With 34% of all HIV cases occurring in the 15-24 age group, imparting sexuality education to adolescents could be crucial for containing HIV/AIDS. But in India, where sexual taboos are strong, neither teachers nor parents are happy discussing the facts about sexuality with youngsters, writes Shabnam Minwalla
The enemy may be tinier than a speck of dust, but the resources gathered to battle it are enormous. Despite the media blitzes, poster campaigns and drug onslaughts, however, the virus remains undefeated—and an estimated 2.4 million people in India today live with HIV.
The arsenal - stocked though it is with crores of rupees, clever catchlines and new drugs - has clearly achieved only limited success. Which is why it is strange that policymakers continue to neglect one of the simplest weapons against HIV/AIDS: sex education in schools and colleges.
That a uniform sex education programme is required is routinely acknowledged—particularly as the school curriculum ignores the subject or tackles it in incomprehensible biological terms. “Over 35% of all reported AIDS cases in India occur among young people in the age group of 15-24 years and more than 50% of the new HIV infections are taking place among them,” states the introduction to the Adolescent Education Programme designed by National AIDS Control Organisation, which warns that misconceptions about HIV transmission are widespread. “Seventy three per cent of young people were unaware that a healthy looking person could transmit HIV infection…Among the injecting drug users, the use of sterile injecting equipment was lower among younger respondents.”
This ignorance, however, can only be addressed after some tricky questions are answered: Can a meaningful programme—that is unafraid to call a condom a condom—ever be introduced without a backlash from the moral police? Even if a sex education module is imposed on schools, are our teachers willing to grapple with it? And do the experiences of other countries indicate that sex education works?
“It’s difficult to arrive at a consensus,” says Neha Madhiwalla of the Centre for Study of Ethic and Rights. “There’s no indication that sex education increases sexual activity so there’s no argument against it. But, equally, there’s no real evidence to show that it can curtail the transmission of HIV.”
The context, Madhiwalla stresses, is most important. “Sex outside marriage is usually labelled `high risk behaviour’, but in India HIV is routinely transmitted through heterosexual sex within marriage. Take the 16-year-old whose husband is a migrant worker. Even if she has the knowledge, does she have the space to negotiate?”
Dr Rajan Bhonsle, head of the Department of Sexual Medicine at KEM Hospital and senior sex educator, however, is less ambivalent. “Adolescence is the most stressful period in the life of a human being. The body is flooded with new hormones and there are feelings of confusion and rebellion. We have to help youngsters understand the changes and also the difference between responsible and irresponsible sex. If our approach is very moralistic, they will want to break all the rules.”
Moreover, information can save youngsters, not only from HIV/AIDS but also from the equally terrifying spectre of sexual abuse. “We can’t be around to protect our children all the time so we have to teach them to protect themselves,” says Dr Bhonsle. “I have been shouting about this for the last 22 years, and finally people are listening.”
Indeed, most schools and colleges in India have been squeamish about sex—and the few that bothered to acknowledge the subject usually conducted half-day-long sessions full of biological jargon and embarrassed evasions. But the growing concern about the spread of HIV/AIDS in India changed things and soon bold experiments were being attempted in parts of the country.
In 1997, for example, the Bombay Municipal Corporation’s health department conducted workshops in city colleges on sex and HIV. Many parents and teachers were annoyed, but the collegians responded with rapt attention and questions: Can kissing transmit HIV? How do we wear a condom?
“Whatever we know about sex is through our friends,” admitted a college student during a session at a modest college in suburban Mumbai. His friend agreed: “If we were to broach the topic at home, we would be slapped and told to shut up.”
Along similar lines, the Bangalore Medical Services Trust has developed a teachers’ training manual and a peer educator programme that covers 500 colleges in Karnataka. A handful of sex educator training programmes have also emerged. “My batches are always over-full,” says Dr Bhonsle, who conducts about five sessions a year. “More and more schools and colleges are sending teachers and even principals for the courses.”
Other schools have taken to inviting experts to hold brief workshops. “I have been invited by more than 10 schools in Panchgani and Mumbai,” says sex educator Bharati Trivedi, who uses stories and real-life examples to communicate issues like sex abuse and HIV to her young audience. “There are times when I am asked to avoid certain topics. But on the whole, school managements are cooperative. The children always have many questions—some good, some stupid and some very intelligent.”
Software professional Sandeep Shetty also conducts similar workshops during his free time, but he consciously targets less privileged children. “Their parents feel that talking about things like masturbation and menstruation are taboo and, unlike more privileged children with their access to the Internet, they have no source of information,” he says. “At the last session I conducted there were more than 50 questions.”
Useful though they may be, such efforts are sporadic. Which is why there is general agreement that a universal scheme is imperative.
Soon after the first nationwide study on child abuse in 2007 - which indicated that almost 50% of Indian children experience some form of sexual abuse - Renuka Chowdhury, minister for women and child development, stressed the need for mandatory sex education. At around the same time, alarmed by the spread of HIV/AIDS, Human Resource Development Minister, Arjun Singh, decided to implement a universal sex education programme.
