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AIDS and the Morality Issue

The morality issue complicates the public understanding of AIDS in many ways. Traditionally sexual permissiveness though accepted in the socities of East, has been regarded as a socially deviant behavior. Thus, AIDS become one of the wages of sin. The patient is not a sufferer but a sinner, and a subject of ridicule not sympathy. The morality issue clouds the public mind, a clear understanding of the disease is denied. The hypothesis is that if the morality issue in relation to AIDS can be diluted from the public mind a clearer understanding and more effective effort can be made possible which will be helpful at the primary as well as the secondary levels of prevention. The role of the people’s organizations is important in spreading a healthy awareness of the human sexuality and shaping the public attitude towards the disease for more efficient prevention and treatment.

AIDS is an illness which is transmitted through blood and body fluids (BBF). An exposure to BBF can occur during sexual act, when HIV infected blood/ blood products are transfused, or accidentally on contact of infected BBF to breached skin or mucous membrane. Apart from this the transmission can be vertical, from the mother to newborn. Out of all these, the transmission during the sexual act is most important. Though the exact proportion of the HIV transmission through the sexual vs. asexual routes is not known, a general opinion assigns foremost significance to the transmission through sexual route. It is observed that this route is bound to play almost exclusive role as transmission through other routes will decrease as better technology at hand (safe transfusions and reliable screening tests), strict observance of universal precautions and increasing public awareness. Also, there are two traps in the transmission through sexual route as compared to other routes: one, the disease has a long incubation period; and secondly, there is a variable interval between the time a person can infect and a screening test becomes positive. Thus, even if due to increased public awareness a negative screening test becomes a prerequisite for a sexual relationship between two persons, the window period can dilute the benefit of carefulness.

In this light, sex is the most important vehicle and sexual act is the most important route of transmission of HIV infection and AIDS. This fact is becoming more and more obvious as the time passes. In other way, the increasing prevalence of the disease is a pointer to the existing overt and dormant sexual chains and sub-chains. All the infected persons act as a reservoir, well before the disease is diagnosed, a period which on average is ten years. Simultaneously, more active a person sexually is, more likely he is to acquire the infection and transmit it.

Fig.1: Sexual chains and sub-chains of HIV/AIDS transmission

HUMAN SETTLEMENTS AND

THE MORAL CODE

# EVOLUTION OF MAN

The human evolution over centuries led to smaller settlements, then to the larger ones. Gradually there developed dependency of Homo sapiens on each other, leading to a highly complex society of the present day.

The complex society is made up of individuals as its basic members and works to fulfill their biological needs – existence, hunger and procreation, and human needs – intimacy, social relations and cultural fulfillment. The sexual act is an important part of procreation, but it is also an expression of intimacy. Because the human society is based on co-existence, a moral code has evolved over the centuries, which pervades all aspects of life. It sets norm of human behavior in a community. It controls and directs sexual behavior of people for purpose of fulfilling sexual needs as well as maintaining group cohesiveness.

# HUMAN SEXUALITY

A human is a unisexual being. One can be a man or woman, and this leads to a process of recognizing, accepting and expressing oneself as a sexual being.

Thus, sexuality is a deep pervasive core of total human personality and is present, perceived and expressed from birth to death. It is a biological fact and a bio-social expression. It is closely linked with gender identity and gender roles. People have a need for intimacy and touch throughout life, and sexual attraction, sexual act and aftermath of the act are further expression of sexuality.

# SEXUAL PRACTICES

PERMISSIVENESS

The socio-cultural elements of a society, religious and legal systems, attempt to prescribe and proscribe sexual behavior. This is the moral code governing sexual behavior of members of a society. A traditional view holds that sex must occur only after marriage. The society prescribes heterosexual relations and through its family institution controls sexual behavior by condoning premarital and extramarital sexual relation. But deviations from this norm are evidently seen. There exist polygamous and polyandrous liaisons, promiscuity and adultery, homosexuality and group sex practices apart from commercial sex workers. All these lead to a breach of sexual sanctity and play their role in transmission of STDs including HIV infection and AIDS.

# THE ‘ZERO AIDS’ CONCEPT

Since sex is the most important vehicle and sexual route is the major, amounting to nearly exclusive, route in the transmission of HIV infection and AIDS, a novel idea of ‘zero AIDS’ concept can be put forth.

In a hypothetical strictly monogamous society where sexual affairs are only marital, divorce rate is zero, AIDS will have no place. Further, if a sexual liberal society decides to approach the hypothetical model, the incidence of HIV infection and AIDS will go down. This model of the hypothetical society is of practical importance. If a traditional society tries to approach the model by setting strict norms for sexual behavior, it can save itself from the AIDS epidemic which is very likely if it changes into a sexually liberal society under the influence of urbanization and Westernization.

