Now more than ever, India cannot afford for fear and shame to drive the AIDS response. In the last two years, India has surpassed South Africa as the country with the largest population of people living with HIV and AIDS, with nearly 5.7 million reported cases. As India's economy emerges on the global stage as a force to be reckoned with, this may not be a title that the country wishes to embrace or highlight.
Yet recently, six Indian states with some of the highest rates of HIV/AIDS have banned sex education in schools. The mainly Hindu right-wing state governments believe that sex education has negative ramifications for their narrow definition of "Indian culture," a misguided perspective that endangers the potential impact of a new national AIDS program, as well as community-based programs with decades of experience.
Recent studies have shown that young people and women are particularly at risk. India's 2005 sentinel surveillance found that roughly 40% of new infections occurred in women. Young people also represent a large portion of those newly infected by HIV/AIDS: of the total number of new AIDS cases reported in 2004, 33% occurred in those ages 15-29 years.
This week, amid the state controversy over sex education, the national government will likely adopt a new National AIDS Control Program (NACP), the third of its kind. The current draft of NACP III has many shortcomings, including a continued focus on targeted interventions with traditional high risk groups, such as men who have sex with men and intravenous drug users. Yet one element of NACP III does attempt to address the reality of India's epidemic: NACP III calls for sex education in schools across the country, in all states, as a necessary component of an effective HIV/AIDS prevention model.
Grassroots activists in India have been successfully developing targeted prevention services tailored towards youth, and women, for years. In Maharastra, one of the states to recently ban sex education, Meena Saraswati Seshu and her organization, SANGRAM, have been fighting the AIDS epidemic for more than a decade, and have received national and international recognition for SANGRAM's effective HIV prevention programs. Recognizing that HIV/AIDS is a reality in Maharastra and acknowledging that traditional models of intervention focusing only on high risk groups don't go far enough, SANGRAM's prevention model focuses on a rights-based approach and educates the general public, including young people, on effective prevention strategies.
An India Today magazine survey last year showed one in four Indian women ages 18-30 in 11 cities had sex before marriage. And, while we know young people are having sex, knowledge about HIV/AIDS is dangerously low: 40 percent of all Indian women have not heard of AIDS, and according to the 2005 sentinel surveillance, almost 73% of young people carried misconceptions related to modes of transmission of HIV/AIDS. Few know where to access contraceptive supplies or other services.
As Meena Seshu recently wrote, "From our experience in Sangli [a large town in Maharastra state] with rural girls and boys, we can say with some authority that the young are really unprepared! We need to teach them that sex is enjoyable, safe and not dirty. They have a right to information and to enjoy a satisfactory and healthy sexual life."
The preemptive strikes of states like Maharastra, more concerned with conservative notions of cultural preservation than the health and well-being of its young people, will most likely result in the passage of a national policy without state-level implementation. If these state policies remain in place, organizations like SANGRAM will face greater obstacles, and India will face an uncontrollable health crisis.