This was the Adolescent Education Programme (AEP), which attempted to impart “life skills” to schoolchildren of standards 10 and 11 during 16 hours of the academic year. The sessions were on growing up, adolescence, reproductive tract and sexually transmitted infections, and HIV and AIDS. Behind the innocuous name, however, lay a minefield. Angry teachers refused to use a flipchart with illustrations of naked bodies and genitalia, while members of the morality brigade kicked up a ruckus about the ‘explicit’ content.
Contending that sex education in schools would encourage youngsters “to experiment with many partners”, the Jamaat-i-Islami Hind launched a countrywide agitation to have the programme scrapped. "Uncontrolled sexual anarchy is the reason for AIDS," declared Aslam Ghazi, spokesman of the Jamaat in 2007. "It is a Western illness. Why should our children be taught about sex?"
This stand had many takers and eventually nine states, including Maharashtra, Madhya Pradesh, Kerala and Karnataka, refused to implement the controversial programme. In fact, the then Maharashtra chief minister, Vilasrao Deshmukh, declared that even the existing sex education programme would be put on hold.
So what happened to the AEP? It was quickly revised, diluted and reintroduced—this time without referring at all to sexual intercourse, condoms and safe sex. Rather, the emphasis was on abstinence and “staying faithful to one partner”. This coy approach infuriated many individuals and NGOs like Nirantar, Prayas and Rahi Foundation. “It is silent even about the biological aspects of reproduction,” they fumed in a joint statement. “Sexual intercourse is shrouded in the euphemism ‘intimate physical relationships’. Without the knowledge of what does cause conception, the curriculum will fail in one of its own objectives -- that of addressing teenage pregnancy.”
While the debate chugs on, however, an entire generation of youngsters is missing out on life-saving information. “We need to guard them against what can happen,” says Priya Gupta, whose pre-teen daughter studies in an upmarket Mumbai school. “I tell her what I can, but it would have much more impact if the school were to reinforce the message.”
Not all mothers manage even this much. A World Health Organisation study ‘Attitude of Mothers to Sex Education of Adolescent Girls’, conducted in a Mumbai slum about a decade ago, found that mothers imparted minimum information to adolescent daughters—just explaining personal hygiene after they started menstruating and warning them not to “talk to boys” as they were now grown up. “The girls were told at the time of marriage how they should behave with their parents-in-law, sister-in-law and husband,” the report states. “No information was given to the girls about what is intercourse, how conception occurred or what family planning measures were available.” The 32 mothers who participated in the study felt this was the job of doctors and teachers.
Teachers, however, feel just as uncomfortable. A study conducted by Renu Gandhi and Avnish Jolly of Punjab University and published in 2006 found that schoolteachers are reluctant to tackle sex education. While a 2002 study found that although HIV/AIDS was a part of the Delhi school curriculum, the teachers clearly needed sensitisation. “A majority of the teachers knew that AIDS is a fatal disease but the routes of transmission were correctly known to very few of them,” the study stated, adding that “only 60% of the teachers have ever discussed the issues of HIV/AIDS with their students.”
Who, then, will teach these important classes? “If untrained teachers are forced to conduct sex education classes, their approach will either be very clinical, technical or downright wrong,” says Dr Bhonsle. “About eight or nine years ago a government resolution was passed in Maharashtra making sex education compulsory. A few years later I asked the health minister why nothing had been done about it and he answered, `We don’t have teachers comfortable with the subject. We need to provide training, but we lack the machinery’.”
While a few training programmes have been undertaken, their success depends on the openness of the candidates. “Schools tended to send biology teachers for training,” says Madhiwalla, who helped train about 500 teachers from 20 districts in Maharashtra in `life skills’—an attempt to help youngsters in their relationships with family members and the opposite sex. “But we have found that often the physical education (PE) teacher or craft teacher or counsellor–who may not have the scientific knowledge–share an easier relationship with the children.”
So what happens if the teachers feel too awkward? “They don’t teach it, that’s all,” says Madhiwalla. “Or they invite some local gynaecologist to give an hour-long lecture about ovaries and fallopian tubes. This is the fate of so many good government initiatives.”
At any rate, will some of these teachers who have been trained in “life skills” return and talk to their students about HIV? “No,” says Madhiwala. “That was considered the task of the NACO (National Aids Control Organisation) programme. There are so many agencies involved that there is constant confusion.”
As policy-makers and the government struggle with the moral police and the tricky mechanics, it is important that they imbibe the experiences of other countries. A 2008 study conducted with 13,000 youngsters in Tanzania has thrown up disheartening results, which indicate that while sex education can improve young peoples’ knowledge about HIV/AIDS, it may not change their actual behaviour. "They need the facts instead of myths and misconceptions, and there are other factors in the community and in the upbringing that we need to look at, that force youngsters into certain behaviour," explained one of the researchers who worked on the London School of Hygiene and Tropical Medicine study.
What, then, can bring about the critical changes in behaviour? “I have never felt that imparting information is so important,” says Madhiwalla. “What we need to do is communicate the basic ideas–about rights and equality—and give them confidence. Once young people have the ideas, they go out and find information for themselves. And in the long run, this is much more effective.”
(Shabnam Minwalla is a former senior assistant editor with Times of India and has written extensively on health and education)
InfoChange News & Features, April 2009