VIBHA MARFATIA

India,

Dr. Vibha Marfatia is working to create a network of peer educators to dispel myths about male sexuality and encourage responsible decision-making. Targeting migrant workers in India's diamond cutting and polishing industry, Vibha's program discourages risky sexual behavior as a way to control the spread of sexually transmitted diseases like HIV/AIDS.

This profile below was prepared when Vibha Marfatia was elected to the Ashoka Fellowship in 2002.

INTRODUCTION

Dr. Vibha Marfatia is working to create a network of peer educators to dispel myths about male sexuality and encourage responsible decision-making. Targeting migrant workers in India's diamond cutting and polishing industry, Vibha's program discourages risky sexual behavior as a way to control the spread of sexually transmitted diseases like HIV/AIDS.




THE NEW IDEA

Vibha works from the conviction that unless men are helped to break myths and address health concerns about their own sexuality and sexual behavior, they can never be responsible partners. Vibha is using a comprehensive approach to educate men on issues concerning male health. Vibha uses strategies like male meetings and male peer educators to create the comfortable environment necessary for addressing the traditionally taboo topics. Targeting diamond cutters and polishers, a group with high-risk behaviors in Surat, Vibha has created an alternative system to control the spread of HIV/AIDS. Vibha is also working with school authorities to introduce sexual education in all schools so young people can become informed at an early age.

Vibha's organization–Social Awareness for Health and AIDS (SAHAS)–has additional plans to convince policymakers and program implementers of HIV/AIDS programs to pay attention to the sexual health needs of men. Considering that HIV/AIDS is one of the most serious health challenges facing India and that nearly 80 percent of HIV infections are transmitted sexually, aggressive education and awareness programs are desperately needed. However, most programs designed to reduce the transmission of STDs and HIV are focused on women.

SAHAS will encourage other agencies working in similar areas to focus on the long-neglected sexual health needs of men. By transferring knowledge, technical capacity, and promoting advocacy between other major donor agencies and policymakers, Vibha hopes to sensitize men to take charge of their sexuality through a critical, autonomous, and responsible decision-making process.




THE PROBLEM

Most STD/HIV/AIDS intervention programs in India include preventative education but do little to provide opportunity for men to discuss anxieties related to sexual health. The programs are oriented toward women and reinforce gender roles that women are the carriers and the vulnerable group open to risky behavior. The male population, who also exhibit risky behavior and have their own sexual health concerns, are simply not addressed. This lack of communication, coupled with the social and cultural taboos surrounding sexual health, make a safe environment where men can begin to think about positive sexual health decisions a necessity. Men's attitudes and behaviors are particularly critical in terms of safe relationships between men and women and between men and men. Understanding how men view their sexuality and how it is expressed in their behaviors can increase the effectiveness of current strategies used in STD/HIV/AIDS control programs.

Surat City has a population that includes 3,000-4,000 migrant workers mainly from the Sourashtra region of North Gujarat. Diamond-cutting and polishing units sit behind the Surat railway station in an area known as "Mini Sourashtra" or Varachha. Some workers form the bridge population, carrying the epidemic from work back to their homes. The men, most of whom are illiterate, form the bulk of workers in these units and range in age from 17 to 45. They are hardly paid during their apprenticeship period, and after training they receive a monthly allowance of at least Rs. 4,000 ($84) for work hours that are long and tedious, usually 12-14 hour days. More than two-thirds of this population is single and those who are married often choose to leave their spouses back in villages they visit annually.

Workers live in close proximity to their peers and coworkers, often in overcrowded and unhygienic conditions. Lack of adequate leisure activities, boredom, and feelings of isolation leave them with few alternatives but to seek entertainment at the red-light areas and at local video parlors showing pornography, that sometimes leads to high-risk sexual behavior. Talking about sexual practices, health, and anxieties is infrequent and a cultural taboo. Lack of proper information and education about sexual health and the risks of contracting HIV/AIDS through unsafe sexual practices make these workers extremely vulnerable to infection.

Vibha sees that the need is apparent. "With my current focus on sexual health, particularly male sexual health, it is quite clear that many men would like to talk about sex, sexuality, and relationships but find it difficult," she says. "They often have concerns about how their body works but do not know where to find information." Many boys do not learn, for example, how women's bodies develop or how contraception works. Women typically rely on family planning clinics, yet men are expected simply to know about sex in a relationship and also about preventive methods. Men need to be given opportunities to discuss sexual health and sexual responsibility, and to find out about their role in reducing the incidence of unwanted pregnancy, STDs, and sexual abuse. Excluding men from sexual health promotion means that women often have to take all the responsibility for both partners' sexual health.




THE STRATEGY

One of Vibha's main strategies is to reach men through a peer network. Peer educators trained from the group of migrant workers offer powerful, affordable means of delivering health education messages. The male-focused program encourages discussion, dispels myths, increases awareness, and promotes responsible decision-making. A training module designed by Vibha has educated 120 peer educators-35 of whom are involved with the program. Peer educators hold counseling sessions at the workplace and often at night in their rooms. They also sell condoms and address crowds during breaks at film screenings at local video houses. Peer educators undertake house visits of patients suffering from HIV and guide them on nutrition, awareness, patient care, and counseling. They also facilitate couple meetings where couples with sexual problems and concerns can discuss them openly and be counseled by the peer educators.

