Intervention in a Village
Email correspondence from the AIDS-INDIA discussion list.
This is in response to your post requesting information on village-level interventions for HIV prevention.
Your description of a village "having low literacy level, low socio-economic status and totally male dominated," fits more than 80 percent of Indian villages. Therefore we could say that strategies adopted in most villages could be applicable in your case also.
But I must say, you must start with "men as high-risk group" and address them first exclusively. Usually health projects address women first, as they are sitting ducks at home, but those projects forget about power relations in sexual matters. So if you start with women, all you will end up doing is creating more fear to go along with their already powerless existence. Women may be easy to approach and available, but make sure, as difficult it may seem, that you address the men first.
Never talk to men in the language of fear and death, for they always live dangerously in life situations and at work. Approach them first with the idea of pleasure and then health. Tell them we need health to sustain pleasure. You may encounter resistance among them about using safe sex methods, especially condoms. Tell them there are ways to wear condoms pleasurably by, say, asking your partner to put them on. Slowly build the idea of health woven strongly with the idea of pleasure, or else they may listen stoically but will never practice.
Next, work out ways to bring up the topic of injustice in power relations that exists between genders -- point out how a submissive and docile wife actually lessens the pleasure, and stress the aspect that an active partner heightens pleasure. Also mention that this is why men seek out sex workers. Under existing conditions it is men who take the initiative in all sexual matters. Thus, once you can build the idea of pleasure around all health aspects, men will start to listen.
In short, first make men responsible for their acts.
Once this part is initiated then you can ask the village heads to address the issue of HIV/AIDS broadly through awareness campaigns and meetings.
Only after this, should you address women exclusively to show the disparities in gender relations and tell them that they should ask their spouses to use safe sex methods. This way the men won't feel affronted when women dare to ask them. This way you can avoid a lot of violence and bitterness among couples.
Don't stick to "condoms are the only method" to safe sex practice. Make sure you teach them the pleasures of mutual masturbation, using thighs, etc. Tell to avoid penetrative sex as far as possible and, if need be, only then use condoms. Tell men that penetrative sex is for making babies and that they don't have to push their stick in all the encounters.
Now, we have to show that there are different sexuality groups and there is nothing to hide or be shameful about. That sex between consenting adults -- between man and man, woman and woman, man and intersex person, woman and intersex person or among intersex persons -- is permissible and "quite natural" also. Also say that there are bisexual persons and there are different shades of sexual orientation, and that there are confused persons with their different sexual orientations, but all is okay, if it is done on mutual agreement with respect and concern. Again show them that there are different sexual practices and all are acceptable with above agreement. What is wrong in sexual encounters is what is forced and without consent. Tell men, even if that happens between married couples, it is wrong.
In short teach sexuality in depth to bring about behavioral changes. Only in a brothel set up one can demand the use of condom in sexual encounters. All other relationships need mutual agreement, responsibility, respect and concern, in short, love.
Men will ask about sexual matters, about pleasure and other details. Talk about these in small, comfortable groups. But never create literature to explain it, for there will be "moral morons" around who will topple the apple cart. The fundamentalist business will come into action, so don't leave anything for them to chew upon. At any confrontation, deny everything, but if you leave anything written, you will be in trouble. Police and the fundamentalist mafia will make mincemeat of you. Sex and the politics of power goes together.
Make sure that condoms are available once you promote their use. Easy availability increases use.
The most neglected issue concerns the treatment given to the AIDS patients. You have to fight for the medicines with all the authorities. This you should do with other NGOs at all levels. Start a care center if there are any AIDS patients, but to treat them you need expert people.
We also have to address the stigma around PLWHAs (People living with HIV/AIDS). Make people sensitive about it. If possible include in your team an HIV-positive person. If there are already HIV+ people in the village, this will help immensely. Moreover this will wipe out fear and discrimination immediately. People see what is preached as practiced.
Okay, these are some of the thoughts that crossed my mind. If you ask on specific matters I may be able to answer them later. Say, I may not know all the answers but all I am saying is I am ready.
This article was provided by Gay Men's Health Crisis. It is a part of the publication GMHC Treatment Issues. Visit GMHC's website to find out more about their activities, publications and services.