WHOM DO HIV AND AIDS IN INDIA AFFECT?

People living with HIV in India come from incredibly diverse cultures and backgrounds. The vast
majority of infections occurs through heterosexual sex (80%), and is concentrated among high-risk
groups including sex workers, men who have sex with men, and injecting drug users as well as truck
drivers and migrant workers. See our page on affected groups in India for more information.

HIV PREVENTION

Educating people about HIV/AIDS and its prevention is complicated in India, as a number of major

languages and hundreds of different dialects spoken within its population. This means that, although

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some HIV/AIDS prevention and education done at the national level, many of the efforts are best carried
out at the state and local level.

Each state has its own AIDS Prevention and Control Society, which carries out local initiatives with
guidance from NACO. Under the second stage of the governments National AIDS Control Programme
(NACP-II), which finished in March 2006, state AIDS control societies granted funding for youth
campaigns, blood safety checks, and HIV testing, among other things. Various public platforms were
used to raise awareness of the epidemic - concerts, radio dramas, a voluntary blood donation day and TV
spots with a popular Indian film-star. Messages also conveyed to young people through schools.
Teachers and peer educators trained to teach about the subject, and students were educated through
active learning sessions, including debates and role-play.

The third stage of the National AIDS Control Programme (NACP-III), was launched in 2006 and runs
until 2011.51 The programme has a budget of around $2.6 billion, two thirds of which is for prevention
and one-sixth for treatment. Aside from the government, this money will come from non-governmental
organisations, companies, and international agencies, such as the World Bank and the Bill and Melinda
Gates Foundation.

As part of its focus on prevention, the government has supported the installation of over 11,000 condom
vending machines in colleges, roadside restaurants, stations, gas stations and hospitals. With support
from the United States Agency for International Development (USAID), the government has also
initiated a campaign called Condom Bindas Bol! (Condom-Just say it!), which involves advertising,

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public events and celebrity endorsements. It aims to break the taboo that currently surrounds condom
use in India, and to persuade people that they should not be embarrassed to buy them.
In one unique scheme, health activists in West Bengal promoted condom use through kite flying, which
is popular before the states biggest festival, Durga Puja:
This initiative is an example of how HIV prevention campaigns in India tailored to the situations of
different states and areas. In doing so, they can make an important impact, particularly in rural areas
where information is often lacking. In some cases, members of these risk groups have formed their own
organisations to respond to the epidemic.
The government has however funded a small number of national campaigns to spread awareness about
HIV/AIDS to complement the local level initiatives. On World AIDS Day 2007 India flagged off its
largest national campaign to date, in the form of a seven-coach train called the 'Red Ribbon Express. A
year later, the train journey completed, having travelled to 180 stations in 24 states and reaching around
6.2 million people with HIV/AIDS education and awareness. Following the success of the campaign, the
'Red Ribbon Express' took off for a second time in December 2009 and a third time in February 2012.
The train now includes counseling and training services, HIV testing, treatment of sexually transmitted
diseases (STDS) as well as HIV/AIDS education and awareness. Phase three of the Red Ribbon Express

has a focus on reaching migrant populations who are particularly at risk of HIV. Its strategy involves
using its strength as an HIV service that migrates to focus on reaching places with a high out-migration.

According to a mid-year report on the progress of the second round of the Red Ribbon Express, NACO
estimates that 3.8 million people reached in the first six months of the campaign. 60 According to NACO
the 'response has been overwhelming', with queues of people waiting to access the services a common

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sight, and follow up surveys indicating that knowledge of transmission routes of HIV and prevention
methods have increased significantly in the areas visited by the train.

STIGMA AND DISCRIMINATION IN INDIA

In India, as elsewhere, AIDS often seen as someone elses problem as something that affects people
living on the margins of society, whose lifestyles considered immoral. Even as it moves into the general
population, the HIV epidemic still misunderstood among the Indian public. People living with HIV have
faced violent attacks, been rejected by families, spouses and communities, been refused medical
treatment, and even, in some reported cases, denied the last rites before they die.

As well as adding to the suffering of people living with HIV, this discrimination is hindering efforts to
prevent new infections. While such strong reactions to HIV and AIDS exist, it is difficult to educate
people about how they can avoid infection. AIDS outreach workers and peer-educators have reported
harassment, and in schools, teachers sometimes face negative reactions from the parents of children that
they teach about AIDS:
Discrimination is also alarmingly common in the health care sector. Negative attitudes from health care
staff have generated anxiety and fear among many people living with HIV and AIDS. As a result, many
keep their status secret. It is not surprising that for many HIV positive people, AIDS-related fear and
anxiety, and at times denial of their HIV status, traced to traumatic experiences in health care settings.
A 2006 study found that 25% of people living with HIV in India refused medical treatment based on
their HIV-positive status. It also found strong evidence of stigma in the workplace, with 74% of
employees not disclosing their status to their employees for fear of discrimination. Of the 26% who did
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disclose their status, 10% reported having faced prejudice as a result. People in marginalized groups female sex workers, hijras (transgender) and gay men - are often stigmatised not only because of their
HIV status, but also because they belong to socially excluded groups.84

Stigma made worse by a lack of knowledge about AIDS. Although a high percentage of people have
heard about HIV and AIDS in urban areas (94% of men and 83% of women) this is much lower in rural
areas where only 77% of men and 50% of women have heard of HIV and AIDS. However, the challenge
lies with ignorance about how HIV is transmitted - for example, the majority of men and women in rural
areas believe that AIDS can be transmitted by mosquito bites. In 2009, NACO carried a population
based survey in Nagaland, where it was shown that 72.8% of people surveyed believed HIV could be
transmitted by sharing food with someone.
AIDS-related stigma and discrimination refers to prejudice, negative attitudes, abuse and maltreatment
directed at people living with HIV and AIDS. The consequences of stigma and discrimination are wideranging: shunned by family, peers and the wider community, poor treatment in healthcare and education
settings, an erosion of rights, psychological damage, and a negative effect on the success of HIV testing
and treatment.

AIDS STIGMA AND DISCRIMINATION

AIDS stigma and discrimination exist worldwide, although they manifest themselves differently across
countries, communities, religious groups and individuals. They occur alongside other forms of stigma
and discrimination, such as racism, stigma based on physical appearance, homophobia or misogyny and

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directed towards those involved in what considered socially unacceptable activities such
as prostitution or drug use.

Stigma not only makes it more difficult for people trying to come to terms with HIV and manage their
illness on a personal level, but it also interferes with attempts to fight the AIDS epidemic as a whole. On a
national level, the stigma associated with HIV can deter governments from taking fast, effective action
against the epidemic, whilst on a personal level it can make individuals reluctant to access HIV testing,
treatment and care.

Community level stigma and discrimination towards people living with HIV found all over the world. A
communitys reaction to somebody living with HIV can have a huge effect on that persons life. If the
reaction is hostile, a person discriminated against and forced to leave their home, or change their daily
activities such as shopping, socialising or schooling.

Community-level stigma and discrimination can manifest as ostracism, rejection and verbal and physical
abuse. It has even extended to murder. AIDS related murders reported in countries as diverse as Brazil,
Colombia, Ethiopia, India, South Africa and Thailand. In December 1998, Gugu Dhlamini stoned and
beaten to death by neighbours in her township near Durban, South Africa, after speaking openly
on World AIDS Day about her HIV status.41 It is therefore not surprising that 79 percent of people living
with HIV who participated in a global study, feared social discrimination following their status
disclosure.

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Stigma and discrimination can also take particular forms within key populations at higher risk. For
example, studies have shown that within some gay communitys there is segregation between HIVpositive and HIV-negative men, where men associate predominately with those of the same status. Some
people living with HIV have linked this rift within the community with depression, anxiety and
loneliness. Other members of gay communities have reported stigma based on physical changes due to
the side effects of treatment, which can lead people to delay seeking and initiating treatment.43

Family
In the majority of developing countries, families are the primary caregivers when somebody falls ill.
There is clear evidence that families play an important role in providing support and care for people
living with HIV and AIDS. However, not all family responses are supportive. HIV positive members of
the family can find themselves stigmatised and discriminated against within the home. There is concern
that women and non-heterosexual family members are more likely than children and men mistreated.

HIV-related stigma and discrimination severely hamper efforts to effectively fight, the HIV and AIDS
epidemic. Fear of discrimination often prevents people from seeking treatment for AIDS or from
admitting their HIV status publicly. People with (or suspected of having) HIV turned away from
services and employment, or refused entry to a foreign country. In some cases, forced from home by
their families and rejected by their friends and colleagues. The stigma attached to HIV/AIDS can extend
to the next generation, placing an emotional burden on those left behind.

Denial goes hand in hand with discrimination, with many people continuing to deny that HIV exists in
their communities. Today, HIV/AIDS threatens the welfare and wellbeing of people throughout the

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world. At the end of the 2010, 34 million people were living with HIV and 1.8 million had died from
an AIDS-related illness that year. Combating stigma and discrimination against people who are affected
by HIV/AIDS is vital to preventing and controlling the global epidemic.
In some countries people living with HIV lack knowledge of their rights in society. In this case,
education needed so they are able to challenge the discrimination, stigma and denial that they encounter.
Institutional and other monitoring mechanisms can enforce the rights of people with HIV and provide
powerful means of mitigating the worst effects of discrimination and stigma.
However, no policy or law cans alone combat HIV/AIDS related discrimination. Stigma and
discrimination will continue to exist so long as societies as a whole have a poor understanding of HIV
and AIDS and the pain and suffering caused by negative attitudes and discriminatory practices. The fear
and prejudice that lie at the core of the HIV/AIDS-related discrimination tackled at the community and
national levels, with AIDS education. A more enabling environment created to increase the visibility of
people with HIV/AIDS as a 'normal' part of any society. The presence of treatment can make this task
easier; where there is the opportunity to live a fulfilling and long life with HIV, people are less afraid of
AIDS; willing to test for HIV, to disclose their status, and to seek care if necessary. The task is to
confront the fear-based messages and biased social attitudes, in order to reduce the discrimination and
stigma of people living with HIV and AIDS.

CULTURAL FACTS OF HIV INFECTION

Attitudes, traditions and values in every culture affect boys' and men's sexual behavior.

In most cultures, boys and men have more sexual partners than do girls and women.

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Certain sexual practices, such as sex between men, are taboo in many cultures; this can

seriously hinder the promotion of safer sexual practices and the use and distribution of condoms
among vulnerable groups.

Some traditions can result in increased risk of HIV infection. They include the following:

Polygamy, if one or more of the wives or the husband is infected;

Circumcision and excision, if the instruments used are not properly disinfected;

Scarring and tattooing, if the instruments used are not properly disinfected;

Brotherhood rites, as a result of possible blood exchange;

Ritual deflowering and sexual violence by men against women, girls and children; and

Dry sex practices used to increase sexual pleasure.

Men often find it difficult to seek help when diagnosed with HIV. Many men withhold

information on their HIV status, because they are afraid of being stigmatized and rejected by their
community or because of cultural taboos.
SOCIAL ISSUES
Socially constructed images of masculinity can encourage high-risk behavior such as violence, sexual
risk-taking, excessive drinking or drug use. These "macho" attitudes, which are encouraged in many
cultures and make women more vulnerable to HIV infection because of the imbalances in decisionmaking power, mean that many women cannot negotiate condom use and often forced to have unwanted
sexual relations. These attitudes also make men vulnerable to HIV infection since they often emphasize
sexual prowess, encourage men to have multiple sexual partners and prompt them to exercise their
authority over women.

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For many men and women, it is often difficult to talk about sex and to reveal one's HIV status.
Advocating abstinence, faithfulness or condom use can be difficult for many couples. In the community,
openly discussing sexually transmitted infections can often mean breaking local taboos, resulting in a
loss of prestige. Many men are afraid of revealing a HIV-positive diagnosis because they fear losing
their jobs and rejected by their social group, or because they feel guilty towards their regular partner.
Community leaders -- including traditional healers or medicine men -- have a critical role to play in
HIV/AIDS prevention and care because they are often highly respected medical, social and
psychological advisers in their community. Their position enables them to either promote or hinder
behavioral change as well as HIV prevention and care in general. Therefore, their involvement in a
community's response to HIV is vital.
Many cultures and religions give more freedom to men than to women. For example, in many cultures it
is considered normal -- and sometimes encouraged -- for young men to experiment sexually before
marriage. Also, in many cultures, it is considered acceptable for men -- even married men -- to have sex
with sex workers. These cultural attitudes towards sex are leading to HIV infections in both men and
women -- often the men's wives.
Because men traditionally seen as the providers, and they believe that they must fulfill this role, many of
them react negatively if they cannot find work or if they are unable to provide for their family. Men's
sense of anger or disempowerment may lead to alcohol or drug abuse, or violent behavior, increasing
both their own and their partner's risk of HIV infection. Employment opportunities for men may restore
self-esteem and reduce their tendency to engage in such risky behavior. However, employment may also
mean that couples have to live apart, since men must sometimes migrate or be mobile for work, as is the
case for long-distance truck drivers. Due to loneliness and the availability of money, these men may

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have unprotected sex with other women or men and become HIV-infected. These HIV-positive men may,
in turn, infect their wives and other sexual partners.
Some beliefs can result in increased risk of HIV infection. One especially dangerous myth, which is
found in some cultures around the world, is that having sex with a virgin will cure HIV. While this is
obviously untrue, increasing numbers of young girls infected because of this practice.
In many societies, there are very negative attitudes towards men who have sex with other men.
Nonetheless, in every society, no matter how strong the taboos, some men have sex with other men.
They do so for many reasons -- for pleasure, for economic reasons, under compulsion, due to a lack of
availability of women, or for a combination of the above reasons. Many men who have sex with men
also have sex with women -- for pleasure, out of a sense of duty, desires of self-denial in order to hide
from others. Therefore, it is important to encourage broader discussion of male-to-male sex, since it is
one of the ways in which HIV transmitted.
CULTURE AND SEXUALITY

Sexuality has different meanings for different people in different contexts. Sexuality is a comprehensive
concept that encompasses the physical capacity for sexual pleasure as well as personalised and shared
social meanings attached to both sexual behaviour and the formation of sexual and gender identities.
Sexual behaviour and attitudes constituted within complex political, social, economic and cultural
contexts. Sexuality understood as a complex social construct that has different meanings within different
communities and societies, and one that has diverse expressions within and across age, gender and social
class.

