How to Empower Women to Negotiate Safe Sex
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How to Empower Women
to Negotiate Safe Sex
A Resource Guide for NGOs
Madhu Bala Nath
In partnership with
Abha Bhaiya, Suneeta Dhar
and Charlotte Faty Ndaiye
HAR-ANAND
PUBLICATIONS PVT LTD
Tel.: 51603490 Fax: 26270599
E-mail: haranand@mantraonline.com
For further information, please contact: madhu.bala.nath@undp.org
UNIFEM Global Programme on Gender & HIV/AIDS
55, Jor Bagh,
New Delhi-110003, India
UNIFEM is the Women’s Fund at the United Nations. It provides financial and technical
assistance to innovative programmes and strategies that promote women’s human rights,
political participation and economic security. UNIFEM works with and in partnership with
UN organisations, governments and non-governmental organisations (NGOs) and networks
to promote gender equality. It links women’s issues and concerns to national, regional, and
global agendas by fostering collaboration and providing technical expertise on gender
mainstreaming and women’s empowerment strategies.
The views expressed in this publication are those of the authors, and do not necessat ily
represent the views of UNIFEM, the United Nations or any of its affiliated organisations.
Edited by Sus lima Kapoor
PRINTED IN INDIA
_____
Published by Ashok Gosain and Ashish Gosain for Har-Anand Publications Pvt Ltd
and printed at H.S. Offset Printers.
[aJM- < C O
033,53
CONTENTS
Acknowledgements
5
Introduction
7
Empowerment and Negotiation
9
The Art of Negotiating
10
Negotiating Safe Sex: The Sonagachi Experience
17
Negotiating Safe Sex: The Female Condom
27
Some Frequently Asked Questions
34
References
Appendices
i
36
37
ACKNOWLEDGEMENTS
This work has been made possible because of the support from a number of people. It has
drawn on existing work on negotiation skills. The principles promulgated by the Harvard
Negotiations project, through the work of Mr. Roger Fischer and Mr.William Ury, set the
tone for the document. The work undertaken by SAFAIDS in Africa on the training manual
entitled, “Facing the Challenges of HIV/AIDS/STDs: A Gender-based Response” and the
work undertaken by WHO, UNESCO and UNAIDS on their handbook on school health have
been extremely useful in the preparation of this resource guide. The UNIFEM/UNFPA/
UNAIDS training manual entitled, “Gender, HIV and Human Rights,” has also contributed
towards the development of this guide.
This resource guide draws upon field work done by Ms. Abha Bhaiya (Jagori, India), Ms.
Suneeta Dhar (UNIFEM, India), and Dr. Charlotte Faty Ndaiye (the Society for Women and
AIDS in Africa (SWAA), Senegal). The working papers prepared by them after many field
visits have influenced the analysis of this document. We would like to take this opportunity
to express our gratitude to our partners.
In keeping with the principle of participation and inclusion, experts from a number of
countries in Asia, Africa and Latin America have commented on drafts of this resource guide.
The time spent by these experts, especially the participants of the Training of Trainers
workshop on “Gender, HIV and Human Rights,” held in New Delhi in April 2000, and our
national programme officers has improved the applicability of this resource guide. We wish
to acknowledge their support, and convey our deep appreciation for the time that they have
invested.
The leadership provided by Dr. Noeleen Heyzer, Executive Director, UNIFEM, has been
the driving force behind UNIFEM’s work in HIV/AIDS. Her continuous support and
commitment has enriched the process and the product of this effort.
Madhu Bala Nath
UNIFEM Regional Advisor, Gender
and H1V/AIDS, Asia-Pacific
< \
INTRODUCTION
This resource guide has been prepared in response to some basic dilemmas expressed by
women across the globe as messages of HIV/AIDS prevention flood the environment around
them. Women have expressed these dilemmas in forums and discussions that have attempted
to inform development policy on issues relating to gender and AIDS.
Can a woman really be sexually assertive? Can she even think of differing from the
concept of mutual fidelity when she has been socialised and brought up on the principle that
her husband is God? Can a woman ensure safe sex by suggesting that her sexual partner wear
a condom when the very suggestion of condom use carries with it an indication of infidelity
that could threaten her personal security and destroy the relationship? Furthermore, if the
woman did have sex using a condom, how would she be able to prove that she is fertile in
a society where her status is dependent on being able to bear a son? These are some of the
dilemmas that women are confronted with. Development agencies like UNIFEM and
UNAIDS have a firm conviction that the spread of the HIV virus can be prevented only when
such conflicts and contradictions are exposed. This new discourse needs to be set within the
framework of women’s empowerment because disempowerment and vulnerabilities lie at the
core of the rapid spread of the virus among women. The role of the civil society in enabling
the empowerment of women and stemming the epidemic is critical.
This resource guide is an attempt to consolidate and synthesise existing information and
experien ce in the area of gender and sexuality. It provides information regarding women’s
sexual disempowerment and brings out the urgency of empowering women to negotiate safe
sex. It explains the concept as well as the process of negotiations. It highlights the basic
principles of the concept and underscores the essential criteria of the process of successful
negotiations in the area of sex and sexuality. These principles and criteria have been
extrapolated from projects where women have successfully negotiated safer sexual practices
with their partners. Over a period, HIV/AIDS prevalence rates in these commumties have
remained static and in some instances even declined.
The relevance of this work lies in the fact that it is based on women’s own experiences.
An analysis of the elements of successful negotiations has been undertaken in partnership
with women undertaking these negotiations on a day-to-day basis. An attempt has been made
to record the experiences of sex workers as well as women living in more stable relationships.
The discussion on negotiating the use of the female condom as a means to enable safer sex
for women is based on empirical evidence drawn from the lives of women who are not
employed in the sex trade, whereas the experience from the Sexual Health Intervention
Project (SHIP) in Sonagachi, Calcutta, in India, delves into the modes of negotiations being
adopted by sex workers for safer sexual practices.
Since this resource guide is primarily envisaged as a useful tool for NGOs, a question that
it frequently asks is, “What can NGOs do to empower women to negotiate safe sex?” The
guide provides a menu of options for NGOs to choose from in order to fill in any lacunae
in their ongoing programmes. However, it is hoped that the usefulness of this resource guide
will not be limited only to NGOs. It can also be of equal significance to government
functionaries as it could offer them a menu for supporting NGO initiatives at the country level
to complement and strengthen the National AIDS programmes being implemented by the
government.
Over a period of one year, we have sought comments and inputs on this manual from
government and non-governmental functionaries working on HIV/AIDS prevention initiatives
in a number of countries, namely, Vietnam, India, China, Zimbabwe, Senegal, Kenya,
Nigeria, Mexico, and the Bahamas. Their inputs were incorporated at every step. This
participatory approach enriched our understanding, and we hope will help in making the
applicability of this work as widespread as possible. Nevertheless, we view this guide
as merely the beginning of a much larger and catalytic process towards change—a process
that will modify, adapt and build on elements of this work. It is with this spirit of humility
that we present this resource guide to a diverse group of users.
8
EMPOWERMENT AND NEGOTIATION
The increase in the numbers of HIV infected women all over the world is reaffirming what
Herbert Daniel from Brazil once said, “Like every other epidemic, AIDS develops in the
cracks and crevices of society’s inequalities.” The HIV virus is not random in its spread or
its impact. It differentiates not only in its medical manifestations but also in its disproportionate
impact on those who are socially, sexually and economically more vulnerable. The “inside
outside” dichotomy which has socially confined women to the “inside” has in fact a definite
bearing on the rapid spread of HIV/AIDS among women. The central issue, therefore, that
needs to be grappled with in efforts to prevent the spread of the epidemic in women is that
of disempowerment and of entrenched patriarchal systems of subjugation and control.
Since women’s subordination encompasses all spheres of her life, the empowerment
process must challenge all oppressive structures, thus creating possibilities for women to
reclaim liberty, dignity and self-esteem. Only when a woman’s sense of her own worth has
been achieved can any effort at developing skills of negotiation for safe sex be successful.
The process of empowering women to negotiate safe sex therefore begins when a woman is
made aware of her rights and her capacities. This consciousness however, needs to be situated
in a broader awareness of how gender stereotypes in the area of sex and sexuality need to
be confronted and broken.
As women have been socialised through religion, mythology, cultural taboos and
behavioural training to accept sexual subordination and even sexual oppression, the process
of consciousness-raising seldom comes from the women themselves and needs to be
externally induced. The role of NGOs in empowering women to negotiate safe sex is
therefore critical. It is these change agents of civil society that can provide new ideas and
approaches, and thus trigger women to question existing power relations, individually as well
as collectively. NGOs can often provide women the time and the space to begin to re-examine
their lives so that they themselves can collectively emerge with a new discourse on sex and
sexuality that can gradually be accepted by the larger society.
Empowering women to negotiate safe sex is not just about sexual partners. The chapters
that follow have been conceived and presented to capture the peculiarities that women face
in the area of negotiating safe sex. Negotiation depends on their location in society—whether
they are sex workers or they are women in more stable and socially acceptable sexual
relationships such as housewives.
THE ART OF NEGOTIATING
Negotiating is a part of life, and we are all negotiators. Everyone negotiates something
every day. What is interesting about negotiations is that we negotiate even when we are quite
unaware of our being in the negotiation mode. Roger Fisher and William Ury have described
the skill of negotiating as “a basic means of getting what you want from others. It is a backand-forth communication designed to reach an agreement when the two sides have some
interests that are shared and others that are opposed.”1
There are two types of negotiators: the soft negotiator and the hard negotiator. The soft
negotiator wants to avoid personal conflict and so makes concessions readily in order to reach
an agreement. Since the soft negotiator wants an amicable resolution, he/she often ends up
exploited and feeling bitter. The hard negotiator, on the other hand, sees any situation as a
contest of wills in which the side that takes the extreme position and holds out longer fares
better. The hard negotiator aims for a hard response^ he/she wants to win at the cost of the
other side and thereby usually harms his/her relationship with the other side.
As far as issues of sex and sexuality are concerned, a large number of women fall
in the category of soft negotiators and most men in the category of hard negotiators.2
The HIV/AIDS epidemic has highlighted this state of affairs in no meager way. Because
of a powerlessness resulting from gender relations, women are not being able to negotiate
safe sex with their partners. Consequently, in Sub-Saharan Africa there are more women
living with HIV/AIDS than men. A large number of these women have been in
monogamous relationships, but have experienced an inability to demand faithfulness from
their husbands and/or protected sex. In personal interviews with the author, several women
reported, “We see our husbands with the wives of men who have died of AIDS. But
what can we do? If we say no, they’ll say, pack up and go. If we do, where do we
go?” The question that arises here is that if women were to move from being soft
negotiators to becoming hard negotiators, would the scenario change. The answer is “No.”
The result would be that two hard negotiators would be pitched against each other in
extreme positions, which they would attempt to hold on to stubbornly, or deceive the
other party as to one’s true views, thus causing anger and resentment and a break-up
of the relationship. Bitter feelings generated by one such encounter could last a lifetime
and this would essentially have very negative consequences on the rapidity of the spread
of HIV/AIDS—a spread accelerated by bitter and resentful sexual encounters.
'Getting to YES, Fisher and Ury, Penguin, 1991.
Hhis however is not a generalisation. There have been cases of sexual negotiation where women have proven to be ‘hard
negotiators’ and men have been ‘soft negotiators.’ This is more an exception than a rule.
1
Communication in Sexual Matters
Although difficult, communication is essential in the negotiation of safe sex. Communication
is never an easy task, but without it, negotiation cannot happen. There are three big problems
in communication:
1.
The first problem arises when negotiators may not be talking with each other. This is
especially significant in abusive sexual relationships. Most women go through puberty
coping with social norms and pressures that are aimed at curbing their sexuality.
Marriage soon after menarche is one method by which parents channel the potent
sexuality of young women into a socially acceptable state—the state of nurturing
motherhood rather than a seductress. The consequences for women have been that there
is an enormous gap between women’s lived experience and what women want sexual
relations to be. Therefore, a woman’s reason for having sex may not essentially be an
expression of love and pleasure or a feeling of being wanted. On the other hand, sex could
be performed for any one of the following reasons:
• to become pregnant;
• as a duty;
• to secure survival or a socially secure position.
Communication between sexual partners can seldom occur in such circumstances.
Notions of “shame,” ingrained in women, form barriers and lead to denial of expression
of their sexuality.
2.
A second problem in communication on sexual matters lies in misunderstanding and
misinterpretation. This is especially true in violent and abusive relationships in which one
hears what one fears. The problem is further exacerbated by the absence of positive
language expressing sexuality. How can men and women express themselves if the
medium of expression itself is considered inappropriate? Since expressions of sexuality
are linked to uncouth street behaviour, it makes it difficult to use such expressions in
socially acceptable ways. Another difficulty is that the language expressing sexuality
remains ambivalent. For example, Mexican women asked to name parts of their body
could find no word for the vagina except, “ la parte,” or “the part”.
A third problem in communication is that even when men and women do talk directly
on sexual matters, they are seldom actively listening to one another. Gender and power
relations are at the core of this impediment to effective communication. In such
negotiations a man or a woman may be so busy thinking about what to say next (to keep
the status quo of masculinity versus femininity) that he/she may forget to listen to the
other party. Women often choose not to threaten their social relationships.
In matters relating to sex and sexuality, men and women are therefore not able to conform
to the three principles necessary for effective communication:
• speak in order to be understood;
• listen actively and acknowledge what is being said;
• make emotions explicit and acknowledge them as legitimate.
11
What can NGOs do to Improve Communication?
