Indirection and the communication of bodily intention
Helen Lambert
indisputable evidence that public discussion of matters sexual is indeed highly problematic, this chapter investigates the grounds for these broad assertions from several directions – not least because silence or refusal to talk may be just as illuminating as what is said. A brief introduction to some essential back- ground on the situation with regard to HIV and other sexually transmitted diseases in India, and on governmental and societal responses to HIV over the past decade, prefaces a consideration of dominant contemporary discourses about sex and sexuality in India. Here, public affirmation of the phenomenon of ‘not talking about sex’ is analysed as a politically and historically situated meta-commentary on the rectitude of Indian society. Language about sexual relations in a variety of specific social contexts is then considered, with indi- rection and allusion emerging as dominant modes of linguistic communication in everyday speech, while those verbal references to sex and sexual relations that are more direct are shown to be framed temporally, spatially and linguistically by the use of particular oral genres which are deployed in particular settings on specific types of occasion. Third, the extent to which speech tends – in both anthropology and public health – to be conflated with and taken to encompass communicative forms in general is discussed, via a consideration of different forms of non-linguistic communica- tion. Finally, some observations on the possible transformational consequences of the use of ‘scientific’ and other languages, and on the interpretation of discourses relating sexuality to health, draw out methodological and theoret- ical issues that may be of more general importance with respect to studies of, and talk about, sex, health and bodily practices in the subcontinent and elsewhere.
Context-setting: HIV in India
The HIV epidemic in South Asia is projected as the fastest rising in the world (Bollinger et al. 1995) and with a population of almost one billion people, India was expected to have more infected people by the year 2000 than any other single country, the numbers being currently estimated at more than 1.5 million. There are major apparent variations in the degree to which HIV is established in different populations and parts of the country, ranging from 40–50 per cent in female commercial sex workers in cities such as Bombay and Pune, and up to 36 per cent among patients at sexually transmitted disease clinics, to less than 0.1 per cent among pregnant women in many states. The epidemic focus in Manipur and the north-eastern states is largely related to intravenous drug use in heroin addicts, but elsewhere the majority of cases of HIV are acquired by heterosexual contact. Although a wide range of sexualities and types of sexual relationship are in fact to be found in India (as in most other places) they have as yet been little documented, and while this chapter seeks to consider issues pertaining generally to sexual discourses and practices, to the extent that it considers particular forms of sexual rela-
tion, my focus is essentially confined to consideration of the normative – that is, to heterosexual sex and gender relations.
The first AIDS case in India was reported in May 1986 (NACO 1994), and several female sex workers were diagnosed as HIV positive shortly there- after. An HIV quarantine law was passed and there were calls to screen foreigners and to repatriate African students found to be HIV positive. The initial government response was to deny the possibility of the epidemic taking hold within India, due to its ‘traditional’ values, by which was meant the strong emphasis on chastity and on sex as being contained exclusively within marriage. With growing evidence of the rapid increases in prevalence of HIV and increasing concern among international donor agencies, however, the Indian Government was eventually forced to make some response. The Inter- national Monetary Fund attached to its economic rescue package the condition that India institute an active AIDS control programme, and the National AIDS Control Organization (NACO) was established in 1992 with assistance from the World Bank. At this stage AIDS Cells were set up in each state of the country (NACO 1994), but despite active efforts from the centre, functioning surveillance systems have only been maintained in a few sites.
This means that it is extremely difficult to monitor the epidemic, and only around 70,000 HIV infections had been reported officially by 1997, though it is accepted that the real figure is much higher than this.
Although there are now active AIDS prevention efforts in many parts of the country, disputes over projections as to the likely scale of the HIV epidemic in India, continuing failures to spend the generous budgets allocated to AIDS prevention activities, and inaction in many places around developing such activities, illustrate a continuing ambivalence about such efforts and point to an ongoing tension between recognition of the potential seriousness of the HIV problem and dominant discourses about both the nature of Indian society and its relations with the West. The complexities of national and international relations in shaping the debate about the impact of AIDS in India can be alluded to only briefly here, but it is clear that strongly national- istic views which were developed through the experience, and rejection, of colonialism, have continued to inform both independent India’s economic policies and the state’s attitude to Western influence in all its forms. Despite – or perhaps in reaction to – the recent (partially externally imposed) transition towards free market capitalism, growing liberalisation and the lowering of bureaucratic controls, there is ambivalence in many quarters about the influ- ence of international agencies in setting health policy and other agendas. A dispute between NACO and UNAIDS which occurred relatively recently over the likely numbers of HIV-affected people in India (leading to a news- paper headline, ‘The AIDS scare in India could be aid-induced’ [Mohan 1996]) could be analysed in Foucauldian terms as bearing hallmarks of resis- tance to the imposition of monitoring and surveillance from the centre, a characterisation of international relations which could also be applied to
federal relations within India between central and state governments in the health sector.