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Women

An important aspect of sexuality in patrilineal India is the control exercised over women's sexuality. It
becomes most evident at menarche. Here begins segregation of girls. They are withdrawn into the house
and a close watch kept on their movements. Seclusion and segregation closely linked with ideas of
female chastity, modesty and femininity.

As mentioned earlier, a womans sexuality mediated through marriage in most communities in India.
While there is a premium placed on the virginity of the bride at first marriage, the same is not true for
the man. After marriage, a woman expected to be faithful to her husband while digressions by the man
overlooked. Sexual activity and behaviour considered being the mans domain, and a woman not
expected to take the initiative. A woman is not supposed to know about sexual matters or else she
labeled as loose and suspected of infidelity. She should remain innocent and know nothing about her
body, contraceptives, and sexuality. Cultural norms do not allow a woman to show desire or question
sexual behaviour of her partner. Sexual activity for women considered a duty of procreation and to fulfill
her husbands wishes. A woman who resists or expresses unwillingness to fulfill her husbands desires
threatened with desertion. Thus, a woman rendered more vulnerable, due to lack of knowledge and lack
of control over her body, to sexual violence within marriage and STIs including HIV.

Men
While there is strict control over female sexuality the same is not true for males. There is no pressure on
men to remain virgins till marriage; neither is there a big stigma attached to pre-marital sex for men.
Studies from all over the country reveal that sexual activity is high among adolescent boys. Between 12-

23

25 per cent of patients at sexually transmitted diseases, (STD) clinics are in their teens. The first
encounters are mostly with sex-workers or with other boys.

At the same time men with other sexual orientations are under very strong social pressure to get married
and procreate. This results in a situation where homosexual men forced into a heterosexual union
through marriage while continuing their homosexual activities.

womans socialisation in Indian society takes a different path from of the man. Here the man has to
prove his manliness and sexual desire otherwise would not be considered strong. A visit to a sex-worker
by a man before marriage ignored by the society. This acceptance is rooted in a general notion that the
man has to be knowledgeable about sex, so as to lead the woman who should be innocent about sex and
sexuality. The man is viewed as sexually powerful and a woman as sexually passive. For any
programme to succeed a deeper understanding of sexuality is necessary to pin down peoples sexual
attitudes and the reasons behind them. The whole gamut of kinship structure, systems of marriage, and
ideologies about gender and sexuality shape the concept of sexuality within a society, and should
therefore be integrated in this process of understanding. Each of these systems structure sexual relations
differently, and the differences compounded when it involves people of different status and with unequal
capacities to negotiate for safer sex. These processes and sexual interactions, therefore, have grave and
differing consequences for the vulnerability of different groups to HIV.

Culturally conditioned beliefs and their implications the entire world of sexuality and HIV/AIDS
shrouded in mystery for the average Indian people. To this environment were added hundreds of myths
and false beliefs on sexuality and HIV/AIDS that were nurtured by the development of the disease.

24

Many of the religious and mythological notions in India had interpreted in different ways at different
points of time. Most of the time, texts are interpreted with little knowledge, which may add different
dimensions altogether. People often have a tendency to construct social prescriptions for them based on
these interpretations. Due to the lack of scientific knowledge, people easily derive unscientific, cause
and effect equations. Young boys grow up with numerous misconceptions and guilt about masturbation.
They believe in the knowledge they acquire from their peers. The absence of clearly defined, transparent
and socially accountable sexual mores, and the prevalence of fostered myths and secrecy, spell
disastrous implications not only for the spread of HIV/AIDS in India, but also in the way it is
confronted.
The table below lists a set of culturally conditioned beliefs and myths that have provided fertile ground
for the formation of culturally conditioned beliefs regarding HIV/AIDS:

Myths

HIV and AIDS are the same thing

HIV/AIDS can be contracted only through vaginal sex

Touching and kissing an infected person spreads HIV

Sharing food spreads HIV, so do mosquito bites

If your home and environment are clean you will not contract HIV

People not suffering from any STIs will not contract HIV

According to the upper and middle classes, HIV/AIDS is prevalent only among slum dwellers
and lower classes, as they frequent sex workers. According to the lower

class and slum dwellers, HIV/AIDS is contracted by the rich, as they have the money to frequent
sex workers

25

Sex workers and some women are reservoirs of all sorts of STIs. If one avoids them, then one
will not get HIV/AIDS

There is no need to practice safe sex with known or expensive call girls, as they are clean and
safe

Sex with virgins cures STIs, including HIV

If you urinate immediately after sex, you wont get any STIs

Sex is essential to release body heat which accumulates after long hours of driving

Condoms are unhygienic, because the semen collects in it and touches the penis

Use of condom reduces sexual pleasure

Injections are the answer to every illness

Pure women (loyal to the husband and his family) do not get HIV/AIDS

A healthy looking person will not have HIV

HIV cured if detected early.

SOCIO-ECONOMIC ISSUES
In India as well as at the international level, serious socio-economic unbalance among populations
impacts heavily on vulnerability and risk in relation to HIV/AIDS. In this respect, poverty,
unemployment and lack of education are crucial aspects of the overall crisis, which shapes the factual
background to the disease.

Poverty and unemployment

Globally the HIV epidemic is most important in Africa, which is one of the poorest regions of the world.
However, there is no evidence to suggest any direct correlation between the epidemic and poverty. Many
of the countries affected are the richer countries of sub-Saharan Africa. An examination of the situation
26

in India also does not throw light on any such link. On the other hand, the states of Maharashtra and
Tamil Nadu, where the epidemic first spread, are among the more industrialized states. While India as a
whole has the third highest GNP in Asia, (before Corea, Indonesia and Russia) the GNP per capita is
only US$ 440, slightly above UN definition of extreme poverty. Thus, high national PNB, rich industry,
business and wealthy minorities do not necessarily entail equal distribution of riches but can, on the
reverse; aggravate the impoverishment of already underprivileged majorities.

Yet, incidence and patterns of spread do indicate a complex relationship with poverty, and factors
closely related to poverty may lead to a kind of risk behaviour or make people more vulnerable as far as
HIV/AIDS is concerned. India has the dubious distinction of being a country with the largest
concentration of people living below the poverty line. A broad feature of the Indian labour market that
may be of relevance in the present context is the high degree of mobility observed in the lower rungs of
the market as a result of a high level of disparity in regional development, manifesting itself in
significant regional differences in job opportunities. This has given rise to much rural-to-urban
migration, both within and outside state boundaries, much of which is circular migration.

Thousands of young men migrate from rural to urban areas in search of employment. Very often, the
men migrate leaving their families behind. It founded all over the world that circular migration has led to
increase in the spread of HIV/ AIDS. As these young men leave their wives behind, they often form
partnerships and relationships with other women in urban areas, which might linked to peer pressure.
Unemployment may also lead to other types of risk behaviour such as substance abuse. Poverty directly
related to nutritional status and health seeking behaviour. This is especially relevant with respect to STIs.
The poor in India have low nutritional status that makes them vulnerable to many types of infections and

27

diseases mostly due to deficiency of Vitamin A and iron, which affects the immune system. This makes
them more vulnerable to contracting STIs including HIV. The poor also have less access to health care
and therefore many of the STIs remain untreated. In this respect, it is worth noting that in the poorest
households women have the dice loaded against them in terms of food, access to health care, a heavy
workload and various cultural taboos and restrictions. For many poor women, sex work is often the only
means of earning a livelihood and maintaining the family. In these situations, poor women become
vulnerable to HIV/AIDS not only because they have multiple partners but also because they are unable
to bargain for safe sex with their clients.

EDUCATION AND LITERACY: WOMENS INEQUITABLE SITUATION

Education often viewed as the panacea of all social and economic problems affecting the country. It used
as one of the indicators for measuring social development. It believed that universal education is
necessary for the economic development of the country. Education deemed to have a positive correlation
with population control, decrease in maternal mortality, child survival and so on. In the gender debate,
education of women also leads to enhancement of womens status.

Education for all is enshrined in the Constitution of India. Yet, today, India is far from achieving the goal
of universal elementary education. The causes for such high illiteracy are varied. Many of the
differences across regions are because education is under the purview of individual states. An important
element is the lack of schools in many areas in spite of progress made. According to a survey, in rural
areas, 94 per cent of the population has a primary school within one kilometre but only 57 per cent of

28

the population has a middle school within one kilometre. Apart from this are the social barriers to access
education. Due to seclusion of girls, many parents are unwilling to send their daughters to schools,
which are further away. In poor families, girls are the first to be withdrawn from school in times of
crises.

In all regions, literacy rates are much lower for women than for men. According to the Human
Development Report of 1998, only five countries have a female-male literacy gap greater than India:
Bhutan, Syria, Togo, Malawi and Mozambique. In addition, no country has a gap larger than the state of
Rajasthan.

The other problems faced are lack of infrastructure in schools and lack of basic requirements for running
a primary school. The quality of education is abysmal in many government-run schools. A low student
teacher ratio, a situation where a single teacher has to handle multiple classes regularly and absconding
teachers add to the problem.

A very important issue is that of the content of education and what education meant to be. For the
planners education is meant to enable the population to know the three R's(reading, writing,
arithmetic), but what is equally important is the curriculum, especially in view of the HIV/AIDS
epidemic. In a study done in Delhi, it found that years of schooling had a positive correlation with
knowledge about HIV/AIDS, partly because it was part of the curriculum, although that did not mean an
increase in autonomy or decision making power. Most schools are still unwilling to take a proactive step
in including sex-education. This is because of the stigma attached to sex and unwillingness on the part
of the teachers to discuss these issues.

29

CURRENT HEALTH CARE SITUATION

A) HEALTH INFRASTRUCTURE AND ACCESS TO HEALTH CARE

The concept of health varies from culture to culture. Standards and concepts of health are
geographically, culturally and historically variable, as they change over time in response to changing
socio-economic and cultural patterns and to prevailing systems of health care. In the traditional Indian
systems of medicine there are two terms used for health: arogya, which signifies recovery from ill health
and swasthya, which is not a mere absence of diseases, but a positive state of well-being. The latter is a
preferred concept. The definition of swasthya is closer to the WHO definition of health.

The demand for health care is constantly increasing with development and increasing public awareness.
In India, three levels of health problems are prevalent:
- Health problems associated with underdevelopment
- The diseases of the affluent
- Environmental and behavioural threats among all population groups.

India has a widespread health delivery system. Public, private and voluntary bodies provide health care.
Along with the allopathic system, other systems of medicines such as unani, ayurvedic, homeopathy,
siddha, etc practiced. There are 85 hospital beds and 110 doctors per one lakh1 population. However,
there is a very strong urban bias visible in the delivery of health care. 80 percent of the government
health care and two thirds of the private practitioners are in urban areas while 70 per cent of the

30

population resides in rural areas. 80 per cent of the doctors are in the private sector and 60 per cent of
them practice systems other than allopath.

GOVERNMENT HEALTH SYSTEM:

There is a wide spread network of the government health system all over the country. At the centre, the
Ministry has three vertical line departments: the department of Family Welfare concerned with
population stabilization programmes, reproductive and child health; the department of Health, which
deals with medical and public health, drugs control, food adulteration, research and education; and the
department of Indian Systems of Medicine and Homeopathy. In rural areas there is one community
health centre for every 120,000, one Primary Health Centre (PHC) for every 30,000, and a sub-centre for
a population of 5000. Each sub-centre has one female and male multi-purpose worker and links the
community to the health care system. One trained doctor and a number of paramedics staff the PHCs.
While the government health system is present in every district, it is grossly inadequate and unevenly
distributed.

INDIVIDUAL EXPERIENCE HIV/AIDS

Peoples experience of HIV/AIDS-related stigmatization and discrimination is affected by commonly

held beliefs, forms of societal stigmatization, and factors such as the extent to which individuals are able
to access supportive networks of peers, family and kin. It may also influenced by the stage of the
epidemic and whether individuals feel, they can be open about their serostatus, age, gender, sexuality
and social status among a host of other variables.

31

Overall, the negative depiction of people living with HIV/AIDS reinforced by the language and
metaphors used to talk and think about the disease has reconfirmed fear, avoidance and the isolation of
affected individuals and, in some cases, friends and families. In a highly stigmatizing environment,
people may withdraw from society as a means of self-preservation. This isolation can extend to
exclusion from social and sexual relationships and in extreme circumstances has led to premature
death through suicide or euthanasia (Gilmore & Somerville, 1994; Hasan et al., 1994).

More often, however, stigmatization causes a kind of social death in which individuals no longer feel
part of civil society, and are no longer able to access the services and support they need (Daniel &
Parker, 1990).

Who to tell, how and when, can be a potential source of fear and anxiety among many people living with
HIV/AIDS and may prevent individuals from accessing treatment and care (Moynihan et al., 1995;
Omangi, 1997). Even where laws enacted to protect the rights and confidentiality of people living with
HIV/AIDS, few people are prepared to litigate in case their identity will become widely known. Those
who identified as belonging to marginalize and/or minority groups may also worry about the reactions of
others, regardless of their serostatus.

