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Aids and maternity in India

Patrice Cohen
Suniti Solomon

Part 3. Vulnerability of indian women for diseases and for HIV/AIDS

9. HIV/AIDS Infection: A Perceptual Study on Urban Working Women

K. Geetha

Texte intégral

Today’s Women

1The present study is concerned with women commuters in the context of HIV/AIDS. In India, the status of women has undergone marked and rapid changes due to modernization, urbanization and industrialization; women are found in rapid transitions, which vary on the basis of socio-economic realities, and which accentuate socio-economic differentiation. These changes have been weakening family organization and controls, and this weakening of traditional organizational forms and controls brings about changes in the sexual behaviour of women; promiscuity is said to be increasing. The tendency of women to take up jobs outside the home leads to greater economic strength and the decline of the joint-family system. Media of all kinds, following Western thoughts and systems, have contributed further in changing the attitudes and aptitudes of women. The participation of women in social and professional life, and the hidden power they derive from this, paradoxically reflect their vulnerability and the discrimination to which they are subjected. The secondary status of women in society and their perceived supplementary role in the economy are reflected in the discriminatory treatment they receive in the allotment and access to family resources, and also have a tremendous impact on their health. The effects of their status in society compound the severity of their biological and social vulnerability. The attitudes, values and perceptions of urban working women commuters are perhaps the sensitive variables that may be used to examine the status of women in the context of the immorality that is attached to, or associated with them. Although there have been studies dealing with migration, urbanization and social changes in India, women’s mobility is not well understood. In particular, studies related to their mobility and their mobility patterns have not attracted much importance or attention. The prevalent cultural images of Indian women, communicated through literature, mass media and religious sources, shape the social perception of women.

2Several factors are responsible for the growth of the newly emerging middle-class working women in Chennai. The changing socio-economic factors, particularly in the Hindu society, have been the product of, and instruments for changes in the lives of women. Educated women from the middle class have come out of their homes, due to economic compulsion. Economic necessity, improved literacy and changing attitudes of both men and women toward women going to work, as a result of urbanization and industrialization, have brought a change in the social and economic status of women. Support from the policy-makers and government policies, globalization and liberalization and increased employment opportunities have all helped to add more and more women to the workforce of the city. Going for a job gives them personal status, a socially useful life and an independent social standing. With the change in women’s personal and social status, a change in their way of thinking is occurring. The attitude of society toward women with jobs has also changed.

Issue of Investigation

3It is generally believed that industrialization undermines extended kinship systems. The extensive mobility required by industrialization is viewed as the principle cause of the break-up of joint families, changes in social status and lifestyles. Industrialization has moved a number of traditional functions away from the family. Whether industrialization weakens the family organization is debated, but it is nevertheless generally evident that the traditional value system of the family has been rapidly disappearing. Westernization has been influencing the lifestyles of Indians residing in urban areas. In those areas, the conjugal bond between the husband and the wife gains greater importance, while the demands of conjugal ties decrease, especially among siblings. In particular, working women commuters generally carry a stigma, as they appear to be more mobile and independent. Economic needs and the splitting of the joint family into nuclear families exert pressure on women to take up jobs outside the home. Women’s liberation and independence may cause a change in their attitudes, belief and behaviour in many aspects of life, including their sexual behaviour. They appear to develop more liberated attitudes toward sex; and it is also true that working women have more contact with both men and women, thereby providing possibilities to weaken discipline and leading to promiscuity. This changed situation of working women may be viewed in the context of the recent outbreak of HIV/AIDS, which is the result of the liberated sexual behaviour of women and men in the recent past. The general public in the current situation tends to believe that women are responsible for the incidence and spread of HIV/AIDS. Thus, working women carry a stigma and are subject to discrimination. Immorality and lubricity seem to be more attached to women than to men.

