Sorry, Dr Harsh Vardhan: Condom use can't be a 'morality' issue

“You don’t get bloody every size in India,” complains a friend. “That still doesn’t mean you shouldn’t use them,” I retort. “You don’t need them in all situations, not when you’re in a committed relationship,” he says. “I disagree, that’s when you need them the most,” I say. The conversation ends, but I feel like a failure for not having converted another person to my steadfast rule: Always use a condom. Not just in cases of casual sex, but also in a committed relationship. Why? Mostly because condoms are effective against HIV, AIDS, unwanted pregnancy and other STDs 97 percent of the time. Plus they make sure that if your partner does break your trust, you don’t end up with a broken heart and a sexually transmitted disease. Condoms are the cheapest, most effective tool for safe sex. It is and ought to be promoted by every health professional to combat AIDS, unsafe abortions, and every kind of STD – unless, of course, you are India’s new health minister Dr Harsh Vardhan. In an interview to New York Times he said, “The thrust of the AIDS campaign should not only be on the use of condoms. This sends the wrong message that you can have any kind of illicit sexual relationship, but as long as you’re using a condom, it’s fine.” And he’s already started to crack down on this excessive talk about condoms. According to Economic Times, Dr Harsh Vardhan, “has already issued orders to the National AIDS Control Organisation (NACO) advising them “to tone down the emphasis on use of condoms and instead promote morals to tackle the disease.” A message that is likely to be well-received since, according to the NYT piece, VK Subburaj, head of NACO the agency also thinks that the “moral fabric” of Indian society is “becoming very thin.” Subburaj also told ET that the emphasis on condoms will be there for high-risk groups like men who have sex with men, but “for the general public the minister has asked to stress on morals like being faithful, not indulging in pre-marital and extra-marital sex.” [caption id=“attachment_1178277” align=“alignleft” width=“380”] Representational image. AFP[/caption] The Health minister’s policy directive is both bizarre and ironic given that his Prime Minister spared no effort to promote the use of condoms and contraceptive pills in order to promote family planning in Gujarat back in 2006. As this Telegraph report from 2006 points out,

“Modi has lent his face to huge crates of condom and contraceptive pills that have suddenly appeared in every ration shop across Gujarat. The shopkeepers have been asked to open the boxes before every customer, man or woman, of the appropriate age and persuade them to take their pick. Early reports suggest that many customers have found the ‘gimmick’ in bad taste.”

Bad taste or not – and Modi condom jokes aside – the move suggested a commitment to contraception use that is laudable. Other than deterring unwanted pregnancies, AIDS, condoms also protects against other sexually transmitted diseases such as chlamydia, chancroid, gonorrhoea, hepatitis B, herpes, HPV (which can lead to cervical cancer in some cases) pelvic inflammatory disease (PID), syphilis trichomoniasis to name a few. And that isn’t to mention the benefit of safe sex without going on the pill, which can interfere with a woman’s menstruation cycle, hormonal balance, and have a number of unpleasant side-effects. For Harsh Vardhan to complain about an “over-emphasis” on condoms in 2014 is not just retrograde but near-unprecedented. Condom use has been aggressively promoted – including airing Nirodh ads on stuffy socialist era Doordarshan – by politicians as part of family planning campaigns. When morality wasn’t an issue for population control programs, why should it now become a part of a conversation about AIDS? To be clear, Harsh Vardhan is not against condom use per se. He’s just promoting a little bit of faithfulness, and that there’s nothing wrong with that. The idea of abstinence as anti-AIDS tool is nothing new. As Anjali Gopalan of Naz foundation, an organisation that works with HIV patients told Economic Times, “the idea of Abstinence, Be faithful, Use a condom (ABC) approach has been around for long, but doesn’t always work.” She also adds, “Just because condom is available, not everyone starts having sex. Either ways you need to promote condom use.” But the minister went far beyond the ABC model as a public health strategy to take a strong moral position, saying his ministry wants to promote “the integrity of the sexual relationship between husband and wife” as “part of our culture.” It is both wrong and dangerous to allow moral values – which may or may not be shared by others – to drive public health policy. And it is inevitably a recipe for failure, much like the Republican-era abstinence programs which abysmally failed to bring down teenage pregnancy rates. Health initiatives fail when they preach, they succeed when they educate. And any education about safe sex must necessarily emphasise condom use. Besides, all this talk about “our culture” ignores the stark reality of how Indians actually behave. We don’t need 4 Seasons of Emotional Atyachar to show us that Indians like to play the field. As author Ira Trivedi noted in Outlook , her extensive research reveals a nation in the midst of a major sexual revolution. “My findings included reports that premarital sex in urban areas is on the rise and is currently at an estimated 75 per cent in the 18-24 age bracket,” she writes, adding, “The changes that we see in Indian sexual culture today are the most significant that we have seen since colonial times.” Nor is this a new story. As Prabha Nagaraja, Executive Director, TARSHI told the ET, “Sex happens in India irrespective of cultural taboos as we have found in our work, especially the helpline that ran for 13 years (1996-2009) and attended to over 60,000 calls.” Now Harsh Vardhan may find these trends distressing, even appalling, but he must not use his position as Health Minister to fight them. It is simply not in his job description. Maybe it’s time his Prime Minister told him so.