Some Mexican men have recently cited fear of telling family members about their homosexuality as
equal to the fear of revealing their serostatus (Castro et al., 1998a; 1998b).The impact of HIV/AIDS on
women is particularly acute. In many developing countries, women are already economically, culturally
and socially disadvantaged and lack equal access to treatment, financial support and education. Being
outside the structures of power and decision-making, this denied the opportunity to participate equally

32

within the community and may be subject to punitive laws, norms and practices exercising control over
their bodies and sexual relations. In a number of societies, women erroneously perceived as the main
transmitters of sexually transmitted infections (STIs), which may be referred to as womens diseases
(de Bruyn, 1992). Together with traditional beliefs about sex, blood and other kinds of disease
transmission, these perceptions provide a fertile basis for the further stigmatization of women within the
context of HIV/AIDS (Ingstad, 1990; Peterson, 1990; Mushingeh, Chana & Mulikelela, 1991; Thant,
1993).

There is clear evidence from recent UNAIDS-supported studies of household and community responses
to HIV/AIDS in developing countries (Warwick et al., 1998; Aggleton & Warwick, 1999) that
seropositive women are likely to treated very differently from men. Whereas men are likely to be
excused for the behaviour that resulted in their infection, women are not. In India, for example, the
husbands who infected them may abandon women living with HIV/AIDS. Rejection by wider family
members reported as common (Bharat & Aggleton, 1999). In some African countries, women whose
husbands have died from AIDS-related infections blamed for the death. Remaining relatives may also
evict the surviving spouse from her home (Henry, 1990). Fearful of such situations, some women may
prefer to remain ignorant of their serostatus or may keep it a secret.

Perhaps in consequence, individual denial of risk and vulnerability is not an uncommon response to the
epidemic. Such denial may manifest itself in self-distancing from the problem and, in extreme cases, can
result in people misperceiving their vulnerability. Denial can also discourage voluntary testing among
many people, particularly among members of especially vulnerable groups. This, in turn, may increase

33

the potential risk of HIV transmission within the community (Lie & Biswalo, 1996). Such action
undermines prevention, care and support.

THE ROLE OF CULTURE IN THE FIGHT AGAINST HIV/AIDS

The role of culture has been particularly problematic in the fight against HIV/AIDS. When one talks of
culture, especially in the context of HIV/AIDS, what comes to mind is the patriarchal society in which
we live, as well as the gender inequalities, which it has given, rise to.
In simple terms, culture refers to the traditions and customs upheld by societies and communities
because of their belief systems and values. Culture defined as the learned, shared and transmitted values,
beliefs, norms and life ways carried by groups of people, which guides their decisions, thinking and
actions in patterned ways. The individual in society bound by rules of his/her culture. Cultures are
different in that the same events that may be fear inducing in one culture may be anger inducing in
another. A more comprehensive definition of culture .The pattern of human activity and the symbols that
give significance to these activities. Culture manifests itself in terms of the art, literature, costumes,
customs, language, religion and religious rituals. The people and their pattern of life make up the culture
of a region. Cultures vary in different parts of the world. They are different across land boundaries and
the diversity in cultures results in the diversity in people around the world. Culture also consists of a
system of beliefs held by the people of a region, their principles of life and their moral values. The
patterns of behaviour of people of a particular region also forms a part of that regions culture. The word
culture hails from the Latin word cultura, derived from colere, means, to cultivate. Hence, the way
in which the minds of the masses inhabiting a particular region are cultivated, in some way determines
the culture of a region.
Culture is never homogeneous. It always marked by diversity. Culture is also never a fossilized or frozen
system or a monolithic structure. Culture, on the contrast, is an ever-changing evolutionary
phenomenon. It has its internal and intrinsic dynamics. Simultaneously, each culture borrows from the
other culture. They borrow ideas, beliefs and practices- tangible, traditional, or contemporary. They also
interact with and get influenced from all kinds of external socio-economic transformation processes,
which any society or a given population undergoes continuously. Culture; therefore; provides the
34

revival, retention, reinterpretation, re-modification and recreation of traditions and ethos. These
evolutionary variations, plural dimensions and contemporary adaptations of culture have integrated in
designing, implementing and evaluating the HIV/AIDS prevention and care strategies.

Settled and Migrant Communities in Delhi

The mainstream community is becoming increasingly vulnerable to HIV/AIDS in India due to a lack
of knowledge, awareness and unprotected multi-partner sex. The position of women in society,
socialisation of boys and girls, segregation, the culture of silence and the taboo on discussions about sex
contribute to the increased vulnerability of the low-risk groups. The ISST study on Gender Dimensions
of HIV/AIDS in 2000 reveals that even the single partner married women are vulnerable though
generally considered least at risk.Our field studies with married women, adolescent boys and migrant
workers confirm alarming trends of high risk of HIV/AIDS among these mainstream groups.

Due to increasing unemployment in rural areas, migrant and/or seasonal workers constitute a large part
of the labour force in most Indian cities. This group, though an integral part of the mainstream
workforce, happens to be a very high-risk group, due to long separation from their wives and the
resultant risk-prone sexual behaviour. Focus group discussions conducted in a community with lower
middle class population and squatter slum settlements. The local people are the proprietors and let out
rooms to the migrant population. The migrant population is mainly composed of rickshaw pullers, smallscale industrial workers, tailors and workers in the informal sector from Haryana, Bihar, U.P. and
Rajasthan.

35

a) Socialization and sexuality

A girl gets married soon after puberty. As soon as a girl starts menstruating, the parents look around for a
groom. Most of the girls reported that their mothers had said you have grown up now and you have to
behave yourself. Sometimes a girl might be able discuss issues related to sexuality with her elder sister
or perhaps a sister-in-law. If she asks too many questions about her body or about sexuality, these
ridiculed. Soon she gets to understand the culture of silence.

The daughters-in-law in a family never sit on the charpai or cot. They sit on the floor, as not allowed to
sit at the same level as their mothers-in-law. This custom demonstrates the subordinate status of
daughters-in-law in the family. They also keep a Men also go to sex workers before marriage. If he
does not get married in time, he might take the wrong path, says an aged participant of a focus group
discussion in Delhi.

Moreover, the generally accepted those men in the Indian society have to prove their manliness on the
first night of the marriage. In many cases, the man visits sex workers before marriage to gain practical
knowledge on sexual intercourse. Due to low condom use, there is an increased risk of getting
infections, transmitted to the bride.

Typically, boys are given more freedom than girls are, thus adolescent boys may get exposed to sexual
risks at an early age. Moreover, sexual outlets often accepted for growing boys and youth as a necessity.
A lot of emphasis also placed on the boy's "character" as well, and many parents exercise a certain
degree of control over their son's actions. Girls often viewed as evil and responsible for luring boys.

36

Men Full or partial veil when they walk in the neighbourhood and cover their faces completely when a
man passes by. Mothers-in-law, on the other hand, do not veiled and joke with the men of the
neighbourhood. In most cases, the girl is married to an older boy. This makes the newlywed bride
Vulnerable, as her older husband might have had premarital sex.Visiting sex-workers is common among
migrant labourers. Due to long separations from their wives, they tend to visit sex workers. This is often
under peer influence.

Women's health
The common illnesses within the community identified as fever and influenza. For illness, women prefer
visiting private doctors. There are a number of private doctors across the slum. In contrast they do not
like to take advantage of free services from the government dispensaries, mainly because the doctors are
impolite and their medicines are of poor quality and thus, not efficacious. In addition, government
doctors do not give enough time to listen to the patients and privacy not ensured.

People feel more comfortable with private doctors. For common ailments and illness, they do not mind
male doctors. They said that the doctors boil the needles before reusing them. At government
dispensaries, they are not concerned about the mothers health but place greater emphasis on childrens
vaccination and family planning. Before, these dispensaries would at least distribute iron tablets but now
they no longer hand out tablets. Women feel their children need more attention and care, we dont need
to spend unnecessarily by getting ourselves treated. During frequent fever and illnesses we (also
Husbands) use self-medication.

37

If the woman of the house falls ill, she has to do all the housework irrespective of her illness. If she is
unable to get up the husband says she is just making a fuss. No one had ever used oral contraception. A
few had used copper -T and a few others had got themselves operated after 4-5 children. Only one
woman admitted that her husband was using condoms as a means of contraception because he said she
was already weak and contraceptives had side effects. Men think that the use of condom is very
inconvenient, and therefore, they do not want to use them. Some women felt that it tears easily hence, it
is useless.

HIV/AIDS awareness among men and women

Women from the selected group had never heard about HIV/AIDS on television. Despite an awareness
workshop in the slum for a couple of days, very few were able to tell the modes of transmission. Most
said that they didnt know what the preventable measures were. Not much of the HIV/AIDS awarenessgenerating programme interiorised by the members. The Members responses like, Hum to achchi
jagah mein rehte hai. Yahan pe yeh sab bimari nehi hai (We all stay in clean places. We do not have
these diseases around here) were given by a number of women.

Boys studying in schools know about HIV/AIDS. In many schools, where NGOs have conducted
programmes on sex education they are aware of HIV/AIDS. One boy confessed that he had used
condoms. The awareness in boys who study in schools where no such programmes implemented is very
low. They have heard of HIV/AIDS, but do not know of the modes of transmission.

Female Prostitution

38

Prostitution is not always subject to criminalization ; in some cultures the practice may be regarded as a
sacred rite. In those societies where prostitution and related behaviour criminalized, it is typically the
prostitute rather than the client, whose behaviour regulated, reflecting double standards of sexual
morality.

In ancient India, Prostitutes was not only recognized but gave access to a certain social status. Prostitutes
could wield a great deal of power through their relationships with noblemen and aristocrats. Today, it is
an outcaste profession. Yet increasing incidences of prostitution and expansion of red light areas suggest
that the profession enjoys the patronage of the society. Growing male dominance, destitution of women,
industrialization have led to the commercialization of the traditional institution, sanctioned by social and
religious customs for certain castes. Trafficking in girls/women is one of the lowest forms of violation of
human rights today, where women and girls sold like commodities and ironically, it is a highly profitable
industry. There are new entrants into this profession every day. Women of social oppression and poverty
a large number of sex workers are descendents of old traditional and religious groups like the
Devadasis in North Karnataka and South Maharashtra, Basavis in Andhra Pradesh, temple dancers in
Orissa, etc. In addition, other communities have been sending their daughters into prostitution for
generations like the Nats and the Bedias of Rajasthan. Women enter into this profession in two ways:

Voluntary prostitution, where women adopt it voluntarily due to lack of any other means of livelihood,
the family may be a party to it;
Women who are forced into prostitution through religious and customary practices, kidnapping, rape and
sale of their bodies through intermediaries.

39

Prostitution and womens overall status

Prostitution viewed in the context of the overall situation of the status of women in India. Besides
economic reasons, old cultural and religious practices, patriarchy, socialisation processes and
superstitions are important factors. There are various other socio-psycho-situational factors and
motivations behind a girl or woman wanting to continue with sex work. Women in prostitution have a
very low status in most societies, perhaps one of the worst in India. They labelled as randi or bad
women and the vectors of HIV and other sexually transmitted infections.The police, the pimps and the
clients alike, harass them and most of the time they have to give in to the demands of the clients who do
not want to use condoms. They have no alternative since their subsistence needs met through this
profession but the price they have to pay is horrendous.

It is difficult to estimate the number of prostitutes in India. The available estimates of Devadasis are
mere conjectures. A survey conducted by Ghosh and Das in the red light areas of Calcutta in 1987
among 6,698 female sex workers found that the average number of clients per worker per day was 2.7,
and the rates for both short-time and night visits varied considerably in different areas. About 37 per cent
of the sex workers reported that they either forced by family members or others or lured into prostitution
with false promises of a job. About 59 per cent reportedly abandoned by their husbands. 30 per cent
were domestic helpers before becoming sex workers.

On the other hand, call girls are women who practice prostitution at a hotel or their clients residence.
They usually do not identify themselves with the sex workers. Their rates are on the higher side and they
have the option of choosing their clients. They mostly linked to upper class prostitution.

40

Laws regarding prostitution

The objective of the Suppression of Immoral Traffic in women and girls Act (SITA, 1956) was not to do
away with prostitutes and prostitution but to inhibit or abolish commercialised vice, namely the traffic in
persons for the purpose of prostitution as an organised means of living. An underlying assumption in the
SITA is that prostitution is unavoidable that provides an outlet for uncontrollable male sexuality.
Though SITA did not aim to punish prostitutes, it gave enough power to police and other government
Agencies to terrorise, harass and financially exploit them. The Immoral Traffic Prevention Act (PITA),
1986, is a uniform legislation applicable to the entire country and is an amendment of the SITA (1956).
It does not confine prostitution only to the act of a female offering her body for hire, but recognizes
sexual exploitation or abuse of a male or a child for commercial purposes. The main thrust of PITA is the
enhancement of punishment and creation of new categories of offenses. The objectives of the Act are
twofold: it recognizes the abuse of power by the police during raids and prohibits male police officers
from making a search of female sex workers unless accompanied by female police officers; and
secondly it seeks to draw women away from prostitution through their rehabilitation in Protective
Homes, which should prepare them for gainful employment.

DEVADASIS (SACRED PROSTITUTES)

The cult of dedicating girls to a deity, called Devadasis, is prevalent in some parts of India. A `Devadasi'
means a woman dedicated to, literally a slave of, a deity, whose duties comprise a combination of ritual
and community entertainment to assert positive fertility and prosperity.

41

Religious prostitution has been in practice in several parts of southern India since the third century AD.
Pre-puberty girls from poor low-caste homes are dedicated through an initiation rite, to the deity in the
local temple during full moon. The system of dedicating women to a temple is a religious act to appease
the deity. Sometimes even before menarche she auctioned for her virginity, the deflowering ceremony
becoming the privilege of the highest bidder. Yellamma represented as the principal Goddess who is
worshipped, but recent research has shown that other deities such as Meenakshi, Jagannath and
Hanuman also propitiated in this manner. Because of being, married to a God or Goddess Devadasis
are called Nitya Sumangali (forever married).However, in the areas where the system/cult is prevalent,
they call themselves Basavi , Jogati/ Jogin, Devali , Naikin and at times Sule (prostitute).
All these terms have sexual connotations either of celibacy (as in Jogin) or of prostitution (as in Sule).