NGOs can empower men and women to listen actively and be able to speak to be understood^
They can help develop skills in how to talk about sex and sexuality, active lis ening, and
making their emotions explicit and legitimate. The appendices contain some learning too
to enable better communication?
Principled Negotiation
As both the hard and the soft negotiation processes have inherent drawbacks, the Harvard
Negotiation Project has in fact offered a third strategy of negotiations—the strategy o
principled negotiations. This strategy could be adapted as a powerful tool thatjNGOs could
use to empower women to negotiate safe sex with their partners. The role of both men and
women is critical as the participants in a process of principled negotiation are seen as problem
solvers, not adversaries. The strategy however involves the following inputs.
• Building the self-esteem of sexual partners;
• Clarifying perceptions regarding gender, sex and sexuality;
*. Helping sexual pa^taem to focus^mitual interests and inventing options for mutual
gain.
Building Self-esteem
themselves and their concern for what others will think of them can often make people more
sensitive to another negotiator’s interest. Building up the self-esteem of men and women is
therefore a critical component in promoting principled negotiations.
It also involves helping women to become more assertive, not aggressive. Women are
socialized and encouraged to be more focussed on their partners’ needs rather than their own
Empirical evidence shows that women sometimes engage m high risk and painful sexual
behavior they believe is pleasurable to their male partners. In parts of West, Central and
Southern Africa, many women insert external agents into their vagina to dry their vaginal
passage because of the belief that increased friction is sexually more satisfying for the males.
These agents include herbs and roots as well as scouring powders, which cause inflammation,
lacerations and abrasions that could significantly increase the efficiency of HIV transmission.
’These learning tools haven been taken front a number of publieations and due eredit has been given to the authors and
ageneies They offer possibilities for adaptation and the creation of new tools that reflect local/nat.onal nuances of women s
lives and livelihoods.
^Placing Women at the Centre ofthe Analysis, E. Reid, UNDP, 1990.
12
Women need to be assisted in breaking the walls of denial and subservience before a
negotiation of safer sexual practices can be introduced in their lives. “Often women have
internalised the definition of male control as male concern for them. This rationalisation has
continued to keep women submissive to and accepting of male domination and sexual desire.
It also conditions them in denying their own respectability.”5
What can NGOs do to Build Self-esteem
WHO’s handbook on Health Education to Prevent AIDS & STDs includes some interesting
exercises on building self-esteem. We have included some of these exercises in the
appendices, which could be used by NGOs with groups of men and women.
Clarify Perceptions
An aspect of effective negotiation involves efforts at enabling discussion of each other’s
perceptions. It has rightly been remarked that conflict lies not in objective reality but in
people’s heads. Looking for objective reality can be useful, but in any negotiation, it is
ultimately the reality as each side sees it that matters. For men and women, a different
perspective exists on matters relating to sex and sexual relations. In several cultures, female
ignorance on sexual matters is considered a sign of purity, and conversely knowledge of
sexual matters and reproductive physiology a sign of easy virtue. This is not true in the case
of men. Ignorance of sexual matters amongst men is construed as a sign of weakness and
therefore male gender norms often prevent men from admitting their lack of knowledge and
seeking out correct information regarding HIV/AIDS prevention. At the same time, while
multiple sexual partnerships for men are condoned, this is not the case for women. These set
of factors make men and women very vulnerable to HIV/AIDS.
As representatives ofthe community, NGOs can promote an “unlearning” ofthese stereotyped
norms and generate a more gender equal discourse on sex and sexuality of men and women.
The unlearning process, if done effectively, can lead to a baring of realities and stereotyped
perceptions, and can lay the foundation for an equal world where negotiating safer sex is
possible. Behaviour change strategies that do not address socio-cultural norms, including harmful
myths and practices are not likely to be effective. For example, in Senegal, it is believed that a
woman who says “no” to her husband’s sexual demands will never have good children as the
mother’s behaviour during the sex act is decisive for the future of the child. Such beliefs
discourage women from trying to negotiate safe sex with their sexual partners.6
'Safer Sexual Practices in the Context ofHIV/AIDS, A.Bhaiya and S. Dhar, UNIFEM, 1999.
6Myths and Sexual Practices: A Gender Approach to Analysis ofthe HIV/AIDS Epidemic in Senegal, Study undertaken by
the Society for AIDS in Africa, UNIFEM, 1999.
13
What can NGOs do to Clarify Perceptions
An interesting tool that can be used to clarify perceptions is the “Agree Disagree 1 questionnaire
that has been included in the Appendices.7 NGOs could use these questions with separate
groups of men and women so that new ideas that may emerge from such discussions are owned
and internalised by the community. Negotiating an agreement on safer sexual practices becomes
mucn easier if both parties (men and women) feel ownership of the ideas.
Help Sexual Partners to Put Themselves in Each Other’s Shoes
The ability to see the situation as the other side sees it, as difficult as it may be, is one of
the most important skills a negotiator can possess. As Ury and Fisher point out, “If you want
to influence them, you also need to understand empathetically the power of their point of view
and to feel the emotional force with which they believe in it. It is not enough to study them
like beetles under a microscope, you need to know what it feels like to be a beetle! 8
The discussion on the gender-based construction of sexuality has remained the missing
link in almost all development initiatives, with the result that an appreciation of these issues
by men (from a woman’s perspective) has been totally absent. In most countries family
planning programmes have operated for more than three decades without considering the role
of sexuality. Population policies were formulated without analysing gender roles. Laws and
legal means, which were meant to address sexual abuse, were in fact often instrumental in
subjecting women through procedural forms of further sexual abuse such as police
interrogation, medical examination and a vicious judicial process that in the end would only
“break” women.
NGOs can play an important role in developing a holistic understanding of sexuality and
abuse by focussing on issues of male responsibility in negotiating safe sex through the use
x>f role-plays in the community. An effective technique in the role-plays is to assign the role
of men (as required in the play) to women and the role of women to men. A stark realization
of the disempowerment of women in matters relating to sexuality has been seen to take place
through this kind of treatment in the Role Play, He Has HIV, She Has HIV (see Appendix).9
Focus on Interests and Invent Options for Mutual Gain
Consider the story of two men quarreling in a library. One wants the window open and the
other wants it closed. They argue about how much to leave it open—a crack, half way, three
quarters of the way. No solution is satisfactory to both men. The librarian tries to resolve the
argument. She asks the first man why he wants the window open. “To get some fresh air.”
'Questionnaire taken from Gender, HIV and Human Rights, M. B. Nath, UNIFEM, 2000.
*Geitingto YES, R. Fisher and W. Ury, Penguin, 1991.
'Gender, HIV and Human Rights, M. B. Nath, UNIFEM, 2000.
14
She asks the other why he wants its closed. “To avoid the draft.” After a moment s thought
she opens wide a window in the adjoining room, bringing in fresh air without the draft The
essential question the librarian asked was “Why do you want the window open and why do
you want the widow closed?
Like the librarian, NGOs also can play a pivotal role in exploring the reasons that are
oreventing sexual partners from adopting safer sexual practices, and help them to f
mZily acceptable options. The rapid spread of the HIV/AIDS epidem.c is clearly stowing
that men and women in spite of their knowledge and awareness regarding the prevention
HIV/AIDS are not adopting safer sexual practices.
If men and women are to negotiate safe sex, the first issue that needs to be analyzed and
for not wanting to negotiate safe
understood by men and women themselves is the reason
because the stereotyped machismo image is supposed to
sex. A man does not want safe sex L—
‘ j know how to overcome risks that are associated with
make him invincible. He is supposed to
“ Secure STDs by having sex with a virgin. He is supposed
unsafe sex, for example,
know
the
difference
between aa woman
woman who
who is
is ‘clean’ and a woman who is unclean
to know the difference ’between
• t a ‘pleasurable’ sexual encounter with methods that
therefore he is not willing to constrain
could“provide safety against HIV/AIDS. His primary interest in sexual rdations; lies m
seeking pleasure and fulfillment, and barrier methods, which provide safety, do not conform
to his interests.
On the other hand, why do women not want safe sex? For women, having chddren is sti
a central issue even if this involves the risk of acquiring the HIV virus. A study Wo™"
between Motherhood and AIDS," undertaken by Cristiane S. Cabral at the Pubhc; Health
Institute in Rio de Janeiro, concludes, “There is clearly a conflict between this disease which
is still fatal and the desire for motherhood, reflecting the eternal conflict between life and
death
According to these women, motherhood is not only the path to building an identity
paying aS rok. i. is also a way io realizing an importan. dream. Not sguevmg
motherhood is a source of intense psychological suffering and may even gravely affect their
health Women who have had children and no longer need to prove their motJ®r^1
do not want to negotiate safe sex for fear of violence. The very suggestion of condom
carries with it an indication of infidelity that could threaten her personal security and destroy
the relationship Most societies continue to believe that women must become mothers in order
to be “real women.” Furthermore, another belief that continues to be perpetuated is that a
“true woman” is one whose fidelity in sexual relationships is unquestionable^ Ini many
I societies women have been socialized and brought up on the principle that the husband is
“god” (“pati parmeswar” in India, “swami in Bangladesh).
'OGetting io YES. R. Fisher and W'
g Cabral, Latin American and Caribbean Women’s Network Journal,
"“Women Between Motherhood and AlDb, ensuanc o.
^-Gender, HIV and Human Rights, M. B. Nath, UNIFEM, 2000.
15
What can NGOs do to Help Sexual Partners Focus on Interests and Invent
Options for Mutual Gain?
Once the interests of men and women have been identified, how can NGOs generate options
for mutual gain? Seme suggestions include:
• Exploring and propagating alternatives to penetrative sex that can provide pleasure and
fulfillment to men and women. A discussion of these alternative sexual practices within
men and women’s groups would therefore be useful. (See appendices for some learning
tools to enable this discussion.)
• Encouraging a fresh discourse on the concept of the “real/true woman. The discussion
should enable a recognition of the fact that being a “true” woman in a relationship
emanates from being capable of loving and being loved, and not by bearing a child.
• Generating options that can address the woman’s need for mothering through
validating and making adoption of children in communities more socially acceptable.
The discussion on adoption is still cloaked in concepts of illegitimacy and disdain. The
prevalent belief is that a child offered for adoption is normally a child of sin. Civil
society organizations will need to reconceptualise adoption and redefine it with a
perspective that makes this option an opportunity for women and men to experience
the joys of motherhood or fatherhood in societies where HIV/AIDS has made
procreation a risky proposition.
• Strengthening women’s position inside the institution of the family and, in the case of
sex workers, in the woman’s work place through enhancing her access to critical
development resources. A sex worker from Kalighat, Calcutta, who has learnt to
successfully negotiate sex with her clients, acknowledges that the notion of empowerment
is gradual. “Living life the way we are, taking the risks we have taken, makes us what
we are. Change can happen only gradually.”
The steps mentioned above could enable negotiation of safer sexual practices within
households and within sexual partnerships. It is anticipated that over a period of time these
kinds of inputs and components in ongoing progranunes will empower women and men to
confront the HIV/AIDS epidemic in a manner that is mutually supportive.
The following chapter narrates ways in which men and women have succeeded in
preventing the spread of HIV/AIDS in a red light area of Calcutta, India. The sex workers
cf Calcutta, their clients and others around them are now engaged in activities, which allow
each one co win without creating ill will in others. Improbable as it may seem, safe sex has
become a reality for these sex workers in Calcutta. The women are practicing safe sex and
are part of a movement of sex workers that is against patriarchy, not men. They have
successfully separated the people from the problem; demystified misconceptions; generated
options for mutual gain; and have provided a unique lesson for development workers in other
locations struggling with the question of how to empower women to negotiate safe sex.
16
I
NEGOTIATING SAFE SEX:
THE SONAGACHI EXPERIENCE
Recently we stumbled upon a movement of sex workers who are successfully negotiating
safe sex in the heart of Calcutta, India. This was an inspiring discovery for those of us
searching for ways to empower women to protect themselves, their partners, and families
from HIV infection.
Over the last twenty years of the twentieth century, HIV/AIDS has emerged as a major
challenge to the health of millions, and ultimately to the development of the world. By the
end of 2000, according to projections made by the World Health Organisation (WHO), 40
million men, women and children world-wide would have been infected by HIV, or would
have developed AIDS. The epidemic is in various stages of maturity in various parts of the
world. It first made its appearance during the 1980s in sub-Saharan Africa and in the
industrialised countries of the North, but is now rampaging in other areas of the world,
including Asia. The years 1998 and 1999 have seen a doubling of infection rates in 27
countries in Africa, in almost every country in Asia, and in some countries in Eastern
Europe.13
HIV/AIDS in Asia
Sixty per cent of the world’s people of reproductive age—assumed to be at the age at which
most sexual activity takes place—are located in Asia. Due to its youthful and rapidly growing
demographic profile, Asia currently has a labour surplus, and as such has huge numbers of
domestic and international migrants. Such mobile populations are known to be at a relatively
high risk of contracting HIV. Studies such as those conducted by Solon and Barrozo clearly
indicate the risks involved.14 This demographic situation, along with existing, and in many
cases increasing, gender inequalities in the region, has led to a scenario wherein out of the
2.7 million estimated new HIV cases in the world in 1996, one million were in South and
South East Asia.15 India is home to about 4 million people living with HIV/AIDS.16 This
is the largest number of infected individuals in any single country in the world.
The current rate of infections in India is very high. Between 1988 and 1989, in Manipur
(a state in the north-east of the country), none of the 2,322 injecting drug users recorded by
the State AIDS Control Organisation tested positive for HIV. By June 1990, the rate of
’’Figures presented by Dr. Peter Piot in an address to the US House of Representatives in September 1998 (UNAIDS, 1998).
