Straight outta India
In India, backward attitudes to sex, and homosexuality
in particular, make tackling sexually transmitted infections, including
HIV/AIDS, difficult. Balaji
Ravichandran discusses Indian
doctors' attitudes to non-heterosexuality
That homosexuality is
still a criminal offence under section 377 of the Indian penal code is a
sad reality. Perhaps what is even more sad is my observation that many
Indian medical educators, if not most, and that largely includes practising
doctors, are homophobic. They believe that homosexuality is a mental
deviation that needs treatment. This observation was reaffirmed when I
talked to students from colleges throughout southern India.
In my sophomore year, much teaching focused on the
impact of HIV/AIDS on the health of the Indian population. I was shocked to
notice my professor declaring, "In Western countries, it primarily
spreads among homosexuals. Of course, in our country, we don't have
any homosexuals." I protested, declaring that homosexuality is very
much prevalent in our country. He was indifferent, and my colleagues were
annoyed.
Later, I approached the professor and asked him what
he thought of homosexual people. He declared his belief that there is no
such thing as homosexuality and that it was an American invention. To see
if this was echoed by others, I tried talking to a couple of professors
under the pretext of having a friend who was homosexual. With the exception
of a psychiatrist, the response was anything but different.
This would not be surprising for most citizens in
India, who have grown up in overtly homophobic communities that fail to
understand a distinct and highly oppressed subculture. And the moral
rightwing authorities in India would stage a protest against anything that
would "destroy their culture." (Cinemas that screened Fire, a film depicting a lesbian
relationship, were ransacked. Ironically, the Kama
Sutra, which originated in India, contains
stunning images of this historically prevalent sexual practice.)
Sexuality in general is a big taboo in India. In my
first year, a female professor refused to lecture on the male reproductive
system and instead asked a male professor to give the lecture. And the
lecture completely failed to focus on the aspects of sexuality that matter
the most to patients with sexual problems. My female colleagues squirm at
the thought of professors raising issues such as oral or anal intercourse
in the context of sexually transmitted diseases, let alone alternative
sexualities. Medical education in India is largely oblivious to
disseminating correct information regarding human sexuality to students.
Generations of doctors in India grow up believing that
any alternative to strict heterosexual vaginal intercourse is abnormal and
treat patients so. Albeit the trend does seem to be changing - one
close friend was told by a psychiatrist that homosexuality is
normal - that medical education does little to alleviate such social
stigmas is disturbing. Promoting tolerance and understanding among the
educated élite of society would be a formidable task, let alone
educating the general public.
I contacted students from seven other colleges in
southern India with whom I had worked during my campaigns about HIV/AIDS. I
asked them about the sexual education taught at their schools. The picture
was much the same. The situation is likely to be the same in northern India
as well, except in metropolitan cities, like Mumbai and New Delhi. And not
one student, of the many that I contacted - not one - recalls
having a discussion about homosexuality. It seems correct to assume that in
India, even in the minds of doctors, heterosexuality is assumed to be the
norm and any alternative is abnormal.
In December, our college was the host to an annual
cultural fiesta that draws attention to at least 4000 students from various
colleges across south India. The council allowed me to organise a
conference on the social stigmas associated with HIV/AIDS in India. Two
incidents related to this conference merit mention.
The chief of the panel was Suniti Solomon, the pioneer
who described the first case of HIV infection in India. When asked about
the role of prostitution in the spread of HIV/AIDS and her opinion on
whether or not it should be legalised, she said, "When I had
discovered the first case of HIV infection, the same question was asked by
a reporter. I replied that [prostitution should be legalised] throughout
India. The next day, a great majority of the newspapers quoted,
‘Legalise prostitution: Dr Suniti Solomon.' Two days later, I
received hundreds of [letters]. All of them were condemnation… from
parents of daughters or persons with moral high ground who felt that I had
done something extraordinarily wrong. From that day on, I decided to keep
my mouth shut on questions such as these."
During the conference, I brought up the issue of
section 377 and the role of AIDS in accentuating the oppression of
homosexuals in India. Although the panel enthusiastically discussed it, a
medical student from the far south (a place called Madurai), stood up and
said, "You are discussing homosexuality as a normal behaviour. For
their disgusting lifestyle, they deserve this punishment. And that's
one reason I feel why no cure must be found for AIDS." And this was
greeted with low grade applause, much at the shock of the expert panel. And
what is worse, my own colleagues now view me with remarkably less respect,
and a few people have boldly severed ties with me for the same reason.
These two incidents are enough by themselves to show
the taboo associated with sexuality, both "normal" and
alternative. Only frank and impartial medical teaching and wide ranging and
repeated discussions can help dispel the great amount of misunderstanding
about an already browbeaten Indian community.