Beyond the political economic shaping of health policies, however, another set of dominant discourses profoundly influences responses to the HIV epidemic. Appeals to ‘traditional’ values which greeted the advent of AIDS in India a decade ago have been mentioned; the public image of Indian society revolves around the alleged moral quality of indigenous culture. The repre- sentation of Indian culture as ‘moral’ is also posed as an explicit counterpoint to popular perceptions of Western society as immoral and degenerate, particu- larly with respect to a putatively rampant and indiscriminate sexual promiscuity. This contrast provides a neat inversion of the situation described by Parkes in Chapter 14 of this volume for the Kalasha, who (as a cultural minority) represent themselves as engaged in a ‘rude reversal’ of the social norms of their Khó neighbours. In India, the spread of HIV is frequently and explicitly associated not just with western influences but with the presence of Western foreigners. For example, popular perceptions in southern Kerala hold that commercial sex and the threat of HIV are both prevalent in the popular beach resort of Kovalam due to the presence of European tourists – despite clear evidence that the limited amount of prostitution which does exist is almost exclusively directed at, and confined to, Indian male tourists visiting the area. Again, a furore greeted the revelation in Rajasthan that a male camel driver working in the tourist industry around Jaisalmer had tested HIV posi- tive, the presumption being that such men expose themselves to risk by having sexual contact with European women. (This is not, of course, to suggest that such risks do not exist, but rather that their public prominence in this case was out of all proportion to their scale relative to the risks of sexual contact with non-foreigners.) There is no space here to detail the colonial history which has shaped these representations within India, but it is certainly plausible to consider whether the often explicitly made contemporary contrast between the putatively promiscuous and individualistic West and the moral integrity of Indian society is not itself a response to earlier orientalist representations of native society – and particularly Hinduism – as morally degenerate, heathen and degraded.
The moral integrity of Indian society is popularly held to reside largely in the sexual virtue (read chastity) of women. Despite the breadth of evidence for an enormous range of variation in local cultures and social formations across the subcontinent, sociological and anthropological studies have in their turn largely replicated Indian – and particularly Hindu – self-representations of India as possessed of a profoundly sexually chaste culture in which the honour of women and the institution of the family are generally pre-eminent.
Attention has also been given, particularly by historians, to ‘subalterneity’, and among feminist scholars to the negative aspects of the Brahmanic emphasis on women as the repositories of caste integrity and family honour in contributing to female subordination. The organisation of gender hierarchy
has been linked to the cultural definition of female sexuality as all-devouring and destructive, and early universal marriage of women and continuous control by men over women within patriarchal family structures are seen as institutionalised solutions to the ‘problem’ of female sexuality (Ramasubban 1992). Most anthropological studies of sexuality and sexual relations in India have, accordingly, been subsumed into broader social structural considerations of kinship and marriage, or subordinated to cultural analyses of the caste and religious ideologies which are held to determine gender relations. This subor- dination of matters sexual to normative systems and ideologies may not be particular to India; Tuzin (1991) provides a historical reading of anthro- pology’s engagement with matters sexual to argue that this indirection towards the topic is characteristic of the discipline’s approach over the past sixty years.
