Sex definitely is a practise in India — reflected in the billion strong population of the country — but it is practise that does not enjoy either the space or atmosphere for discussion between the practising partners … a practise less about consent and more about power. As a result many women remain unaware of what HIV/AIDS really means and how they can protect themselves. As the third worst affected country with the deadly disease, the Indian health industry has a lot of worrying to do. Wearing blinkers will definitely not solve the problem with over 50 lakh (five million) people in the country living with the virus. Of these, women make up two-fifth (2 million) of the infected population and their numbers are steadily rising.
Moreover, HIV is no longer is a problem that can be passed off as a particular state's problem. AIDS-afflicted districts today run the length and breadth of the country — from the western state of Maharashtra to the eastern state of Manipur; the northern state of Punjab to the southern state of Karnataka (which has recently shown the highest incidence in the district of Dharwad at six percent of the population).
For years, most interventions on HIV/AIDS targeted the high risk groups of truckers, who, by virtue of the nature of their job travelling for long periods over long distances, are potential carriers of the virus. Lack of information and awareness on the issue has resulted in these men not only infecting themselves with the virus, due to unsafe sexual practises, but also carrying it wherever they travel, including back home to their wives — and consequentially even their children.
But ironically, it is this general perception that has also worked to the disadvantage of women. While campaigns have worked with sex workers in creating awareness and safe sex practises, the wives of truckers have been ignored. Sex workers today constitute less than one percent of the AIDS-afflicted women population, even as married women, trapped within the confines of their own ignorance on the issue, are facing a greatly increased risk.
Sex. Abortion. Parenthood. Power.
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The vulnerability of these women is compounded by many factors all very much a part of the patriarchal setup into which their lives are entrenched, and it is these intractable gender practises that really raise the risk of HIV (and other STIs) for them. The typical environment — both at the maternal and marital home — means that post-marital agency is invariably limited for these women. Not only do they not exercise choices in their husbands' homes, but the limited intimacy with their husbands only exacerbates vulnerabilities related to their sexual reproductive health.
The existing double standards in such patriarchal cultures condone and even encourage premarital and often extramarital relations for men, while condemning the same for women. Skewed gender relations ensure that women cannot even negotiate the use of condoms within marriages, due to the limited ability for sexual negotiation in their relationships, limited information on protection, and limited access to services. In fact, the suggestion of a condom by the wife would very often be an indication of promiscuity on her side, since the perception is that condoms are something used by women of "suspect" character. Furthermore, gender norms give men a sense of entitlement to sex, even if forced, with their wives.
Additionally, since most of these women are illiterate, they cannot take advantage of AIDS prevention campaigns and information. But the lack of a space to discuss the issue of AIDS and the taboo associated with the subject means that it is not only the illiterate women, but also the so-called educated women who are not aware of HIV/AIDS. According to the latest National Family Health Survey (NFHS), only five percent of Indian women have comprehensive knowledge about ways of preventing HIV/AIDS. Hence, the focus of campaigns must shift so that agency for HIV prevention moves into the hands of the women themselves rather than being dependent on their spouses, as well as making adequate information on the subject available to women.
In many cases monogamous married women assume they are not at risk for HIV because monogamy is such a prominent focus of health campaigns. Lack of knowledge about the sexual history of their husbands before marriage — or for that matter, even extra-marital encounters – increases their risk. And the blinker syndrome is at work here yet again, as men — despite the risk associated with unprotected sex — do not recognize their own behavior as risky. In India, 27 percent of male clients of female sex workers are married or living with a female partner.
The situation is no better for the urban poor who inhabit slum communities — where either the husband migrated alone or where (even if they have moved together) the opportunities for intimacy for women with their husbands are limited because of huge extended families inhabiting limited residential spaces. Such situations tend to create a peculiar interrelationship between forced sex, extramarital sex and marital violence.
As far as access to health care is concerned, not even 25 percent of the infected women have been able to access HIV-related health care facilities, despite constituting nearly 40 percent of the HIV positive population. More than one percent of pregnant women in five states are living with HIV. Nearly three quarters of the HIV-positive women have contracted it through sexual contact with their husbands. A further risk comes from women's need for blood donations due to reproduction-related issues; with most women going through many and frequent pregnancies as well as illegal sex selective abortions, the risk is even further multiplied. Even in normal situations women tend to find themselves neglected when it comes to health needs, nutrition and medical care — with family resources almost always devoted to men. And the situation only worsens if they contract the virus.
While HIV/AIDS affects both men and women, the manner and extent to which it affects women has far deeper social implications, making it a far greater human rights issue for them as far as discrimination is concerned. A substantial number of women contract the virus from their husbands, yet they are blamed for the disease and abandoned. The stigma and discrimination with regard to AIDS is far more potent with women who risk violence, abandonment, ostracism and destitution, from family and community. In fact, there have been instances of women who, even when infected themselves, continued in their duties as care givers (closely tied to their economic and financial dependency on men), only to be thrown out of their marital homes after the death of the spouse and pushed into the realms of a burgeoning homeless population.