Balaji Ravichandran, second year medical student, Madras Medical College, Chennai, India
Email: mira.balaji@gmail.com
studentBMJ 2005;13:221-264 June ISSN 0966-6494
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Responses published this month
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Articles
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Responses
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LIFE
Straight outta India
Balaji Ravichandran (June 2005)
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Dr.Satheesha Nayak B
(June 05, 2005)
Read this response
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LIFE
Straight outta India
Balaji Ravichandran (June 2005)
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Lakshmi Narasimhan
(June 08, 2005)
Read this response
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LIFE
Straight outta India
Balaji Ravichandran (June 2005)
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Radhika Jadavji, Vikas Dhikav
(June 28, 2005)
Read this response
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LIFE
Straight outta India
Balaji Ravichandran (June 2005)
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Balaji Ravichandran
(June 30, 2005)
Read this response
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LIFE
Straight outta India
Balaji Ravichandran (June 2005)
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Dr.Satheesha Nayak B
(June 05, 2005)
Selection Grade Lecturer in Anatomy, Manipal Academy of Higher Education, Manipal, Udupi District, Karnataka State, INDIA. 576104 nayaksathish@yahoo.com
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Balaji Ravichandran’s article throws light on Indian philosophy about sex. I do not agree with certain things that the author has mentioned in the article. Indians are quite different compared to many other countries when it comes to sexual relationships and sexual behaviors. In India, people don’t feel very comfortable talking openly about sex. The author mentioned that Indian teachers are reluctant to teach about genital organs. I do not know how about all other countries, but in India, teachers do show some hesitation or shyness towards it. The socially sensitive areas like female breast, male and female external genital organs are not taught with the same enthusiasm as for the other regions of the body. Often teachers don’t explain them properly or explain them very fast and finish with it. This is because of the student reactions. You can see how uncomfortable the students are in the class while discussing about genital organs. I have taught Indian, Malaysian and American students. The reactions/behavior of the students of different countries is almost same in those classes. As an anatomist, I have to dissect the genital organs in front of the students and have to explain them in lecture classes also. I have seen students gazing silently with less number of questions being asked. From the body language of the students, it is clear that they wish the class to be over fast. Probably this behavior of students is age related also. The average age of students in Indian medical schools is 18-22 years. In western countries, the average age of medical students is more than that. It makes a lot of difference when the age group to which you are teaching. It is easy to teach sex related issues to the older age group.
Regarding the homosexuality, I think it is not a "fully normal" behavior though it is not abnormal. Actually, the nature has provided each organ for a specific purpose. If you use that organ for a different purpose, you are either abnormal or desperate. Food, sex and shelter are the primary instincts of all animals. Food is for the survival of the individual and sex is for the survival of the progeny. The "pleasure" in the sex is a bribe of nature to drive the animal to reproduce. Reproduction is possible only when the opposite sexes mate. If it was a difficult and painful process, then animals wouldn’t have reproduced at all. I think this homosexuality is an alternative method to suppress the sexual desire. You can compare this to mouth breathing when the nose is blocked. The "normal" and "abnormal" behaviors of animals are also coined based on what percentage of animals behaves that way. If a large majority does something and you do something different then people call you abnormal.
Let us put aside all those controversial issues and decide what has to be taught to the medical students and teach that well. Student population also has to understand that the teacher is a human being just like them and behave the same way as for other classes so that the teachers feel comfortable in teaching such issues without reluctance or shyness.
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LIFE
Straight outta India
Balaji Ravichandran (June 2005)
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Lakshmi Narasimhan
(June 08, 2005)
student 1st year mbbs, student 1st year mbbs prof.lakshmi@gmail.com
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I completely agree with balji ravichandran on the need for change in attitude in india about sexuality. Being a student of the same college i am also witness to the horrifying prejudice against homosexuals and aids patients.
The primary reason for teachers and students alike shying away from the topic is because of their strong views formed at an even earlier age than college. At the beginning of adolescence itself when chidren come up with queries regarding sex, parents here tend to hush them up or change the topic. This makes them think the topic is taboo and at their mouldable age form extremely unscientific and inappropriate views regarding sex.
The issue of homosexuality needs to be addressed at the family and school level itself. Many students here think that anything outside textbooks is 'abnormal' and they swear by information from textbooks. For changing this attitude cooperation of both students and teachers is necessary along with the authorities who at the least have to repeal the barbaric crimilisation of homosexuality.
Coming from an extremely conservative society, the only reason for my open views on sexuality are owing to my open minded family. all my queries regarding sex were answered in a scientific manner by my parents, and i do my best to answer queries posed by my younger brother too.
I request other parents too to keep in mind the grave dangers posed by bigotry and prejudice and sensitise their children to the atrocities comitted against so called 'abnormal' people. Please teach your children to respect the views of everyone keeping in mind that there is no one who is 'normal'.