4The AIDS scenario in India is quite pathetic; the total number of AIDS cases was 24 680 in 2000, 18 783 of whom were males and 5 897 female. By July 2001, the number of AIDS cases had risen by 593; males accounted for 422 and females for 151 cases. The number of females acquiring the HIV infection has been increasing since 1981. The high prevalence of HIV/AIDS is seen in the states of Karnataka, Nagaland, Andhra Pradesh, Gujarat, Goa, Tamil Nadu, Maharastra and Manipur. Tamil Nadu records the most rapid spread of the HIV infection, with 11 954 AIDS cases in 2000. In Tamil Nadu, Chennai City reported the highest number of AIDS cases. The AIDS cases rose from 501, in 1998, to 2 235, in 2000. It is to be noted that by July 2001, the number of cases had risen to 3 337, an increase of 1 000 cases in a period of six months. Thus, Chennai City appears to be emerging as an AIDS city in India.

5The present study investigates how the mobility of women and their stigmatization can be related to the incidence of HIV infection, taking the perceptions of the general public as the main source of information. An attempt is also made to assess the incidence of the HIV infection and the level of awareness among working women commuters. Women were taken as the sample group because they are prone to be perceived as the responsible vectors, rather than as the victims.

6Hence, the issue of women and AIDS needs to be placed in a broader social and cultural context. Women’s vulnerability to HIV is increased by the inequalities and discrimination they face in society.

Figure 9.1 - Mobility, HIV Risk and Stigmatization: A Flow Chart

Figure 9.1 - Mobility, HIV Risk and Stigmatization: A Flow Chart

7Women have been the subordinate sex, relegated to second-class status, and kept uneducated or under-educated, dependent, isolated and confined within the four walls of their homes. They are often denied access to education, health, independent income and property rights, and although the situation has begun to change, the change is yet to be significant and widespread. This suppressed community faces a greater vulnerability and preventive campaigns are not effective. Thus, it is necessary to understand the interaction between HIV infections and cultural values, the rights and needs of women and the socio-economic patterns in society.

8Increased mobility has brought changes to all aspects of human life. The aspect in which we are interested here is socio-behavioural change. Increased mobility both directly and indirectly increases day-to-day interactions. This type of interaction evolves interpersonal relationships and, in due course, interpersonal relationships become intimate relationships between both sexes. This type of behavioural change may evolve only where contacts are frequent, and for this reason the setting of the office has been selected for study. When such is the case, the intimate relationship may also develop into promiscuous heterosexual behaviour. One has to consider whether the increased interaction leads to the risk of contracting HIV/AIDS, or whether the increased exposure to the outside world brings greater awareness about the spread or transmission of the HIV infection.

On the Study

9The aim of the study is to understand the relationship between the mobility pattern of women commuters (working and non-working) and the stigma generally attached to them in the context of the HIV/AIDS infection. This relationship is further analyzed by looking into the perception patterns of both men and women.

Objectives and Hypothesis

10The major objectives of the study are:

  1. to understand the spatial mobility pattern of women commuters (working and non-working) and the emerging stigma
  2. to examine the sexual behaviour of women commuters by linking the social, cultural, and economic aspects
  3. to assess the relationship between sexual behaviour of urban women commuters and risk of HIV infection
  4. to look into the perceptions and behaviour of working and non-working women and men in the context of stigmatization with regard to urban women commuters.

11To achieve these objectives, the following major hypotheses are formulated:

  1. There is a direct link between women’s increased mobility and the higher incidence of HIV infection.
  2. Increase in mobility increases the level of awareness of HIV/AIDS.
  3. There is a relationship between the increased mobility of women and the stigma of immorality associated with them.

Data and Methodology

12Movement is a social reality, and men and women participate in this dynamics. With modernization and urbanization, the mobility of women is accelerated for various reasons, such as work, social calls, shopping and entertainment. This increased mobility results in the development of perceptions among men and women about women.

13Secondary data were extensively used to describe the study area, Chennai City, and the incidence and spread of HIV/AIDS there and in India. The objectives of the study are realized with the primary data collected from a sample survey. The study is made from the sample data collected from the city of Chennai. A purposive multi-stage sampling procedure is adopted. Initially, a pilot study was carried out and this helped to develop the methodology best suited to the study.