Several factors responsible for the origin and existence of divine prostitution in India. The fact that
temples require whole-time devotees to serve them was a primary factor. This, in turn, led to the belief
that women thus dedicated would appease the Gods and would ensure fertility of women belonging to
that culture. Hence, they developed their own status, roles and rituals, whereby they participated in
religious/auspicious ceremonies in the community. Over time, the custom encouraged exploitation of
one section of society especially the poor families in the lower castes by others, using religious
sanctions to gratify male desire.

Some other factors that could have led to this sub-culture may be:

42

The custom of dedicating girls to temples emerged as a substitute for human sacrifice,With the
aim of appeasing Gods and Goddesses and thus securing their blessings for the community as a
whole.

It is a rite to ensure fertility of the land and an increase of human and animal population.

It is part of the phallic worship that has existed in India from early times.

Probably sacred prostitution sprang from the custom of providing sexual hospitality for
strangers; and if the mortal wives of a deity offered such hospitality, prosperity was bound to
result.

The Devadasi cult represents licentious worship offered by a section of society, subservient to the
degraded and stakes of a priestly class.

The Devadasi system is a custom deliberately created to enable exploitation of lower

Caste people in India by upper castes and classes as:

- The upper castes have influenced the establishment of an order of prostitutes who licensed to carry on
their profession under the protective shied of religious belief. - The establishment of such system due to
poverty ensures that upper class males have access to low caste women to satisfy their carnal desire.

- The system ensures that powerful people in society are in a position to subordinate lower-caste people
out of fear. There is no evidence of temple prostitution in early times, though it certainly existed in
Ancient civilization. The earliest reference to girls dedicated to temples appears in a Tamil inscription
dating back to 1004AD. In the Karnataka region, since time immemorial, prostitution has existed and
Devadasis have been part of this profession. By the 7th century AD, the Devadasi institution seemed to
have taken firm roots in the Indian culture. In the course of two centuries, many temples built in South

43

India and Devadasis recruited to provide various rituals to Gods and Goddesses. In northern India, the
destruction of temples by Muslim invaders led to the decline of Devadasis but it continued unabated in
southern parts of India. Even after state governments enacted legislation during the 1920s and 1930s
preventing the dedication of girls to temple Gods and Goddesses, the institution survived in some places
in different forms and on a smaller scale.

The present study conducted in the Bellary and Kudligi taluks of Bellary district in Karnataka. Bellary is
one of the most backward and drought-prone districts in the country. The available government
infrastructure and services are quite inadequate and of low quality. The majority of the population
belongs to scheduled castes and tribes and other backward communities. Health problems compounded
due to malaria, gastroenteritis, AIDS etc. A number of the Devadasis are living in Kudligi and Bellary
taluks along with other sex workers who come from other general communities. The Devadasis are
called Basavi in the region. The Basavi does not marry but lives in her parents house with any man of
equal or higher caste whom she may select and her children inherit her fathers name. In earlier times, it
considered prestigious for a rich property owner to keep young girls. He would bear all expenditure. The
present situation is very different: it is a daily sex business. In this district, most Devadasis practise from
home, though there is also a large proportion of Devadasis in the red light areas of Chennai and
Mumbai.

FAMILY, SOCIALIZATION, SEX WORK AND MARRIAGE OF DEVADASIS

Most of Devadasis mothers are also Devadasis. These days, a number of poor families have many
daughters and no male member to earn a livelihood. The eldest daughter in such cases is dedicated as a

44

Devadasi even though the mother is not a Devadasi. There are cases where girls lose their virginity
before marriage and forced to become Devadasis. Most of the Devadasis stay with the parental family.
One strong reason for dedicating their daughters to God in the name of Devadasi or Basavi is that the
family gets an income and them taken care by the man to whom the girl is dedicated. The girls enter
prostitution at the age of 12 years or whenever she attains puberty. The practicing Devadasis live within
the community but in separate areas or streets and not always found in groups. For example, in Kudligi
most of the Devadasis live in an area, which is close to the bus stand and centrally located. In Bellary the
Devadasis do not stay in the outskirts like other sex workers. They are scattered and stay amidst the
community.

These days, many Devadasis marry one of their partners or clients usually from their own caste
(valmiki) and sometimes from an upper caste (lingayat). Some unmarried youngsters also come forward
to marry Devadasis because of the influence and education dispensed by the local NGOs and
government department schemes. They are mostly from the same caste and from the same locality.

Government departments such as, KSWDC (Karnataka State Womens Development Corporation),
Women, Child Development Department, and local NGOs often organize mass marriages for such
women. These initiatives have had limited success and have raised questions about their real outcome on
the lives of Devadasis. There are reported cases of men who married Devadasis for certain benefits and
who have deserted them .Some Devadasis in Kudligi (colony) are staying with a single partner without
any official marriage. The Devadasis usually stop sex work after marriage. They stay loyal to those
whom they marry. These Devadasis may entertain other clients if it is inevitable and if the
partners/husbands are not capable of supporting them financially. Few partners/husbands dont live with

45

the Devadasis but visit them frequently, fulfill their demands and support the family with cash, clothing
etc. They have their own families staying separately.

In Bellary, the Devadasis practice their sex work from their homes. Generally, the Devadasis enjoy a
better position in the community than other commercial sex workers do because it is a traditional
practice. Even if not married, most Devadasis have one or two partners. The income of the practicing
Devadasis depends on their age and looks. The young and beautiful ones get more customers and more
money. Men say that Devadasis get better treatment than wives do because they are always available for
the man.

BEDIAS (TRIBAL GROUPS)

The Bedia identify themselves with the Kshatriya Rajputs and come under the Scheduled Caste category
in India. Traditionally, the community formed vagrant gypsy-like groups. Dancing and prostitution have
been a female profession for generations as well as the major source of income for the community.
Earlier women and girls used to serve as concubines to men of the upper castes. They always lived in the
villages where the Bedia women were reportedly concubines of rich farmers. The community divided
into various clans. They practice community endogamy and clan exogamy. Most of them live in
extended families. Their women, who make money from prostitution, largely contribute to the family
income. According to traditional accounts, a large part of the Bedia earnings came from prostitution and
dancing. Now most of them are engaged in agriculture. Traditionally the Bedia women did not entertain
people from communities considered lower than their own. In the last few decades, as the practice of
concubinage declined in the region, the Bedia women got involved in prostitution.

46

A large part of the Bedia population resides in the Bharatpur district of Rajasthan. The study conducted
in two villages in Bharatpur. From the outset, it is essential to mention that the Bedia community does
not identify itself with sex workers. In fact, they object if they are labeled as sex workers. Historically
their relationship has always been unfriendly with the Jatavs and Gujjars. The Bedias consider
themselves higher than they consider two communities who have always looked down on them. Due to
this reason, a number of Bedia families shifted to the neighbouring village, where they are the majority.
In the early eighties, the relationship became worse. The Jatavs and Gujjars repeatedly protested against
prostitution of Bedia women inside the village. They felt it was a bad influence on their women folk.
This forced many of the Bedia to move to the outskirts of the village. The girls and women in the
profession started moving out to metropolitan cities like Delhi and Mumbai and to other towns in North
India. They are also functioning in small numbers on the highways.

It mentioned that a large number of Bedia women who are involved in prostitution in different towns
and cities are actually from these villages. Bedia men prepare country liquor, which they sell during the
evening. The people who come to buy liquor lured to have sex with Bedia girls. In recent years, a
number of Bedia families have acquired agricultural land. This has become a slight diversion from their
main income source. Men do not work full time on the fields; they employ widows and women from
nearby villages to work on the fields. These women labourers influenced by the Bedia girls and soon
realize that there is more money in sex work. So they also get involved in the sex trade.

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FAMILY, SOCIALIZATION, SEX WORK AND MARRIAGE OF BEDIAS

In the Bedia community, girls enter the profession as early as 12. Traditionally only the eldest daughter
of the family was dedicated to this profession. Now times have changed and it observed that any
daughter sent to this profession. In the case of poor families devoid of land all the girls take to
prostitution one after the other to support the family. These girls or women function from home or sent
to red light areas through pimps. The pimps and the intermediaries are part of the Bedia clan. These
Girls could be sent to the red light areas of Mumbai, Delhi, Alwar and to other small towns in and
around Rajasthan. From their place of work, they send money and maintain their links with the families
by visiting them during festivals. From early childhood, younger girls sent to visit their sisters and
cousins who are into the dhanda (sex work). They observe everything. As a key informant mentioned,
There are cases where sex workers have married one of their clients. Many a time, the couple then work
as pimps. The girls could be their own daughters, could be bought or kidnapped. When the women
cannot attract many customers due to their age, they start their own business by bringing their girls into
the profession.
The Bedias spread across other districts in Rajasthan. In some other districts, buying and selling of
Bedia girls is common. Bedia girls sold only within the Bedia community. After a few years of work,
they sold again to another pimp.

Men having sex with men (MSM)

The data presented here based on a field study in Calcutta. Homosexuality, or sexual activity between
persons of the same biological sex, is a phenomenon, which exists universally, but is subject to wide

48

variations in its incidence and in the way that society and the culture view homosexual acts or
relationships. To develop appropriate prevention strategies, it is essential to understand the psychocultural frameworks within which sexual behaviour operates, and the context in which they operate in
India. A distinction needs to be made between homosexual behaviour, found in most known societies,
and homosexuality as a particular role around which individuals construct identities and communities of
sub-cultures are framed.
Homosexuality is a matter of strong social disapproval in contemporary India and was a taboo subject in
public forums until recently, when some educated and professional men and women took up the question
of recognition and rights of homosexuals.

Homosexuals in this country are not given enough space to express themselves, though a number of
ancient Hindu texts, including Kama Sutra do talk about homosexuality. Even the Vaishnavic notion of
worshipping Krishna, where the devotees body contains the feelings of Radha, interpreted as a concept
of sexual dualism. In Islamic Sufi literature homosexual eroticism is a metaphorical expression of the
spiritual relationship between God and man.

Along with societal denial and disapproval, Section 377 of the Indian Penal Code (1860) criminalizes
homosexual acts. This statute is based on the British law Offences against the Person Act (1861) ,
which was subsequently instituted in all colonised countries, including India and Ireland. The law passed
making the act of sodomy illegal, but not homosexuality as such. In independent India, section 377 of
the IPC is still in force.

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Homosexual activists in India think that because of the existence of this law, male homosexuals are
subjected to systematic harassment, blackmail and extortion at the hand of enforcement agencies and
the public. On the other hand, scrapping off this law without an amendment of the existing rape-law
would wipe out the last option for lodging a complaint against male rape. It mentioned here that rape is
quite common in homosexuality.

Indian homosexual movements that have come up recently are strongly westernized and are present
among upper middle class and upper class people. Moreover, people from upper income groups with
access to resources are more vocal and have more access to western information. In general, homosexual
behaviour is still almost very unacceptable. Even if it exists in the society, the responses of the
community are mostly:
It does not happen in our communityit is not part of our culture or our men are not like that. Many
men, even if inclined to homosexuality, would not be determined or adventurous enough to translate it
into homosexual or bisexual behaviour. However, it mentioned here that cultural construction of
homosexuality in India is different from that it in the west. First, homosexuality is not politicised in this
country like in many countries of the west. Secondly, physical proximity among the people of same sex
is quite natural here. Some homosexual activists in this country think that the Indian society is not as
homophobic as in the west. They think that in some western country, strong anti-gay lobbies also exist
side by side with a strong gay lobby. The lobbies are absent where homosexuals are discriminated
against mainly in the form of verbal insult and teasing.

IN INDIA, MSM CAN BE CATEGORISED AS FOLLOWS:

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Amongst males-who-have-sex-with-males networks, boys/men self-defined as koti or dhurani. They cut

across income groups, class, caste, religion and region. They gender themselves through effeminate
behaviour in specific spaces. Their exaggerated behavior makes them visible in several public arenas;
this is used as a flirtation mechanism. Males in need of sexual relief irrespective of their sexual choices
may often respond to these feminized males for oral sex, masturbation and where space and a measure
of privacy permits, anal sex. Significant numbers of kotis also sell sex in certain environments. Kotis
speak of the real man, who is the panthi, also known as giria or parikh. It is not a self-defined term
like koti. Among the males who exhibit a so-called normative behaviour, some may sexually desire
other males, while for many it is simply an act of sexual penetration. The panthi visits specific locations
where he knows kotis are available for sex, for which he may or may not have to pay. MSM have their
cruising points and generally seen at these points (like the lake, certain parks and some public toilets)
From seven to ten in the evening.

Sexual relationships between kotis and panthis, both for commercial and noncommercial purposes are
prevalent. Some kotis have their fixed babus (patrons/clients). Others look for new partners every night.
The act of sex does not necessarily depend on monetary transactions as emotional attachment and like or
dislike develop a lot in the relationship. Kotis have sex with their partners for gifts, money or just for
pleasure.

Many of the men stated that they liked anal sex because it was tighter than vaginal sex. They seek kotis
as sexual partners due to non-availability of women for anal and oral sex. Recent anecdotal evidence
indicates that many males see females as vectors of sexual diseases and therefore unsafe for sex. They
also feel that vaginal sex is more risky than anal sex.

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The majority of panthis are invisible. In India, it is a hidden group. They do not want to reveal their
sexual identity. Many of them are either married or likely to be married in future. The third group among
homosexuals known as dupli. Duplies believe that there should not be unequal power dynamics in
sexual interaction. It is not important for them, who is penetrating who in a sexual act. Hence, they can
be both penetrated by their partners or penetrate their partners.

SOCIALISATION PROCESS OF MSM

The socialisation process is a very important phase in the lives of the MSM. The childhood years are
important for knowing the self. They like dressing up like girls and playing with dolls. They do not face
much gibes from their elders during this period. During school years the distinct realisation that they are
different dawns on them. This is the time when others easily mark them out due to their effeminate
behaviour. Their classmates start teasing them. At the same time, problems also come from friends,
neighbours and relatives. They develop low self-esteem. On the other hand, in their sex life, they are
subject to rejections from their dream men. A number of kotis also forced to have sex with senior boys.
Experiences are not always negative. Few of them start enjoying the sexual act by that time. Persons
with a similar attitude and sexual identity come together and a community feeling develops. As a result,
a network among the kotis forms at the local level.