Nevertheless, contemporary social mores concerning (hetero)sexual rela- tions as a form of gender relations certainly have their own materiality. The frequent characterisations of Indian women as repressed and submissive have been contested as only partial truths by feminist scholars anxious to recover the ‘voices’ of the oppressed and to demonstrate the existence of alternative modes of expression indicative of resistance to patriarchal norms. AIDS campaigners, however, have been quick to point to the difficulties of, for example, promoting condom use for HIV prevention. In a social context in which condoms have been heavily – but largely unsuccessfully – promoted as family planning tools, strict marital monogamy is a normative standard largely applied in practice only to women, and women’s generally subordinate status means that there is little potential for them to assert control over their sexual and reproductive health. In such an environment, the associations of HIV and other sexually transmitted diseases with moral pollution and societal degener- ation render acknowledgement of the presence of this epidemic in India, and engagement with it as a healthproblem, particularly fraught.
The insertion of anthropology into public health
One reason for the relatively slow pace at which HIV prevention activities have been initiated (though as indicated in the previous section, by no means the only one) is a lack of knowledge concerning the extent to which local populations are vulnerable to the spread of HIV, since so little is known about either sexual behaviour and networks, or about the prevalence of sexually transmitted infections.2In consequence, initiatives (such as, for instance, health education or promotion of condom use among sex workers) tend to be set up either on the basis of pre-existing assumptions or by using what are often inappropriate models imported from elsewhere, rather than on accurate knowledge of the local situation. There is a growing demand within interna- tional health generally for anthropologically informed studies to help develop locally appropriate prevention and control programmes, and this applies to the
case of sexually transmitted diseases and HIV in India as elsewhere. This sensi- tivity to ‘local culture’ and the associated development of a range of increasingly systematised methods for gathering sociocultural data, has come about after decades of failure to successfully implement potentially useful
‘biomedical’ solutions to public health problems. Anthropologists were first enlisted when it was realised that imported technical ‘fixes’ could not success- fully be introduced into new contexts without taking into account existing local understandings of and cultural resources for dealing with the health problem in question. In response, various approaches to the rapid collection of qualitative data – some formally dignified by acronyms such as RAP (‘Rapid Anthropological Procedures’), FES (‘Focused Ethnographic Studies’) or REA (‘Rapid Ethnographic Assessment’) – have been developed for use in the limited time frames usually available for conducting research before a health intervention is initiated, with guidelines provided in the form of handbooks or manuals (see Herman and Bentley [1992] and Manderson and Aaby [1992]
for discussions of this trend). In such approaches, investigation usually focuses on the local terminologies (vocabularies) used to refer to the symptoms, diseases and behaviours of interest and on people’s treatment-seeking patterns.
A further additional stimulus to the use of both qualitative research and anthropological involvement in international health has been the advent of AIDS, due to its inherent links with the unarguably sensitive subjects of sex and sexuality, together with the absence of any obvious possibilities for control of the epidemic other than through behavioural change.
My exposure to applied anthropology of this sort has entailed working over the past two years with a multidisciplinary India- and UK-based team of researchers on the development of a methodology for carrying out what has come to be known as ‘SASHI’ (‘Situational Analysis of Sexual Health in India’), a strategy for collecting information that can be used to prioritise and design locally appropriate HIV and STD prevention and sexual health promotion projects. This methodology has been piloted by local research teams in two sites in Gujarat and Kerala, since part of the intention is that local researchers can undertake the necessary research themselves. Our methodology differs from some of the rapid assessment procedures mentioned above, in that it includes not only elements which might be called anthropo- logical but also clinical and epidemiological components to assess the prevalence of sexually transmitted infections, as well as other sociological work on treatment providers and their services. My reflections here, though, concern only those components which seek to investigate sexuality and sexual behaviour.
Although neither our methodology nor indeed many other examples of rapid assessment are dignified by an acronym specifically denoting a form of rapid anthropological research, all such procedures share certain features by dint of the fact that they are necessarily all forms of applied social research directed at producing usable information in a relatively short time frame.
