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Facing HIV challenge through early intervention

Sep 01, 2013

A new study highlights the benefits of a holistic counseling based approach in preventing women’s sexual health problems.

New Delhi: An early and holistic intervention in married lives can help mitigate the risk of women’s sexual health problems according to a program and study implemented by International Centre for Research on Women (ICRW) and its collaborating partners.

The innovative project called RISHTA (Research and Intervention in Sexual Health: Theory to Action), the findings of which were released here today, was implemented in a slum community in Mumbai over six years. Designed to reduce the sexual risk and improve the sexual health of married women from low income communities, the study tested an approach that worked on the marital relationship supported by community intervention focused on gender equity to address women’s sexual health issues in an effort to prevent their potential negative consequences.

RISHTA (meaning “relationship” in Hindi & Urdu) used a multi-level approach with a view that bringing about changes in women’s attitudes must be accompanied by positive change in the marital relationship and community norms that perpetuate gender inequitable attitudes. The approach incorporated counseling on marital relations with women and group meetings of couples. It also included a community education component to target gender inequitable norms.  This approach was highly successful in reducing tension in women’s lives, increasing their negotiating power and involving male partners in their health and well-being.

Globally, marriage is seen as the greatest risk factor for women’s vulnerability to sexually transmitted diseases (STI) and HIV. Women are particularly vulnerable due to the patriarchy and gender inequity that dictates most marital relationships, limiting husband-wife communication, women’s ability to negotiate marital sex, and their mobility to seek testing and treatment.

As part of the project, married women were recruited based on complaints of gynecological problems, principally ‘vaginal discharge’ (safed pani). These women were then treated at the Women’s Health Clinic, set up especially for RISHTA at the municipal urban health center. Participating women were randomly assigned to individual counseling and to couples’ groups where husbands and wives participated in presentations, discussions and role plays on relationships, violence, sexuality and sexual risk.

The individual counseling helped women understand their issues and empowered them to deal with them effectively. According to a participant, “My husband used to be intoxicated a lot and would beat me when angry. But after speaking to my counselor, I began explaining things to him in a different manner and now the fights have reduced and we talk things out instead.”

“As women were put into discussions with our counselors, they would tell the story of their lives, and these discussions would tell a whole lot of things about how they understand their own risks and vulnerabilities,” explained Dr. Ravi Verma, Asia Regional Director, International Center for Research on Women (ICRW).

Trained counselors led group counseling sessions, which helped husbands and wives understand each other better and to learn how to live their married and conjugal lives in greater harmony.  Prof. Shubhada Maitra of the Tata Institute of Social Sciences (TISS) says, “When we brought the husbands and wives together, where both of them heard each other’s perspectives, it was an eye opening experience. It was informative for both of them to hear what each had to say about violence and other issues of tension and household responsibilities.”

A 30-year-old married woman further shares, “After participating in the group counseling sessions, my husband has not only stopped eating gutkha, he also respects my wishes and no longer forces sexual relations if I am not willing.”

One activity in the group sessions involved blindfolding one spouse while the other provided instructions, without touching, in how to move to avoid obstacles. One man who was guided by his wife stated that, I never saw so clearly as when I was blindfolded and had to trust my wife to guide me.”

To change community beliefs about the roles and relationships of men and women, the RISHTA consortium worked with local community-based organizations to conduct campaigns on gender and gender-based equity and spread awareness about the importance of improved marital communication through events and public information gatherings. In a unique move to target men in the community, the research team brought the Imams (Muslim religious leaders) on board to deliver messages concerning women’s health, violence, sexual risk about improved marital communication (the community is 80 % Muslim).

“We found that at the masjid (mosque) when many men gather to listen to the taqrir (lecture given by the Imam), which takes place before the Namaz, provided a good opportunity to share the RISHTA messages through religious leaders. Involving the Imams to design and propagate messages on marital communication, domestic violence, sexual risk, marital sexual relations, gender equality and women’s health was a very effective technique to change community norms, particularly among men”, says Rajendra Singh, project coordinator of ICRW.

The integrated RISHTA model showed multifaceted benefits at the end of the study period.

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