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INITIATION TO SEX IN THE LIFE OF AN HOMOSEXUAL

Young men and boys, usually unmarried, may find themselves sexually aroused through body contact
when either playing or sleeping next to each other. Many a time it transcends into a variety of sex acts.
Here the sexual act may be mutual masturbation or thigh sex. Male to male sexual acts is very narrow in
this context. These sexual acts not seen as sex but as masti or khel, a sexual play between boys, which
not considered as serious because it does not involve a woman. Where there is an age or power hierarchy
or both, anal and oral sex may occur, generally the younger partner acting as the receptive partner. This
type of sexual activity can be called dosti sex (friendship sex) and is linked to discharge sex without
any construction of sexual identity. Desire focused on females. Non-availability of

Females lead to this. Friendship sex does not prevent marriage and may continue after marriage.
Unequal power or age hierarchy may lead to sexual abuse. In hostels or at home, senior boys or elder
relatives ranging from cousin brothers to uncles often abuse young boys sexually. Many a time sexual
exploitation by seniors and colleagues becomes the initiating factor

Friendship and romance

Romance and friendship in the true sense come in the later years at school. Many of the kotis establish
relationships with so-called straight men at this stage. The relations are not always stable. Partnerships
generally last between a week and three months. Stable and yearlong partnerships also reported. The
emotional attachment is much more intensive for the koti than for the other person in the pair. The

53

partners sexual preference and identity

not known in most cases. He may be a bisexual or a

homosexual. Rejection in love comes quite often in life.

Male sex workers in Calcutta

A number of kotis in Calcutta are engaged in sex work in some form or other. Several dynamics exist in
homosexual sex work. One popular form of sex work is gift-sex. It is a form of male sex work, where
the service provider receives gifts instead of cash. In Calcutta, the gift ranges from a pair of leather
shoes, to an expensive jacket and maybe to a cellular telephone. Gift sex seems to be happening a lot in
hotels and guesthouses.
Waiters, massage boys are involved in sex-work in these places. There are also a number of youths, who
looked after by their clients, in terms of accommodation, clothing and food. Many male sex workers
appear to work in public sex environments, where clients are from across the classes. Sometimes, clients
will take them to a guesthouse from the pick-up area. In south Calcutta, the lake area is one of the most
interesting cruising joints for homosexuals. By six in the evening they come to this place in search of
clients. The monetary transactions start from 50 Rupees per sexual act. It may go up to 200 Rupees per
act. The rate varies between good-looking kotis, bad-looking ones, and the appearance of the panthi. If
he is handsome, a koti may agree to have sex with him for less money. The sexual act takes place
behind a bush in a park, on a deserted platform, in a railway compartment, in one of their houses or in a
hotel.

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HIV/AIDS and risk linked to MSMs sexual behaviour

Homosexuals are extremely vulnerable to STIs and HIV transmission. Discussions with many of them in
Calcutta indicated low prevalence of condom use for anal sex. It spoils pleasure is a very common
expression. It believed that HIV s transmitted only through vaginal sex. Many a time anal sex seen as
masti by the panthi, and is not considered real sex, and so they indulge in unprotected, sex.

Emotional involvements are another reason that leads to unprotected sex. If the panthi is handsome or a
nice man with a gentle disposition, the koti may develop an emotional attachment to him. It becomes
very unimportant to use a condom in such cases. Emotional attachments also reduce the bargaining
power of the kotis. Many a times the relationships do not last long. Moreover, these men are sometimes
desperate to get a partner, which further reduces their bargaining power. They do not hesitate to go with
a complete stranger.

The location used for a sexual act is another important factor in determining whether a condom used or
not. Sexual acts, which take place near lake, deserted railway platforms or railway compartments are
mostly without condoms. These sexual acts are of short duration. Due to the shortage of time and space ,
the koti can neither bargain with his client nor can he monitor his client for the use of condom. Partners
often cheat kotis by taking off the condom before penetration. A support-group member, who is working
among the kotis in Calcutta, informed that condom use is very low. Although he distributes condoms the
kotis do not use them.
After a risk assessment programme by an organization in Calcutta, it has been found that condom use in
the suburbs is absolutely nil. In south Calcutta few demand condoms and there hasnt been much
response among the kotis of north Calcutta. North Calcutta is relatively more congested as compared to

55

the southern part; hence there is lack of availability of space and open venues to hold such discussions.
A difference in the outlook of the people is observable between the residents of north and south Calcutta.
The former are the traditional people with conservative viewpoints and the latter have a relatively
modern, indifferent and non-interfering outlook on life. Anal sex is very common among homosexuals
in Calcutta as elsewhere. During anal sex, some kotis may end up with ruptures and injuries, though it is
not very common. They visit the local practitioners and are unable to explain the situation to them. They
generally say that they have piles. The doctor gets to know and threatens the koti that his family
informed if he does not speak the truth. He operated only when he tells the truth.

Self-esteem is generally low among the kotis in Calcutta. Low self-esteem drives people to risky
behaviour. In the terminology of male power, the male who is penetrated during sex is considered to be
like a female and hence inferior. The simultaneous giving up of male power makes a koti a subversive
and timid entity in the eyes of the others, and they marginalised in society. There is little urge to protect
oneself from any harm. In a number of cases, kotis castrated or tried to join a group of eunuchs in search
of an identity. Many kotis have a high level of dissatisfaction with their male bodies. This also
negatively influences their sense of self-esteem.

Kotis at the lake have a strong community feeling. They keep contacts with each other and help each
other. At times they discuss their problems and try to figure out the possible solutions. However, there is
a distinct difference between the kotis from the low and the highincome groups. The ones from the
higher income group have separate cruising venues and dont interact with other kotis. MSM who earn
Rs 500 do not interact with those who earn Rs 200. A member termed these people as selfish.
Street children

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UNICEF has defined street children as, those who are of the street and on the street. Of the street
refers to those who live in the street and on the street to those who spend a significant part of the day
on the street either for vocational reasons or for a wide range of other activities like begging, rag
picking, car washing or attending to some side street shop. UNICEF has included them under children in
difficult circumstances. They are also called high-risk children, children in need of care and
protection, abandoned children, etc.

The problem of street children is a global one and exists in both the developed and developing countries,
with a difference in size and magnitude. As the countries are becoming more and more urbanized, the
number of street children is growing. The following are the categories of street children:

1. Children on the street these children still have more or less regular family contact . Their focus in
life is still the home. Very few attend school, most return home at the end of each working day.
2. Children of the street this group is smaller but complex. Children in this group see the street as their
home and it is there that they seek shelter, food and a sense of family among companions. Family ties
exist but are remote and their former home visited infrequently.
3. Abandoned children these have severed all ties with the biological family, they are entirely on their
own, not for material but also for psychological survival.

Every Indian city has a sizeable number of children who are unaccounted for and who live in shocking
inhuman conditions. These children found on the streets, railway platforms, markets, slums and squatter
colonies. Along with other miseries in their lives, these children exposed to high-risk sexual behaviour
in their early years. They have often been subjected to abuse and harassment. Sex is easily available for

57

them. Finding it very hard to make both ends meet, they driven to a life of precarious survival. Health
services, for this marginalised group, are inaccessible and unfriendly. The major focus of the existing
HIV/AIDS programmes is on school-going children. The responses to prevent the spread of the infection
in out-of-school children are isolated interventions by some NGOs. There are few efforts to link work on
prevention of HIV/AIDS with developmental programmes that address poverty, gender, education and
access to health care.

Running away from home and socialization on the streets

For the present study, discussions with street children held in Calcutta. Children run away from home
early in life at the age of 7-8 years. Most have contacts with their families and visit their family
occasionally. They run away from families because of ill treatment from their father and stepmother,
lack of space at home, in search of a better life and to seek freedom. Some said that they could not fulfill
their parents wishes and ran away. Some did not like to go to school and study. Many children run away
from home because they cannot bear the stress of family problems, especially when the father
is alcoholic and beats the wife regularly. They are sometimes motivated by friends who have already run
away . Soon they start earning through rag picking, working in tea stalls or stealing. Slowly a
relationship develops between the older ones and the new comers.

b) Sexual abuse/sex in life

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For most of them, the first sexual contact in their lives is through sexual abuse or forced sex. A large
number of the boys are also repeatedly sexually abused by some men in the station, which lead them to
indulge in sex early in life. Some of the boys watch adult movies with older boys and friends. Later they
try to enact the scenes from the movies. Gradually, they start having sex with their peers.

Forced sex is a big problem in childrens lives. Children cannot protest. They threatened by exclusion
from the platform. A number of times, little boys taken to hospital for treatment of injuries caused by
forced anal sex. This becomes the initiating factor for the children. The peer educators later found the
same boys indulging in sex for pleasure. Kids also agree to have sex for money and food. Sometimes
older men show a lot of affection towards a particular young fellow who might be a newcomer to the
area. They provide food and a place to sleep and later compel the young boy to have sex with him. Even
in the cinema halls, older men have sex with young boys in the darkness.

Drug users

The phenomenon of traditional drug use in Asia documented since the presence of the British in the
region. Substances such as cannabinoids and opioids have found their way to Western markets with
substantial profit margins, which resulted in International pressure for Supply Reduction and crop
eradication measures. Drug users are a highly elusive group in India. Information on the magnitude of
the problem among the general population is available from four kinds of sources:

The risky behaviour of this group is needle sharing, which known to be an efficient mode of HIV
transmission. The profile of the IDU in India is diverse and dependent on the location of the user. In the

59

northeastern states of India such as Manipur and Mizoram the IDU cuts across all socio-economic strata.
In other regions of India, the lower socio-economic slum communities appear by the phenomenon.
Those who indulge in this behaviour mostly share a common syringe within a group. Injecting drugs
with nonsterile syringe is one of the key risk factors leading to HIV. The entire system of taking drugs
makes them vulnerable to HIV. Another group of people, who actually do not indulge in injecting drugs,
are also at high risk because they are the sexual partners of the addicts. The twin epidemics of HIV and
substance abuse are fuelled by low awareness levels on the modes of transmission of HIV as well as
community marginalization and social policies that prevent and prohibit access to sterile needles and
syringes for IDUs.

A life dependent on drugs

Many young people start experimenting with drugs during their adolescence. Most of the time they start
taking so-called soft drugs like charas (hashish) or ganja (marijuana), later they try hard drugs like
heroin or other chemical drugs like ecstasy hallucinogenic drugs. The dose increased gradually. They
take money from their parents; if possible, otherwise they may indulge in stealing or other illegal
activities. Peer pressure is high among drug users. Nevertheless, it should also be mentioned that peer
pressure is not the only factor triggering their use of drugs. An important number of young people start
taking drugs only for fun or experimentation, at times it has nothing to do with depression or peer
pressure.

An activist told us that taking hard drugs or hallucinogenic drugs is also due to great exposure to the
western society through television and films. It reported that many start taking drugs just for the
experience. In the process, it does not take much time for many of them to become completely addicted.

60

Once addicted to a particular type/brand, a drug user first goes in search of his or her drug. If it is not
available then any kind of drug is accepted. Anti-epileptic and antispasmodic capsules are also
swallowed or injected.

According to informants, there is a hierarchy among drug users based on the types of drugs used and the
way the dose taken. IDU rated the lowest and will always be found in separate groups. The upper middle
class drug users indulge more in western drugs and hallucinogenic drugs, which are orally absorbed.
Many users also come from the middle class , but according to a psychologist there is a lot of guilt
involved.

Drugs and sex

Additional risk behaviour is multi-partner sex after taking drugs. Initially, drug use heightens sexual
desire. Not only IV drug users, all drug users including alcoholics, are equally vulnerable to HIV if they
indulge in multiple partner sex or unsafe sex while under the influence of drugs. A number of
intravenous drug users men, women, and children sell sex to procure drug money. Frequently, street
children who may themselves be peddlers get into drugs, some men get their wives to procure money for
their drug habits. These women, in turn, also end up using drugs and selling sex to procure the money.

Attitude of family and community

Family bondage is still very powerful in India. There are strong emotional links within families. But as
far as HIV/AIDS is concerned, the economic burden is the main problem for the family. Most of the

61

time, a family cannot afford to keep a positive person who has developed AIDS, as medical expenditures
are too high. It is not always true that the affected persons dumped in care-homes. Family members keep
track of their loved ones. However, there are cases where families need to be motivated. They may be
compelled to take back an affected person. The community looks down upon the addict who is mostly
stigmatised, marginalised and alienated from the society.

False beliefs about drug use

- Once a person starts taking drugs, he/she cant stop (proper intervention can help a person to stop drug
use).
- A drug user always lies, cheats, steals (it does happen in a number of cases, but one cant label a drug
user a liar/thief).
- He/she starts taking drugs because of friends or the company he/she is in (at times people who have no
friends and are lonely take drugs).
- People take drugs only when they are low (drugs are always associated with negative emotions which
is not true, at times even the happiest of people take drugs, it adds to the sense of elation).

THE CULTURAL APPROACHES OF HIV/AIDS IN INDIA

The cultural approaches of HIV/AIDS in India necessarily start with the family. Family is the basic unit
of social organization. This is where the socialization process begins, where behaviour and roles are
taught and, gender norms are defined. Moreover, the family provides a support structure for the affected
individual and thus assumes greater importance in the absence of state-sponsored welfare.

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It is also important to examine the familys role with reference to the mode of spread of HIV/AIDS.
Sexual activity is the mode of transmission in nearly 75% of the cases and the infection is spreading
very rapidly among monogamous single partner married women who considered until now as a lower
risk category. Hence, it is necessary to examine the family structure in India, and its implications in HIV
transmission and care of the infected.

