Every day humans are faced with issues, obstacles, and other life events that play a role in the kinds of health care one receives. In America, citizens are granted Medicare and Medicaid. Medicare is given to lower income people, while Medicaid is meant for older citizens with high medical costs. This means that depending on one’s age and income level, American citizens are categorized and grouped in order to receive healthcare. Interpretive theory would explain this in terms of recognizing a pattern—why are there two different types of healthcare and what purpose do they serve? Similarly, the health determinants for Indian culture include social, cultural, political, and economic factors that play a huge role in the kind of healthcare that Indian citizens receive.
Interpretive Theory is also known as symbolic theory- symbolic in that anthropologists look at a particular culture for symbols, patterns, or commonly held beliefs that affect the people of a culture in a way that directs everyday life. In order to interpret a culture correctly, it is a must for anthropologists to find a kind of illumination that will shine a light on the factors that influence a certain group to action. Once the actions are identified, that is when they become open for interpretation; studying a culture and recognizing the role of rituals in a society allows for an accurate understanding of what and why things take place within a culture. (Symbolic and Interpretive Anthropology. Hudson, Scott). Interpretive Theory is the most appropriate perspective for examining the reasoning for the spread of HIV and AIDS in India.
This health issue in India is important to examine because of the people who have AIDS in India, women account for nearly 25%. To understand that number better, India is a very large state with over a billion people living there, and of those people who reside there, about 2 million of them have HIV/AIDS. This means that about 1/4th of the population with AIDS is through men having sex with women. The other populations include men who have sex with other men, the sharing of needles to inject drugs, transgender people, etc. This raises the question then, why are so many women living with HIV through sex with men? The prevalence in HIV and AIDS in India is highest in poor social and economic areas, but it is also found in cultures where abuse and violence occur. India is a male-oriented society where reproducing females is shunned, “Indian society praises patriarchy and male sexuality and mourns the birth of daughters” (Without My Consent-Women and HIV-related Stigma in India. Ninan, Ann). The highest risk groups include female sex workers, adolescent girls, sexually active women, and women survivors of abuse and rape… why is this so? Why are these women at a far greater risk than any other social group? Since India veers women as least powerful, incidents of abuse and rape are easily blamed on the women for not pleasing their men.
Interpretive Theory begs the question, what cultural factors allow for women to be subject to this kind of behavior at all? In America, the HIV/AIDS epidemic is not comparable to India. Progressive America has worked towards women’s equality; women are not viewed in the same mannerism as Indian women are. Although complete equality for women has not fully surfaced in America yet, our nation has made much bigger strides towards that than India has. It is important in anthropology to understand why a culture lives the way it does, are these Indian men “pigs” or are they simply acting in a way that society has allowed for years? People all across the world are products of their culture, this is why interpretive theory best allows us to examine the health issues that Indian women face. With limited power, access to knowledge, and decreasing social and economic status, these women are subject to rape and abuse.
Social determinants of health can range from economic circumstances, stress, early life, social exclusion, work related issues, addiction, food and transportation, all the way to having a support system. It seems that the way in which women are able to live a healthy life is regarded in terms of controllable and uncontrollable factors. For example, for the women in India, the controllable factors from that list may only consist of addiction—and even that may be something that is irrepressible at times. For example, the women who live in India are so severely suppressed and looked down upon that their health is determined by almost all uncontrollable things. Their economic circumstances, for example, has much to do with who they marry in to. If their husband lives a wealthy life, then they will be better able to take care of themselves. But since India is a predominately patriarchal society, women have very little say in any part of their life; if they decide to not marry a man and raise a family, finding employment, food, transportation, and even a support system may be very difficult. Indian women very early on learn that their health is determined by the life these choose to live; either being supported by a man, or supporting themselves on their own. Both are choices, but both bring many issues for these women.
In “Effective social determinants of health approach in India through community mobilization,” Alok Mukhopadhyay says that one of the main health determinants is the inequity of health status within the population. Being a female in India means that women have a lower chance of receiving healthcare. If the woman is ill, overworked, or needs medical attention, the decision rests in the hands of the husband—therefore it is common for Indian women to be inadequately rested, cared for, and nourished, all of which are detrimental to her health and life expectancy. If a woman in this area is inadequately cared for, social and economic status will decline. This could turn to more serious health effects such as HIV or AIDS.