"“Overseas Contract Workers and the Economic Consequences of HIV/AIDS in the Philippines,” O. Solon and A. Barrozo,
in Economic Implications ofAIDS in Asia, eds.. Bloom and.Lyons, UNDP, 1993.
'‘'Report ofthe Global HIV/AIDS Epidemic, UNAIDS, 1997.
,6J Joint Response to AIDS, UNAIDS, 1999.
infection among them stood at 54 per cent and at present is 77 per cent.17 However, figures
like this merely show the tip of the iceberg. It is believed that only eight per cent of the
infections in India have occurred through contaminated syringes for drug use, and a further
eight per cent through blood transfusions. About 75 per cent of the infections have been
contracted through sexual contact. In 1995, WHO recorded that there were 333 million cases
of sexually transmitted diseases (STDs) in the world, out of which 150 million were in South
and South East Asia. The presence of STDs in the human body increases the risk of HIV
transmission five-fold.18 According to a behavioural survey financed by USAID in Tamil
Nadu, India, 82 per cent of the chosen sample of male STD patients involved in the survey
had had sexual intercourse with multiple partners within the last 12 months, and only 12 per
cent had used a condom.19
Although the links between gender identity and roles, sexual behaviour and HIV infection
are complex, it is becoming more and more clear that gender-based discrimination is at the
core of both the causes and consequences of the HIV/AIDS epidemic.20 The geographic
locations where the epidemic is thriving are areas where gender inequalities are shaped and
exacerbated by economic, social and political factors. In our work at UNIFEM, we pilot new
and innovative approaches in various parts of the globe to address the gender dimensions of
the epidemic and search for answers to the questions raised again and again by women in
their struggle to cope with the rapidly spreading epidemic. These questions include whether
a woman can be assertive in her sexual relationship with a man.
For most Indian women, it is almost impossible to contemplate this. Women are brought up
to rely on the principles of mutual fidelity in marriage and the concept of “pati parmeswar”
(husband is God). Very often, reliance on these ideals creates for her an illusion of safety, which
then shapes her attitude towards risk. Even in the absence of such illusions, it is difficult for her
to suggest safe sex since the very suggestion carries with it an indication of infidelity that could
threaten the security of not only the relationship but also her very existence.
Exploring Sonagachi
Amidst the grim statistics on HIV and AIDS in India, the story we tell here is encouraging.
It focuses on the sexual health and HIV intervention project in Sonagachi, a red light area
in Calcutta, which UNIFEM visited in August 1999. Some of the red-light areas in cities and
towns in India have been recording a prevalence rate of HIV/AIDS as high as 55 per cent
since 1996.21 A recent study in India has revealed that 90 per cent of the male clients of male
sex workers reportedly were married.22
^HIV/AIDS and Sexually Transmitted Diseases - An Update, J. Narain, WHO, New Delhi, 1999.
^ODA Health and Population Occasional Paper, ODA, 1996.
■ “’Ibid.
20Placing Women at the Centre ofthe Analysis, E. Reid, UNDP, 1990.
-'Fact Sheet, UNAIDS, 1996.
22ODA Health and Population Occasional Paper, ODA, 1996.
18
For the past four hundred years, Sonagachi has been known as the area in Calcutta where
vice and crime prevails. In a focus group discussion, some of the sex workers reminisced
about their lives in the area. Shankari Pal’s memories included abuses of all kinds. “We got
only slaps. Shoes were thrown at us; cigarette butts were stubbed on our cheeks.” Stories are
common of trafficking in young girls. It was usual for the services of sex workers to be bought
through some kind of coercion. Women in Sonagachi told us that many of the most
exploitative brothel owners—the malkins—had been the most vulnerable of sex workers
themselves. One malkin, Bela didi, had lived in bondage herself for ten years. Every penny
she earned went to repay her ‘debt’. The debt was the money the pimp paid to buy her
(approximately 150 US Dollars), the money for clothes and cosmetics, rent (for a tiny room
in the brothel), food, water, electricity, and medicines (interview, Calcutta, 1999).
Police brutality against sex workers was an enormous problem. While people from
‘respectable’ society frequented the red light area in Sonagachi, they came reluctantly and
took pains to avoid any kind of recognition. Life in the area laid bare power relations and
the resultant exploitation in the crudest form possible. Sonagachi was a land of negotiations,
where agreements were being negotiated day in and day out.
The first sex worker in Calcutta to test HIV-positive did so in 1982, in Kidderpore.
Subsequently, other cases were detected, in adjoining red light areas, including Sonagachi. As
the estimated prevalence rates among sex workers rose to five per cent, the World Health
Organisation (WHO) started supporting the STD/HIV Intervention Project (SHIP) in 1992.
NORAD and DFID provided financial support as well. The SHIP project had been set up in
1992 by the All-India Institute of Hygiene and Public Health, a semi-autonomous government
institution in Calcutta funded by the state government of West Bengal. Dr. Samaijit Jana, an
epidemiologist, was appointed as the project director and it was under his leadership and
participatory approach to development that the vision and goals of the project were drawn out.
The SHIP Project in Sonagachi
The SHIP project was an experimental public health intervention, focusing on the transmission
of STD/HIV among communities in Calcutta. It set up a STD clinic for sex workers in
Sonagachi, to promote disease control and condom distribution, in line with the then-popular
approach of targeting HIV prevention to particular groups who were particularly at risk.
However, during the course of the project, the focus broadened considerably beyond disease
control, to address the structural issues of gender, class and sexuality. Sonagachi is a
community where negotiations are a part of daily life, and SHIP has been able to use the
existing communication channels to address issues of sexuality and gender power relations.
The SHIP project has three fundamental operating principles for its work: respect,
recognition and reliance. The belief that sex workers are best suited to manage their affairs
has informed its strategies. For example, 25 per cent of the key managerial positions in the
project have been reserved for sex workers. This strategy was initiated by the charismatic
leader of the project, Mrinal Kanti Dutta, who told us, “only if there is no alternative will
outsiders be considered” (interview, Calcutta, 1999). The child of a sex worker, Mrinal was
19
bom in an alley in Kalighat, a red-light area. To protect him from harassment, his mother
sent him to a school in a neighbouring locality—a move that somewhat uprooted him. While
Mrinal’s education separated him from the offspring of other sex workers, his identity kept
him ostracised from conventional society. He attributes his abilities as an activist to this
unusual start in life (personal conversations, Calcutta, 1999).
The focus of the SHIP project is to use ‘insiders’ to motivate their own peers. At the start of
the project, members of the sex workers’ community were invited to act as educators, clinic
assistants, and clinic attendants in the project’s STD clinics. Mrinal was the first to join as a
clinic attendant. Sixty-five female sex workers from the community were enrolled as peer
educators. Since the beginning, SHIP has aimed to build sex workers’ capacity to question the
cultural stereotypes of their society, and build awareness on issues of power and who possesses
it. It seeks to do this in a way that is democratic and challenging, yet non-confrontational.
Negotiating with Otters Self
The respect and recognition that the peer educators received because of this project
transformed their lives (personal communication, Calcutta 1999). From the beginning, the
project made it very clear to the sex workers that in no way would a ‘rehabilitation approach
be adopted. The project had not been established to ‘save’ ‘fallen women’. The peer educators
acquired a uniform of green coats and staff identity cards that gave them social recognition.
A series of training activities were organised, with the aim of promoting self-reliance and
confidence, and gaining respect for them in the community. Comments from peer educators
are on record in one of the project reports. One educator reported, “The project has enabled
me to face society with confidence.” Another said, “This apron has changed my life, my
identity. Now I can tell others that I am a social worker, a health worker.”23
A base-line survey was conducted using a participatory methodology. A series of group
discussions were conducted to debate, “Why am I where I am? Discussions confirmed that
extreme economic poverty and social deprivation were the main factors driving women into
the sex trade. 84.4 per cent of the sex workers were found illiterate. Only 8.6 per cent of the
sex workers had come willingly to the sex trade; the rest were there because of acute poverty,
a family dispute or because of having been misguided and kidnapped.24
Once the sex workers saw the results of the discussions and the survey statistics, they
could see their vulnerability to structural problems. Those who had previously seen
themselves as ‘sinners’ and ‘loose women’ altered their perspectives. In focus group
discussions, peer educators had interesting insights to offer.
“Por us, this trade is also an employment. Why shouldn’t the government recognise it as
such? Who says we are loose women?”
23 The Fallen Learn to Rise-A Report on the Social Impact ofSHIP, Durbar Mahila Samanwaya Committee, June 1997.
2^A Dream, a Pledge, a Fulfilment - A Report on the SHIP Project 1992 - 1997, All India Institute of Hygiene and Public
Health, 1998.
70
“Are we the only ones to be blamed? What about the men who come to us? Are they not
also polluting the society?”
-We give our art. In fact, we give a lot <0 thts
se^
society has an obligation to give us respect in re u .
•
Calcutta 1999)
rehabilitation as we are not disabled.” (focus group discussions, Calcutta
)
This awakening is a very significant transformation that
S^-onXt SXXXis the first stage of negotiations towards safer
sexual practices—a negotiation with one s self.
Negotiating H’ith Peers
During the period that women in Sonagaehi were engag^i in bmiding
questioning unequal power,. an lira ent occu
co]lecte<i
with them in these research trials.25
Although the SHiP pr^t hrf
The peer educators began
10 to 15 brothel owners. T y
J
effective dissemination of information
“w ,he s“WOTkers'
i
rui-tant for the educators to visit all the brothels and promote a sense
of commun“ ongTm. This coming together had a direct bearing on promoting safer
^-me Faile,. Le^to Rise - A Report on the Social Impact ofSHIP. Durbar Mahila Sanranwaya Committee, June 1997.
21
sexual practices since the clients soon realised that at least in some clusters they could not
move from one brothel to another in search of condom-free sex. The conditions were the same
in all the brothels.
As the project progressed, educators monitored the use of condoms by encouraging sex
workers to dispose them off in cardboard boxes. When asked by researchers about the rate
of condom use and whether it had shown signs of rising, educators said, “Look at the dustbins
in this area and you will get an answer. The cardboard boxes are there to show that the rate
of condom use has definitely gone up.”26
As these activities got underway, awareness about the project grew in the community. The
project had begun as a targeted intervention to prevent the spread of HIV/AIDS. However,
by using a strategy that promoted behavioural change, it had become clear to all involved
that the main obstacles facing the successful implementation of the project were not just
related to behaviour patterns. The obstacles were to do with the way sexuality is seen in
society, lack of social acceptance, and the legal ambiguities relating to sex work. All these
were increasingly recognised by the community as elements to be confronted, battled against,
and overcome. Sex work is an occupation, not a moral condition. The occupational hazards
of contracting STDs and HIV, the inherent violence and sexual exploitation that is part of
a sex worker’s life had to be acknowledged as such, and overcome.
Negotiating with Structures—Building Alliances with the Clients
In 1993, early in the life of the project, peer educators conducted a survey with ‘babus’ (long
term, regular clients). The survey revealed that only 51.5 per cent of the clients had heard
of HIV/AIDS, but even this group lacked awareness regarding the use of condoms. Only 1.5
per cent regularly used condoms, and 72.7 per cent had never used a condom.27 After the
survey, a meeting was organised to begin building alliances between sex workers and their
regular clients in the interest of promoting safer sexual practice. About 300 clients attended.
The discussions that began at this meeting led to the opening of clinics in the evenings for
the clients, where they could receive free treatment, counselling and access to condoms.
Socio-cultural programmes were organised to introduce safer sex and HIV/AIDS messages
targeting the clients. Today, the clients have come together in a support group called the
‘Sathi Sangha’ (‘group of friends’). This group supports sex workers in motivating new
clients to use condoms, as well as their efforts in eliminating sexual violence in the area.
Training the Police
A training session for police personnel was organised after the All-India Institute of Health
and Hygiene established a strong partnership with the Calcutta Police Department. By the
end of April 1996, about 180 police officers had attended these training programmes.
26lbid.
21A Dream, a Pledge, a Fulfilment - A Report on the SHIP Project 1992 - 1997, Ail India Institute of Hygiene and Public
Health, 1998.
22
Forming the Durbar Mahila Samanvaya Committee
The issue of HIV/AIDS, which was the entry-point for work in Sonagachi, had become a
starting point for social transformation. An organisation for sex workers the ur ar a i a
Samanvaya Committee (DMSC), was formed in February 1995. The leader of SHIP, Mnnal
Kanti Dutta, was involved in the development of DMSC. The organisation became a u yfledged union for sex workers, promoting and enforcing their rights. The sex workers in
Sonagachi became vociferous advocates for legislation that would recognise t eir wor as
a profession.
Leading newspapers and the media hailed the move because it was radically different from
earlier attempts in this direction. Earlier groups attempting to bring sex workers together had
given themselves names such as the “Patita Udhar Samiti” (the “fallen” women s organisations).
These attempts disallowed new notions of self and only served to enhance guilt and shame
amongst their members. As noted in the UNIFEM Report, “Such attempts had been
apologetic rather than liberating, and had placed women on the periphery.
On the day that Mrinal became the head of the DMSC-lst May 1999-the organisation
won its first major political victory. The DMSC members, together with the help of officials
from the Department of Social Welfare, and the State Women’s Commission, succeeded in
setting up a self-regulatory board that was given formal recognition by the state government
The board outlined a mutually agreed code of conduct for all stakeholders in the red hg
areas of West Bengal. With the help of peer educators, the boards ensure that the code of
conduct is adhered to and activities in the red-light area are monitored closely.