14The sample consists of 900 cases. Chennai City is divided into 155 wards for administrative and development purposes. Among the 155 wards, using the random sampling technique, 16 wards were selected as sample areas for the representation of the whole of Chennai City. The sample population consists of three types of people: working women, non-working women and men. From each sample ward, a maximum of 19 respondents were interviewed. Respondents were selected from the work spot, especially the working women, and the non-working women and men were selected from each ward randomly. This made it possible to obtain a reasonably representative sample in Chennai City.

15An interview schedule, non-participant observation and interviews were the main techniques used for data collection. An interview schedule was prepared to gather five categories of information, the details of which are as follows:

  • Social background: Name, age, sex, martial status, religion, caste, education, type of family, number of family members, family structure, place of residence, place of work, type of work, employment category, monthly income, family’s monthly income.
  • Movement pattern: Mode of travel, distance and time of travel to work, work environment, working hours.
  • Personal information: Marriage problems, rating of their marriage, choice of marriage partners, freedom of mixing, sexual and reproductive problems, double sexual standards for men and women, pre- and extra-martial relations, autonomy for career and freedom of movement, freedom to work
  • Means’ perceptions: Perception about women’s freedom to move, liberation.
  • Status of women: Subjective and objective perceptions about the status of women today, and the criteria for the enhancement of their status, in addition to any other comments or observations.

16Collected data were tabulated to obtain a frequency distribution and to quickly grasp the meaning of the fundamental relationships of the identified variables. Data were subjected to rigorous analysis with multi-variety techniques, such as principal components analysis and regression analysis. This analysis helps to assess the relationships more quantitatively, and to postulate more reliable generalizations.

Scope of the Study

17In reality, every major infectious disease has created not one, but two epidemics: the illness itself and society’s reaction to it. Following initial denial, there is hysteria and a search for a scapegoat.

18Primarily, for the HIV/AIDS epidemic, the scapegoats have been commercial sex workers, the gay community and intravenous drug users. The NGOs (Non-Governmental Organisations) and other voluntary organizations focused on these people. When geographers became involved in research on HIV/AIDS, there was an immediate focus on the spatial spread and distribution of the infection. Gradually, the mobile people became the focus of study, as they are the important carriers of the infection. For instance, truck drivers, militants, refugees, sailors, travellers and slum dwellers have been the targets for prevention and education by various national and international organizations. Because of the prominence given by different agencies to these groups, they are discriminated against and stigmatized in society. In the 1990s, women were targeted, as it was believed that they are equally potential carriers of HIV/AIDS infection.

19Thus there has been a degree of understanding about different target groups in the context of the HIV/AIDS infection and its spread. However, the case of women has yet to be seriously analyzed. The primary mission of HIV research is simple: to determine how HIV is spread, causes disease, and how it can be treated. Although it is true that many advances have been made in each of these particular areas of research, still a complete cure is yet to evolve. The vaccine that was invented does not suit all cases of HIV/AIDS infection.

20Various researches have been carried out regarding the HIV/AIDS infection in clinical, epidemiological, biological, behavioural, and sociological fields. In the field of sociological research, researchers are focusing their study on counselling, rehabilitation, discrimination and stigmatization of the entire targeted group. In this situation, a further study is much needed on the awareness level and the level of knowledge, not only among the infected population and those associating with them, but also in the general public. The present study investigates the awareness and perceptions among a small sector of people, women. This study can be used as a framework for a macro-study.

Study Area

21Chennai City, the capital of Tamil Nadu, is located on the east coast of South India. It is about 174 sq. km. in area. The climate of Chennai is a tropical maritime monsoon type. The mean minimum temperature rarely falls below 20°C, while the maximum temperature seldom crosses 37°C. There are four seasons: the season from the beginning of October to the end of February is usually warm; from March, the hot weather begins and the temperature rises gradually until May/ June; the southwest monsoon is noted from June to September; and the northeast monsoon from October to December, which is the main rainy season for the city. The annual mean average rainfall is 127 cm, and the mean relative humidity is high throughout the year.

