Sunday, August 30, 2009

India's Troubling Miracle

Interesting article in the Globe and Mail about HIV in India: it seems to arrived there later than elsewhere, and it now seems to have been contained within a small proportion of the population, with the help of aggressive government education programs and private funding.

The author, Stephanie Nolan, keeps saying "But ...."

What has happened here is starting to draw global attention. Yet so much of this story is unique to India, with its strengths (such as pro-active governments) and its weaknesses (particularly the rigid control kept over its female citizens) that it's questionable how much its example can be applied anywhere else.

Toward the end of the article, a section called "The Darker Side":

But there are also less-pleasant truths about India's victory over HIV. Beyond literacy, condoms, blunt ads and brilliant bureaucrats, one thing more than any other has checked the spread of the virus here: the oppression of Indian women.

The extreme control exerted over women's personal lives – first by their parents, then by their husbands and in-laws – means that very few ever have the opportunity to have a sexual partner other than their husbands.

Where 25 per cent of men report more than one sexual partner, less than 2 per cent of women do. Married women get infected by their husbands, and sometimes pass HIV to their children, but the virus stops there: They do not have other partners to pass HIV on to.

This is a marked contrast to Africa, where it is now clear that the “concurrent sexual network” – the tendency for both men and women to have overlapping partners rather than serial ones – has been the key driver of the epidemic.

(Meanwhile, discrimination has played a sharply different role in the spread of HIV among men who have sex with men – it has extremely limited AIDS organizations' ability effectively to provide these men condoms and information. As a consequence, they have HIV infection rates 10 times those of the general population.)

There is, in fact, a broader issue of culture at play in India's AIDS success story, the sort of squishy subject that makes AIDS researchers flinch because it lies so far outside tidy quantifiable data.

But many in the field agree that Indian society remains rigidly hierarchical, still infused with the powerful role of the caste system, and people are accustomed to the strong role of government in their lives.

That's a contrast to many African countries with weaker states and more egalitarian societies. And it meant that when the Indian government sternly told people to use condoms and cut back on partners, they listened.

There are several interesting points here.

1. Very few women have AIDS in India because women are oppressed there--there is simply little opportunity for sex outside of marriage. The implication is that sexual freedom might be better on the whole--more just--even it brought about more AIDS, as in Africa. A further implication, not really hinted at in the article, is that North America has the perfect bourgeois combination of sexual freedom and (relative) freedom from disease. Perhaps because there is so much serial monogamy, as opposed to the "concurrent sexual networks) in Africa.

2. The caste system makes many people in India somewhat submissive to government decrees. Surely this is only the half of it, if that. There is rigid social stratification, which would also tend to work against true or open sexual promiscuity. There is a limited range of people you are both able and willing to eat with, much less have sex with. It is not stated, but presumably the prostitutes in the article are among the so-called untouchables. We are all conscious of how a caste system keeps those who are down, down. But does it also lend a kind of self-respect to those who are not at the bottom, and help them (among other things) avoid contagious disease? Maybe a belief in cleanliness as opposed to uncleanliness actually contributes to cleanliness?

Africa is presented here, for purposes of contrast, as free and easy, and anti-authoritarian. But surely the story of AIDS in Africa can be told in a way that stresses there is oppression of women there, too. Could it be that wide or wild promiscuity, and a resulting instability of domestic relationships, is more the idea of men than women? That it might seem smart for men insofar as they are avoiding the consequences of pregnancy, but suddenly it doesn't seem so smart when there is a dangerous STD around?

Nolen seems to be referring to sub-Saharan and non-Muslim Africa. What about Muslim Africa? Again, an emphasis on purity, sexual segregation, and some degree of social stratification?

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