The family in India has to be viewed as part of a wider kinship system. Even the Indian nuclear family
exists in a network of formal and informal ties with other families. It needs to be stressed that there is no
single model of family and kinship structure in India.

Different family structures have emerged from different types of lineage systems, patterns of residence
and the types of marriage practised by various communities in the country. They influenced by religious
ideology, patterns of production, social divisions in the society, ecology and environment, various
behavioural norms and cultural concepts of man and woman. Different family and kinship systems
confer different types of rights and entitlements on individuals based on sex, age and marital status. This
often determines the right of membership in a family, and access to family resources, division of labour
and gender relations.

The most common family structure in India is that of patrilineal descent (succession and inheritance
passes from father to son) with patri-virilocal residence (after marriage the woman lives with her
husband in his fathers house). This system is culturally ideal and has had a strong influence on the
values and beliefs, and on gender constructions. Females and males have different status in patrilineal

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societies. This reinforced by the fact that men carry the lineage forward, while women move out to
become part of their marital homes. Inheritance laws of all religious groups in India are strongly
patrilineal where the male members of the family are entitled to inherit property thus excluding the
female members partially or completely. Patrilineal joint families are prevalent, mostly among
communities engaged in trade and who own land. Joint family may exist without property. Smaller joint
families found among traders, artisans, agriculturists and even urban service classes. In the absence of
property, the joint family functions collectively to pool resources and labour.
The culture approach to HIV/AIDS facilitates the reinforcement of the positive elements in the local
culture of a given population to foster positive behaviour. Attitude seeks acceptable and relevant changes
in the not-so-positive elements in the same cultural process to motivate the given group or persons to
avoid risk-taking behaviour and vulnerable situations. Cultural references and resources of any given
population which are considered as obstacles for HIV/AIDS prevention and control strategies include
sexual violence against women and girls, polygamy; religious dogmas, taboos, exclusivity, and
superstitions, lack/inadequacy of primary health facilities in remote rural areas, leading to peoples
dependence on unskilled and unsafe heath services. Peoples blind faith in superstitional physco-therapic
treatment by the traditional healers. A process of simultaneous co-existence and conflict of positive and
negative values, influencing and shaping behaviour pattern and attitude, prevail in any given society or
culture or group. The need is to optimize, harmonize and popularize the positive factors in the culture of
a given population as well as minimize and eliminate the negative elements or obstructive aspects
therein to ensure safe and responsible behaviour to reverse the process of expansion of HIV/AIDS
epidemic. No attempt made to change the culture of a community or a given population group as the
same will be counterproductive and will be deprivation of human rights as culture is the greatest assert
and sense of autonomy of a given population. The cultural approach is indispensable if behaviour

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patterns are to be changed on a long-term basis, a vital condition for slowing down or for stopping the
expansion of the epidemic.

ReviewofLiterature

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The preamble to the Mexico Declaration of Cultural Policies of UNESCO, dated 1982, defines culture
as a set of distinctive spiritual and material, intellectual and emotional characteristics, which defines a
society or social group. Culture in this sense encompasses ways of life, the fundamental rights of the
person, value systems and beliefs.

T. Scarlett Epstein defines culture as inclusive of behavioural norms of the society and an inventory of
solutions. She suggests that the success of developmental projects depends on changes in social
behaviour that are often deeply rooted in traditional cultural norms, without an understanding of which it
is unlikely that necessary and socially desirable behaviour changes can be expected to take
place.(Epstein, 1999)

The acknowledgement of the cultural dimensions of development would, therefore, entail basing the
theory and practice of development within a cultural approach, at the level of strategy, institutional
action, programmes, projects or field work. (UNESCO, 2000).

The two major documents published by UNESCO in this perspective are respectively Change in
Continuity: concepts and tools for a cultural approach to development (UNESCO, 2000) and the
overall publication Summary of country assessments and project design handbook based on the
cultural approach to HIV/AIDS prevention and care (UNESCO/UNAIDS, 2000).

An historical and sociocultural perspective may be helpful in understanding the negative reactions
triggered by HIV/AIDS. In previous epidemics, the real or supposed contagiousness of disease has
resulted in the isolation and exclusion of infected people (Volinn, 1989; Gilmore & Somerville, 1994).

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Sexually transmitted diseases in particular are notorious for triggering such socially divisive responses
and reactions (Carrara, 1994; Goldin, 1994).

From early in the AIDS epidemic, a series of powerful metaphors was mobilized which serve to
reinforce and legitimate stigmatization. HIV/AIDS as death as punishment (e.g. for immoral behaviour);
HIV/AIDS as a crime (e.g. in relation to innocent and guilty victims); HIV/AIDS as war (e.g. in relation
to a virus which needs to be fought); HIV/AIDS as horror (in which infected people are demonized and
feared); and HIV/AIDS as otherness (in which the disease is an affliction of those set apart).

Together with the widespread belief that HIV/AIDS is shameful (Omangi, 1997), these metaphors
constitute a series of ready-made but highly inaccurate explanations that provide a powerful basis for
both stigmatizing and discriminatory responses. These stereotypes also enable some people to deny that
they personally are likely to be infected or affected.

People living with HIV/AIDS are seen as ignominious in many societies. Where the infection is
associated with minority groups and behaviours (for example, homosexuality), HIV/AIDS may be
linked to perversion and those infected punished (Mejia, 1988). In individualistic societies, HIV/AIDS
may be seen as the result of personal irresponsibility (Kegeles et al., 1989). In yet other circumstances,
HIV/AIDS is seen as bringing shame upon the family and community (Panos, 1990; Warwick et al.,
1998). The manner in which people respond to HIV/AIDS therefore varies with the ideas and resources
that society makes available to them. While negative responses to HIV/AIDS are by no means
inevitable, they not infrequently feed upon and reinforce dominant ideologies of good and bad with
respect to sex and illness, and proper and improper behaviours (Warwick et al., 1998).

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HIV/AIDS and diversity, societal and cultural components Broad epidemiological patterns of the
incidence and prevalence of HIV conceal the considerable local, regional and cultural variety in social
practice and sexual behavior in India. It is quite likely that HIV prevention programmes based on
epidemiological patterns have had little impact on the spread of the virus. Current programmes of
prevention that are targeted at specific social high-risk groups such as sex workers, truck drivers,
intravenous drug users (IDUs) may for these reasons miss out on the vulnerability of others who may be
equally at risk.

A recent study conducted by ISST on Gender Dimensions of HIV/AIDS (2000) also corroborates the
fact that the prevailing socio-cultural features have significant implications on the spread of the HIV
epidemic in India. Cultural practices and codes play a very significant role in relation to HIV/AIDS in
India both positive and negative.

For example, girlsearly age of marriage in many parts of India makes them biologically more
vulnerable. Cultural restrictions on discussion relating to sex result in perpetuation of ignorance, often
leading to avoidable vulnerabilities. Having relations with multiple sexual partners for men, which leads
to high-risk behaviour, is ignored by society and considered as part of maleness and a necessary
initiation in sex.

Nevertheless, there is the institution of the family. The Indian family can play a significant role in
prevention, and it provides the essential support for HIV positive members, irrespective of the social
ostracism they might be facing. Similarly, the traditional value systems could form the basis of more

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effective methods of prevention and care. Cultural influences on institutional care need to be examined
as well past experiences of AIDS control and prevention, projects highlight that care and prevention
efforts are more likely to be sustained if they are integrated into the existing community structures.
Programmes need to be updated within their continuum to take into account the needs of the target group
to better ensure the requisite behavior change.

THE IMPORTANCE OF CULTURE IN FIGHTING HIV/AIDS IN INDIA

INTRODUCTION TO CULTURE
There exists a multitude of definitions and descriptions of the concept of culture, and the ones I present
here all address some central aspects of my interpretation of both what culture is and what culture does.
The word culture as The totality of socially transmitted behavior patterns, arts, beliefs, institutions, and
all other products of human work and thought.
Moving on to more traditional literature on the concept of culture, Kluckhohn who argues that Culture
regulates our lives at every turn. From the moment we are born until we die there is, whether we are
conscious of it or not, constant pressure upon us to follow certain types of behaviour that other men have
created for us (Kluckhohn 1949: 26). Accordingly, the world we are born into already defined by
cultural patterns. He explains further, A culture is learned by individuals as the result of belonging to
some particular group, and it constitutes that part of learned behaviour which is shared with others
(Kluckhohn 1949: 26). At the same time, he claims that Most groups elaborate certain aspects of their

69

culture far beyond maximum utility or survival value. In other words, not all culture promotes physical
survival (Kluckhohn 1949: 27). This might be a controversial proclamation, but the literatures I will
present in the following chapters in large part substantiate Kluckhohns statement.

The Washington State Universitys Baseline definition of culture highlights the fact that people learn
culture as cultures essential feature:
Culture, as a body of learned behaviors common to a given human society, acts rather like a template
(ie. it has predictable form and content), shaping behavior and consciousness within a human society
from generation to generation. So culture resides in all learned behavior and in some shaping template
or consciousness prior to behavior as well (that is, a "cultural template" can be in place prior to the birth
of an individual person). (Baseline Definition [s.a.])

CULTURAL APPROACH AND AIDS/HIV

The culture, which is to be learned, does however not appear in the form of a textbook with a constant
enduring content. Culture is constantly changing and this is a second significance to take into account
when giving culture its appropriate attention. The existence of HIV in a community, may in turn
influence not only peoples perception of HIV itself, but also how people see other aspects of life, hence
the culture is changing. An example of this influence, which I will examine later, is fatalism. While
fatalism is an inherent part of life in many South East African communities, the presence of HIV and
AIDS can easily strengthen this vision as people see their friends and family dying of AIDS without
having any ability to impede its advancement.

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Susan Sontag introduces another aspect of culture learned in her essays Illness as Metaphor and AIDS
and its metaphors. She presents metaphors as responses to diseases which are not understood;
mysterious diseases which have no cure. Writing about cancer, she argues that cultural myths about the
illness tended to isolate and estrange cancer patients (1991). These myths or metaphors are cultural
constructions, passed on within and between communities, taught and learned. With HIV/AIDS today,
such cultural metaphors may prevent people from getting tested or seeking treatment due to fear of
social stigma; social stigma which is already making life worse for those living with a publicly known
HIV/AIDS infection. The literature presented in Chapter 5 will also illustrate that learned approaches
and perceptions in South East Africa are not always the interpretations most beneficial to public health.
It also shows, as the case was with cancer, that cultural beliefs and practices make people question what
is presented as scientific evidence, the scientific cure or the scientific method of prevention. In the West,
it took quite a while from cigarette smoking being connected to cancer was presented as a scientific fact,
throughout public health campaigns, before the linkage was considered common knowledge and
smoking in some countries was ruled illegal in pubs and public places. With sexuality and the prevention
of HIV/AIDS the transformation of beliefs and behaviour is even more difficult, hence likely to take
longer, as peoples sexuality is so sensitive and intimate, so central to ones identity and ones sense of
self.
Culture can be seen as the context within which we live, and one of the matters I am trying to highlight
with my thesis is that single elements in a culture cannot be fully understood without being viewed in
relation to and in consideration of other cultural elements surrounding it. Kluckhohn furthermore argues
that cultural features may serve as preserving continuity with the past, making certain sectors of life
familiar and predictable (Kluckhohn 1949). Alfred Kroeber who compares culture to a coral reef where
new corals build on their deceased relatives uses a similar approach. Like the coral reef, culture is

71

different from and exceeds the sum of its parts and its form gradually developed often without the
actors self-awareness of it happening (Eriksen 1998). Moreover, people are not always conscious about
where their own attitudes and belief systems come from nor the implications these can have on their
own as well as their loved ones health. The Mexico Declaration on Cultural Policy of 1982 proposed
the following definition of culture, which still widely used and referred to today:
Culture said to be the whole complex of distinctive spiritual, material, intellectual and emotional
features that characterize a society or social group. It includes not only the arts and letters, but
also modes of life, the fundamental rights of the human being, values systems, traditions and
beliefs (UNESCO 1982: 41)

On the basis of this definition UNESCO holds culture to include ways of life, traditions and beliefs,
representations of health and disease, perceptions of life and death, sexual norms and practices, power
and gender relations, family structure, languages and means of communication as well as art and
creativity. Hence culture is important in relation to HIV/AIDS because it influences peoples attitudes
and behaviours (UNESCO 2002). To be able to change peoples behaviour in the fight against
HIV/AIDS, UNESCO argues for culture taken into account at various levels:
as context an environment in which HIV/AIDS communication and prevention education takes
place;
as content local cultural values and resources that can influence prevention education; culturally
appropriate content of sensitization messages is mandatory for them to be well understood and received
and as a methode that enable peoples participation, which helps to ensure that HIV/AIDS prevention
and care is embedded in local cultural contexts in a stimulating and accessible way. (UNESCO 2002:
last paragraph)

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Geertz state that man is an animal suspended in webs of significance he himself has spun, I take culture
to be those webs (Geertz 1973: 5). This will also be my interpretation. What I see as culture, borrowed
from Clyde Klukhohns Mirror of Man, is a peoples way of thinking, feeling, and believing and their
learned behaviour. A set of values, beliefs and behaviours.

Kluckhohn also addresses the concept of cultural relativity. He states that The concept of culture, like
any other piece of knowledge, can be abused and misinterpreted (Kluckhohn 1949: 41), pointing at the
fear of cultural relativity weakening morality through promoting an attitude of somebody elses actions
legitimising ones own. His statement is however also valid in the sense of justification and
legitimization of harmful practices; it is their culture and hence we can not condemn it. He also points at
the principle of cultural relativity of seeing customs in a context and the need to evaluate these habits
with regard to how they fit in with other group habits (Kluckhohn 1949).

On their web-pages on a baseline definition of culture the Washington State University introduces
another aspect of culture which is also important in understanding the bigger picture of South East
African culture:
To the extent that culture consists of "the learned behaviors of a given human society," women
and men figure equally in the cultural system. However, the cultural "template" [.] is
constantly being negotiated, revised, and reproduced, and the power to participate in this process
of negotiation historically been divided along gendered lines. (Women, Culture and Power [s.a.])

