The first HIV (human immunodeficiency virus) case in India was detected in 1986 among female sex workers. The rapid spread in HIV infections subsequently due mainly to high-risk behavior among vulnerable population groups required a sensitive, multisectoral, multipronged response that had to influence risk behavior and alleviate the socioeconomic impact of the epidemic. The journey has been a unique one in many ways in the history of public health in India. The challenges emanated from the economic, social, legal, and cultural contexts in which risk-taking behavior took place, and to be effective, the response required a framework that had to be vastly different from the usual public health approaches adopted in the country. The fairly successful national response was made possible due to the presence and subsequent co-option of a vibrant civil society, which shaped discussions and discourses around sex, sexuality, and gender and could reach out to marginalized and stigmatized groups with messages and interventions. During the course of the thirty years of response to the epidemic, shifts in positions of individuals in the three organs of the government—executive, legislative, and judiciary—on key sensitive issues around sexual behavior and preferences could be discerned to some extent, which was unprecedented and helped strengthen the response.
New infections have come down significantly over the years and treatment has scaled up massively. However, the momentum in national HIV programs has slowed down globally and in India, with lower finances and a shift to other national priorities. The sociocultural and economic contexts have yet to change for most of the groups vulnerable to HIV, and they will continue to determine risk behavior, requiring interventions to continue at a fairly high level of intensity.
Article
Elizabeth D. Lublin
In the early 1600s, the Tokugawa shogunate licensed prostitution as one of many policies that it implemented to establish order and to consolidate its control over a once war-torn Japan. The system that emerged confined legal sex work by women and girls to designated quarters, enclosed by walls and with their gates tightly regulated. The prostitutes within overwhelmingly came from impoverished commoner families who sold their daughters into indentured servitude to secure cash advances critical to their own survival. These transactions escaped condemnation due to the belief that girls so sold were fulfilling their filial duty. The absence of any stigma associated with officially authorized sex work conversely drew scores of men to the licensed quarters, and rapid expansion of the commercial sector of the economy, the increasing use of cash, and urbanization produced a commoner class able to vie with samurai, their political and supposed social superiors, for the affections of licensed prostitutes. By the 18th century, the licensed quarters had become destinations for the masses, integral components of the urban economy, and both site of and subject matter for a flourishing early modern culture. The very existence of the quarters helped to legitimize prostitution and, together with growing economic stratification, stimulated demand for cheaper sex. Sex work proliferated legally in the licensed quarters with female prostitutes and both semiofficially and illicitly in cities, market towns, ports, and post stations around Japan, with women and men and girls and boys selling and being sold for sex. While the shogunate tried to regulate clandestine female sex work where it could and periodically imposed harsh penalties where systematic oversight proved elusive, it largely turned a blind eye to male sex work. The vast majority of clients of male prostitutes were men themselves, and sexual relations between men not only had been a common practice within samurai society for centuries but also did not threaten the sanctity of the family or challenge gender norms. While the shogunate largely overlooked sex work with foreigners as well during the early Tokugawa period, beginning in the 1640s and coincident with restrictions on foreign trade, it sanctioned sexual labor but only by licensed brothel prostitutes. The easing of those restrictions through treaties in the 1850s and the influx of foreigners prompted the opening of legal brothels and quarters just for non-Japanese. Much more so than prostitutes with only Japanese clients, those servicing the foreign population were stigmatized by Japanese and foreigners, with the latter linking them to the threat of syphilis.
