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Sexual Health Exchange, 1996 - no. 3

This section focuses on health promotion strategies, needs assessments, materials and methodology development and evaluation results.

India

The high prevalence of reproductive tract infections among lowincome women in India and their limited access to health services suggest that women may be particularly vulnerable to HIV. The low social and economic status of women and girls and their high rates of illiteracy and ignorance about sex and reproductive physiology further contribute to their risks of HIV infection. Early intervention, by targeting adolescent girls with family life and sex education as well as programmes to improve their selfconfidence and social status, may be an effective way to safeguard their future health status.

With this in mind, World Vision of India developed a model for an AIDS education programme targeting lowincome adolescent girls in Bombay. The project was implemented in three phases. During the preparatory phase, household surveys were conducted to gather background data about the girls' communities. Focus group discussions, interviews and observations gave insight into the daily lives, interests, sexual activities and health problems of adolescent girls and boys. In the second phase, an educational intervention was designed based on the information gathered in the preparatory phase. Finally, a oneday workshop was held to report on the project findings.

963IndiaThe NGO Kuleana in Tanzania uses T-shirts to help dissemi- nate the idea that girls should have the same rights as boys

 

 

 

 

 

 

 

 

The first phase of the project determined that for the girls to participate in the programme they needed:

  • the support and cooperation of their parents and the community at large
  • support services (such as child-care activities for their younger siblings) so as to lighten their heavy workloads
  • encouragement to talk to each other, express their opinions and build their self-confidence, and
  • discussion of issues related to women's status and rights rather than only focusing on HIV/STD prevention.

Drawing on these lessons, an educational intervention was developed that covered the following themes: being a woman, puberty in girls, human sexuality, sexual exploitation and harassment, the human immune system and health problems (with specific reference to HIV/STDs, women and AIDS, and the development of a plan of action to protect oneself against HIV infection).

The messages were conveyed in lectures, video films, plays, puppet shows, quizzes, story telling, role-plays and group discussions. Care was taken to create a conducive atmosphere by playing popular music, involving the girls in the registration procedures and personally escorting the girls to the educational hall. Incentives were also offered in the form of strings of flowers, name tags, quiz prizes, refreshments and certificates of attendance. Altogether 76 girls attended the sevensession course; their average age was 14 years.

At the same time as the girls' course, an AIDS awareness programme was conducted for the community, including community leaders, mothers of adolescent girls, young men and adolescent boys. A street play was used to dramatize the status of women at different stages of their life cycle.

A followup survey of the participants indicated that a higher proportion of girls reported correct knowledge about menstruation, reproduction and HIV/AIDS than in the baseline survey. About 83% of the girls reported that they had talked to others about a range of topics covered in the intervention; HIV/AIDS was discussed by the largest number of adolescents (62%), followed by menstruation (55%).

The project demonstrated that an AIDS prevention and education intervention for young girls can be successfully integrated into a lowincome community if the following elements are taken into consideration:

  • Where communities have yet to experience the impact of AIDS, and where women's vulnerability to the virus is greatly increased because of their low socioeconomic status, HIV/AIDS prevention education for girls must be set within a broader context of women's status and rights.
  • The intervention must include efforts to raise selfconfidence and improve communication skills, while providing basic family life education and education for sexual health.
  • It is critical that the education not be restricted to the young girls but involve and target the broader community as well. This is to ensure girls' attendance as well as to facilitate a wider climate for behaviour change.

The project highlighted the extent to which the young girls are shrouded in a culture of silence that encompasses many aspects of their lives. The difficulty in researching topics related to sexuality in adolescent girls in such a cultural context necessitates the use of multiple methods for data collection. Although this project provided some insights into this complex and sensitive issue, more work is needed to gain a better understanding of the social and sexual lives of adolescent girls and boys living in Indian urban slums.

To accomplish this, World Vision has continued the Women and AIDS project, working in the same area of Bombay with wider coverage of 21 slums and two industrial complexes. The educational programme covers four target groups, namely adolescent boys and girls, adult men and women. Detailed modules for specific target groups are being developed. The Family Welfare Training and Research Centre, Bombay, working under the Ministry of Health and Family Welfare, has proposed an action research project incorporating this education model. A model on the same lines is also proposed for adolescent boys.

    Indian slum girls' assessments of their own situation:

  • Of course, boys are given more importance in the house. After all, a girl is like a stranger, who lives in the house only temporarily (before marriage). The boy has a right over the house. It is not the same with the girl.
  • A girl has to be continuously working. That is why I always feel that being a girl means "work". I am fed up with working so hard.
  • A girl is beaten up by her father, mother and also her elder brother. A boy is never abused by anyone.
  • A good girl is one who does all the housework.
  • After all, we are girls. We will be criticized and get a bad name if we stay out till late night. So we stay home.
  • I am alone at home the whole day, so the question of talking to my mother does not arise.

Asha A. Bhende, Purnima, D12 Dattaguru Society, Deonar Village Road, Bombay 400 088, India; Tel: 9122-556-5143/556-9534; Fax: 91226482778


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