Gender Justice – Primary prevention
SIAAP jointly with Prajnya, conducted discussions among girl students on primary prevention from STIs, as part of Prajnya’s campaign against Gender violence. The discussion focussed on fundamental understanding of sexual and reproductive health and discussions on how girls can prevent themselves from the infection.
Discussions with Students on how women can safeguard themselves against Sexual & Reproductive Health
1st Dec 2017 – MMM College of Nursing (50 students – 2 batches)
2nd Dec 2017 – Asian College of Journalism (6 students)
As part of Prajnya’s 16 days campaign against gender violence, SIAAP and Prajnya jointly organised discussions with students in two colleges. The discussion commenced with a session on fundamental understanding of sexual and reproductive health and completed with brainstorming with students on how they (all girls) could prevent themselves from the infection.
There were two sessions at MMM college of Nursing and 1 session with Asian College of Journalism. Dr. Shyamala Nataraj, founder and Executive Director of SIAAP, facilitated the sessions and helped students think about the current situation, what are all required, what could help.
Session:1 Students from MMM College of Nursing
Dr. Shyamala helped students to open up for discussion by asking them to share about their emotions. Many responded that they were happy and relaxed while few were anxious and worried and did not want to climb out of bed. She asked those who felt good and positive to share their support to those who felt a bit down by hugging and asking them, ‘what was that they could do to help them feel better’. It was a nice exercise with lot of fun and laughter.
The topic started on sex work and how initially sex workers were tested without consent and detained illegally, if tested positive and how the court, cited Article 21 and released saying that it was not possible to arrest all who are at risk of HIV due to the window period and that the sex is a day-to-day act and almost every individual was at risk.
The initial work on HIV focused on at risk population – sex workers, homo sexual men, truck drivers, drug users, transgender, etc. and that condoms were promoted to prevent spread of HIV. The facilitator asked the group about condoms and the students knew it was a contraceptive and that it would help prevent spread of STI/HIV infection. It was notified that male condoms were widely available and propagated for and there were very few options for women. Female condoms were both not available in market and not very convenient to use. So the power rested on the men and they had the choice to make. They could prevent themselves but the women did not have the agency to protect themselves or to talk about condom usage during the initial period of marriage.
The condom usage among married couples was 6% in India as against 99% in Japan. Out of the 100 cases of incidence of new HIV infection, 15% were at risk population, 5% were children, 40% were men and 40% were women. And out of this 40%, 35% women were married and have only one sexual partner. So it implies that women are unable to prevent themselves from getting infected.
The facilitator shared that two prong programs for HIV was to prevent men from infected by using condoms and prevent transmission to children through medicines. But there was no primary prevention available for women. She split the students into groups and asked them to explore ideas on how they would prevent themselves from getting infected.
Responses from group 1:
- Screening of couple for STI/HIV before engagement and marriage ceremonies, while having a 6 month gap between the two events
- Better quality of female condoms available
- Pre marital counselling
- Conversation with men before engagement & marriage
- Sex education at schools & build knowledge on contraception
- IEC for all age groups – with more emphasis to teenage groups
- A court order for Mandatory testing for STI/HIV for registering of marriages
- Parents to be educated about the importance of screening
The facilitator closed with the question on how they think they could continue to prevent themselves from becoming infected, all through their life.
Session:2 Students from MMM College of Nursing
The second batch students were asked to share about their community work experience with respect to the latest dengue epidemic and were asked to share about the percentage of people who would be able to prevent stagnation of water in their neighbourhood. There were mixed responses and it was concluded that mere awareness creation wouldn’t help in action whereas, awareness combined with tools, skills, money, man power and commitment would definitely result in action.
Accordingly the session was facilitated with inputs on STI infection, signs and symptoms, etc. The students were split into groups and were asked to discuss and come up with ways of protection for women from their spouses.
Responses from group 2:
- Screen the couple
- Re-test and follow up after window period
- Psychological support & Family counselling – providing awareness and education of management of infection
- Use of male condoms and education to men to use condoms
- Research and develop female condoms and make them widely available
- Avoid sex if the woman feels there is a problem
- Contact wife independently – nurse visit wife; Doctor/nurse to disclose status of husband and provide counselling
- Negotiate to avoid sex during treatment
- Develop vaccination to prevent STI
- Govt to encourage free distribution of female condoms
- Provide sex education (sexual hygiene) to prevent future infection
- Reduce multiple partners
- Regular health check up & follow up
The session was concluded by indicating that among the list, there were all the components required (awareness combined with tools, skills, money, man power and commitment) for a change to happen.
Session:3 Asian College of Journalism
As against 17 who had signed up, only six students turned up for the meeting. It was interesting to note that few chose to participate as it was exclusively conducted for women and it provided them safe space to be free and talk their mind. Few thought it was sex education session while few thought it was about sexual health – the most forbidden topic but which was the most important too.
The session explored their lives with respect to their experiences and ideas about sex and sexual health. The students shared comfortably about their views on sex, how they value trust and safety, their experiences, choices, protection measures, and their fear about STI. Few shared that they had never had unprotected sex. There were few who said they would want to know the person well before having sex and that they cared about the safety of the place, trust in the person, and about the contraception (emergency pills) they use apart from condoms. Few shared about their masturbation experiences, safe period calculation and getting tested for HIV before deciding to have sex.