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Historically most dominant world cultures have been patrilineal, and most cultures to some degree still
are today, in the developed as well as the developing world. The power of women is limited as women
are still under-represented politically, they are paid less than men for equal work, in many major
religions women are restricted from access to positions of authority, and family descent is most often
traced through the father (Women, Culture and Power [s.a.]; Pratt 2002).
In an introduction to their cultural approach to HIV/AIDS prevention and care UNESCO state that
Health has always been an essential component of development policies. In this domain, as in others,
culture has a fundamental role to play. Conceptions of health and disease, and related beliefs, traditional
practices and the use of medicinal plants: these are all essential variables to be taken into account when
building sustainable development policies. (UNESCO 2002: 1)

Culture is what gives meaning to peoples lives and it is the basis for how we behave. Relating this to
the battle against HIV/AIDS, peoples understanding of what good sex and acceptable sex is, and
whether or not condoms can be a part of such sex is linked to and is in part a result of peoples cultural
belief systems. Important to note however is that men traditionally are the ones to define good sex and
many women may even never have experienced such a thing. Rather, what men define as good sex is
for them what is experienced as expected sex.
As culture helps people make sense of daily life, it is my argument that to fight the spread of HIV in
South East Africa these belief systems need to be better understood. Hence culture should be approached
as part of the solution, rather than part of the problem. Culture is often seen separate from economic,
social and political factors, but in fact it includes all of these, and I will address those subjects briefly in.
Furthermore, as an example of this close connection, I will show in the following that womens

74

vulnerability is intertwined with the cultural practice of them being brought up to be submissive and
being taught that men are to be dominant, while men learn to be dominant.
Culture is at the basis of how people make sense of HIV and of life. It is at the heart of what perception
is all about, including peoples perception of risk. Our culture in large part defines what we believe to be
right or wrong, how we make sense of what disease is about and how we include sources of information
and make it part of our knowledge of life. That is why incorporating culture into HIV works is so
important.

OBJECTIVES OF THE STUDY

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General Objectives
Strengthen the different socio-cultural approach in projects planning and evaluating the of HIV/AIDS in
three regions of the country.
The study seeks to understand the different cultural approach of HIV/AIDS within the different
vulnerable groups and diverse cultural contexts.
SPECIFIC OBJECTIVES:
Further explore the cultural factors, values, traditions and practices associated with the

HIV/AIDS

Present guidelines for the development of research on vulnerable groups.

Implement methodologies for intervention projects in vulnerable groups.
AIM OF THE STUDY
The basic concern of the research is to assess the different cultural approach to HIV/AIDS.
SCOPE OF THE STUDY:
The scope of this study to better understand, the criticality and importance of the different cultural
approach to HIV/AIDS. By this study, we would identify multiple role and activities of cultural factors,
values, traditions and practices associated with the HIV/AIDS
.
METHODOLOGY
Various methods of qualitative research methods used for the study.

Desk-Based Research - The study were based on available secondary information on cultural
attitudes towards sexual behaviour, gender relations and life-threatening infections.

Field Studies - The desk-based research were supplement with primary data collection in
relevant to cultural practices and norms in specific communities perceived to be at high risk from
HIV/AIDS in different parts of India.
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SAMPLE FOR FIELD STUDIES

In respect of the cultural diversity of the country and the period, an attempt made to focus on
communities from different regions. The sample selected includes both mainstream communities and
people outside the popular mainstream culture including culturally distinct ethnic groups.
Selected communities in Delhi: local people and the migrants
Sample Size: 50

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Findings and Analysis on different cultural approach to HIV

Types of Family system

One of the most useful features of bar charts is that they display how the Family system significantly
play important role in the current study of Different cultural approach to HIV/AIDS among the migrant
labour and permanent resident of Delhi. Consider the above bar chat that depict the comparative study of
Types of Family system of the respondent. Bar chart in this case indicate that 97% of the total sample
size where nuclear family system. Nevertheless, on the other hand in the Recent the study depict that
3% of the total sample size where from joint family system .

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Nature of Job

The pie charts that display how nature of job of the respondent. Consider the above pie chat that depicts
the respondent nature of job performed for the livelihood. pie chart in this case illustrate that 45% of the
total sample size where service classes who work for different organization .About 28% where of
migrated labour, trader, artisan from different region .

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AWARENESS ABOUT HIV/AIDS

The pie charts that display awareness about HIV/AIDS

among respondent. Consider the above chat

that depict that 72% of the respondent were aware about HIV/AIDS. However the pie chart also reflect
that one fourth of the total percentage that still not aware of HIV/AIDS . Moreover the 28% respondent
were some partially aware and some not aware completely. considering further more those 28% of the
respondent were of migrated labour ,small trader ,artisan as in this case illustrate that 45% of the total
sample size where service classes who work for different organization .About 28% where of
labour, trader, artisan from different region .

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migrated

AWARENESS THAT SEXUAL ACTIVITY IS THE MODE OF TRANSMISSION OF HIV/AIDS

The pie charts that display awareness that sexual activity is the mode of transmission of HIV/AIDS
mode of transmission among respondent. Consider the above chat that depict that 72% of the respondent
were aware about mode of transmission of HIV/AIDS. However the pie chart also reflect that one fourth
of the total percentage that still not aware that sexual activity is the mode of transmission HIV/AIDS.
Moreover the 28% respondent were some partially aware and some not aware completely. Considering
further more, those 28% of the respondent were of migrated labour.

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Figure 2 UNPROTECTED MULTI-PARTNER SEX CAUSES HIV/AIDS

The pie charts that display awareness aware that unprotected multi-partner sex causes HIV/AIDS.
Consider the above chat that depict that 62% of the respondent were aware unprotected multi-partner
sex causes HIV/AIDS. However about the 38% respondent were not aware unprotected multi-partner
sex causes HIV/AIDS. Considering further more the study has determine that of the respondent not
aware that multi-partner sex causes HIV/AIDS.

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OPENLY DISCUSS SEX ACROSS GENDERS AND AGE GROUPS

The pie charts that display that openly discussion about Sex and sexual related issue among the family
member and at age groups among respondent. Consider the above chat that depict that 98% of the
respondent never discuss about Sex and sexual related issue among the family member and at age
groups. However the pie 2% of the total percentage discuss about Sex and sexual related issue.
Moreover Indian culture sex considered to be a taboo to be discussed openly among family member but
the modern trend has transformation from such taboo .

83

APPROACHING OF SEX WORKERS BEFORE MARRIAGE

The pie charts display the information about involvement in sex before marriage. Consider the above
chat that depicts that 31% of the respondent had gone to sex workers to buy sex before marriage.
However the pie 69% of the total percentage discuss that sex before marriage is considered to be sin in
the relgion, fewer respondent hold their view that they did not get an opportunity .

84

REASON FOR VISITING SEX WORKERS BEFORE MARRIAGE

The above bar charts that display that openly discussion about the reason for visiting sex workers before
marriage. Consider the above chat that depict that 76% of the respondent visit sex worker for pleasure
and 15 % respondent responded that visit sex due to long separations from wives . However, the bar
chat with 2% of the total percentage visit to gain experience on sexual intercourse.

85

USE CONDOM WHILE HAVING SEX

The above bar charts display information about the uses of condom during sex among respondent.
Consider the above chart that depict that only 36% of the respondent use of condom during sex and
concerned about the safe sex and 69 % respondent responded that they dont use condom during sex .

86

VISITING SEX WORKERS BY MEN IS ACCEPTED BY THE SOCIETY

The pie charts display opinion on visiting sex workers by men is accepted by the society. Consider the
above chat that depict that 89% of the respondent were not in favor of men visiting sex workers among
the family member. However the pie 11% of the total percentage hold the view that visiting sex workers
by men is not accepted nevertheless when men get involve without family member knowledge in
considering the circumstance men are accepted .

87

INFLUENCE OF DOMINANT CASTE /RICH PERSON TOWARD SPREADING

HIV/AIDS AMONG LOWER CASTE

The pie charts display that how dominant caste influences toward spreading HIV/AIDS among lower
caste in the society. Consider the above chart that depict that 92% of the respondent were not in favor of
dominant caste influence toward spreading HIV/AIDS among lower caste in the society in delhi
however significantly the same subject hold different view point among different region . However the
pie 8% of the total percentage hold the view dominant caste influence toward spreading HIV/AIDS
among lower caste in the society .

88

CULTURAL NORMS AND VALUES THAT ALLOW EXTRA MARITAL SEXUAL

RELATIONS FOR MEN

The pie charts display that cultural norms and values that allow extra marital sexual relations for men
the society. Consider the above chart that depict that 7% of the respondent hold the view that extra
martial were not allowed in cultural norms and values however different religious and caste allow one to
get addition marriage. The pie chart depict that 93% of the total percentage hold the view that cultural
norms and values never allow extra marital sexual relations for men.

89

DEALING TOWARDS WOMEN AND MEN WHEN INFECTED OR BELIEVED TO BE

AFFECTED BY HIV/AIDS

The pie charts display that opinion about dealing of affected Women and men in the same way when
infected or believed to be among the society. Consider the above chart that depict that 72% of the
respondent hold the view that dealing with affected Women and men in the same way when infected or
believed to be among the society significantly differentiate among women and men thought women
effected through men still the women is treated as character less among the society . The pie chart
depict that 28 % of the total percentage hold the view that Women and men are treated in similar in the
same way when infected or believed

90

WOMEN WITH HIV/AIDS, ARE BLAMED, WHEN THEIR HUSBANDS HAVE

INFECTED THEM

The pie charts display that how Women with HIV/AIDS, were blamed, when their husbands have
infected them. Consider the above chart that depict that 72% of the respondent hold the view that
Women with HIV/AIDS, were still blamed in the society , when their husbands have infected them to
emphasis on the same that Females and males have different status in patrilineal societies and marital
homes. This is reinforced by the fact that men carry the lineage forward, while women are blame for the
same
.

91

CHANGING PERCEPTIONS AND CULTURAL PRACTICES THAT CONTRIBUTE TO

THE SPREAD OF HIV/AIDS

The pie charts display that Changing perceptions and cultural practices that contribute to the spread of
HIV/AIDS. Consider the above chart that depict that 62% of the respondent hold strong view that
Changing perceptions and cultural practices that contribute to the spread of HIV/AIDS the society , The
pie chart depict that 38 % of the total percentage hold the view that Changing perceptions and cultural
practices does not contribute to the spread of HIV/AIDS

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PSYCHOLOGICAL REJECTION OF HIV/AIDS-RELATED STIGMA CAN

SERIOUSLY UNDERMINE THE INDIVIDUALS FEELING OF SELF-WORTH AND
SELF-ESTEEM, AND IN EXTREME.

The pie charts that display that psychological rejection of HIV/AIDS patient as stigma and its
seriousness undermining the individuals feeling of self-worth and self-esteem, among respondent.
Consider the above chat that depict that 62% of the respondent responded that fear of rejection within
the community and work will be a stigma and undermining the individuals feeling of self-worth and
self-esteem in the society is the major concern of overcome issue. However, the pie 38% of the total
percentage holds the view to support affected HIV/AIDS patient

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RECOMMENDATIONS

The vast cultural diversity of India which includes many culturally fragile communities, does not allow
the conduct of exhaustive studies within a limited time span and limited resources. Thus, the scope of
the study was as broad as wished. Keeping in view these shortcomings, the conclusions are more generic
in nature.

Established facts

Culturally defined gender constructions and masculinity may put men and their sexual partners at risk of
HIV infection. In India, being predominantly patriarchal, men are the decision makers. They are not
supposed to display emotions ( they are not supposed to cry, etc.). They can change sexual partners
without much opposition. Moreover, it is men who determine when and how often to have sex.

Girls and women socialized to assume an inferior position. Pre marital or extra-marital relationships are
not culturally accepted or tolerated. There is increasing evidence of domestic violence and sex without
consent.

Cultural tolerance to male-male bonding. From a very early age, a boy is expected to be friendly with
other boys but not with girls. So male bonding gets quite strong. It is socially approved for men to hold
each others hand or hug each other. Men often develop strong bonds among themselves and thus,
bisexuality goes unnoticed.

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At a time of rapid social change a deeper understanding is needed for culturally accepted behaviour
patterns related to courtship and marriage. There is very limited inter-spousal communication in matters
related to condom use and fertility, virginity and other matters related to sexuality and sexually
transmitted infections (STIs).
There is very little qualitative data on patterns of sexual risk behaviour of out-of school male adolescents
and unmarried young men. Anecdotal evidence is pointing to widespread sexual networking and
prevalence of unsafe sex among this extremely diverse sub population. They are the ones who are
creating risk for others and are at high risk themselves.

Beliefs and perceptions of different groups on seeking treatment for STIs is an interesting area of study.
Once again, anecdotal evidence is indicating that most men seek treatment for STIs, but do not
necessarily inform their wives / partners .

Wives/partners may get infected but majority of them do not have the courage to disclose it to their
husbands/partners. Due to the culture of silence, seeking treatment for women is often the last recourse.
Moreover, preferred treatment may well be from an unqualified practitioner who provides privacy and
confidentiality to home remedies. Further understanding needed in the area of treatment regimes that are
widely acceptable.

In India, the family plays a crucial role in the life of an individual. It provides emotional support and
acts as a buffer. Family bonds are very strong and most families feel that it is their duty to take care of
the infected person, especially if the person happens to be the male breadwinner. Most often stigmatising

95

diseases like leprosy and TB are closely guarded secrets within the family. It is often a Matter of shared
confidentiality.

Societal attitude towards individuals and families living with HIV and AIDS (PLWA) is yet to be
understood in the Indian context. Media reports of social exclusion and violence against families
affected are frequent. As mentioned earlier the enabling environment for PLWA to live with dignity is
yet to evolve.

