Let us first be clear what good health is. The World Health Organisation (WHO) characterizes good health as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. Thus good health is often a combination of various physical, mental and social aspects.
Physical health or fitness is about the ability to perform aspects of daily activities, occupations and sports. It is generally achieved through proper nutrition, moderate-vigorous physical exercise, sufficient rest and a clean environment. There may also be an element of heredity involved. But let us not forget that without mental and social well-being physical health is not sustainable. Besides, our understanding of issues like ability and disability is changing.
In India, two physical health issues are a major part of the public health disease burden. These are tuberculosis and diabetes.
What is the connection of disability with health? If you can think of disability as only something negative, then you probably need to refresh your understanding. It is important to not look at a person with any disability as someone to be shunned. If you wear glasses or are a little hard of hearing, are you not disabled? Disability can happen to anyone, including the fittest people.
The WHO explains that ‘disability’ is an umbrella term, covering impairments, activity limitations, and participation restrictions. Disability may be physical (blindness, deafness or limbs related), intellectual (learning disability or autism), mental health related or psychosocial (like chronic depression), neurological (cerebral palsy or Parkinson’s disease), or blood disorder related (haemophilia). It may also be age related. One may have multiple disabilities.
It is now also argued that disability is not just a health problem. A major part of the problem is not even with the person who has a disability. It is to do with the attitudes of larger society and with the barriers in the environment in which the person lives. There are innumerable examples to show that if someone with a disability is provided the support and guidance they need, then they too can participate in society on an equal basis in any social sphere.
What is mental health all about? According to the WHO, mental health is defined as a state of well-being in which every individual realizes their own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to their community. Being able to establish fulfilling relationships is also part of mental health.
A person struggling with their mental health may experience stress, loneliness, depression or anxiety, or have relationship problems. Many persons with mental health problems have suicidal thoughts, grief, addiction, attention deficit hyperactivity disorder, obsessive compulsive disorder, or learning disabilities. But mental health problems can be managed, treated and cured with therapy, counselling and medication provided by mental health professionals.
Often women with mental health problems face more stigma than men, and as a result of that they are often subject to violence and denied basic choices in life. Similarly, LGBTIQA people are often abused as ‘mentally sick’ and have to face violence in different forms. These issues are related to social prejudices, gender inequality and myths that we must all question. The fact is homosexuality is no longer considered to be a mental sickness.
The World Psychiatric Association (WPA) states that “same-sex attraction, orientation, and behaviour are normal variants of human sexuality” and not a mental health problem. In early 2014 and again in 2018, the Indian Psychiatric Society also issued a similar statement. Being transgender is not a mental health disorder either. Transgender identities are normal variations in the way people think and feel about their gender. The term ‘gender identity disorder’ is being replaced with ‘gender dysphoria’ – a feeling that your body does not reflect your true gender. This feeling may cause distress. It is this distress that needs treatment rather than being transgender itself.
All the so called treatments for ‘curing’ homosexuality and gender variance are useless and can also be harmful. Rather, LGBTIQA people need help in dealing with the stress caused by social stigma around their sexual orientation and / or gender identity.
This brings us to the topic of sexual health. According to the WHO, “Sexual health is a state of physical, mental and social well-being in relation to sexuality. It requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence.”
We have looked at the mental and social aspects of sexual health. A look now at some of the behavioural and medical aspects: Prevention, testing and treatment of STIs and HIV. One of the first issues is safer sex. Any sexual activity that does not involve the exchange of body fluids like blood, semen and vaginal fluids between you and your partner is safe. Example: Using a condom every time during penetrative sex (oral, anal or vaginal), irrespective of whether your partner is male, female, intersex or transgender.
About STIs: If detected and treated early, most STIs can be cured completely. If you are sexually active, the most common symptoms to look out for are burning sensation while urinating; itching, redness, rash or sores in the genital area; and unusual discharge and foul smell from the genital area. If you have any of these, visit an STI specialist or dermatologist for confirmation. If you have an STI, it is best to stay off sex till the disease is cured. It will be good for your sexual partner also to get a check-up done.
About HIV and AIDS: The human immunodeficiency virus (HIV), if unchecked, destroys your body’s immunity and leads to an illness that is called acquired immune deficiency syndrome or AIDS. The person who gets AIDS becomes ill with many different infections and if not treated in time dies because the body cannot properly recover from these infections. A cure for HIV infection is yet to be found. But care, support and treatment for HIV is possible, and it can improve the person’s immunity and even reverse the condition of AIDS.
HIV is also an STI and can spread through unprotected penetrative sex (vaginal, oral or anal). If you use a condom every time during penetrative sex, you can protect yourself and your partner from these infections. HIV can also spread through non-sexual routes – transfusion of infected blood and blood products, re-use of contaminated needles and syringes, and from an infected mother to her baby before, during or soon after birth (through breast milk).
HIV infection can only be detected through special blood tests. These are done free of cost at government-run integrated counselling and testing centres across India. HIV tests must be accompanied with pre and post-test counselling to prepare a person for the test itself and for the results. It is mandatory for test centres to maintain complete confidentiality around the HIV test results. Other than the relevant health care providers, only the individual tested must first come to know their test results (unless they are a minor or dependent on a guardian).
About HIV treatment: It has two components: (1) Treatment for HIV infection through anti-retroviral therapy (ART). If started at the right time and taken regularly, ART can prevent the growth of HIV and reduce the viral load in the body to negligible levels. ART must be taken life-long; (2) There should be early and complete treatment for the opportunistic infections that invade the body when a person develops AIDS (example, tuberculosis and diarrhoea). HIV treatment is available free of cost in specific government hospitals.
HIV treatment must be accompanied with care and support for people living with HIV as well as their family members. This includes hygiene, nutritious food, clean drinking water, exercise and rest, stress management, prevention of infections and diseases through safer sex and other means, emotional as well as financial support (all of this often summarized as ‘positive living’). Care and support may be home based, and not necessarily in a hospital or hospice.
About PEP and PrEP: PEP (post-exposure prophylaxis) and PrEP (pre-exposure prophylaxis) are new approaches to prevent HIV through intensive and time-sensitive use of ART. PEP involves taking ART within 72 hours after being potentially exposed to HIV during sex or through shared needles to prevent becoming infected. PrEP helps people who do not have HIV but are at substantial risk of getting it to prevent the infection by taking a pill every day. PrEP is yet to be adopted by the government for large scale use in HIV prevention programmes. Both PEP and PrEP require strict adherence through the entire course as advised by a qualified doctor.
Harm reduction: This refers to policies, programmes and practices that aim to reduce the harms associated with the use of psychoactive drugs, tobacco and alcohol in people unable or unwilling to stop. The focus is on the prevention of harm, rather than on the prevention of drug or substance use itself. Example, needle exchange programmes for injecting drug users can help them continue to inject but prevent transmission of STIs and HIV. Harm reduction may help complement other means to reduce or stop the intake of drugs, like abstinence.