"Women are often not in a position to say 'No' to sex" - Femina

Dr Kathleen Cravero, Deputy Executive Director, Joint United Nations Programme on HIV/AIDS, explains the ABCs of the issue in an exclusive interview

1 In India, where awareness about condoms is narrow and their use limited, what are the options available to women?

First and foremost, women need access to information on HIV and AIDS. According to a recent publication issued by the United Nations, 62 per cent of young Indian women aged 15 to 24 and 63 per cent of young Indian men in the same age group know that condoms can prevent HIV, but they may not always have access to them, and women are not always in a position to insist on their use.

Currently, the only available female-controlled prevention method is the female condom, but it is not widely available in India and still requires some degree of negotiation and co-operation with the male partner. We therefore, need to address the vulnerabilities that put women at risk and focus on gender inequality and empowerment of women, both socially and economically. With resources, education and jobs, women acquire real options to live safely and productively in a world with AIDS.

2 In the Indian context, certain sections uphold the ABC strategy as more pertinent and valuable to women than a condom-centric approach. How do you respond to these debates?

The ABC prevention strategy (Abstain, Be faithful or reduce number of sexual partners, and use Condoms) is a comprehensive package. But when it comes to many women and girls in poor countries, the ABC approach, is insufficient. It does not respond to the daily realities of women and girls.

The power dynamics in society and in families make it difficult for women to pursue the ABC strategy. First, many women are not in a position to abstain from sex. Aside from cases of coercion and violence, married women are often not able to abstain from sexual relations with their husbands, even if they suspect he is unfaithful or HIV positive. The same is true for sexually active young women. Second, monogamous women who are married or in steady relationships are often at risk from husbands and partners who have multiple partners. Finally, it is often difficult for women to insist on condom use. Often, women cannot negotiate safer sex due to their low social and economic status - in short, they lack options.

3 What advice would you give women regarding protecting themselves against AIDS and yet asserting their sexuality?

First, all women need to take responsibility for their own health and safety. They need to be informed about reproductive and sexual health and HIV prevention. They need to protect themselves. Such actions will include abstaining from sex, delaying sex or practising safe sex.

4 Which are the areas where you think India has made distinct breakthroughs?

In 1992, the Indian Parliament passed the 73rd Constitutional Amendment, giving recognition to local self-governance units (Panchayats), and reserved 33 per cent of the seats for women. These reserved seats have been critical to ensuring that women have a 'voice' in India.

The work of India's Positive Women Network has also been remarkable. This self-help group has successfully linked women's issues to the issues facing people living with HIV. They have actively promoted 'legal literacy' among women as well as identified income-generating programmes to help women and children support themselves.

5 With much of the recent evidence clearly indicating that marriage actually increases women's risk to HIV/AIDS, how do you assess these challenges?

We need to make marriage safer for women. Traditionally, most married couples do not discuss sex, sexuality or family planning. Some groups have proposed mandatory couple counselling before marriage. While this may not be feasible, we should strongly promote couple counselling, as well as create an environment conducive to open discussions about sex and sexuality.