Lessons Learned from the Sonagachi Experience
Using Stories and History to Rally the Community
Part of the success of the Sonagachi story depends on the fact that, historically there
was vitality in the sex workers’ community. In 1980, a group of sex workers had formed
the Mahila Sangha (‘women’s organisation’). Braving threats, they carried on a sustain
campaign against a local criminal who extorted money from the sex workers, finally driving
him away from the area.2’ When the SHIP project started, the peer educators were able
to use stories of these earlier successes to stir people’s imagination and rally them towards
a common objective. By reminding them of the significant role played by a group of
lbabus ’ in the history of prostitution in Calcutta, clients .were motivated to assist in ongoing
efforts During the days of the nationalist struggle against colonialism in India in the
early twentieth century, these babus had inspired the Sonagachi women to raise funds
to aid the freedom struggle.
'-•Safer Sexual Practices in the Context ofHIV/AIDS, A.Bhaiya and S. Dhar. UNIFEM, 1999.
'-me Fallen Learn to Rise-A Report on the Social Impact ofSHIP. Durbar Mah.la Sanranwaya Comm.ttee, June 1997.
23
Retaining Flexibility so that the Project could Respond to Changing Needs
The SHIP project tried to respond to the perceived needs of sex workers in Sonagachi as and
when they arose. For example, although SHIP focused on the sexual health needs of the sex
workers at the start of the project, arrangements were made to provide non-formal education
to the sex workers when the demand for literacy programmes arose. During 1996-97, in
response to their concerns about security in old age, vocational training programmes were
conducted for older sex workers. A credit and savings society—the Usha Multipurpose
Society—was set up start self-employment schemes. This component also aimed to liberate
the community at large from the exorbitant rates of interest charged by moneylenders. More
and more women joined as they found these efforts meeting their needs. The report of the
DMSC, published in June 1997, states that 2000 sex workers had enrolled as members and
the assets of the co-operative amounted to Rupees 697,100 (equivalent to US Dollars 17,000).
They had also acquired a piece of land in Madhyamgram, the market price of which was
Rupees 80,000,000 (equivalent to US Dollars 160,000).
Using Drama to Promote Communication
The sex workers set up a theatre group, thus creating for themselves opportunities for
communication and self-expression. Sharing information about methods of negotiating safe
sex is critical, and drama has become an important medium for the sex workers to negotiate
publicly with the clients, the pimps, the brothel owners and the police in a non-threatening
environment. The sex workers claim, “It has given us the space to say things that reside in
our hearts”, and they acknowledge, “This medium has been very effective in improving a
code of health conduct in our clients” (interviews, Calcutta 1999).
Ensuring Male Responsibility
The project is based on the principle that what needs to be opposed is patriarchy, not men.
In addition, it believes in enlisting groups of men to work with women if it is mutually
beneficial. For example, the sex workers enlisted the support of clients to fight HIV infection
to their mutual benefit. In 1993, a team of sex workers from the project met with the
‘mukhiya' (chief of the pimps) to ask for support. It became clear that the 'mukhiya ’ did not
want to support the project, because he feared that recognition of the fact that the HIV virus
was present in Sonagachi would destroy their business. The project team explained that, in
fact, turning a blind eye to the spread of AIDS is what would destroy the business. The pimps
subsequently did not resist the campaign.
Similar approaches were adopted with the police and the brothel owners who benefit from
patriarchal power structures. The success of the police training sessions can be seen through
comments of peer educators, who reported, “The police now have to think twice before
hitting us,” and “Today, when we go to the police station, we are offered a chair. Earlier they
did not even register a case if we went to report abuse” (interviews, Calcutta 1999). The
brothel owners have also responded to the efforts underway. A number of brothel owners
today keep condoms and provide these to the clients as they arrive. Some provide days off
24
for the 'chokns ’ (young sex workers), especially during menstruation. This was not the case
a few years ago. Bela didi, the brothel owner mentioned earlier, informed us that she had
opened an account in the Usha Co-operative Society for the girls working for her.
From the Periphery to the Centre
Development work has tended to shy away from addressing issues of sex and sexuality. In the
last two decades, HIV/AIDS has forced many policy-makers and practitioners to venture into
the area of sex and sexuality, but the discomfort that most of them feel has kept the discussion
at very preliminary levels. It is still rare to discuss perceptions about sex and attitudes related
to morality and values. The SHIP project is unusual and inspiringbecause it raised these issues
with the aim of transforming and re-forming power relations between women and men, sex
workers, and those who profited from their work—both the buyers and the sellers.
Over the last eight years, the SHIP project has regularly celebrated International Women’s
Day, the World Environment Day, and the World AIDS Day. It has participated in book fairs
and flood relief programmes; and has sent delegations to Nepal and Bangladesh, and to World
AIDS conferences. The sex workers have met with a range of partners, and have arrived at
the conclusion that their struggle as sex workers is not very different from the struggles of
poor women in the informal sector. The struggles are against patriarchy and domination.
Certain nuances in these struggles may be different, but the overall spirit and thrust remain
the same. Both struggles have questioned power relations; explored and identified
vulnerabilities; and have tried to break structures that are oppressive. The sex workers of
Sonagachi have today re-examined their situation vis-a-vis mainstream society, and have
come up with some very powerful observations and insights. Mala Sinha, one of the sex
workers, referred to the women of mainstream society as well as the sex workers of her
community as dogs, “The difference is simply that one is a dog with a collar and one is
without” (focus group discussion, Calcutta 1999). Minoti Dutt, another sex worker we met,
remarked, “We are more liberated and free in many ways than those who are in oppressive
marriages. We don’t need husbands to give us our identity.”30
The Sonagachi movement has also managed to intervene successfully in stopping child
trafficking in West Bengal. The self-regulatory Boards set up in 1999 are mechanisms that
are enforcing anti-trafficking laws. Considering that a number of trafficked children have
been returned to their homes, the organisation is clearly contributing in various ways in
helping reduce crime and violence in the larger society.
^Safer Sexual Practices in the Context of HIV/AIDS, A.Bhaiya and S. Dhar, UNIFEM, 1999.
25
Conclusion
.on the sex workers of Sonagachi dreamt of having a community without
Seven years g ,
STDs The dream seemed unrealistic in the prevailing
hs second mod,omdem. plan for
and
epidemiological analysis done by ^H0' f0160*!* *proiected^the future AIDS capital
Conference held in Yokohama in 1994, India was be g p J
the National AIDS
of the world. Studies of high-nsk behaviour c°^sl°ne^
^/above diagnosis. A
Control Organisation in 65 cities of India validated and con
ed
survey of randomly selected households in ami
ronsidering that nearly 10 per cent
SZS iSyXS lASiha. had a negate
rate of HW/AIDS
(The Telegraph, 18 September 1995).
ofa^o"LS“»"^^^
,o re-
define sex and sexuality from the perspective of women.
'”8; "d DMSC- ””
26
NEGOTIATING SAFE SEX:
THE FEMALE CONDOM
Discovering New Possibilities
risk behaviour is sexual in^u^ew..
e“= ^™3
proporhon "f'tho'sVnewly infecled wilh H1V/A1DS, in both the developing and the
world Worldwide, the proportion of HIV infected adults who are women rose from 25 per
• 1000 tn 46 ner cent in 1998 While these are official numbers of cases reported to
™«DSthe numb of women who are living with HIV is undoubtedly much higher.
"oX reTute from women's lack of access to heaitl. cam and tesfng servtces or
denial by health care providers to diagnose women with the disease.
The messages of AIDS prevention initiatives—mutual monogamy, limiting partners and
cMributing towards a redefinition of gender imbalances and prevention of the spreadlol^t e
epidemic. As Srilata Batliwala says, “Empowerment is a process that must,,e3^le wome
to discover new possibilities, new options and a growing repertoire of choices.
IbXe female"condom and access to this method of HIV/AIDS P^^.’VX^d
cXl empowerment strategy to enable women to
also add value to ongoing efforts to prevent the spread of HIV/AIDS among women.
Can Women Negotiate the Use of the Female Condom?
In the context of women’s unconditional sexual availability in marital relationships and her
^"empowerment, the experience of Senegalese women successfully negotiating
the use of the female condom (femdom) offers some interesting ins g
««. S. C.w, U«n
SE” Z; 525S—• A.« S—
Education, 1993.
'”‘'
B“~ •<«“«
Senegal, a country situated in the northwestern part of the African continent, is replete
with a history of human subjugation, and of human trade. Senegal is a country where men
as a rule, rather than an exception, maintain polygamous relationships at various stages of
their lives and the statistics of single women as compared to men portray a unique scenario.
Today, only 5 per cent of the men above sixty live as widowers as against 54 per cent of
the women in the same age group.36 Women in Senegal have a life expectancy of 54 years
and the country has a high maternal mortality rate of 560 per 100,000 live births. The total
fertility rate, that is births per woman, is 5.6 and, as a natural corollary, only 13 per cent of
the married women practise contraception. 50 per cent of all HIV infections in the country
are among women.37
As part of its effort to understand the gender dynamics of sexual negotiations in the context
of the use of the female condom, the United Nations Development Fund for Women
(UNIFEM) and the Society for Women and AIDS in Africa (SWAA) worked in partnership
to pilot and test new approaches in empowering women to negotiate safe sex. Fifty women
from five fish factories of Dakar, the capital of Senegal, were trained in the use of the female
condom and were provided condoms as a device to negotiate safer sex with their partners.
The average age of the women was 36 years. 67 per cent were married, 14 per cent were
divorced and 19 per cent were single. 80 per cent of the women had some basic education
and 20 per cent were illiterate. A series of skill development workshops were held for the
participants, and the agenda included discussions on gender disparities and power relations
among men and women in Senegal as well as an analysis of the socio-economic profile of
Senegalese society. The workshops also focussed on the usefulness of traditional contraceptive
methods and the impact of existing myths and rituals regarding sex and sexuality on women’s
vulnerability to HIV/AIDS. The physical aspects of the female condom were explained to
the women and skills for its effective use were imparted. At the end of the workshop, the
women were provided with some female condoms for use.
Over a three-month period, the women reported several observations regarding their use
of the female condom in negotiating safer sex with their husbands.
1. Seventy-three per cent of the women found that they could negotiate use of the female
condom successfully with their partners. Their conclusions were based on the following
experiences:
a. Its insertion and removal was easy—80 per cent of the women found its use easy, 20
per cent found it difficult.
b. Nine out of 10 women derived sexual pleasure during sexual intercourse using the
condom and, in addition, felt a sense of security and safety from the disease. There were
no leakages or tears reported by any woman.
c. The men felt that the female condom with the inner ring gave a strange feeling during
intercourse but it enhanced pleasure and hastened orgasm.
■bThe World's Women - Trends and Statistics, United Nations, New York, 2000.
'7lbid.
28
d. The women felt a sense of autonomy as the female condom could be inserted hours
before intercourse and thus gave them a sense of control over their sexual lives.
2. The women expressed some reservations regarding the noise, the wetness, of the condom,
the rather large size, and the discomfort caused by the outer ring. Another constraint
mentioned by both men and women was that the condom could not be used in multiple
sexual positions.
3. About 27 per cent of the women could not negotiate the use of the female condom with
their partners. Some of the reasons for this failure are illustrated by the comments given
to us by women themselves.
a. Economic dependency on the husband: The sample of the research included women
who were casual labourers in fish factories as well. It was largely this group—with its
irregular and low income—that could not successfully negotiate the use of the female
condom with their husbands.
b. Fear of losing the affection and attention of the husband: The polygamous structure of
the family in Senegal at times acted as a constraint in enabling an open and free
discussion on the female condom. Some women, who were already in a vulnerable
situation due to factors such as fear of losing the affection of their husbands, could
hardly negotiate use of the condom. The women in polygamous relationships were also
unable to discuss the female condom with the other wives due to fierce competition
between wives for the husband’s affection. It is common belief that maintaining the
status quo in sexual matters is critical to keeping the delicate balance of sexual
relationships.
c. Fear of social rejection: According to Charlotte Faty Ndaiye, President of SWAA, the
response of the government and religious institutions towards AIDS prevention has
been very positive. The use of condoms and other prevention efforts seems to be
socially acceptable in spite of the religious taboos regarding use of contraceptives.
Nevertheless, there is a dichotomy between the public and the private spheres. Within
families, women are expected to uphold their religion and avoid using contraception.
The perception of the female condcm therefore is very critical. For women who see
it as a contraceptive similar to the male condom, its use becomes a religious issue, but
women who see it as a preventive tool against disease, have no inhibitions and are
therefore able to negotiate its use more effectively with their husbands.
Research undertaken in Senegal, as well as in other parts of the world, has revealed that
the female condom has a high degree of acceptability provided two factors are present: (1)
women regard it as a preventive tool against HIV; and (2) women are given training to
develop their self-esteem and assertiveness.
The findings that follow have been consolidated based on research undertaken on women
who were not employed in the sex industry.
29
Do Men and Women Accept the Female Condom?38
Women in Papua New Guinea expressed the need to have female condoms available to them.
“Women should have a choice, not simply to alternate responsibilities or level out gender
power—they should also have available an alternative when men are either out of condoms,
too drunk to get them on, possess outdated condoms or will not use them.”
In Ghana, women were able to negotiate safe sex and the use of the female condom
because women and men perceive the female condom as a means to protect themselves
against HIV/AIDS and not just as a contraceptive. The perception responds well to the
instinct of self-survival. All the 12 men (18 per cent of the sample) preferred the female
condom to the male condom because “it made their sexual relations better in comparison to
use of the male condom.”