22According to the 2001 census, the population of Chennai City is about 4 million. Being the capital of the state, it is the abode of all the head offices of the government departments. The suburbs support many industries. The city has a major port. In the last four decades the urban population in the city has more than tripled. In Chennai City, the population grew at 27.35 % during 1971-1981; 15.82 % during 1981-1991; and 16.7 % during 1991- 2001. The areas of George Town, Triplicane, Purasawalkam and Tondiarpet are the older commercial and residential areas of the city with very high population densities. Nungambakkam, Egmore, Chintadripet, Perambur, Mylapore, Theyagaraya Nagar and Kodambakkam are the high-density areas, while Sembium and Ayanavaram fall under the moderately dense areas. Guindy and Adyar are the least densely populated areas. The city is divided into 155 divisions and 5 zones for municipal administrative purposes.

23Chennai City is slowly growing into a city with diverse cultures. The floating population and the inflow of migrants, both from rural and urban areas, have brought a great change in the composition and socio-cultural lifestyles of the people of Chennai. Apart from the cultural diversification, the in-migrants have brought their social lifestyles and habits with them to the places where they live. Open defecation, squatting on open spaces, setting up residence in any available space, and spreading unsanitary conditions are some of the negative effects of this change. Overcrowding encourages the spread of both communicable and non-communicable diseases. Nearly one-third of fatal diseases in the city are caused by respiratory infections, intestinal infections and anthropoid-borne infections, surface-infections, non-communicable diseases and other ill-health. Apart from these infections and diseases, the prevalence of HIV/AIDS in the city is also rising rapidly.

24Chennai is one of the leading cities in India today in terms of industry, and this industrial development promotes a movement of population toward the city. The importance of Chennai City in trade and commerce plays an important role in attracting industries. The availability of skilled labour and proximity to port and railway stations are the other factors promoting industrial development. It is generally observed that northern Chennai is the habitat for the city’s workforce, with Madras Port Trust at the head of the list, and south Chennai, for the tertiary-sector population. Real estate economy classifies Boat Club Road, certain parts of Nungambakkam, Kilpauk Garden, Gopalapuram, Poes Garden, Abiramapuram and Raja Annamalaipuram as posh areas. Parrys, Poondamalli High Road, Pondy Bazaar, Koyambedu, Annasalai, Ranganathan Street and Egmore are commercial centers. Kodambakkam and Vadapalani contain the entire Tamil film industry, whereas Thiruvanmiyur, Kalakshetra Colony, Anna Nagar, Besant Nagar and Adyar are the areas where the upper middle class and officers live. Triplicane, Mylapore, Thiruvanmiyur, Velachery and Alandur are the old villages caught up within the city. Ethnicity defines Royapuram, Royapettah, Pudupet and Thousand Lights as Muslim areas; Sowcarpet and Georgetown as North Indian areas; and Perambur and Ambattur as Anglo-Indian settlements. Taramani is emerging as an IT corridor. Slums are dotted all over the city and about 40 per cent of city population live in slums.

Growing numbers of Working Women

25The working population of Tamil Nadu increased from 15.4 million, in 1961, to 20.2 million, in 1981, and then to 24.2 million, in 1991. According to the Census of 1991, the female workforce represented 30 per cent in Tamil Nadu, and this was an increase of about 5 per cent from 1981. According to the statistics provided by the Directorate of Employment and Training, Tamil Nadu, the female work participation was about 40 per cent in 1993-94. There has been a consistent growth in the female workforce and increasing literacy (female literacy was, in 1991, in 51 per cent in Tamil Nadu) and economic compulsion must have been responsible for this. Chennai City reports one-third of its population as the working population. However, only 9 per cent of the female population are employed. Between 1981 and 1991, there was a growth by 50 per cent in the female working population, and most of these women find jobs in services.

