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Dear Umesh,
This is in response to your posting requesting information on village level intervention for HIV prevention.
The description "having low literacy level, low socio-economic status and totally male dominated" will fit more than 80% of the Indian villages. So we could say the strategies adopted in any of the villages could be applicable in your case also.
But I must say you must start with "men as high-risk group", address them exclusively. Usually all health projects address women, as they are sitting ducks at home, but forget about the power relation in sexual matters. So if you start with women, all you will end up is the creation of fear also along with their
powerless existence now. They may be easy to approach and available. But make sure, how difficult it may
seem, that you address the men first.
Again never talk to men in the language of fear and death. For they always live dangerously in life situations and at work. But approach them with the idea of pleasure and then health. Tell them we need health to sustain pleasure. You may encounter resistance among them in using safe sex methods especially condom. Tell them there are ways to wear condom pleasurably, 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 the ways to bring the topic to injustice in power relations exist in gender relations. How actually a submissive and docile wife lessen the pleasure principle and also stress the aspect of an active partner heightens pleasure. Also mention that is why men seek out sex workers. Thus once you can build around pleasure all health aspects, then men will listen. More over in existing conditions it is men who takes initiative in all sexual matters.
In short make men first responsible to their acts.
Once this part is initiated then you can ask the village heads to address the issue of HIV/AIDS broadly. Awareness campaigns and meetings.
Only after this, you must address women exclusively and show the disparities in gender relations and 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 lot of violence and bitterness among couples.
Don't stick to ' condoms as the only method' to safe sex practice. Make sure you teach them the pleasures of mutual masturbation, using thighs etc. etc. Tell to avoid penetrative sex as far as possible and if need be then only 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 shameful about it. 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. And also there are bisexual persons and there are different shades of sexual orientation. And also 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 it 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. Never write a 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. Any confrontation - deny everything, but if you leave anything written, you will be in trouble. Police and fundamentalist mafia will make mince meat of you; have a case study of the NAZ foundation people. Sex and politics of power goes together.
Make sure that condoms are available once you promote it. Easy availability enhances the use.
The most neglected part is 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 in all levels.
Now, we have to address the stigma around PLWHAs. Make people sensitive about it. If possible include in your team an HIV+ 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 practised.
Start a care centre, if there are any AIDS patients but to treat them you need expert people.
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 I am ready.
Love,
Maitreya
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