Inter Press Service - October 31, 1999
Ranjit Dev Raj

"I was taught by my mother that menstruation was unclean and she refused to speak on the subject ... and no one taught us anything about sexual matters in school," said Munni who goes to college.

A series of workshops, run this month at Sagarpur, an industrial area sandwiched between Delhi's army cantonment and a busy international airport were a revelation for Munni and some 30 other adolescent girls, several of them married.

"If not for the workshop many of us may have gone through life knowing very little about female hygeine and sexual functions, let alone STD and HIV/AIDS," said Manju who is studying for a master's degree in commerce.

According to Dr Shankar Choudhury, consultant for UNAIDS, a U.N body, discussing sex is taboo in most Indian homes and young girls and women even if married are not expected to ask too many questions on the subject even of their partners. Choudhury said he has known young adolescent women who have attended workshops on HIV/AIDS prevention and then found themselves unable to discuss condoms with their husbands.

The workshop at Sagarpur was conducted by Drishtikon a non- government organisation (NGO) specialising in reproductive health, STD and HIV/AIDS and which has, for a year now, been running a model health centre at Sagarpur.

"We started out with the aim of preventing HIV/AIDS infections through the control of STDs in poor urban women and their sexual partners," said Dr Sushma Sengupta, director of 'Drishtikon' (a view point).

But a few months into the project, supported by the World Bank funded National AIDS Control Organisation (NACO), Dr Sengupta was compelled to convert it into a "multi-dimensional intervention with several inter-linked components."

For example, she said, our outreach centres and the STD clinic were complementary to each other and both contributed to the areas of capacity building and training.

The fact that Drishtikon had a fully functional laboratory and was run by respectable lady doctors like Sengupta helped win the confidence of the community and attract its women.

"These women had nowhere to go to get treatment for a variety of STDs they suffered because a nearby government health centre had no gynaecologist," said Dr Priyamvada Chaturvedi, Drishtikon's medical coordinator.

A woman patient at the clinic who suffered from genital rashes and discharges for years before seeking treatment said members of her family dismissed her symptoms as due to "excessive heat."

Said Meenu Kapoor, a counsellor at Drishtikon, "There is a great need to sensitise women in Sagarpur to the dangers of remaining ignorant on reproductive health -- too many of them complain of backaches, discharges and recurent rashes."

In Kapoor's estimation, at least 30 percent of the women in Sagarpur which has a population of nearly 300,000 people crammed into 150 slum clusters suffer from one kind of STD or another.

Sexual initiation begins early because children cannot be kept from watching parental sexual activity in one-room shanties, Kapoor said. "But speaking about sex is culturally taboo and menarche can be particularly traumatic for girls," she said.

As for the adolescent boys in Sagarpur, many are school dropouts and harbour unhealthy ideas about girls and women as a separate workshop run for them earlier in the month by Drishtikon revealed.

"Many of the boys revealed that they regularly visited hidden commercial sex workers who are a feature of Sagarpur," said Dr Chaturvedi.

Long after the three-day workshop for the boys was over, many of them have been coming back to Drishtikon's clinic for counselling and medical advice, she said. "We feel sorry for them and wish there were regular schemes for them." Workers at Drishtikon say that counsellling boys and men or treating them for STDs have been the weak spot in the programme although it is evident that they continue greatly to passing on STDs.

"Few turn up here for treatment and we have difficulty getting them to accompany their wives whom they have obviously infected," Dr Sengupta said. As for HIV, Drishtikon has yet to discover a single case in Sagarpur in spite of the high prevalence of STDs and risky lifestyles such as low levels of condoms use. "We cannot explain this," Dr Sengupta said.

"All I can say is that if it happens an HIV epidemic would devastate places like Sagarpur which is typical of urban India complete with squalid surrounding and unemployed young people," she said.

NACO's director, Prasada Rao says that work to control STDs must go on. "Gaining control over STDs is key to putting a lid on the HIV/AIDS epidemic." India currently ranks as the country with the largest number of people living with HIV/AIDS but prevalence is lower than in most in the Asia-Pacific region. India reported 79,574 HIV positive persons at the end of December 1998 among 3.3 million people screened. (END/IPS/rdr/an/99)
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