These characteristics largely result from methodological and practical constraints. In the case of work on sexual health, the almost universally private character of sexual acts in particular means that they cannot be directly observed, and participant observation is generally impossible (cf. Friedl 1994;
Tuzin 1991: 870) or ethically dubious; while the need to produce information relatively rapidly for use in the design of AIDS prevention initiatives means that the traditional strategy of long-term ethnographic fieldwork is arguably too slow to utilise for applied purposes (cf. Manderson et al. 1996: 5). As a result, the information collected in rapid assessments, particularly on these topics but also more generally on other health problems, is almost exclusively derived from people’s accounts of what goes on, rather than also from knowl- edge of what actually does go on. The consequent separation from the everyday situations within and through which more traditional ethnographic material is conventionally collected, tends to privilege the production of cognitive models which are divorced from the selective and particular utilisa- tion of local understandings in practice, yet are taken to be predictive of actual behaviour. More critically for the present argument, these anthropological procedures also come to endorse implicitly a model of culture and human behaviour as being represented directly in language.3
Talking about sex indirectly
What then if verbal accounts are not readily elicited or expressed? Most verbal references to sex and sexuality in India are, indeed, highly allusive. In northern India, sexual intercourse is referred to euphemistically, through terms such as
‘meeting’ (milna), ‘sitting’ (baithna) or ‘conversing’ (bacit). Women are decidedly more reluctant than men to describe these and other sexual encounters in directly referential terms. Nirmala Murthy’s (1998) study of sexuality and sexual behaviour among youth in three Indian cities offers some interesting observations about the research process in this respect. Many of the female respondents initially approached were deeply suspicious of the intentions of the researchers and the purpose of the investigation, either refusing explicitly to participate or failing to turn up to appointments. Finally girls had to be recruited through the college authorities via a sympathetic psychology professor, and those prepared to be involved asked for their parents not to be approached directly for permission. The boys, on the other hand, were recruited directly through peer networks, and the main problem was to retain their interest in the study. The issue of verbalisation is particularly pertinent:
in a ‘free listing’ exercise of terms to describe ‘what is sexual behaviour’, the boys tended to report words verbally while the girls wrote them down because they felt uncomfortable in verbalising them. Similarly, the boys tended to compete in trying to produce as long a list as possible, whereas the girls had to be prompted, and many said that they knew the behaviours but could not express them in words. In later work, which involved developing
scenarios to illustrate particular forms of sexual behaviour, the boys talked about their own patterns of behaviour as well as those of friends and neigh- bours, asserting that they often talked about such things amongst themselves anyway. The girls, on the other hand, unanimously described scenarios concerning friends, neighbours or other girls in their college, never using themselves as examples.
What this appears to suggest is either that girls and women seem to lack a language with which to talk about sex and sexuality directly; or, that the implications of verbalisation so unequivocally associate the speaker with the activities being referred to, that women are socially constrained not to speak of them explicitly. Some support is lent to the former hypothesis by Murthy’s observation that girls ‘knew’ the relevant behaviours but did not have words for them, and also by Das’s account of the socialisation of Punjabi girls, in which she describes how taboos regarding menstruation are communicated entirely without speech, and how ‘one of the most important ways in which women must learn to communicate is by non-verbal gestures, intonation of speech, and reading meta-messages in ordinary languages’ (1988: 198). Das notes that menstruation is the first event which reveals to girls that ‘women must never use words which make emotions explicit … or subvert the authority of the ordering principles of language and law, especially in domains that include relations between men and women’. Conversely, support is lent to the alternative hypothesis that women are socially constrained not to speak of sexual relations and sexuality explicitly by Annie George’s (1997) study of a slum community in Bombay, which reported that the topic of sexual needs, preferences and pleasures was the one which women felt most uncomfortable talking about. She notes that women felt it was not appropriate – that it would jeopardise their honour – to admit to having sexual feelings. It was considered ‘improper’ to talk about sexual needs or to express sexual feelings to husbands, in some cases because such behaviour may give rise to suspicions about the woman’s general conduct. This is remarkably reminiscent of Susan Gal’s analysis of women in the French Revolution, who supported the revolu- tionary cause but could not actively participate in discussion at political meetings due to fear of offending social propriety, as being offered ‘either speech or respect, but not both’ (1991: 180–1).
It is certainly suggestive that sexual intercourse between a husband and wife is frequently referred to among women in northern India by the terms bacit (converse) or bat karna, to speak. Here, we find a direct inversion of the kinds of data that are sought in interrogating subjects about their sexual lives;
the metaphor of verbal communication is used in order to express physical intimacy. The symbolic association between verbal communication and inti- macy between speakers is consistent with the prohibition which is part of the social institution of parda (purdah) in this region, against women not only being seen by, but also speaking to, men in certain categories of relatedness. In situations where communication with prohibited categories of kin is unavoid-