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LIFE
Straight outta India
Balaji Ravichandran (June 2005)
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Radhika Jadavji and Vikas Dhikav
(June 28, 2005)
Medical Student, London, UK,and All India Institute of Medical Sciences, New Delhi, 110029, INDIA vikasdhikav@hotmail.com
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Throwing light on shadow alone doesn’t dispel darkness: Attitude change is needed to prevent against discrimination of gays and HIV cases.
One of the problems of discussing anything related to sex in India is that you meet 10 people, and they would give you 10 different opinions! Though, that can happen in any country, but problem in India is compounded by ignorance, prejudice and lack of knowledge.
In present article, author has discussed several issues1, including 377. The law is surely archaic as it says homosexuality is punishable offense let alone their rights and all. He has suggested the remedy as medical teaching. That’s not enough and is unlikely to be so.
At least part of the reason is: Doctors come from our own society. Many a times, if not most, unfortunately though; they too share same illogical prejudices and beliefs. So is merely preaching a doctor sufficient? The answer seems to be a clear no!
An important tool we have to educate doctors is to include sex education in schools. I agree with Bala on one count that Indian medical students and doctors do not feel too comfortable discussing sex2,3. Homosexuals are among the worse treated people and are greeted with contempt, humiliated and seen with disgust.
While teaching medical students and doctors, I have felt several times the unease when the words like impotence, vagina and penis come during discussion. Very few students show interest while others try to evade the teacher’s eyes. Girl students are clearly embarrassed discussing disorders like paraphilias. Many a times, I have noted quite a bit of unease when I teach rectal route of drug delivery!
Why does it happen? Doctors know anatomy (both male and female) more than general public. But still why are they shy? An important reason is cultural psychology producing barriers. Sex is viewed as being lewd and lusty. An attempt is done to prevent interaction between members of opposite sex. A common example of such cultural comedy is that when mother or father introduces the neighbor’s or friend’s daughters to their sons, they begin by saying: "meet your sister!" this of course embarrasses the young and this forcible attempt of separation leads to inquisitiveness.
It is apparent that merely putting more burdens on minds of students reading already very thick medical books does not solve this problem. If doctors feel insecure talking about sex just educating them is likely to bring least improvement.
"Catch them young" can be an effective solution. The children in schools can be given sex education and the adults including medical students and doctors offered reinforcement. The emphasis should be on general sex education and media has vital role to play.
- Balaji R. Straight outta India studentBMJ 2005;13:221-264.
- Dhikav V. More on treating homosexuality as a sickness: homosexuality is punishable in India. : BMJ. 2004 May 22;328(7450):1261.
- Dhikav V. Sexual deviations-the paraphilias-hidden aspects of sex in India. In: Male homosexuality. New Delhi: AITBS, 2003: 5-11. (Chapter 2.)
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LIFE
Straight outta India
Balaji Ravichandran (June 2005)
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Balaji Ravichandran
(June 30, 2005)
Second year medical student, Madras Medical College, Chennai, India mira.balaji@gmail.com
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AUTHOR'S REPLY
EDITOR-This is in reference to the responses published online with regard to my article 'Straight Outta India' (June 2003). It seems correct to assume that everybody agrees with how sexuality is viewed by the ordinary Indian. Similarly, the irrationality of prejudices and bigotry have been appropriately endorsed. But, I feel that the context of the article has been widely misplaced.
I would like to place for the record that the primary intent of the article was to emphasise the homophobic nature of Indian Medical Community, and not the public at large,though a perspective on the latter does justice to recapitulate the former. Hence, viewing sexuality in India from a larger view point helps understand the social and medical paradigm within which homosexualiy in India falls. When worldwide medical community is of the view that homosexuality is not a mental deviation, in India, aversion therapy is still widely practised by doctors, advocated as a 'cure' for homosexuals. Clearly, this is misplaced medical knowledge.
Jadavji and Dhikav's sentiments are well expressed, but not concordant with the context of the article. I have not suggested 'preaching' doctors about homosexuality as a remedy. I have emphasised the need for proper medical knowledge about sexuality at large in medical schools, as doctors have their responsibility for their patient's health. Surely, no one can deny the impact of misplaced medical knowledge manifested as tagging homosexual people as 'patients'.
I completely agree with the responders that a change of attitude in society is absolutely necessary for prevention of discrimination against sexual minorities. But viewing them as deviants and forcing medical treatment upon them is unacceptable. Therefore, I refute any suggestion that sex education in medical schools are any less important, or that discussions about the nature of homosexuality can be evaded at a time when students clearly need to be taught the truth, and prevent them from going around believing that only gay men get AIDS.
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