In the article “Know AIDS for No AIDS: Determinants of Knowledge about AIDS among Women in India,” a study was done using the National Family Health Survey (NFHS) using a representative sample of 90,000 married women aged 15-49. The study wanted to discover how women’s knowledge of AIDS/HIV is related to socioeconomic characteristics of these women. The study found that geographically speaking, women in rural areas had far less knowledge about AIDS than did women in cities. Researchers also found that “awareness levels also vary with husband’s education level,” meaning women who are married have higher awareness of this disease if they are married. What’s most alarming is that of the women surveyed who reported being aware of AIDS, about one-third of that population thought there was no way of avoiding it. Interpretive theory makes me wonder why this is so. If women are knowledgeable on not just the disease but also on the preventative measures that can be taken, then how come so many Indian women claim that there is no way to avoid transmission? According to the study, political and cultural restrictions placed upon the education for condom use severely impacts whether or not these Indian women practice safe sex or not. Even among the educated women- the ones who completed high school- only 45% of them admit to knowing about condoms. That is less than half of the women of the representative population, meaning that there is immense truth behind not being aware of the preventative measures that can be taken to prevent the transmission of AIDS. Continuing on with women’s knowledge about AIDS, although two thirds of the population admit to being aware of the at least one of the modes of transmission, only “38% of the women reported knowing about the blood mode while only 3% knew about transmission through IV drug use.” More than half of these Indian women knew of only one mode of transmission: through heterosexual sex. Since knowledge often comes from experience, interpretive theory would say that it is far more common to be impacted by AIDS through sex with an infected male partner. These women are taught at a very young age that not only does AIDS deem unpreventable, but it is also a part of their knowledge about their culture. If a drug use epidemic surfaced and HIV/AIDS transmission was on the rise, then the cultural factors would be different. The health issue is the same, but the knowledge behind the matter would be altered and the statistics would change. It appears that rural uneducated women face the most extreme health disparities and have very little access to prevention.
In another article “Social Determinants of HIV/AIDS,” the author says that the spread of HIV/AIDS is not random at all and is subject to many conflicting factors. “Poverty, migration, gender inequality, and stereotypical gender roles influence vulnerabilities. Significant factors such as lack of autonomy for women and girls, violence against women, discrimination against sexual minorities, abuse of power and lack of access to health services” are what determine the healthcare women in underdeveloped countries receive. Since India is an underdeveloped country, socioeconomic (SES) factors obviously effect women’s access to health care. The correlation between wealth and education on condoms was very high; the higher SES, the more educated. However, a woman’s socioeconomic status is determined by other factors more so than just education. Since an Indian woman has far less power within her culture and gender inequality is so immense, the HIV and AIDS epidemic represents how the disempowerment of women impacts their health. “The gender dynamics of the epidemic are far-reaching due to women’s weaker ability to negotiate safe sex and their generally lower SES.” Why are women unable to negotiate safe sex? Why do they engage in risky behavior if they know about the epidemic? How is an Indian woman able to educate herself on disease and preventative measures if she has a low SES and minimal means to prosper? The article says that often times women wait until it’s too late to get tested, that they only become aware they are HIV positive until after her husband’s diagnosing/death. This raises the question then, do behavioral factors affect their health? The article says that it most definitely does, and for women with “a lower life expectancy may have low self-esteem and low levels of health seeking behavior and might take risks with their health.” If we put aside cultural factors for a moment and solely focus on human behavior, it makes sense that a woman within an Indian culture may feel very little reason to take care of herself. In the most detrimental and restrictive case- a married Indian woman from a rural city with a low SES and has minimal knowledge and education- she has very little inclination to take control of her body and health. She might feel as though this is the life destined for her and it is better than not being alive at all. If an Indian girl grows up watching her mother, sister, and friends live in a harsh society like this, what means will she have to take to change her future and prevent becoming infected? One of the basic ideas in interpreting behavior is to look at the people before us; our best form of reference is through others and through experience.
The health determinants for the HIV and AIDS epidemic in India has been acknowledged in terms of socioeconomic status, education levels, gender inequality, and behavioral conduct. While some factors are controllable, like getting married or using drugs, most of them are not. The life these women live are determined very early on in life and the only way to prevent transmission is to educate themselves beyond primary and secondary schools and to take action before it is too late. Though these Indian women are subject to disempowerment in a predominant patriarchal society, it is detrimental that the educational system provides students with as much safe sex information that they can in order for these women to be knowledgeable enough to take action. Cultural, political, and economic factors are long-term restrictions; they will not change overnight. And attaining gender equality in India will have to surface before the HIV/AIDS epidemic goes away all together—even if medicine finds a cure before equality exists, there’s still going to be the violence, abuse, and disempowerment against these women.