On a recent Saturday morning in Lucknow, the capital of the northern Indian state of Uttar Pradesh, male commuters at a local bus station couldn't help but notice a canopy and table set up near the entrance. A poster displayed prominently behind the stall showed a pale pink condom cartoon character next to the Hindi words "Kabhi bhule na," meaning "Never forget."
Some of the men snickered and hurried past when they realized what the stall was promoting. But others remained, listening curiously and attentively as the man behind the table pulled out a pale pink dildo. After unwrapping a condom, holding it up to the light, and explaining how to use it, he encouraged members of his audience to try it themselves. Hesitantly, one of them obliged. After fumbling slightly with the dildo, the young man placed the condom on the head — handling the tip with care, as instructed — and rolled it down.
Ved Prakash Tripathi, the man behind the table, admired the young fellow's effort, awarded him a blue pen, and then proudly exhibited the dildo so that other men could see the properly placed prophylactic.
"We are trying to motivate them to use condoms," Tripathi, a communications officer with Hindustan Latex Family Planning Promotion Trust (HLFPPT), told VICE News. "The main work is to break the hesitation."
While condom advertisements and discussions about sex have become common in some of India's urban areas, educating men about safe sex practices remains a significant hurdle throughout much of the patriarchal country. Prevailing stereotypes give men the upper hand in sexual matters, but they are often left to contend with their insecurities alone. Because of the constricting nature of gender norms and the widespread mobility of men, health professionals believe that sensitizing and educating them is key.
The coyness and complicated social relations surrounding sex are the biggest barriers when it comes to contraceptive use, whether in the case of birth control or in the prevention of sexually transmitted infections.
HLFPPT works across the country to promote condom use for family planning and HIV/AIDS prevention and control. Hubs like bus and railway stations serve as on-the-spot venues for demonstrations that offer education and outreach to men who commute from rural to urban areas for work.
"Over time, there has been an evolution of the [HIV/AIDS] epidemic," Oussama Tawil, the country coordinator for UNAIDS in India, told VICE News. "One of the main factors is of course mobility."
India's HIV/AIDS awareness and prevention program has expanded in recent years to include targeted interventions with migrants and long-distance truck drivers in addition to core at-risk groups: female sex workers, men who have sex with other men, intravenous drug users, and transgender individuals. Though the country's latest HIV/AIDS surveillance report showed that the epidemic was stabilizing among those groups, Tawil noted that the movements of traveling men are suspected of influencing infection patterns in different Indian states.
Historically, authorities have monitored high rates of infection in portions of India's northeast and parts of the south. But an alarming 41 percent of new infections are taking place in states like Uttar Pradesh, Rajasthan, Orissa, Madhya Pradesh, and Gujarat — areas with historically low HIV/AIDS prevalence, and where large numbers of men are leaving in search of employment.
"They're the ones who act as a bridge between the high-risk groups and the general population," Dr. Sangita Pandey, the joint director for information, education, and communication for the Uttar Pradesh State AIDS Control Society, told VICE News. Studies have found that migrant men and their partners are at a higher risk of HIV infection than non-migrants due to their having unprotected sex with different people.
Reaching out to and educating men is also important because of assumptions in India on who has authority when it comes to sex.
"In Indian society, it's the general opinion that males are the main decision-makers of the family, so we target them," Safia Abbas, a communications manager at HLFPPT, told VICE News.
Last month, more than a dozen women in the Indian state of Chhattisgarh died in a botched mass sterilization surgery. While recent reports suggest that tainted medicine might have caused the deaths, the incident drew attention to family planning methods in India. Female sterilization is the country's most common method of birth control — 37 percent of Indians favor it, whereas only five percent use male condoms, according to United Nations data.
Reports on the Chhattisgarh incident, in which a doctor and two assistants operated on more than 80 women within a few hours, have revealed that various incentives under a population control scheme were associated with the case. These included sterilization targets among healthcare providers and cash payments of about 1,400 rupees ($23) offered to persuade women to undergo the surgery — a common enticement in India.
India's social conservatism makes it difficult for most people to talk frankly about sex, let alone casual sex that might occur outside of marriage.
The coyness and complicated social relations surrounding sex are the biggest barriers when it comes to contraceptive use, whether in the case of birth control or in the prevention of sexually transmitted infections. For many couples, the religions and social norms governing their lives teach that the point of sex is to reproduce a family, so they are generally not interested in impermanent contraception like condoms or intrauterine devices. The decision to undergo sterilization comes later.
"They generally decide [after having a few children], 'Our family is complete, now we should go to the permanent method,' " Mukesh Sharma, the deputy director of Urban Health Initiative in Lucknow, a project of the Bill and Melinda Gates Foundation that counsels families in urban slums on health and family planning, told VICE News.
But male sterilization, though safer, is exceedingly rare — only one percent of Indian households report using it for contraception. Sharma said that it is generally not a favored option because of masculinity myths associated with the procedure, such as that men are afterward incapable of doing physical labor. Patriarchy also invariably plays a role, because men favor themselves when making family planning decisions.
Meanwhile, women in rural India are practically powerless to make decisions themselves regarding sex, according to Narendra Kumar, a project director for the Uttar Pradesh State AIDS Control Society.
"The female population cannot really go and buy condoms," he told VICE News. "It is also the males who have their inhibitions."
India's social conservatism makes it difficult for most people to talk frankly about sex, let alone casual sex that might occur outside of marriage. Health experts noted that men are also often concerned that using a condom will decrease sexual pleasure, or fear stories shared among them suggesting that it will burst during intercourse — a rupture that is generally the result of improper application, according to Tripathi, the communications officer at HLFPPT whose demonstrations are meant in part to ease male anxieties.
"We explain to them that their usage is not correct," he said.
Besides the condom demonstration, his stall featured a dart game poster that he uses to teach about sexually transmitted infections and how condoms help prevent them. The cartoon condom, pink dildo, and lighthearted quizzes and games make raising awareness of safe sex more entertaining and easier to discuss.
"It's not presented so seriously," Tripathi noted. "But when they come, they understand."
When men express worry about the loss of sensation, he reminds them that they have a choice among rubbers.
"We tell them, 'If you don't feel pleasure, then buy the dotted [textured] kind of condoms,' " he said.
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