Preliminary Results of the Study

26The perceptual analysis indicates that both men and women are predominantly aware of and accept women’s mobility. Women who go to work are widely accepted. There are usually objections to Westernized women, and this particular group seems to be most stigmatized. It is widely perceived that women are more susceptible to acquire HIV today. The reasons for this conclusion are: women are more independent; more exposed to the outside world; copy Western lifestyle and culture; and, there is a lack of sexual fulfilment. Some think that there is a greater possibility now for extra-martial and pre-marital affairs, as do the women themselves, because of their increased participation in the job market. Increasing entry into the job market gives a chance for the women to be somewhat more free in their approaches and attitudes. Because of this, many perceive an increased promiscuity among women, which may accelerate the acquisition of the HIV infection. There is a total lack of focus on risk practices and this may also be a reason for the rapid spread of the infection among women. With the high participation in the sphere of work, the mobility pattern of women has recently increased. Most women work in the unorganized sector. The predominant age group of working women is 20-29 years; and this young group belongs to the middle-class, for which it is also necessary to work. Their mobility pattern depends on income, age, employment type, marital status and educational level. Most of the married and unmarried working women prefer to travel by bus, largely influenced by income level and employment type. They prefer to have their work places at shorter distances; and they also combine their other activities, like going to market or to a friend’s house, along with their going to work. Combining different activities with the travel to work is seen more among the married working women.

Conclusion and Suggestions

27There is growing concern regarding the increasing rate of HIV infection among women. Policy planners, voluntary agencies, and women’s groups have been taking a keen interest in understanding the problem of HIV infection. But much greater coordination and networking is required among these groups in order to better understand their different perspectives and priorities. Such interaction would help to develop a more comprehensive research framework for looking into women’s problems in relation to HIV, and to lessen the vulnerability of contracting the HIV infection. Such networking would also facilitate access to research results and enhance their utilization.

28In the past, women’s voices were largely missing from policy debate. Research should enable and empower women to better understand and articulate their health needs so that their views are incorporated in the policies and programmes that are designed for them. Women’s participation in research would help researchers to better understand women’s perceptions of their health needs and would also strengthen women’s ability to engage in public dialogue and discussion on reproductive health issues (STI, HIV, AIDS). Finally, strategies for the dissemination of research results should be formulated explicitly for different user groups including policy makers, health professionals and women’s organizations, so that there is better-informed public debate on issues of women’s reproductive health.

29Using the present study as a framework for further studies with other sections of the population, we can have a better understanding of the vulnerability of different groups. It is necessary to group the people separately, as one group may differ from another. When all these people have been studied, we can recognize their awareness level of the epidemic, and then frame a better method to increase awareness. If there are better awareness messages and methods, the implementation, monitoring, evaluation and reprogramming can be carried out successfully with the help of NGOs.

30Our challenge now is to apply this understanding to the young women of our societies. We must acknowledge their vulnerability to infection and we must ensure that they acknowledge it. And this is an even more difficult task. Perhaps the most difficult task of all, once this awareness of vulnerability has been created, will be to give young women the self-confidence and skills required to change their behaviour and to choose or create relationships based on mutual concern and respect and freedom of choice. This freedom is dependent on the improvement of women’s economic independence and on changes occurring in the ways societies construct gender and sexuality.

31The current study is based on a relatively small sample, and as such the results, although significant, should be viewed with caution. Assessing or describing one’s perception is not easy. Stigmatization is a mental image and perception, and it is not easy to quantify and map it. To bring it out quantitatively requires further intensive fieldwork, interviewing the sample population. The present study can be extended with intensive fieldwork to quantify and map the stigmatization of women, and this exercise will be enormously useful for policy makers as concerns controlling the HIV infection. The study may be further extended for rigorous testing of the changed behaviour and work environment of women and the incidence of HIV infection.


32The thesis is largely based on primary data, collected from a sample. The sensitive nature of the study, the short time available, and limited resources have limited the sample size. The results could have been more reliable, had the size of the sample been larger. The population structure of Chennai is quite varied and variations are not readily known. Thus, one cannot assume that the sample selection of this study would have accounted for all the variations, although care was taken to reflect the structural variations in the selection process. The reliability of data gathered from the sample households is certainly dependent on the memory of the respondents, and to the greatest possible extent care was taken to get correct information.

Table des illustrations

Titre Figure 9.1 - Mobility, HIV Risk and Stigmatization: A Flow Chart
Fichier image/jpeg, 53k


Dept. of Geography, University of Madras, Chennai

© Institut Français de Pondichéry, 2004

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