New Delhi: The average sexual debut of boys in rural settings is 15.4 years and for girls 15.6 years; in most cases the first sexual experience is without protection; increasing number of married women in monogamous relationships are getting infected with HIV; 2/3rd deliveries in India take place at home, excluding them from anti natal care; even where a couple is aware of their HIV status, they still want to have 2-3 children, if only to prove to society that they are capable of rearing babies. These findings were part of a series of studies released by the Population Council of India in the capital today.
The research has pointed out that we can no longer afford to isolate young people who have to avail of second generation messaging, which addresses their vulnerabilities and leads to desired behaviour change. With over one-third of all reported AIDS cases occurring among young people (15-24 years) and the infection moving from high risk groups into the general population, women and youth are at the centre of the epidemic.
Four different projects were undertaken during August 2006-January 2007 using qualitative and quantitative methods amongst high risk groups in Guntur district of Andhra Pradesh and Dhar and Guna districts of Madhya Pradesh, primarily to support the Government of India’s National AIDS Control Programme (NACP )-III.
One of the projects included the creation of an intergenerational communication package on sexuality and HIV/AIDS. Using a participatory approach, set of four comic books on HIV prevention for young men in urban slums in India were developed in partnership with Prerna (New Delhi), Apnalaya (Mumbai), CINI Asha (Kolkata) and Divya Disha (Hyderabad). Focus group discussions with young men between 15-24 years were carried out and comics brought out in Hindi, Telugu, Bengali and English. The stories, Josh Mein Hosh (Passion with Sense); Khoon Ka Khatra (Danger of Blood); Savdhan Senior (On your guard) and Pyar ka Packet(A packet of love) were drawn in a visual grammar that young men find attractive, using street language that is part of their lingo.
The study established a link between mardangi (masculinity) and HIV risk. It highlighted common perceptions where men think it is “cool to be violent”; “condoms are to be worn only with sex workers and not with regular partners”; “regular girl friends ought to be meek and submissive” and “sexually aggressive women are bad and immoral”. These notions perpetuate bias and abuse while creating high risk situations where indulging in injecting drug use, exchanging needles and having unprotected sex and/or multiple partners heighten vulnerabilities. The stories focused on this dominant norm of mardangi while proposing an alternative to what a “real” man should be, with attributes of being caring, supportive and responsible.
According to Saroj Pachauri, Regional Director, South and East Asia, Population Council, “what made the communication campaign relevant is that it drew inputs from the community and incorporated it before the final State specific printing. A conscious attempt was made to explore social and familial issues that enhanced young people’s at-risk factors without focusing directly on HIV.”
On the advice of young men, comics were given a generic look in colour, design and text so that they looked like regular pulp literature and were not identifiable as “HIV material”. Also they did not want information to be too detailed and technical. They wished to be informed, but in a “spicy story manner”. Those not conversant with comics, felt that sequencing had to be such that even for the illiterate, a mere look at pictures could help them follow the story.
For low literate rural women in Orissa and Andhra, an innovative training module was designed for trainers and a takeaway booklet printed, again keeping in mind cultural norms. Since rangoli and alpana designs are drawn by women in practically every household, these booklets had floor designs printed and interspersed with stories, facts and risks associated with women’s sexual health and HIV. With a shelf life and the fact that they can be kept within the household, sans embarrassment, added to their popularity, readability and message retention ability
High risk behaviour especially amongst migrant labour and truckers typically implies multi partner sex. The comics with their strong visual content had explicit pictures illustrating the same. Women expressed reservations and addressing their sensitivities a format was decided with flaps which allowed them to “shield” certain information.
In West Bengal, there was a draft story that outlined the saga of an HIV infected family. It started with the husband’s drunkenness/wife beating and spending all his money on alcohol and gambling. When nothing worked, the wife went to the factory owner and expressed her predicament. The man lost his job, experimented with drugs, graduated to injecting drug use, got infected with HIV and passed it on to his unsuspecting wife and unborn child.
While the chain of events found resonance amongst the community, with stories echoing similar patterns, women here raised objection to one angle in the story. They were unanimous in their reaction, saying, “we will never lodge an official complaint against our husband at their place of work. We may fight at home but we will not terminate our only source of income or bring such disrepute to our man”. This feedback was factored in and the communication material altered accordingly.
Similarly, in certain Muslim pockets, young boys expressed their discomfort at having same religion names rather than having a story which had a Hindu boy and Muslim girl’s name. In many cases the colloquial term for condom was altered to suit prevailing terminologies of different regional pockets.
Depending on which State the comics were intended for, the State’s focus area was incorporated. Delhi State AIDS Control Society, which is currently emphasizing on voluntary testing, brought out that element in the comic intended for the Delhi audience. Similarly, Andhra which has the “Be Bold” campaign, had this theme running through their picture book.
According to Shireen Jejeebjoy, Senior Programme Associate, Population Council, “the response has been extremely encouraging with over 3,00,000 copies already distributed within the first few weeks and some of the State AIDS Control Societies undertaking fresh rounds of printing”. However, there has been a slight hiccup with the recent ban on sex education in select States. While states like Maharashtra have found a way out, through an active network of grassroot level NGOs who will distribute material, it excludes students in municipal schools.