In Kenya, a study by AIDSCAP conducted in January 1997 with 100 women revealed that
86 per cent liked using the female condom.39 Through peer groups and women’s groups, the
organization had been successful in promoting communication on sexual matters between
partners so that a sustained use of the female condom was made possible. In the focussed
group discussion on the use of the female condom held with 46 male, only one man reacted
violently when his wife suggested the use of the condom. The other 45 spoke approvingly
of the female condom.
In a study conducted in Malawi in 1994, Blogg & Blogg found that the introduction of
the female condom assisted in breaking stereotyped perceptions.40 Men used the male
condom mainly for contraception, but saw the female condom as a device for STD/AIDS
prevention. Women in this study saw its use as a means of enhancing their self-esteem since
its use signaled messages of “personal control, power, strength and warmth.” Women in
Senegal reported that the use of the female condom “provided more pleasure and a greater
feeling of security.”41
In South Africa, high school students—both male and female—showed interest in the
female condom and found it theoretically acceptable and feasible.
Is the Female Condom Safe?
One of the reasons for acceptability of this female initiated means of protection is its safety.
All studies have shown the female condom to be safe. There was no evidence of trauma
associated with the use of the female condom nor were there changes in the vaginal flora.42
The empirical details in this section have been taken from ‘'The Female Condom - An Information Pack,” WHO and
UNAIDS, Geneva, April 1997.
39Quoted in The Female Condom - A Review. WHO 1997
40lbid.
Sexual Negotiations and the Use oj the Women's Condom, Niang in Kolda and Kaolack, Senegal, 1996.
4-Quoted in The Female Condom - A Review, WHO, 1997.
30
I
i
In studies sponsored by Wisconsin Pharmacal, a post-coital leak test involving 108
couples found that the leakage rate for the female condom was 0.6 per cent as compared to
a 3.5 per cent rate for the male condom. Concerning dislodgment of the female condom, these
studies found that the vaginal exposure to semen occurred among 2.7 per cent of the users
in comparison to 8.1 per cent for users of the male condom.
Is this Method Female Controlled or Just Female Initiated?
Another factor in the acceptability of the female condom, especially among women, is that
it has a potential of not just being female initiated but female controlled as well. The female
condom can be inserted into the vagina several hours before the sexual activity. It thus
provides an advantage over a diaphragm, which requires the woman to insert the method
shortly before intercourse. The female condom does not have to be immediately removed
after intercourse.
Interestingly, a recent study by UNAIDS in Thailand showed that the use of the female
condom can lead to a sizeable reduction in STDs. Some groups of commercial sex workers
were given male condoms only; others were given both male and female condoms. Among
those supplied with both male and female condoms, the number of unprotected sex acts were
fewer and the incidence of STDs was one-third lower than among those given male condoms
only (Fontanet et al).43
Another study conducted by Trussel et al (1994) estimated that the perfect use of the
female condom may reduce the annual risk of acquiring HIV by more than 90 per cent among
women who have intercourse twice weekly with an infected male.44
Can the Availability of the Female Condom Increase Women’s Power to
Negotiate Safe Sex?
In 1993, Ford and Mathie reported an overall shift from a pre-use “neutral attitude” of couples
to a diversity of “positive and negative” attitudes over a period of three months. They also
noted that, after three months, 52 per cent of the 67 couples generally felt positive about the
use of the female condom. In the same study, however, 36 per cent of them felt negative about
the female condom and the remaining 12 per cent perhaps were cases that responded with
a “no or don’t know.”45 Evidently, a large number of women are still not successful in
negotiating the use of this device. The reasons for this failure are:
1. Availability and cost: The high price of the female condom in relation to the male condom
is a major obstacle to its use. The newly agreed public sector price for developing
countries is slightly less than a US dollar. Even in countries like Zimbabwe that have a
43lbid.
44lbid.
■‘'Ibid.
31
VmH - i t o
v 8 3 13
full-blown HIV epidemic, and where men and women have begun to perceive its
usefulness, women are prepared to pay only a maximum of 25 Zimbabwean cents or 0.03
of a US dollar (Ray et al, 1995).46
2. Effect on gender relations: The female condom was perceived by some men to have the
potential to change existing social and gender relations. In Zimbabwe, the female condom
was not acceptable to some men who felt that their wives might become promiscuous and
thus potentially change the existing social balance in which only men are allowed to be
promiscuous. Thus, “partner resistance” has been cited quite often as a reason for non
use or discontinuation of the use of the female condom. In a number of studies, some of
the reasons offered for partner resistance were fears related to changes in gender roles
with women taking charge of an area that has traditionally been the men’s domain.
3. Fear of violence: Women reported fear of violence by their partners as a barrier to
negotiating use of the female condom. This however has not been confirmed in the studies
conducted. In Kenya, while women feared that men would act violently towards them for
suggesting the use of the female condom, violence took place in only one of the 96 sexual
encounters.47 In a study in Papua New Guinea, where the prevalence of violence against
women is very high, only 4 cases of violence occurred among 224 women asking their
partners for use of the female condom (Jenkins et al 1995). Thus partner resistance,
whether perceived or actual, posed a barrier to the use of the female condom in order to
negotiate safe sex. The need to involve men in the effort to introduce this means of HIV/
AIDS prevention for women is therefore critical. A positive example is the social
marketing effort in Zambia where, according to Timyan and others, men are now
purchasing female condoms more often than the women.48
The female condom therefore has the potential of changing power relations in a positive
manner. Several studies especially those which included interventions on women’s
empowerment have concluded that introducing the female condom in a relationship provides
an opening for communication on sexual matters otherwise not discussed. A study in Senegal
points out that the female condom increased women’s knowledge about their bodies and gave
rise to discussions between men and women on sexual and reproductive health, thus
reinforcing women’s bargaining power.”49
“Ibid.
47Maxine Ankrah - personal communication
“Quoted in The Female Condom - A Review, WHO, 1997.
^Sexual Negotiations and the Use ofthe Women's Condom, Niang in Kolda and Kaolack, Senegal, 1996.
32
I
What Can NGOs do?
The potential that the female condom has in empowering women to negotiate safe sex is
tremendous. NGOs, with their insight into issues of gender and development, can move this
discussion to a dynamic plane of effective action. Some of the interventions include:
• Spreading information among women about the acceptability, safety and constraints
about the female condom among women to enable an informed choice regarding HIV/
AIDS prevention methods. The information should be supported with some of the
empirical information provided in this chapter.
• Using discussion on the female condom to increase women’s knowledge about their
bodies. “Introducing processes that bring women closer to their own biology, physiology,
psychology and gynaecology can further strengthen their bargaining power. The
essential prerequisite is restoring the notion of respect for one’s own body. The process
by which women learn to live and care for their bodies demands that the notions for sex
and sexuality, desire and desirability, sense and sensuality be redefined from the
women’s perspective.”50
• Using discussions on the female condom to evolve new perceptions and new visions
among men and women. The image of a condom has to be changed from just being a
contraceptive to being a useful tool for disease control. This approach could also trigger
support from religious leaders on issues that have until now not received their support.
• Undertaking indicative demand studies on the female condom and using the findings to
start a public debate which would influence policy makers and planners regarding
pricing policy, distribution and consequent access of the female condom by women at
the grassroots level.
■"Safer Sexual Practices in the Context of HIV/A1DS, A.Bhaiya and S. Dhar, UNIFEM, 1999.
33
SOME FREQUENTLY ASKED QUESTIONS
1. What does building women’s self-esteem mean?
Building women’s self-esteem means <enabling women to respect both their identity and
their work.
2. How can this be done?
We can do this by promoting self-analysis within groups and by encouraging selfrepresentation.
3. How can we promote self-analysis?
We can promote self-analysis among members of a community by raising questions and
encouraging the community to search for answers either through mutual information
sharing or through empirical exercises that enable them to see themselves in totality. The
process of situating themselves within a broader framework of socio-political-economic
factors influencing their lives is one that would help them to analyse themselves as
individuals with a range of emotional, social, political and material needs some of
which they could have control over.
Such analysis would normally help groups to evolve an ideology that is pertinent for their
lives and livelihoods. In Sonagachi, for example, the indicators of self-esteem ranged
from wearing a green coat with an identity card that proclaimed their status as a peer
educator to experiencing the pride of co-chairing sessions in a workshop with a
representative of the government. The manifesto drawn up by the sex workers
organisation is radical, and provides a strong ideological basis that allows women to
develop their own identity.
4. How can we encourage self-representation?
As long as others speak on behalf of the people who are participating in a struggle, the
real essence of their struggle cannot be captured. NGOs should create spaces that provide
visibility to men and-women who have been marginalised in different ways, thus ensuring
that their voices are heard in public forums. As one of the sex workers, who participated
in the International AIDS conference in Geneva in 1998, remarked, “In Geneva, when
I told my story on the mike, it was not from my papers. I spoke the language of my heart
and the language of the heart is very deep.”
5. How can we ensure and encourage male responsibility?
Ensuring male responsibility means changing male consciousness and perceptions about
their sexuality. This is critical to “humanise” relationships51 and to prevent the spread of
f'Safer Sexual Practices in the Context ofHIl'/AIDS, A.Bhaiya and S. Dhar, UNIFEM, 1999.
HIV/AIDS between men and women. The stereotyped perception about male sexuality
relates to the fact that men are expected to be physically strong, daring and virile. Some
of these expectations translate into risky behaviours. Since men, in almost every part of
the world, tend to have more sex partners than women, they have to be encouraged to
adopt positive behaviours and play a much greater part in caring for their partners and
their families. Stereotyped perceptions that it is ‘unmanly’ to worry about drug related
risks or to bother with condoms need to be revisited and discussed in safe and non
threatening forums for men. The approach should be not against men but against
patriarchy. Blaming individuals or groups has never been a successful way of encouraging
greater involvement and responsibility.
6. How can we build group consciousness effectively?
We can build group consciousness effectively by providing time and space to groups of
men and groups of women or even groups of men and women to re-examine their lives
critically and collectively. They should also be given safe forums for a creative expression
of their analysis and the beginning of a new discourse. A cultural forum is usually the
most non-threatening space for this kind of expression. External change agents are
normally needed to initiate this process of consciousness building. These change agents
are not part of the community and so can enable the groups to look at old problems in
new ways, to recognise their strength and potential, to alter their self image, to access
new kinds of knowledge and skills and initiate a joint action aimed at gaining greater
control over existing resources. The ultimate aim for such an exercise should be mass
mobilisation to support the new discourse and a wider articulation of the collective
learning generated in this process.
All of the above questions—or variations on them—will arise as NGOs conduct
training to empower women to negotiate safe sex with their partners, thereby
contributing towards the prevention of HIV/AIDS across the globe. Strategies that
emerge will vary for different countries and different communities, but essentially they
will all have to be placed within a larger strategy in which economic security and
protection of existing relationships and sexual partnerships is ensured.
35
REFERENCES
Abha Bhaiya and Suneeta Dhar. Safer Sex Practices in the Context ofHIV/AIDS Challenges Issues
for Women's Empowerment. Internal UNIFEM Report, New Delhi, 1999.
All India Institute of Hygiene and Public Health, A Dream, a Pledge, a Fulfilment—A Report on the
SHIP Project 1992-1997, 1997.
Bruyn, Jackson, Wijermars, Knight and Berkvens. Facing the Challenges of HIV/AIDS/STDs: A
Gender-based Response. Royal Tropical Institute and SAIFADS, The Netherlands, 1998.
Charlotte Faty Ndaiye. The Female Condom. Internal UNIFEM Report, 2000.
Cristiane S. Cabral. “Women Between Motherhood and AIDS,” Latin American and Caribbean
Women’s Network Journal, No. 3, 1998.
Durbar Mahila Samanwaya Committee. The Fallen Learn to Rise—A Report on the Social Impact
of SHIP. June 1997.
KIT and SAFAIDS. Facing the Challenges of HIV/AIDS/STDs: A Gender-based Response. The
Netherlands, 1998.
Madhu Bala Nath. Gender, HIV and Human Rights: A Training Manual. UNIFEM New York, 2000.
Narain J. HIV/AIDS and Sexually Transmitted Diseases—An Update. WHO Regional Office, New
Delhi, 1999.
Niang. Sexual Negotiations and the Use of the Women’s Condom, in Kolda and Kaolack,
Senegal, 1996.
ODA Health and Population Occasional Paper Sexual Health and Care: Sexually Transmitted
Infections— Guidelines for Prevention and Treatment by Michael Adler, Susan Foster, Dr. John
Richens and Hazel Slavin. Published by ODA, October 1996.
Peter Gordon and Carolyne Sleightholme. Review of Best Practices for Targeted Interventions.
Second Draft Report. Submitted to the Health and Population Office, Development Cooperation
Office, Delhi, India. Published by International Family Health, London, 1996.
Reid E. Placing Women at the Centre of the Analysis. UNDP, 1990.
Roger Fisher and William Ury. Getting To Yes. Penguin Books, USA, 1991.
Solon and Barrozo. Economic Implications of AIDS in Asia. Eds., Bloom and Lyons, UNDP 1993.
Society for AIDS in Africa. Myths and Sexual Practices: A Gender Approach to Analysis of the
HIV/AIDS Epidemic in Senegal. UNIFEM, 1999.
UNAIDS. Intensifying the Global Response to the HIV/AIDS Epidemic. UNAIDS, September 1998.
UNAIDS. Report of the Global HIV/AIDS Epidemic. UNAIDS, June 1997.