Peer educators have recorded an increase in their confidence and in their zeal to work with their friends and coworkers. "Many of my friends are now regular condom users. Some of them have stopped taking chances with their lives," Harshadbhai, a peer educator with SAHAS says. "I am hopeful that one day we will be able to make our country AIDS free."

Vibha is encouraging peer educators to form an autonomous registered society that she feels will yield the final empowerment. A defined society will also make the educators' mission more sustainable and will help Vibha reach the goal of eventually covering a population of four million. Vibha also plans to get all diamond unit owners interested in her work as stakeholders so that the peer educators have the financial and institutional support they need.

Another one of Vibha's main strategies is to increase both male involvement and the general participation and discussion of men and boys regarding sexual health. Working with different groups of men, each with different needs (e.g., migrant men, men having sex with men, older men, adolescents), Vibha hopes to make it easier for couples to communicate and question a number of gender-based prejudices. Opportunities will be provided to listen to their concerns, demystify issues regarding sex and sexuality, and remove misconceptions. Setting up male-friendly health services, media campaigns to help spread basic information to men who may not be in touch with sexual health services, male support groups, gender sensitivity, and sexuality education for men and boys in and out of school are some of the methods that will be used.

Vibha also stresses the need to target young people as a key in the fight against AIDS. Over 50 percent of all new HIV infections occur among young people. Young people–defined as individuals between 15 and 24–are more likely to engage in riskier practices like not wearing condoms. That group, however, is likely to wield the most power in the future–both as individuals in their private lives and as leaders responsible for the communities in which they live. Their participation is key to reversing the spread of the epidemic. Catching young people while they are still learning about their bodies and their responsibilities to others makes more sense than trying to counter habitual attitudes and patterns of behavior when they are adults.

A strategy to introduce sexual education in all schools for wider impact has begun in eight schools in Surat City and in a community in the village of Udhna. Regular meetings are held with adolescents in and out of school where they are taught about their bodies, sex and sexuality, STD/HIV/AIDS, contraception, personal hygiene, problems of early pregnancy, nutrition, gender issues, and decision-making skills. The young people are encouraged to ask questions or drop them off in the question box kept in their schools. A telephone helpline has also been set up to handle questions on any of the issues. Some 1,900 young people have been reached in the first year of the program. Teachers and parents have been involved to help create a comfortable, learning environment. Vibha is planning to train teachers as peer educators to sustain the program in their schools. Out-of-school adolescents–15 girls and 28 boys–are being trained as peer educators to address substance abuse, sex and reproductive health, promotion of self-esteem, and decision-making skills.

Transferring knowledge and technical capacity to other agencies working in similar areas is Vibha's final strategy. SAHAS has already provided support to Anarde Foundation in Gujarat, in doing a needs assessment of industrial workers with specific inputs on planning, collecting data, and sensitizing. SAHAS has worked with other citizen organizations in the arena of sexual health offering training and technical support for taking up needs assessment studies with their target groups. Vibha is also part of the state-wide network working through advocacy, major donor agencies, and policymakers to look beyond condom promotion and treatment of STDs as part of behavior change strategy in sexual health interventions.




THE PERSON

Vibha's roots in the conservative Patel community of Gujarat, her early years in Uganda, and the challenges of being a minority in the small town of Colchester, England, opened her eyes to many cultures, ethnicities, and challenges. She joined nature clubs and was an avid trekker. On a backpacking trip to India after finishing her Ph.D. in Immunology in Rheumatoid Arthritis from London University, Vibha met her future husband, a businessman from Surat, a small town in Gujarat with the largest diamond-manufacturing units in India.

Vibha's early exposure to a multicultural world was seriously challenged when she married into a very conservative but supportive family. Here, women had to follow several restrictions and were not free to pursue a career. Vibha survived the early years by supporting a nature club for upper middle-class citizens of Surat. Her real challenge came when an organization called GAP came looking for people to train to work in an outreach program in the red-light district of Surat. Her background in immunology made her interested in HIV and AIDS and in 1995, she started visiting prostitutes and building rapport with them.

Vibha got a glimpse at the real problem when prostitutes noted that even if they promoted prevention by urging condom usage, it was the male clients who often continued to indulge in risky behavior. This helped Vibha realize the dire need for AIDS programs that focused on male sexual concerns and attitudes.

In 1997 the government identified Surat as one of the areas with a high number of HIV cases. Vibha was offered a job to start working with the migrant workers of the diamond industry. One of Vibha's challenges was to make all stakeholders in the project sit down together–diamond merchants, representatives from Surat Diamond Workers Union, doctors, DFID (U.K.'s Department of International Development) consultants, and respected members of the community–so she could explain the work she was undertaking. Vibha then set up Social Awareness for Health and AIDS, (SAHAS, meaning courage) along with four others took charge of the program.