Sexual Behaviour and HIV/AIDS Related Implications

U.V. SOMAYAJULU

This article is based on the data collected for a study carried out in Andhra Pradesh to understand the sexual behaviour of the population sub-groups — adult males, male students and fishermen and the HIV/AIDS related implications thereof. The study used qualitative techniques such as focus group discussions, and in depth in­ terviews and quantitative structured interviews. The findings of the qualitative study revealed that there was poor awareness of AIDS in rural areas. Most of the re­ spondents were aware of the sexual transmission of AIDS and that the clients of commercial social workers carried high risk of AIDS. On the whole, the target groups covered exhibited high risk sexual behaviour. The married respondents re­ ported premarital and extramarital sexual practices and there was little or no prac­ tice of safe sex. The major constraints for the use of condoms in these sub-groups were lack of satisfaction and lack of knowledge. The study concludes that there is an urgent need to educate these sub-groups about safe sex practices, consistent use of condoms, preventive care and non-penetrative sex practices.

Dr. U.V. Somayajulu is Research Director, TNS India, Hyderabad, Andhra Pradesh, India.

INTRODUCTION The concept of sexuality includes not only sexual identities, sexual norms, sexual practices and behaviour but also feelings, desires and experiences related to sexual awareness and sexual acts as well as sex­ ual relations (Vance, 1984). The Human Immunodeficiency Virus (HIV), which leads to AIDS, is a leading epidemic across the world. According to the UNAIDS es­ timates, 40 million people across the world are living with HIV/AIDS, of which 3.2 million are children. India has the largest number of people living with HIV/AIDS — nearly 5.1 million. About 5.8 million new HIV infections were estimated in 2003. This means that almost 14,000 people are infected everyday. In view of the threat Sexual Behaviour and HIV/AIDS Related Implications 597 posed by HIV/AIDS, there is a need to get an in depth understanding of the sexual behaviour of the population sub-groups. Research studies on sexuality in India are grouped, on the basis of the thrust area, into the following categories: • premarital sex, especially with reference to urban youth, • sexual behaviour of vulnerable groups, • extramarital sexual behaviour, • homosexuality, • sexual networks construction and disposition of sexuality, and • methodologies for studying sexuality. The population sub-groups covered so far include female sex workers, homosexuals, urban youth, rural youth, clients of female sex workers and the urban underprivileged (Tata Institute of Social Sci­ ences, 2000). But, so far, the efforts in this direction have been con­ fined to some of the high-risk groups such as commercial sex workers (CSWs) and truck drivers. This article looks into the sexual practices or behaviour of the general population in both rural and urban areas and the student community stay­ ing in the hostels (in view of the greater levels of freedom they have). This article aims at understanding the • sexual behaviour of the population sub-groups — adult males, male students and fishermen; and • HIV/AIDS related implications of the sexual behaviour of the popu­ lation sub-groups — adult males, male students and fishermen. METHODOLOGY This article is based on the data collected for a study carried out in Andhra Pradesh. The study used qualitative techniques such as focus group discussions and in depth interviews and quantitative structured interviews. The target groups covered in the study included : • Adult males (18+ years), from rural as well as urban areas • Male college students (18-24 years) from urban areas • Men (18-49 years) involved in fishing activity, from rural as well as urban areas. The details relating to coverage are as follows: Target Group Research Technique Number Adult males Structured Interviews 2300* Male students Focus Group Discussion 5 Fishermen Focus Group Discussion 5 *Rural = 1300 +Urban = 1000 598 U.V. Somayajulu

FINDINGS

From the Qualitative Study Findings

Profile The fishermen belong to the age group of 20-25 years and are illiter­ ate. They are married, but some live alone. The fishermen work for 10-25 days in a month and earn Rupees 800-1,000 a month. Most of them smoke regularly and consume alcohol after returning from work. The fishermen spend half their earnings or more on alcohol every month. Most of them listen to the radio, even when they are out fishing. The students are in the age group, 21-25 years. They have high as­ pirations. Their role models are, by and large, their father, mother and Swami Vivekananda. Visits to places of worship are common. Expo­ sure to mass media is very high among the student community.