UNAIDS Report.
Joint Response to AIDS. UNAIDS, October 1999.
UNAIDS Fact Sheet. UNAIDS, December 1996.
UNAIDS. AIDS Epidemic Update. UNAIDS, December 1998
United Nations. The World's Women—Trends and Statistics. United Nations, New York, 2000.
WHO/UNESCO/UNAIDS. WHO Information Series on School Health—A Resource Package for
Curriculum Planners. WHO, Geneva, 1999.
WHO. The Female Condom—An Information Pack. WHO, Geneva, 1997.
APPENDICES
Appendix I:
Skill of Active Listening—Developing Group Work
Related to HIV/AIDS
38
Appendix II:
Skills of How to Talk about Sex and Sexuality
40
Appendix III (a):
Skills to Make your Emotions Explicit—Using Stories to
Explore Gender, Sexuality and Sexual Health
42
Appendix III (b):
Skills to Make your Emotions Explicit—You Decide
44
Appendix IV (a):
Building Self-Esteem and Learning to be Assertive—
Am I Assertive?
46
Appendix IV (b):
Building Self-Esteem and Learning to be Assertive—
Responding to Persuasion
48
Appendix V (a):
Clarifying Perceptions—Questionnaire
50
Appendix V (b):
Clarifying Perceptions—Using Picture Codes to Assess
Everyday Experiences
51
Appendix VI (a):
Acting out Problems and Solutions
53
Appendix VI (b):
Helping Sexual Partners to Put themselves in Each Others
Shoes—He has HIV/She has HIV
55
Appendix VII (a):
Focussing on Interests and Inventing Options for
Mutual Gain—What’s Next?
57*
Appendix VII (b):
Focussing on Interest and Inventing Options for Mutual
Gain— Negotiation Role Play
58
Appendix VIII:
Dealing with Threats and Violence
60
All exercises in the appendices have been takenfrom existing materials. We havefound them extremely
useful in our work, and would like to thank the respective authors for their contributions.
Appendix I
Skill of Active Listening
Developing Group Work Related to HIV/AIDS
In working with adults or youth we need to remember that:
Information provision alone does little to help people change
behaviour.
We need to work with people rather than talk at them.
People already have their own values, knowledge, ideas and
experience. We should work with these, not against them.
We need communication methods to engage people actively
in their own exploration and learning, building on what they
already know.
LISTENING SURVEY
Before starting group work, it may be a good idea to undertake a
listening survey to find out what people’s main concerns are about
a given problem or situation. How do they deal with it or what
prevents them from coping? This means spending time informally
with people as they go about their daily business, e.g., in pubs or
at the bus stop, work, marketplace.
QUALITIES AND APPROACHES OF FACILITATORS
Facilitators should:
Be friendly, welcoming and communicate well.
Be aware of their own values, beliefs and ideas not allow
their personal likes and dislikes to influence the group.
Accept without judgement values, beliefs and ideas which
differ from their own.
Be aware of and honest about the limits of their knowledge
and skill.
Be sensitive to the needs of different group members.
Use appropriate language, dress suitably and act in culturally
sensitive and appropriate ways.
Help even the shyest members to participate actively and
prevent stronger group members from dominating.
Help group members explore issues and discuss problems
and solutions rather than “give them the answers”.
Be confident enough to accept criticism and change methods
that do not work well; be flexible and adaptable.
Avoid giving sensitive information learned during group
discussions to others.
PREPARING FOR GROUP WORK
Be clear about the objectives of the work.
Establish an appropriate group, taking into account: the
objectives; the group’s membership, size, availability;
resources needed; venue; time; length and frequency of
sessions.
It helps to offer refreshments.
38
CONDUCTING A
LISTENING SURVEY
Time needed
at least half a day.
Objective
e.g., to assess current awareness
and understanding of HIV/AIDS,
attitudes to sexual practices and
behaviour.
Activities and orientation
»
Work with a colleague if
possible but pretend you do not
know each other.
»
Start a discussion on AIDS
by making a comment that
provokes a reaction.
»
Listen carefully to what
people say; show interest but keep
silent where necessary.
»
Do not judge, criticize,
interrupt or argue.
»
Keep discussion going
through appropriate
encouragement, i.e., nodding,
smiling, verbal encouragement.
»
Try to isolate the main
problem, finding out people’s main
concerns; encourage debate.
»
Show warmth, support,
understanding.
»
Be patient, take time.
Afterwards: record the main
comments, feelings, views and
ideas expressed. Highlight the
problems people mention and
solutions they identify, taking note
of what issues aroused the most
emotions, debate and concern.
Make sure the venue is quiet and free from interruption; it
should be comfortable, feel safe to the participants and be
easy to reach.
Remember that the group may include people living with
HIV/AIDS or who have relatives and/or friends already
infected or who have died of AIDS.
ORIENTATING A GROUP
You need to help people feel both relaxed and involved:
Acknowledge that you are going to focus on sensitive issues;
seek permission from the group to do this.
Encourage everyone to respect each other; say that different
views are welcome and should not be ridiculed.
Seek agreement from all participants that anything personal
said in the group will remain confidential.
Acknowledge that people may feel shy at the start: introduce
a warm-up exercise.
SELECTING ACTIVITIES
Many different activities can be undertaken; only a few are
described in the other cards of this resource pack. Activities
should be selected on the basis of:
Appropriateness to the objectives of the group meeting
(although many activities can be adapted to meet a wide
range of objectives)
Sensitivity to the skills of the group (e.g., avoid written
exercises if group members may be illiterate)
Awareness of how sensitive a topic if for a given group;
highly sensitive topics may require less threatening activities
that do not involve direct personal disclosure
The nature of the group: is it mixed male and female; do
people already know each other or are they related; will they
see each other outside the group; how old are they; how
homogeneous or diverse are the members; what is their level
of education; what is their culture like; what are the conditions
of their daily lives?
EVALUATION
Activities should be evaluated so they can be repeated or improved
another time. Simple evaluation methods are shown at the right.
WARM-UP EXERCISES
“
»
Ask people to tell their
expectations of the activity you will
be doing, what they most want to
gain from participating. Afterwards,
ask how far their expectations
were met.
»
Paired introductions: each
person talks for a few minutes
with another group members; then
each introduces their partner to
the group.
»
Form a circle and have
people throw a ball (or other
object) to each other, calling out
their name as they do so. When
everyone has called their name
two or three times, ask them to
throw the ball to each other
naming the person to whom they
are throwing it.
»
Ask each person to say (or
write) one word that describes
how they feel at that moment. You
could also ask people to say one
word on their feelings at the end
of the group session and see how
their feelings have changed.
»
Organize a fun session early
Aon, e.g., brainstorming words for
sex and sexuality.
»
Ask everyone to write down
or say one short phrase summing
up their feelings about the
activity.
»
FOLLOW-UP
The ideal is to be able to organize a series of group meetings over
a period of time. This allows people to reflect on things they have
learned, explore new ideas and actions, and gain feedback,
reinforcement and further help with new problems that arise.
Often only one meeting may be possible, perhaps only a oneday workshop. However, you may be able to help people obtain
further information and support by providing factual leaflets, for
example, or recommending agencies that provide information,
counselling, spiritual support, practical help, medical treatment or
other services.
-
Ask everyone to note down:
what they found most useful/
interesting
what they liked least
what they would like to
explore further.
»
Ask everyone how far the
activity met their expectations and
why (or why not). Ask them to
suggest ways to improve the
activity.
Source: Facing the Challenges of HIV/AIDS/STDs: A Gender-based Response. KIT and SAFAIDS, The
Netherlands, 1998.
39
Appendix II
Skills of How to Talk about Sex and Sexuality
SEX AND SEXUALITY: A CONCEPT CLARIFICATION ACTIVITY
Many traditional cultures try to protect young people from premature sexual experiences by making taboo
virtually all discussion of sex and sexuality until marriage. The secrecy and embarrassment that come to be
associated with sex often prompts them to find other ways of accessing the information they want. However,
piecing together what they learn from movies, TV, print media, or clandestine discussion with their peers,
seldom equips young men and women todeal with the pressures associated with their own sexuality, including
the physical and emotional changes occurring within their own bodies and in their relationships with others:
peers, family and adults. Girls in particular are likely to have low self-esteem with regard to their sexuality
and helping young people to be comfortable talking openly and honestly about sex and sexuality can be critical
in developing self-worth, mutual trust and negotiating skills.
Purpose: To enable participants to:
1.
share and understand why people may not be comfortable talking about sex.
2.
explore some of the reasons for the secrecy surrounding sex and the perception of sex as dirty or
immoral.
3.
examine why women in particular tend to have negative feelings about their own bodies and to deny
or be unaware of their sexuality.
4.
consider the extent to which such attitudes may influence women’s judgement in sex-related matters.
Time: 1 to V/2 hour
Materials: Flip Chart paper. Markers
Procedure: If participants are literate, write the following three questions on three different pieces ofchart
paper before the session starts and paste them all on the wall. If they are not literate, simply ask the questions.
Key Questions: Recall the first time you heard the word “sex”.
How old were you and how did you feel about discussing the subject?
Recall the first time you asked someone about sex and under what circumstances. How did this other
person react to your question? Was your discussion in private or among others?
Have you ever seen yourself naked in front of a mirror? What were your feelings about your body?
Recall the first time you asked someone about sex and under what circumstances. How did this other
person react to your question? Was your discussion in private or among others?
Have you ever seen yourself naked in front of a mirror? What were your feelings about your body?
Ask each participant to turn to the person on his/her right and discuss the above questions with each other
for five minutes.
Then ask whoever volunteers to share their experience with the whole group. If no one is willing to speak
out, ask each person to talk very briefly about their own or their partner’s experiences (with their consent!).
Encourage the group to share thoughts on any societal mores that inhibit discussion of sex and sexuality.
They should focus on the similarities across their experiences: e.g., girls are told not to play with boys after
the onset of menstruation; before marriage a girl is usually told that her husband would “know what to do”;
and in schools, teachers, more often than not, skip the chapter on reproduction and ask students to study at
home.
Facilitate a discussion on the following issues:
40
What sexual information do you feel you lacked as a child? As an adolescent? Today?
Why is it important to know that information?
Did you have access to that information?
Would you have felt differently about sex? About yourself?
What might you have done differently had you known before?
What sexual information do you still lack today?
Conclusion: After participants have freely expressed their views, you may wish to provoke further
reflection by offering some tentative ‘conclusions’ of your own, preferably in direct response to participants’
contributions and the themes which emerged in the discussion. For example, trainers may wish to emphasize
that while sex is linked to procreation, it is not limited to it and potentially, sex can be a pleasurable experience
for both partners. Women should be encouraged to recognize and respect themselves as sexual beings and
overcome their reluctance to talk about their own sexuality.
j
Source: Strengthening Community Responses to HIV/AIDS. UNDP HIV and Development Programme^ New
York, 2000.
41
Appendix III (a)
Skills to Make your Emotions Explicit
Using Stories to Explore Gender, Sexuality and Sexual Health
TARGET AUDIENCE: COMMUNITY-BASED ORGANIZATIONS
/pinv?16 hkely t0 lnC,ude: associat‘ons of people living with HIV/AIDS
SPS COn,Cerned wi,h sexual a"d reproductive health women’s
he 1th, advocacy and rights groups, religrous and church-based g ouXh
“Xw“v'’
■
OBJECTIVES
Most people like listening to stories wherever they live so stories are an
entertaining and dynamic way to explore and challenge various conditions
-
-
explain that most women are at greater risk of HIV/STD infection than
most men and provide information about HIV/STDS
Discover and discuss how women are caught up in a web made up of/
landed Pe°iP e and their mterests (husbands. fathers, lovers, bosses
“xSpr™"''po“"!
-
Stimulate discussion, listening and drama skills
Link up with existing PHIV associations and find
ways to work
together. These voices are important.
EXSS
rietS SUT
ted will
herebe’ each
groupfocus.
or facilitator
lecides which of the ob°
objectives
above
the main
Sample
discussion questions
-J are listed at the end.
'
SITUATION STORIES: LISTENING AND ACTING OUT
The following two stories present different situations in which a vn„n»
woman may be exposed to risk of HIV/STD infection and violence Aftef
he facditator tells each story in her own words, small groups of 4 i 5
9Z
'iTyaA
DRAWING A LIFELINE:
MONDAY’S STORY
This is a woman-centred,
self-discovery exercise.
Ask participants to reflect
on the sexual life of an
I imaginary local woman
(Monday) from birth to old
age by drawing a line
showing her different
years of life. Important
i events and influences can
I be shown by symbols and
pictures, with happy ones
above and sad ones
below the line. The lifeline
can be drawn on a board,
paper or the ground with a
stick (sample below).
I
When they are done,
ask each person to tell
another participant
Monday’s story according
to the lifeline. Then the
stories can be discussed
in the larger group. Does
anyone think her story is
exceptional? Allow people
to express their feelings
about it. Then list
Monday’s health and other
needs and discuss how
these could be met.
/l kflux.
/ll/ZK h4j/
/X Met’
Gurla^
------
$
h'ykts
I--------------------- 1-----------
o
S
«
*°
AIom<
"to tMaCt ud
42
participants could act them out. There will be different versions of the same
basic stories, with different negotiations and endings. Participants may also
introduce other characters (e.g., sistersi or health workers) who may lend
support and have other ideas.
ANGIE’S STORY
Angie is 15. She lives close to the border with her mother,
grandmother and 5 younger sisters and brothers. Her father died
four years ago and she has not been to school since. People
say her mother should remarry but she doesn’t want to. Angie
works very hard, looking after the family and helping her mother
farm and sell vegetables at the roadside. Sometimes, a man in
a car will stop, buy something and tell her how lovely she would
look if she had a nice dress and new shoes.
