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Risky Sex, Addictions, and Communicable Diseases in India: Implications for Health, Development, and Security

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Risky Sex, Addictions, and Communicable Diseases in India: Implications for Health, Development, and Security Risky Sex, Addictions, and Communicable Diseases in India: Implications for Health, Development, and Security Rajan Gupta Theoretical Division Los Alamos National laboratory, Los Alamos, NM 87545 [email protected] LAUR 02-5305 This monograph was published as Special Report 8 in the Health and Security Series by the Chemical and Biological Arms Control Institute (CBACI), Washington D.C., September 2004. ABSTRACT: This monograph provides a comprehensive and unifying view of a number of health issues confronting India and how, over time, they could impact the stability and security of the nation. New pandemics like HIV/AIDS have confounded attempts at containment because their spread highlights vulnerabilities in social and political norms and behaviors that have historically been ignored. Their spread also exposes a highly inadequate medical and educational infrastructure. To stop the spread of communicable diseases for which risky individual lifestyles and behaviors, societal norms and beliefs, poverty and lack of empowerment, and stigma and discrimination are major factors it is necessary to examine the system as a whole and to develop new paradigms and tools. Sexually transmitted infections and addictions to alcohol and drugs have emerged as a major interconnected global threat. This monograph makes the case that India is highly vulnerable to this threat and major policy changes, an unprecedented cooperation between public and private sector, and an order of magnitude more investment in health and education is needed to prevent a runaway situation as has transpired in much of Sub-Saharan Africa. 1 CONTENTS FOREWORD ................................................................................................................................4 AUTHOR’S PREFACE ...............................................................................................................5 I. INTRODUCTION ....................................................................................................................6 IIA. INDIA MUST ACT DECISIVELY TO STOP THE SPREAD OF HIV/AIDS..............9 IIB. THE HIV/AIDS SITUATION IN INDIA.........................................................................12 Status of HIV Infections in the Armed and Police Forces...................................................16 Factors Preventing Effective Response to HIV/AIDS and other STIs...............................18 Poor Public Health and Health Care.....................................................................................19 Poor Policy in an era of Simultaneously Occurring and Mutually Reinforcing Health Crises.........................................................................................................................................21 Poor Implementation...............................................................................................................23 III A. RISKY SEX......................................................................................................................25 Sex Work ..................................................................................................................................25 Sex Industry:........................................................................................................................25 Brothel Based Workers:......................................................................................................26 Street Workers:....................................................................................................................27 Housewives and Casual Sex Workers: ..............................................................................27 Call Girls and Boys: ............................................................................................................27 Sex in Exchange for Favors:...............................................................................................27 Men Having Sex with Men (MSM)........................................................................................28 Hijras and Transsexuals:....................................................................................................28 Migrant Workers and Slum Dwellers ...................................................................................28 Child Labor and Work Gangs ...............................................................................................29 III B. Social Norms and Practices, and Reproductive Health in India.................................30 Religion and Culture:..........................................................................................................30 Private Sector: .....................................................................................................................30 School and College Students: .............................................................................................30 Abortions:.............................................................................................................................31 Rape:.....................................................................................................................................32 Abuse of Children: ..............................................................................................................33 Incest:....................................................................................................................................34 Pre-Marital Sex And Sex Education: ................................................................................34 INTERVIEW...........................................................................................................37 A Taxi Driver in Delhi Talks about Risky Sex.......................................................37 INTERVIEW...........................................................................................................41 Sex Workers in Chennai talk about their trade .....................................................41 IV. ALCOHOL AND DRUG ABUSE ......................................................................................45 2 Background on alcohol abuse.................................................................................................45 Failures at Control ..................................................................................................................46 Trafficking Of Illegal Drugs and Unregulated Sales of Pharmaceutical Drugs ...............48 INTERVIEW...........................................................................................................52 Conversation with an Alcoholic..............................................................................52 INTERVIEW...........................................................................................................57 Conversation with a Taxi Driver in Delhi on drug abuse .....................................57 V. PREVAILING REALITIES, BELIEFS, AND CHALLENGES ......................................61 VI. WHY HAS THE SONAGACHI PROJECT NOT BEEN REPLICATED?...................65 VII. CREATING SOCIAL AND POLITICAL WILL...........................................................69 VIII. RECOMMENDATIONS FOR INTERVENTION STRATEGIES.............................74 Health, Sex, and Life Skills Education ..............................................................................74 Public Health Campaigns:..................................................................................................75 Harm Reduction Strategies: ...............................................................................................76 Voluntary Testing and Counseling:...................................................................................77 Care and Treatment:...........................................................................................................77 APPLYING THE STRATEGIES ..........................................................................................77 Empowerment:.....................................................................................................................78 Treatment:............................................................................................................................79 Targeted intervention: ........................................................................................................79 Stigma and Discrimination:................................................................................................80 Prohibition: ..........................................................................................................................81 Monitoring: ..........................................................................................................................81 The role of donor nations, international and charitable organizations:........................82 Examples of decisive action:...............................................................................................82 IX. IMPLICATIONS FOR STABILITY AND SECURITY OF INDIA ..............................84 X. SUMMARY............................................................................................................................92 ACKNOWLEDGMENTS..........................................................................................................95 REFERENCES ...........................................................................................................................96 3 FOREWORD This study on India
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