Honor, Home, Heritage, and HIV

At 8 a.m., it was already 101 °F indoors. The waiting room, adorned with posters proclaiming the primacy of marital fidelity, was filled with couples whose physical appearance confirmed the clinical pattern I had come to examine every day. Sick men presented with advanced disease accompanied by their still-asymptomatic wives whose own disease status remained unknown. Patients camped out on the hospital grounds. Entire families came by bus and train to the big city a few times a year for treatment so that nobody back home would know about their disease. In the best of scenarios, their suffering remained an enigma back in the village.

I am a second-generation Indian-American medical student and had spent my life in the midwestern United States. The experience of conducting research in my family's ancestral home had proven to be contradictory—the changes sweeping a new globalizing India were a world apart from my parents' memories of an unchanging India recovering from its colonial past. Although the new riches of modern India were ubiquitous, it was my impression that entrenched gender and cultural inequities had yet to be adequately questioned in the social realm.

For the women in the waiting room, 2 of the most traditionally cherished attributes of Indian womanhood—marriage and monogamy—were what most likely put them at risk for HIV. I had thought that in a sexually conservative society, couples counseling would be the panacea to halt the spread of the virus within families and could even provide a forum for reconfiguring traditional gender roles. It seemed to me that this approach encouraged couples to candidly discuss sex, condoms, and intimacy before it was too late. What I soon realized was that it …