When it is time to plant, Angie’s mother is not well and she
cannot manage this, even with Angie’s help. At church, they see
their neighbours, most of whom are poor farmers. Some, like Mr
Sam, are in business. Mr Sam promises to visit them. When he
comes the children are excited because he brings drinks and
biscuits. They talk about the farm and he says: “Maybe I can
help you? I pay two men to help with my digging. I will ask one
of them to come and see you when he is finished."
Angie’s mother is grateful. Mr Sam says: “What are
neighbours for, if they cannot help each other? I am sure there
are things you can do for me.” He puts his arm around Angie.
“Such a pretty girl. And she works so hard here. I have an idea.
What if Angie came to my house to help my wife? She’d get a
new dress and some things to take home from the market. You’d
like that, wouldn’t you, Angie?” Mr Sam and Angie smile at one
another. Angie’s mother and grandmother look at both of them.
When Mr Sam leaves, the three women discuss his offer.
JOAN AND EMMANUEL’S STORY
|
Emmanuel gained the respect of his community when he was
arrested for organizing a protest over poor conditions in his
workplace. People consider him a “real man" but for some time
he has been beating his girlfriend, Joan, because she won’t
have sex with him. When he is drunk, he may also flirt with her
sister. Joan, a student nurse, knows how HIV/STDS can be
transmitted. Emmanuel travels and often spends nights away;
shes sure he is not always alone. Joan has heard rumours that
Emmanuel has HIV. She says she will have sex with him if he
wears a condom; if not, may be they could try other ways of
feeling good together. Emmanuel is angry, saying that she
doesn’t love him any more and that using a condom means
there is no trust and little pleasure. Joan disagrees. For her,
safer sex means caring for the other person and finding new
ways of giving pleasure to one another.
Discuss how stories with different
decisions and endings have different
consequences. Two groups with
contrasting stories could act out
their versions in front of the whole
group. Discussions could focus not
only on what risks of infection the
women may encounter but also how
these situations affect their rights.
SUGGESTED QUESTIONS AND
ACTIVITIES FOR GROUP
WORK
- Is it difficult to talk about or
listen to these stories?
- Do you think it is important to
talk about these things, even if
it is difficult at first?
- What do you think are the
health needs and risks for each
person at particular points in
the stories?
- Are there other needs?
- Are these needs catered for
locally at present?
- How could a health or
development worker help?
- What information, services and
support do these stories show
the participants, particularly the
women, need?
- What activities can group
members cany out using these
stories - like discussing a
lifeline or health risks with 3
sister or a cousin?
- How can the participants
organize and campaign for
changes that will make their
lives safer?
NOTE: similar stories could be used
to promote discussion among
men.
Source: Facing the Challenges of HIV/AIDS/STDs: A Gender-based Response. KIT and SAFAIDS, The
Netherlands, 1998.
43
Appendix III (b)
Skills to Make your Emotions Explicit—You Decide
You Decide
Why?
How?
Boy/men often have different ideas about sex from
girls/women. Most of these are old ideas and need to
be changed. In this activity you get a chance to
change the old ideas to new ones.
1. Circle A (agree) if you think the statement is
correct or right for you.
2. Circle D (disagree) if you think the statement is
incorrect or wrong for you or is not the right way
to think.
1
2
3
4
5
6
7
8
D
D
D
D
The success of an evening out with a young woman/ young
man can be judged by how sexual it was.
When someone says “No” to sex, it means that he/she does
not like the other person.
If a lot of money is spent on a date, sex should be given
in return.
When a girl/young woman says “no” to sex, it really means
“maybe”, and “maybe” really means “yes”.
A real man is one who has had sex with a woman.
D
D
D
D
Someone who dresses in a sexy way wants to have sex.
If a girl/boy accepts an invitation to go to somebody’s
house alone, she/he would be expected to have sex.
It is the woman’s responsibility to decide how sexual a
relationship becomes.
44
! >
You Decide
New statement
3. Finally, write a new statement that you think would
be better for both boys/men and girls/women.
The success of an evening out should be judged on...
When a person says no to sex, it means...
If a lot of money is spent on a date it does not mean...
No to sex really means...
You are a real man if...
If someone dresses or acts in a sexy way...
If a person wants to go to someone else’s house when there is no one else home...
It is...
... responsibility to set sexual limits
Source: WHO Information Series on School Health—A Resource Package for Curriculum Planners. WHO
Geneva, 1999.
45
Appendix IV (a)
Building Self-Esteem and Learning to be Assertive—Am I Assertive?
Am I Assertive?
Why?
How?
You are assertive when you stand up for your personal
rights without putting down the rights of others. If you can
do this you will be able to: 1) Say “no” without feeling
guilty; 2) Disagree without becoming angry; 3) Ask for help
when you need it. As a result you will feel better about
yourself and have more honest friends and relationships.
Your teacher will help you to
understand these three types
of behaviour.
Passive
•
•
•
•
•
Take no action to assert your own rights
Put others first at your expense
Give in to what others want
Remain silent when something bothers you
Apologize a lot
Assertive
'Ti
•
•
•
•
•
Stand up for your own rights without putting
down the rights of others
Respect yourself as well as the other person
Listen and talk
Express positive and negative feelings
Be confident, but not “pushy”
Aggressive
• Stand up for your own rights with no
thought about the other person
• Put yourself first at the expense of others
• Overpower others
• Get your own goals, but at the expense ofothers
46
Assertive Messages
Why?
How?
To be assertive you must first learn the skills. The first time you
do this, it will be difficult. As you practise, it will be easier and
feel more natural. Here are the four steps in making an
assertive message.
Your teacher will explain the
various- steps in making an
assertive message.
Money problems
Joccai and Mannu are good friends. Joccai has a part-time job after school and he has lent money to Mannu
on previous occasions. Lately Joccai has noticed that Mannu is becoming slower to pay the money back. Joccai
decides to discuss this matter with Mannu after school and to ask that Mannu pay the money back sooner.
Steps to deliver an assertive message
Words you might say
Message
Step
Description
1. Explain
your
feelings
and the
problem
State how you feel about • I feel frustrated when...
• 1 feel unhappy when...
the behaviour/problem.
• I feel... when...
Describe the behaviour/ • It hurts me when...
problem that violates your • I don’t like it when...
rights or disturbs you.
I feel as if I’m being used when I lend you
money and don’t get it back right away.
2. Make
your
request
State clearly what you • I would like it better if...
would like to have happen. • I would like you to...
• Could you please...
• Please don’t
• I wish you would...
I would like it better if when you borrow
money you would give it back as soon as
possible.
3. Ask how
the other
person
feels about
your
request
Invite the other person to • How do you feel about Is that OK with you?
express his/her feelings or
that?
thoughts about your • Is that OK with you?
request.
• What do you think?
• What are your thoughts
on that?
• Is that alright with you?
Answer
4. Accept
with
thanks
O'
V
Ya, I guess you’re right. I’m not too good\
The other person indicates The other person responds. at getting money back right away, but I’ll
his/her feelings or thoughts
return it sooner next time.
about the request.
Thanks for understanding. Let’s go and listen
If the other person agrees • Thanks
to the music.
with your request, saying • Great, I appreciate that
“thanks” is a good way to • I’m happy that’s OK with
end the discussion.
you
• Great
Source: WHO Information Series on School Health—A Resource Package for Curriculum Planners. WHO
Geneva, 1999.
47
Appendix IV (b)
Building Self-Esteem and Learning to be Assertive—Responding to Persuasion
Responding to Persuasion
Why?
How?
Developing an assertive
message as a class will help
you understand the steps in
responding to distracting or
persuading statements.
As a class you will, in this activity, develop an assertive
message to use with someone who is trying to get you to do
something you don’t want to do. Use the situation on the
next page. This will help you make your own message in the
next activity.
Steps
Words you might say
1. Explain your feelings
and the problem
•
•
•
•
•
2. Distracting statements
Other person tries to get you off topic.
3. Get back on topic
• Please let me finish what I was saying...
• I’d like you to listen to what I have to say...
4. Make your request
•
•
•
•
•
I would like it better if...
I would like you to...
Could you please...
Please don’t...
I wish you would...
5. Ask how the other person
feels about your request
•
•
•
•
•
How do you feel about that?
Is that OK with you?
What do you think?
What are your thoughts on that?
Is that all right with you?
6. Persuasive statement
Other person tries to get you to change your mind.
7. Refuse
• No, no, I really mean no
• No, no and I’m leaving
• No, I’m not going to do that
I feel frustrated when...
I feel unhappy when...
I feel... when...
It hurts me when...
I don’t like it when...
Delay
• I’m not ready now - may be later
• Maybe we can talk later
• I’d like to talk to a friend
Bargain
• Let’s do... instead
• How about we try...
• What would make us both happy?
48
What are the advantages of being assertive?
•
Can say “no” without feeling guilty
•
Ask for help when needed
•
Avoid arguing
•
Have better relationships
•
Others will respect you
•
Disagree without becoming angry
•
Feel better about yourself
•
Have more friends
•
Have respect for yourself
Source: WHO Information Series on School Health—A Resource Package for Curriculum Planners. WHO
Geneva, 1999.
49
Appendix V (a)
Clarifying Perceptions—Questionnaire
AGREE OR DISAGREE
1.
Cultures in many parts of the world consider female ignorance of sexual matters a sign of purity.
2.
Because ignorance is construed as a sign of weakness, male gender norms often prevent men
from admitting their lack of knowledge and seeking out correct information regarding HIV/AIDS
prevention.
3.
Children represent a definition of self worth and social identity for many women around the
world and so non-penetrative sex and use of barrier methods like condoms present difficulties.
4.
Multiple sexual partnerships are accepted/condoned for men in many societies.
5.
Sex between men is socially stigmatizing and in many cases illegal and so contributes to the
inability of those men to be reached with information and services to reduce their personal
vulnerability.
6.
Modesty and virginity as a value is central to the image of womanhood.
7.
There is no positive language for sexuality. For example, Mexican women asked to name the
parts of their bodies could find no word for the vagina except “la parte” or the part.
8.
Behaviour change strategies that do not address socio-cultural norms, are not likely to be
effective in preventing the spread of the epidemic.
Source: Gender, HIV and Human Rights—A Training Manual. UNIFEM, New York, 2000.
50
Appendix V (b)
Clarifying Perceptions
Using Picture Codes to Assess Everyday Experiences
WHAT IS A PICTURE CODE?
A picture code is an illustration showing a theme about which a group or community may have strongfeelings.
It presents a picture dealing with a common experience in everyday life. It is designed to raise questions and
hence awareness. Picture codes could be developed after a listening survey to ensure they reflect a realm
problem or situation.
----------------------------------------------------------------------»
Picture codes are not the same as posters. Posters
given information, raise awareness or propose
solutions to problems. A picture code illustrates
a problem and has no caption. Picture codes
make people think about a situation and
encourage discussion and debate. Samples are
shown on the back of this card.
What is happening in this picture?
This and related questions should lead to simple
description, not analysis of the picture.
»
What feelings are involved?
This (and related questions) probes for analysis.
USE AS A GROUP ACTIVITY
Used in a group, a picture code may:
raise questions, e.g., at the start of a
problem-solving session
generate discussion
stimulate interest
help people solve problems.
»
Why are the people (is the person) doing this?
»
Does this happen in everyday life?
Help the group explore the action or situation
shown. Where does it happen, how often, what
leads to it, etc.? The aim at this stage is to ground
the picture in reality.
USING PICTURE CODES FOR
PROBLEM-SOLVING IN A GROUP
A small group is convened, usually between
5 to 10 people.
You need an appropriate picture code. It
must be large enough for all the group to
see easily. Put it on the wall, nail it to a tree
or lay it on the ground.
Give the group a few minutes to look at the
picture and think about it.
Guide the group through a series of
questions, with enough time for discussion
between each question.
What problems arise from what is happening
»
(or from the situation)?
Help the group discuss related issues, moving away
from a focus only on the picture code itself.
»
What are the foot causes of this problem?
<
Challenge the group to analyse the deeper basis of
the problem and what prevents change.
Using the basic steps and questions shown at the
right, the facilitator should formulate further
discussion questions according to the picture code
being used, the specific topic under discussion
and what is most relevant to the group.
»
What can we do about the problem?
This is the action planning stage. Help the group
debate different ways of dealing with the problem.
People may or may not relate it directly to their own
situation and what they personally wish to do. This
might be too threatening in the group although the
problem is relevant at an individual level.
It is also possible to use two picture codes
showing the development of a problem. The
participants say why and how one picture leads
to the next and then explore the problems raised.
51
UJW' (TO
S 8 3'4 3'
QUESTIONS
What is happening in each picture?
What feelings are involved?
Why is this happening?
Why are the people (is the person) doing
this?
Does this happen in everyday life?
What problems arise from what is happening
(or from the situation)?
What are the root causes of this problem?
What can we do about the problem?
Why and how does the situation in picture
1 A lead to the situation in picture 1 B?
Source: Facing the Challenges of HIV/AIDS/STDs: A Gender-based Response. KIT and SAFAIDS, The
Netherlands, 1998.
52
Appendix VI (a)
Acting out Problems and Solutions
Drama, or community theatre, involves groups ofpeople acting out in
a play day-to-day problems and possible solutions to these problems.
Local professional actors and/or community members may participate.