Only one among the group had used a female condom and shared that it was highly uncomfortable and wouldn’t want to use it because of the bizarre sounds it make. Issues such as poor accessibility, stigma attached to women buying female condoms, and the fact that it was far too expensive compared to the male condoms were among the other reasons discussed pertaining to poor uptake of female condoms.
Dr. Shyamala then asked the students about the ways of protecting women from STIs and they said but for male condoms, they could not think of any other. Dr. Shyamala gave out the statistics of condom use in India and about how women form the major junk of a whopping 40% of new incidence of HIV as per the 2016 data. The girls were startled and saddened by knowing how even girls from urban background are unable to have a conversation on condom use, which was the only tool available. Dr.Shyamala shared about male circumcision and how it reduced the risk of HIV by 60% and that it was dismissed by the Govt under the pretext that ‘it would hurt religious sentiments of hindus’. She also shared about PREP & PEP and about the Vaginal microbicides – which was still clinical trials stage-III.
As a response to a question on what would they do to change the plight of women in India, the girls responded that they would first buy and use female condoms and understand the difficulties associated and as journalists, would write about it and about the fact for developing newer mechanisms in prevention.
At the end they shared they felt helpless and would definitely use the media to instil thoughts in the minds of people and policy makers. They said though they wouldn’t be able to join the rally as per their journalism norms, they would definitely support by covering the news and write about it extensively.
Roundtable on Sexual and Reproductive Health with key stake holders on 4th Dec at the Dementia Training and Research Centre.
Key stake holders present:
Dr. Shyamala Nataraj, SIAAP
Dr. Amudha Hari, Consultant Gynaecologist
Ms. Swarna, Prajnya
Ms. Renuka, CWDR
Ms. Sheryl, Prof. Ethiraj College for Women
Ms. Akshaya, CWDR
Ms. Tibu, Journalist
Ms. Subaidha, Journalist – The Hindu
Ms. I… – Student from Ethiraj
Ms. Archana – Schools of Equality
Ms. Radhika – Research Fellow, Prajnya
Ms. Sudar Oli – Prajnya
Ms. Malavika – Campaign Associate, Prajnya
Ms. Sandhya – Intern, Prajnya
Ms. Anu Aaron – SIAAP
Ms. Swarna welcomed the group and shared about the 16 days campaign against gender violence and that the discussion on Sexual and Reproductive Health was long drawn and could not be done in the previous years of campaign and that it was possible because of Dr.Shyamala.
Dr. Shyamala narrated her story of how she got in to the field of working with people with HIV. She narrated her experiences as journalist, who was commissioned to write about women testing positive for HIV and about the year long wait to clear administrative requirements to get permission to meet women who were detained because of their positive status. She exclaimed about the way women were locked up in a old crumbling building that had no windows and how they were ostracised and discriminated by being called as ‘AIDS’. She narrated what her first encounter with a woman named Vijaya who spat on Dr.Shyamala and accused her and people for earning money by writing about them. Dr.Shyamala shared how furious and humiliated she felt for having women under arrest while men who could be possible carriers left out to move around freely and to spread the infection.
She then jointly filed a Public Interest Litigation with eminent lawyers – Ms. Geetha Ramseshan and Late Smt. Bagirathi Narayanan and how the court ruled out that there was no law to detain women against their will and to be released immediately. Then she shared about her early days work among people at high risk to acquire HIV, viz., Sex workers, Men who have Sex with Men, Transgenders, Migrants, Truck drivers, etc.
She shared that for all along the last three decades the programs for HIV concentrated on preventing transmission to men from sex workers and promoted condom use and the other was to prevent transmission from mother to child through medicines during pregnancy. She expressed her deep sense of anger and regret for the policy makers who had neglected the welfare of women. She opened it for discussion by asking for people’s responses.
People felt that there required more awareness generation on women health issues and improve the health seeking behaviour of women. A journalist shared that there is stigma attached to women approaching a gynaec’s consultation before marriage and it was widely accepted. It was felt that there was very little care and concern for women and women related health issues. There were citations on how women were targeted for family planning programs. The group was alarmed by Dr.Shyamala’s data discourse on HIV incidence and condom usage. The group were angered by the lack of availability of alternate options for women’s protection. A student exclaimed on how there was stigma attached to purchase of sanitary napkins in cities and that there would be no way for women to come forward to purchase female condoms. The professor shared that it was not widely available too and that the inaccessibility was a handicap for even those who would choose that as an option.
Concluding notes – follow up action points:
- Create awareness about among women about sexual and Reproductive Health and Rights, with adequate tools, at all levels – schools, colleges, community
- Have women representation to bring about policy level changes
- Use Female condoms and share feedback
- Insist pharma companies to carry out research and development of female condoms with respect to Indian women and bring about an improvised product that is well promoted and widely available
- Educate children on reproductive health and build confidence and break taboo related to SRHR
- Parallel efforts at different levels – policy advocacy, at Doctors and at community level
- Have conversation with women doctors on gender related issues and help them be more open minded with respect to their views about fellow women.