# THE MORALITY TABOO

Traditionally, sexual permissiveness though accepted in societies, has always been regarded as a socially deviant behavior. But accepting socially deviant behavior is one thing, coming to terms with the results of deviancy is another. This was apparent when for the first time the unknown disease afflicting homosexuals in Los Angeles was attributed to to homosexuality and various perverse sexual practices. Later, of course, the causative virus was discovered, so were other patients suffering from the disease who were not homosexuals. Still because the disease is sexually transmitted it is seen by majority a result of sin.

The morality issues associated with the disease are:

1. The main sufferers are ones who breach the norms of sexual behavior. They form the part of chains of disease transmission. They get infected as a result of promiscuous behavior or as a result of commercial sex liaison.

2. Spouses of the main sufferers are infected as a result of normal sexual alliance with their infected partners. They form the sub-chains. They are innocent victims.

3. The children born to HIV infected mothers get the infection as a result of vertical transmission. They are also innocent victims.

4. The commercial sex workers get infected in course of their profession and act reservoir of infection, transmitting the infection to their clients.

5. The rape and child abuse victims are another group of innocent victims.

The different types of patients arouse different types of reactions in society. The group 1 patients are sinners morality-wise and suffer neglect, ridicule and self-imposed guilt. The group 4 patients are again who breached the moral code and are deviants, and are treated similarly if not worse. The rest of the groups are those involved innocently and are subject of sympathy but because of potential to transmit the disease which, by far, is untreatable, avoided by the society amounting to hate.

Thus, morality issue complicates the scientific understanding and dealing of AIDS patients by the public and medical workers in many ways. It clouds the public mind, and a clear understanding of the disease process and thus education is denied. The patients are not sufferers but sinners, directly or indirectly, cut off from the mainstream of the society and live on its fringes, and are treated with ridicule and avoided as untouchables.

THE ROLE OF PEOPLE’S

ORGANIZATIONS

The basic hypothesis is that if the morality issue in relation to AIDS can be diluted or sidelined from the public mind, a clearer understanding of the disease and more effective education can be possible. This will have at least two implications: one, it will be helpful at the primary as well the secondary levels of prevention; and secondly, a more humane treatment socially and medically can be met out to the AIDS patients. Here, the role of people’s organizations is important. They can help in spreading a healthy awareness of human sexuality and shaping the public attitude towards the disease and its reorientation for better understanding and awareness, and more efficient prevention as well as treatment.

They can work in following ways:

Fig.3: The Role of People’s Organizations

1. SPREADING HEALTHY AWARENESS

OF HUMAN SEXUALITY

a. Sex Education: In the society the learning comes from the sexual value system of the family and community. The people’s organization can help in scientific and rational sex education. A step-wise sex education can be organized with help of community and must counter the sex fads gained from peers and mass media which often lead to sexual learning in unhealthy way.

Healthy Sexual Practices: The people’s organizations, with help of community, can work in this direction. Stress on monogamous relationships should be given. A monogamous relationship can be heterosexual or homosexual, the sexual orientation need not change. A bisexual orientation, of course, is an evident risk. A new sexual relation should be preceded by a screening test for HIV. In this regard, it is important to note that a screening test for HIV does not become positive following exposure to infection for weeks or months. About 95% infected individuals can be detected by screening tests within 5 months of infection. So, a Period of 6 months for both partners of a new relationship is safe. The risk linked with casual and commercial sex should be highlighted.

c. ‘Safe Sex’: The use of condoms for ‘safe sex’ has been widely publicized. But a poor quality or accidental breakage of condom during sexual intercourse is a real danger.

2. RE-ORIENTATION OF

PUBLIC ATTITUDE

This is an uphill task. In a natural course as the number of AIDS patients is on increase, the acute public reaction will subside. An AIDS patient need not be isolated. He should be rehabilitated within his family and in his job, of course taking needful precautions. The aim is to break the chains of transmission by putting barriers, not to outcast the patients. All HIV +ve and AIDS patients should be regularly followed up, and helped in getting treatment and properly rehabilitated. Efforts by people’s organizations in this regard should come.

3. NODAL SUPPORT TO

HIV +/AIDS PATIENTS

The people’s organizations can act as nodal points for giving support to the HIV+ persons and AIDS patients in various ways. They should encourage the patients to come out with problems and help in solving them. Acceptance by the family and community, occupational rehabilitation, and follow up and treatment are such problems and can be solved by drawing scientific programs and projects by people’s organizations with help of community and government.

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