Sexual Practices Sex with CSWs is more common among the fishermen. Other sex partners include non-regular, non-commercial partners who are neighbours or close relatives. Unmarried fishermen reported having sex with girlfriends. The following quotes indicate this: Whenever we feel like having sex, we go to the night queens [CSWs]. We keep changing these sex workers. We prefer to have sex with known women living in the neighbourhood. Awareness of Nirodh, which is synonymous with condom, is high among the fishermen, though it has not been reported. Some of the fishermen (with higher levels of educational attainment) recognised the condom or Nirodh as a device for prevention of disease. Some of the fishermen reported using condoms with sex workers. The most common reasons for not using condoms were 'lack of knowledge', and 'lack of sexual satisfaction'. Sex with CSWs and girlfriends was reported by the students. Mas­ turbation was common among the students, especially among those living in the hostel. By and large, the students accepted paid sex con­ tacts. According to the students, 30 per cent of the students living in hostels had sex with men. Nearly all the students reported awareness of condoms and differ­ ent brands of condoms such as Moods, Kamasutra, Nirodh, Durex and Sexual Behaviour and HIV/AIDS Related Implications 599

Kohinoor. Students knew that the use of condoms helped in prevent­ ing sexually transmitted diseases (STDs) and HIV/AIDS. Knowledge about condom outlets was also high among students. But use of con­ doms was not reported often. Many did not feel the need to use con­ doms as they had sex with the same partner. However, many used other methods of contraception to avoid pregnancy.

Sexually Transmitted Diseases Not many fishermen were aware of STDs and their symptoms. Some of them associated STDs with commercial sex. Not all the fishermen knew about the prevention of STDs through use of Nirodh. On the other hand, students had a very high level of awareness of STDs and could recognise symptoms of STDs in men. The STDs known to students were gonorrhoea and syphilis. The student com­ munity referred to these as gold and silver medals. The students were aware of the fact that STDs could be prevented by using condoms.

HIV/AIDS Almost all the fishermen had heard about AIDS, but they had very limited knowledge about the mode of transmission and prevention of AIDS. Some of them considered AIDS a disease without cure or med­ icine. Many of the fishermen were not aware of the role of Nirodh in AIDS prevention. All the students who participated in the focus group discussions re­ ported to be aware of AIDS. The students considered HIV/AIDS a fatal disease. Commercial sex, sharing of blades and transfusion of contaminated blood were the major ways of transmission known to students. Sex with a single partner or a known girlfriend and use of condoms were methods to prevent AIDS, according to the students.

From the Quantitative Study Profile Table 1 gives the socioeconomic and demographic profile of the rural and urban respondents. About one-tenth of the urban males and 45 per cent of their rural counterparts are illiterates. On an average, the re­ spondents are about 30 years of age. Majority of the respondents (43 per cent) belong to the age group, 20-29 years and are currently mar­ ried with the proportion of such respondents being slightly higher in rural areas. About one-fifth of the respondents are 'never married'. 600 U. V. Somayajulu

TABLE 1: Profile of the Rural and Urban Respondents

Rural Urban All Education Illiterate 45 11 27 Literate but no schooling 7 8 7 Primary 14 12 13 Middle 14 22 18 High School and above 20 47 35 Age (Years) 18-19 9 9 9 20-29 44 43 43 30-39 32 32 32 40-49 15 16 16 Mean 29.7 29.6 29.7 Marital Status Currently married 81 75 79 Widowed 4 2 2 Never married 15 23 19

Premarital Sex All the rural and urban males interviewed were asked a few questions in order to understand their premarital sex practices. The results pre­ sented in Table 2 indicate higher prevalence of premarital sex prac­ tices in rural areas. One-fifth of the rural males and about one-tenth of their urban counterparts reported to have had premarital sex. In most cases, the first sex partner was a friend. The first sexual ex­ perience with a neighbour or friend was more common in rural areas, while first sexual experience with a commercial sex worker was more common in urban areas. About three-fourths of the respondents in rural areas and half in the urban areas had their first (premarital) sex experience in their teens. The mean age at the time of first premarital sex was 18 years in rural areas and 19 years in urban areas. Only one-tenth of the males re­ ported use of condom during the first premarital sexual encounter. The proportion of condom users was higher in urban areas than in rural areas. Sexual Behaviour and HIV/AIDS Related Implications 601