The magnitude of stigma and discrimination at the corporate level,, in health care centres and even at
community level is being reported from various parts of the country. Little or no information is available
on the nature of discrimination at the workplace. Enabling legislation and policies are yet to be put in
place.

The social system and functioning of brothels are subject areas that much less understood. Women and
girls are often sold into the sex trade. Brothel owners, Madams and pimps dominate this complex
system. Sex workers are totally powerless and this jeopardizes their right to self- protection.

The sub-culture, group dynamics and social cohesion of injecting drug users are critical aspects for
understanding vulnerabilities. At the same time, it reported that the rate of partner change among drug
users is high. In addition, utilization of health and other services is poor.

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Rapid urbanization is giving rise to the phenomena of street and working children. These children run
away from homes for better life, but are paradoxically at an increased risk of sexual violence from older
peers and other adults.

The phenomena of seasonal migration and the risk associated with it require a deeper analysis. Young
men (both married and unmarried) from poorer states migrate to bigger cities and towns for
employment, leaving their families behind.
Once in an alien environment, far away from prying eyes and with some money in the pocket, many of
them indulge in unsafe sex and take the infection back home.

Many cultural minorities (Viz. Nut and Bedia communities, Devdasis, groups practising caste and
religious prostitution, tribal populations, etc.) exposed to the risk of HIV; their existence appears fragile.
With rapid social change, their motivations to adopt alternate occupation and coping mechanisms are to
be explored.

With the erosion of their traditional occupation more and more of the Hijras (mostly castrated males)
are in the business of prostitution. Their clients are men who have anal intercourse with them, though
paradoxically, such men (the clients) do not identify themselves as homosexuals/bisexuals.

Cultural and linguistic terminology that predisposes vulnerability. Terms such as, Guptrog (means
hidden disease), mahila rog (AIDS-womans disease), swapan dosh (fault during sleep), gandi baat
(sex) are part of common vocabulary, which have implications on HIV prevention programmes.

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Each culture has defined coping, bereavement and ritual cleansing mechanisms. Coping processes of
individuals and families living with the virus need to be studied empirically. In view of the enormous
psychological stress that AIDS, as a condition, has on individuals and families a deeper understanding of
social support mechanisms available will prove beneficial for management and care of PLWA.

A wide range of recommendations suggested for further elaboration of the project based on the country
research. They summarized fewer than two headings: In depth and long-term issues addressed and
methodological recommendations:
a) In-depth and long term issues to be addressed
In order to fill this breach and make intervention strategies more culturally sound and thus acceptable, it
would be necessary to mobilize academic departments and other institutions to undertake action research
studies so that interventions could be intensified. A few important areas where action research would be
desirable for more effective programming mentioned below:

Multi-centric studies to understand the impact of AIDS on cultural minorities and targeted
intervention to reduce their vulnerability along with prevention efforts;

Developing more in depth data on behaviour patterns in specific cultural groups such as the
Hijra Community, specially on their sexual networking and perpetration of violence by their
clients;

Further exploration of culturally accepted behaviour patterns related to courtship and marriage
within the context of vulnerability;

Better understanding of peoples semantic stock on sexuality for appropriate prevention

programmes;

Intensive research on the subculture group dynamics and social cohesion of injecting drug users;

Research on the reasons and patterns of migration in order to reach migrants in their workplace
for preventive education;

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Further exploration of the impact of AIDS on household income and its effects on children
education particularly on girls and possible restoration of the family role in this matter;

Identification of factors that contribute to stigmatisation, social exclusion and violence against
affected families , with special emphasis on stigma and discrimination at workplace, in order to
identify relevant strategies, possibly with the participation of PLWA;

Content analysis of IEC messages aimed at rural and remote communities;

Document concerns and violations of HIV/AIDS Human Rights;

Survey and improved accessibility of out-of-school male adolescents and married young people,
in order to develop appropriate contacts and messages with them;

Develop and customize information in order to secure community participation in care

programmes carried out by Voluntary Counselling and Testing Centres;

Facilitate an expanded response to the epidemic through involving traditional practitioners and
systems of medicine. This will play an important role in HIV and AIDS prevention and care.

Capacity building of social scientists both in terms of methodology and research tools is an
urgent need. Such studies would be extremely helpful in designing culturally relevant
intervention programmes that would have peoples support and approval.

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IMPLICATIONS FOR POLICY, PROGRAMMING AND FUTURE

RESEARCH
The local studies of the determinants of HIV/AIDS-related stigmatization, discrimination and denial
described here took the form of extended rapid assessments of six months duration. When originally
planned, they as the precursors to subsequent enquiries involving larger numbers of respondents and a
more in-depth approach. Given the scope and nature of the enquiry, therefore, it would be unreasonable
to expect detailed policy and programming implications derived from the data.
This was not the aim of the local investigations carried out. However, with respect to policy
development the following general points made:
Efforts to tackle HIV/AIDS-related stigmatization, discrimination and denial seem doomed to fail in the
absence of a supportive legal framework. In the words of the India report, It is not enough to spread
awareness about HIV/AIDS, its transmission matters or even about legal rights. What is urgently needed
is government anti-discrimination policy supported by a law that will ensure the protection of (HIV)
positive peoples rights.
Even where such laws exist, or where governments make active efforts to combat HIV/AIDS-related
discrimination, it is vital to challenge popular myths, stereotypes and judgments that provide the ground
upon which HIV/AIDS-related stigma can grow. At the policy level, prevention programmes should
foster tolerance and social solidarity using, wherever possible, an approach, which is non-judgmental
and not based on fear.
In both employment and health care, discriminatory policy needs developed to protect and safeguard
the employment and health care rights of people living with HIV/AIDS. Central to this must be
principles of confidentiality and respect for human rights.
Interventions targeting discrimination need to take place concurrent with the establishment of a
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supportive legal framework that includes generic antidiscrimination laws covering health care,
employment, education, housing and social security, as well as effective enforcement mechanisms.
Other important and complementary activities must include efforts to change attitudes through
Communication campaigns in the media, education and training.
Interventions and activities should aim to move from providing only information to providing services
and social support aimed at countering the prejudices and popular beliefs about HIV/AIDS that
seemingly justify stigmatization and discrimination.
Greater attention needs given to the gender-biased nature of HIV/AIDS related stigma. Efforts made to
address not only womens risks of HIV/AIDS infection but also their heightened vulnerability to the
social stigma associated with HIV/AIDS. In the majority of societies, a double standard exists whereby
men are permitted (and even encouraged) to have more than one partner, while women are blamed for
the consequences of this behaviour. The effects of this double standard on womens health and wellbeing, property rights and rights of access to children are serious, and addressed urgently.
Efforts must be made to tackle the forms of felt and enacted stigma that make it difficult for people
living with HIV/AIDS to be open about their serostatus. This secrecy causes them to withdraw from
social life, and makes it difficult for them to play a full part in prevention and to benefit from care.
With respect to future research, more needs to be learned about:
The determinants of these different kinds of HIV/AIDS-related stigmatization, discrimination and
denial, and the circumstances and factors that lead to a reduction in stigmatization and its negative
consequences.
The pervasive discursive, cultural and structural frameworks that act as sources of HIV/AIDS-related
stigmatization, discrimination and denial, the manner in which these are utilized and resisted, and their
consequences for the social exclusion of certain categories of individual.
The processes and dynamics of exclusion that accompany HIV/AIDS-related stigmatization,
discrimination and denial, including the self-exclusion associated with felt stigma and the collective
exclusion associated with institutionalized forms of discrimination.

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CONCLUSIONS

Widespread of cultural practices and attitudes in the context of HIV/AIDS prevention and care , and
focuses on some groups and communities that show focused and specific manifestations of Indian
culture. It also broadly covers the sociocultural background of Indian society in the context of
HIV/AIDS, and depicts an enormous variety of cultural practices and beliefs all over the country. Such a
discussion highlights the importance of adopting a culturally specific and culturally appropriate
HIV/AIDS intervention strategy in this country. A common general strategy can be developed at the
broader level, but for specific cultures and communities, the intervention programmes should follow an
appropriate culturally sensitive policy.

Mainstream Indian culture and traditions firmly based on the values of patriarchy. The widespread
impact of patriarchy found at all levels of social institutions starting from family and kinship to marriage
and sexuality. . The values of patriarchy are so strong that although women take greater responsibility
within the family, males maintain their superior status.

In India, many customary and contemporary influences have combined to result in present-day practices,
beliefs, norms and values that play significant roles in impeding the adoption of safer sex practices.
Some elements of culture have changed through time while some have persisted, others have mutated
and still others have disappeared while the ideals and values that they reflect continue to shape the way
people think and feel about certain behaviours. New elements of culture have also arisen and added to
the milieu in which sexual decision making, amongst other things, is taking place. Foreign media

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densification along with a host of more recent globalising and modernizing processes are adding their
own shaping influences to the socio cultural environment in which the HIV/AIDS epidemic is occurring.

Making HIV prevention, more effective in India will require approaches that better attuned to the
cultural specificities of the people concerned. This in turn will require a deeper understanding of the role
of culture in the production and management of disease. Culture is far more than a collection of easily
identified and measured beliefs and practices; it is about that which gives meaning and purpose to
human life. Taking a cultural approach to the problem of HIV/AIDS means taking into account the
particularities of the socio cultural domain at each stage of the intervention process, from
conceptualisation and design of policies and programmes to evaluation of outcomes and impacts. Thus
far, there has been little evidence of any serious attempt to do this either at the level of HIV policy
making or programming in India. There remains a need to engage more directly with the socio cultural
factors that make our local communities so exceptionally vulnerable to this disease.

Here lies the importance of adopting a cultural approach to HIV/AIDS prevention and care, mainly to
reach every corner of our society and to make the intervention programme successful. One possibility is
to highlight that the focus of patriarchy is male responsibility. In the present context of a cultural
approach to HIV, intervention strategies need to identify and strengthen positive characteristics in the
culture where the male assumes responsibility as the patriarchal head.

Under the strong influence of culture, discussions on sex have become a taboo subject. It narrows down
the space to talk about sex and sexuality and therefore hinders sex education. Lack of positive language
on sex makes sex a more hidden and obscure subject for the adolescent population. Due to the absence

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of proper sex education, sex becomes an issue of uninformed discussion among peers, which, in turn,
results in unscientific and incorrect information among young boys and girls. The lack of knowledge on
sex continues even in later phases of life. Many myths are generated due to the lack of latitude for
gaining knowledge. The influence of societal norms on one hand, myths, and misconceptions on the
other make a large section of Indian men and women vulnerable to HIV/AIDS, as unprotected sex is the
most important route of HIV transmission.

Prevention of HIV/AIDS is crucially dependent on social and sexual behaviour of the population, aside
from factors such as level of awareness, availability and accessibility of services. An intervention
programme oriented by the cultural aspects of the society would help to understand the intricacies of the
sexual behaviour of a community. Sexual behaviour and social interaction patterns are culture-specific.
No uniform strategy package can be designed that will uniformly address all cultural groups.

Any intervention programme on HIV/AIDS should be integrated into other existing development
programmes and must meet the basic needs of a community. There is need to have inter-sectoral links
with other development programmes such as the health, education, and judiciary programmes.

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Annexure
QUESTIONNAIRE
Name:

Gender: Male / Female

Family: Joint Family

Age:

Location:

nuclear family

Nature of Job
a) Traders b) artisans, c)agriculturists d) labour e)service classes
1. Have you ever heard about HIV/AIDS?
a) Yes
b) NO
2. Do you aware of sexual activity is the mode of transmission of HIV/AIDS?

a) Yes
b) NO
3. Are you aware that unprotected multi-partner sex causes HIV/AIDS?
a) Yes

b) NO

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4. Do you openly discuss Sex across genders and age groups?

a) Yes

b) NO

5. Have you ever gone to sex workers to buy sex before marriage?
a) Yes

b) NO

6. Why do you visit sex workers before marriage?

a)To gain practical knowledge on sexual intercourse b)Due to long separations from
wives
c) Under peer influence
d) pleasure
7. Do you use condom while having sex?
a) Yes

b) NO

8. Do you think visiting sex workers by men accepted by the society?

a) Yes

b) NO

9. The hierarchical caste system in India has a crucial socio-economic as well as cultural
dimension.
a) Yes

b) NO

10. Do you think dominant caste has influence toward spreading HIV/AIDS among lower caste?
a) Yes

b) NO

11. Do you discuss on sex and sex-related matters among the family?
a) Yes

b) NO

12. Do you agree having relations with multiple sexual partners for men, which leads to high-risk?
a) Yes
b) NO
13. Do you think culture of silence and tendency to hide sexual problems?

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a) Yes

b) NO

14. Do you think widespread denial of HIV/AIDS is a problem in the community to respond to
seropositive individual?
a) Yes

b) NO

15. Do you think felt stigma as triggering an uncooperative attitude as individuals refused to accept
the help and support offered to them?
a) Yes

b) NO

16. Do you think cultural norms and values that allow extra marital sexual relations for men?
a) Yes

b) NO

17. Do you think Women and men not dealt with in the same way when they are infected or believed
affected by HIV/AIDS?
a) Yes

b) NO

18. Do you think men with HIV/AIDS amore accepted by family and community?
a) Yes

b) NO

19. Do you think Women with HIV/AIDS, blamed, when their husbands have infected them?
a) Yes

b) NO

20. Do you think Changing perceptions and cultural practices that contribute to the spread of
HIV/AIDS?
a) Yes
b) NO
21. Do you agree strong culture influence fear of rejection and isolation from both close relatives
and the community at large make people live silently with HIV/AIDS?
a) Yes

b) NO

22. It is a risk to have extra-marital affairs in this day and age, which could infect the wife or

husband with HIV and AIDS.

a) Yes

b) NO

23. Do you think psychological rejection of HIV/AIDS-related stigma can seriously undermine the
individuals feeling of self-worth and self-esteem, and in extreme?
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a) Yes

b) NO

111