For a workplace drama, members ofthe workforce themselves could be
involved. A well-informedfacilitator is required to guide the process of
drama development and to ensure that appropriate messages are
incorporated.
The more participatory and relevant the drama, the more chance it has
of promoting communication, awareness and even behaviour change.
The drama can be performed in a local venue or out in the open, some
where people can reach easily and where they feel relaxed. Many work
places could provide a suitable venue. Management support should be
sought to perform a drama during the lunch break or even working
hours, or to use facilities after hours.
WHY USE DRAMA?
Drama is great fun! It combines education and entertainment. Drama
can be an effective channel to raise awareness and change attitudes and
behaviours by:
engaging people’s interest and emotions
involving local culture, language and relevant situations
reflecting social reality, addressing current conflicts and problems
using and building on local skills, using local people as actors
promoting dialogue and problem solving
presenting information in a non-didactic way
openly addressing and desensitizing difficult issues, e.g., commercial
sex, condom use, extra-marital affairs
creating a social climate for change, e.g., concerning women’s
rights.
Drama may:
»
pose a problem: e.g., women being blamed for AIDS
» expose the root of a problem: e.g., why men often seek
extramarital sex
» reach a solution: e.g., show how a wife or husband may
convince their partner to use condoms
» show the benefits of solving a problem: e.g., women
gaining inheritance rights through promoting the making of wills.
53
PREPARING A DRAMA
Key volunteers should carry out a listening survey to find outwhat problems most concern people
what they are saying about a particular problem
what worries them and prevents action to solve the problem
what they feel are the potential solutions.
The group then explores ways to approach the problem through
drama. Decisions must be made on:
a-hieveeCtiVeS °f
drama’ Wha‘ tO pOrtray’ what to
to
-
-
the key messages of the drama
time and venue for the presentation
the theme, story and sequence of presentation to meet the
objectives
the characters, dialogue and actions that should be practised
individually and in groups
how the group will seek feedback from the audience
whether (and how) to incorporate songs, slogans, puppetry
dance, etc. Puppets may convey sensitive issues well, for
example, or songs highlight key themes
making costumes, seeking props, etc. if needed.
After the drama the audience is invited to discuss the issues raised,
e -informed facilitators are needed to ensure that information is
accurate. The audience might also be invited to suggest changes
to the play s outcome. These could then be enacted with the new
solutions followed by further discussion.
PITFALLS TO AVOID
«
HOW DO WE MEASURE THE IMPACT OF THE DRAMA?
Feedback may be obtained by:
noting audience reactions during the play and their level of
participation
noting the types of questions asked by the audience
informal discussion and mingling with the audience after the
performance and at a later date
a further listening survey or observation to note changes in
attitudes or behaviour
a more formal evaluation in some situations, e.g., a drama
performed at school or work could be evaluated by a simple
written questionnaire in addition to the methods mentioned
above.
» If the drama is too
long people may lose
interest.
» Too much complexity
leaves people confused;
the main point may be
lost.
w Drama should not
reinforce negative
strereotypes, attitudes and
ideas. It should not
stigmatize individuals or
groups.
» Drama should not tell
people what to do.
Source: Facing the Challenges of HIV/AIDS/STDs: A Gender-based Response.
KIT and SAFAIDS, The
Netherlands, 1998.
54
Appendix VI (b)
Helping Sexual Partners to Put themselves in Each Others Shoes
________________ He has HIV/She has HIV*
He has HIV
She has HIV
You have tested positive for HIV. This
is a terminal illness. Be careful about
your health.
You have tested positive for HIV. This
is a terminal illness. Make sure that you
do not conceive as it will transmit to
your child and you will be the one to
blame for the misery which the child
will suffer. In case you are pregnant, it is
imperative that, you abort the child as
early as possible.
You should not fall sick. I will be by
your side. Your service is my honour.
You women with a large vagina. You
must be sleeping with someone else. You
are a curse to my life. You need not stay
here at all. Find a place for yourself.
You have brought us shame. It is better
that we keep the. family’s honour by
dissociating ourselves from you.
Please leave the house. Take your wife
and children with you.
We did not know that we were sheltering
a whore in this household. Leave the
children here and before the sun rises
tomorrow we do not want to see you
here. Even your shadow is doomed for
us. She leaves alone.
It is unfortunate that this has happened
to him. After all men will be men.
They do go around sometimes but such
misfortune does not strike everybody.
It is his karma. In any case a bull is
not a bull without scars.
The kind of karma she has indulged in
she has got away lightly by just being
thrown out. In our times she would have
been branded so as to be a lesson for
other girls to keep away from base
activities.
The employer learns about their
employees' HIV positive status
None of those interviewed had
revealed their husbands’ sero-status
to their employers.
Prior to receiving their HIV status, none
of the women had held jobs. Upon
learning their status, none of the women
had held jobs. Upon learning their status
and being kicked out of their homes the
women have looked for work with little
success. There is a deep fear of rejection.
The individuals begin getting
opportunistic infections
His wife has provided the medical
The woman is made to wait by the clerical
staff with extra money and favors in
staff, the nurses, and the doctor.
order for her husband to be seen by
the doctor. The doctor refuses I
knowledge of patients’ HIV status.
The Doctor breaks the news
Notifying
spouses
their
respective
The family learns of their HIV
positive status
The community learns about their
HIV positive status
Adapted after discussions with poverty-stricken women in India, some of them living with H/y/AIDS.
55
The need for medical treatment
arises
The inevitable happens—death
The family uses all of their savings
and his wife seeks additional jobs to
pay for the medications. She eats less
and cuts down the nutrition of her
children in order to be able to provide
medicines for her husband.
OR
In case they are living in an agricultural
subsistence economy in rural India
the burden of care for the husband
leaves very little time for the wife to
work in the fields. She grows tuber
instead of wheat or rice which is less
labour intensive and the produce is
inadequate to nourish either her or the
children.
The woman is left alone hearing the
inevitable from all quarters— “she will
also die soon”. The burden ofchildcare
and their survival lingers on... There
is a very bleak chance that she will
ever remarry—perhaps another man
with HIV. The question that arises is
will she want to go through it all again.
The need for medicine remains
unfulfilled. The issue of survival looms
large food and shelter are more critical
than medical care.
Or
In case that she lives in an agricultural
subsistence economy, her marginal land
is lying fallow and she is waiting for a
show of sympathy by the members of
the community to save herself and her
children from death.
The children wail. More orphans join
the children of the street.
Source: Gender. HIV and Human Rights-A Training Manual. UNIFEM, New York, 2000.
56
Appendix VII (a)
Focussing on Interests and Inventing Options for Mutual Gain
_____________________What’s Next?
What’s Next?
Why?
How?
Physical affection can be very sexually
arousing. The more sexually arousing the
activity is, the more likely it will eventually
lead to sexual intercourse. If you want to
delay sex, it is important for your and your
partner to know your limits...
Where should you stop before it leads to sex?
1. Place each of the sexual behaviours from
the list of “Physical affection activities” in
the appropriate level, from the one that is
least physical (1) to the one that is most
physical next to sexual intercourse (7).
2. Then answer the questions in “Teacher
asks”.
Physical affection activities:
MOTT
Teacher asks
1.
2.
3.
4.
Why is it hard to stop as you get closer physically?
Would it be easy to go back to a safer activity? Why or why not9
Where do you think the limit is?
3
Who should decide where the limit is? When should this limit be decided’
GenXa, ^99. 'nf°rmatiOn
SChO0, Hea,,h-A ReS°Urce P^ for Currieutu.n Planners. WHO
57
Appendix VII (b)
Focussing on Interests and Inventing Options for Mutual Gain
Negotiation Role PUr
In role-plays, people pretend they are in a icertain situation and act out how they think persons in that
situation would behave. The role-plays shown in the
---; boxes
can be played by facilitators or teachers or, after
instruction, participants.
NEGOTIATION
SCENARIO
NEGOTIATION ROLE-PLAY
Questions for discussion
What worked out in the negotiation? Why?
What would you do in the same situation?
Key points to address in the discussion
Negotiation involves making a mutual decision, i.e., going through
a decision-making process together. The couple considered their
different opinions together, without one simply deciding for both.
Negotiation also involves each person being able to express
herselfor himselfand each person listening to the other. Both need
to be respectful, caring and willing to compromise.
A A A girl goes to visit her
k boyfriend unexpectedly.
She wants to talk; he
wants to play basketball.
After discussion, they
plan to meet after his
basketball to talk.
CONDOM NEGOTIATION ROLE-PLAY
Questions for discussion
-
Is faithfulness (or trust or honesty) enough to protect people? Was
the girl right in suggesting condoms?
What worked well in resolving the problem?
If the boy respected the girl’s choice this time, is it fair to say that
next time she should do as he wants, if he doesn’t want to use
condoms?
Key points to address
-
-
The couple took time to think about their opinions before having
sex; they got advice from each other; they considered the
consequences oftheir different options. They listened and respected
one another: the boy agreed to the girl’s wishes, but she also
recognized his discomfort and tried to suggest ways they could
make the option more appealing for both of them.
Fairness is not simply a matter of alternating options when the
consequences of the options differ greatly, e.g., “this time we’ll
risk some discomfort and next time we’ll risk disease and
pregnancy”. This time the boy and girl concluded that the
consequences of sex without condoms (e.g., pregnancy, HIV/
STDS) are much worse than the consequences of sex with
condoms (e.g., adjusting to discomfort). The next time they want
to have sex, they may go through the decision-making process
again, but the great differences between these sets of consequences
will not change. If the potential consequences are so great, and two
individuals cannot reconcile themselves to the same option, they
may want to reconsider whether they want to be sexually involved.
58
CONDOM
J 4 NEGOTIATION
SCENARIO
A boy and girl want to
have sex. The girl
suggests condoms, but
the boy is against it. They
discuss why it is not a
matter of trust, but safety.
The girl encourages her
partner, saying that they
can make it enjoyable
through foreplay. The boy
agrees to try it.
ABSTINENCE NEGOTIATION ROLE-PLAY
ABSTINENCE
NEGOTIATION
SCENARIO
A girl and boy have
been involved for a few
months. They have not
yet had sex. He would
like to but she is
uncertain, saying that
she needs to wait until
she is sure. After some
discussion, he agrees to
wait.
Option A
They get into other
topics of conversation
and leave to meet
friends (implying that
they can still have a
good time together as
usual).
Option B
They leave to go have a
drink. After a couple of
beers, he tries to
seduce her. Though
feeling less confident,
she says that beer
should not make them
change their minds and
she suggests going to
sit with friends.
Questions for discussion
-
Is it all right for a girl to refuse sex with
with her
her boyfriend?
boyfriend?
Why did the boy agree? (For boys:) Would you agree?
Why or why not? What should the couple do if they cannot agree?
Do boys sometimes feel pressured to have sex before they are
ready?
Do boys prefer to marry a girl who is a virgin? Why?
If so, why do they pressure some girls to have sex?
Do girls think boys are always after sex and how do they feel about
For option B: What should the couple do when, after alcohol or
drug use, reasonable discussion becomes difficult?
»
Key points to address in discussion
—
-
Each couple needs to discuss and decide what is “right"for their
individual relationship, sexually or otherwise. There is no rule
about when a sexual relationship should begin (you could ask:
“What is the rule? Sex after one week? Or is it two months and
three days? etc.”).
Bling up the fact that boys also can be pressured into sex,
especially due to role expectations. Boys are often expected to lose
their virginity as soon as they get the chance, to want sex with a
girl whenever they can get it, or to have sex with a willing girl even
if the boy is committed in another relationship. People often think
that boys do not have the same emotional attachment to sex that
girls have, when in fact many boys do, and they may prefer to wait
for sex with a girl they care for and trust.
Discuss how it feels for girls being pressured into sex.
Discuss the influence of alcohol and drugs on previously made
agreements.
Source: Facing the Challenges of HIV/AlDS/STDs: A Gender-based Response. KIT and SAFAIDS, The
Netherlands, 1998.
59
Appendix VIII
Dealing with Threats and Violence
Dealing with Threats and Violence
Why?
How?
Women need to be aware of situations that may lead to violent
sex, and people who may put them in those situations. It is
important for you to learn ways of avoiding or dealing with
pressures and threats to have sex.
1. Read the story of Maria
2. Discuss the questions
under “Teacher asks”
After they had walked for quite a
while, Carlos started flirting and
talking about sex.
Maria was not prepared for this and
was silent and quite embarrassed.
This encouraged Carlos, who thought
Maria felt alright about having sex.
Maria had agreed to go for a walk
with Carlos along a country road.
V
As they reached an abandoned house,
he took Maria in and started touching
her. Nobody was nearby and Maria
got very scared.
She kept saying “no”, “no”, but Carlos
forced Maria to lie down and although
she fought, he was too strong for her.
<r
c
They had sex and Maria was left
crying and very worried.
i
Teacher asks
1.
2.
3.
4.
5.
Do you think that Maria could have been aware of what was going to happen?
What were the clues that could have told her?
Maria was silent and embarrassed when Carlos started talking about sex. What
could she have done instead of being silent and embarrassed?
What should she do now? Keep it a secret? Tell someone she trusts (parents,
teachers, religious leader)? Should she talk to Carlos about the matter? What
might happen if she doesn’t tell anyone about the situation?
List things you can do to help prevent violence and threats:
a) When you’re with someone who suggests having sex and you don’t want to.
b) When someone becomes physical and tries to force you to have sex.
What do you think about Carlos? Are there other men like Carlos? What should
he have done in this situation? Why did he do what he did?
Source: Gender, HIV and Human Rights—A Training Manual. UNIFEM, New York, 2000.
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