TABLE 2: Distribution of Respondents by Premarital Sex Practices Rural Urban All Respondents who had 20 12 16 Premarital Sex (in per cent) First Sex Partner Friend 62 60 61 Neighbour 19 9 15 Relative 16 9 13 Commercial Sex Worker 3 22 11 Age at First Premarital Sex (in Years) 14-16 19 8 15 17-19 58 47 53 20+ 23 45 32 Mean 18.1 19.4 18.7 Condom usage at first Premarital 6 17 11 Sex (in per cent)

Current Sexual Practices among the Unmarried Males All the unmarried males were asked a series of questions to under­ stand their current sexual practices. Table 3 shows that about half of the rural respondents and one-third of their urban counterparts were sexually active at the time of survey. This indicates higher prevalence of premarital sex in rural areas. Most of the unmarried males preferred to have sex with friends or neighbours or relatives; CSWs were the other sexual partners. About 41-47 per cent of the unmarried males kept changing their partners in­ dicating the prevalence of multi-partner premarital sex in rural as well as urban areas. Ever use of condoms as well as consistent use of condoms was re­ ported more in urban areas. On the other hand, rural areas recorded low levels of ever use or inconsistent use of condoms. Unprotected sex, involving multiple partners, was more common in rural areas. Lack of sexual satisfaction and non-availability of condoms emerged as the major constraints in the use of condoms.

Current Sexual Practices among Married Respondents All the married respondents were asked relevant questions in order to get an idea about their sexual practices. Table 4 indicates that majority of the married men were faithful to their wives. It was observed that 602 U.V. Somayajulu sex with women other than the wife was more common in rural areas. Slightly less than one-fifth of the rural males and less than one-tenth of their urban counterparts reported having sex with women other than their wives. The other partners were friends, CSWs, relatives and neighbours. Changing sex partners was more common among the urban respondents.

TABLE 3: Distribution of Unmarried Respondents by Current Sexual Practices

Note: * Total exceeds 100 due to multiple response.

Less than one-tenth of the rural respondents and more than half of their urban counterparts reported to have ever used a condom with any of their partners. Consistent use of condoms (using it every time) was reported more in urban areas (22 per cent as against 2 per cent in rural areas).

AIDS Awareness

On being asked whether they had ever heard about AIDS, 44 per cent of the rural respondents and 88 per cent of their urban counterparts re­ plied in the affirmative, indicating low levels of awareness of AIDS in rural areas. Further probing on the mode of transmission of AIDS revealed that nearly all the respondents were aware of the nature of sexual transmis­ sion of AIDS. The respondents were also aware that CSWs and their Sexual Behaviour and HIV/AIDS Related Implications 603 clients carried high risk of AIDS. They also knew that AIDS could be prevented by confining themselves to single partner sex. TABLE 4: Distribution of Married Respondents by Current Sexual Practices Rural Urban All Sex with (in per cent) Only Spouse 82 92 86 Other woman 18 8 14 Total 174 112 286 Partner * Friend 78 22 66 Commercial Sex Worker 13 44 20 Relative 13 22 15 Neighbour 16 11 15 Changing Partners 38 67 44 Condoms Usage Never 91 44 80 Every time 2 22 10 Most times 7 11 4 Sometimes 0 22 6 Total N 32 9 41 Note: * Total exceeds 100 due to multiple response

CONCLUSION The target groups covered fishermen, male students (in hostels) and general adult male population having high risk sexual behaviour. The married respondents reported that they indulged in premarital as well as extramarital sexual practices. The sub-groups covered in the study had low levels of awareness / knowledge about STDs and HIV/AIDS. Practice of safe sex (includ­ ing use of condom) was not common among the population groups covered. Lack of satisfaction and lack of knowledge emerged as major constraints for the use of condom. There is a need to educate the population sub-groups about safe sex practices, including consistent use of condoms, STDs, HIV/AIDS and preventive care to be taken. These groups need to be sensitised about the HIV/AIDS risk they carry with them in view of the unprotected high risk sexual behaviour with multiple partners, including commer­ cial partners. There is also a need to educate these population groups 604 U.V. Sotnayajulu about the non-penetrative sexual practices that may be considered as an alternative.

REFERENCES Tata Institute of Social Sexuality In India: An Overview, Working Group on Sex­ Sciences uality, Mumbai. 2000 Vance, C.S. Pleasure and Danger: Exploring Female Sexuality, 1984 Boston: Routledge and Kegan Paul.

THE INDIAN JOURNAL OF SOCIAL WORK, Volume 65, Issue 4, October 2004