Aids

Internal and External Mainstreaming alongwith Complementary Partnerships: Focussed interventions for economic transition towards betterment of the HIV/AIDS affected people Submitted by Bharat Integrated Social Welfare Agency (BISWA), India At the Hope 2008 International Conference

Hope 2008 International Conference was organized by Drug Abuse Information Rehabilitation and Research Centre (DAIRRC), India (in consultative status with the United Nations’ Economic & Social Council) On 10th, 11th and 12th October 2008 at The Taj President Hotel, Mumbai, India Introduction A person when identified as HIV+ve can still hope to survive for next 15-20 years with the same responsibilities to earn and provide for his/ her family. On the contrary, the resultant effect is social ostracism which debars him/ her from all family and community ties. Livelihood approach to address HIV/ AIDS epidemic promotes thinking across board from health impact to economic and social support for equal growth opportunities. Our concern remains that a person living with HIV/ AIDS does not stop being a family or community member but the revealed identity alters his/ her access to work and financial assets, family and community relations for an undermined living condition. Bharat Integrated Social Welfare Agency (BISWA) is working in 11 states of India through an integrated development approach focusing on the poor and marginalized communities since 1994. In Orissa, Chhattisgarh and Jharkhand, BISWA is working with full vigor to promote Micro Finance inclusive of Micro Credit and Savings, Micro Enterprise, Micro Insurance and Social Development. As on March 2008, BISWA has promoted more than 25000 Self Help Groups and 15000 Enterprises. The approach towards HIV/ AIDS has been health care through preventive, referral and counseling measures incorporated with the micro finance activity.

Concern: Orissa context

While presenting the HIV Sentinel Surveillance data 2007 in Rajya Sabha, the Minister for Health and Family Welfare, Dr. Anbumani Ramadoss named four districts of Orissa: Bolangir, Bhadrak, Ganjam and Angul under category ‘A’ with high prevalence of HIV infected population. As per category ‘A’, districts having HIV occurrence in more than one percent among Antenatal women of general population and hence it indicates the vulnerability among women and any further increase in prevalence rate would rise the number of adults living with HIV/AIDS. Within Orissa, Ganjam district is at the first place in the row in terms of degree of prevalence of HIV/ AIDS among different states of India, as per the Impact Study of NACO study, April 2006. The report elaborates that there are more than 600,000 Oriya migrant labourers working in Surat from Ganjam district alone, out of 900,000 labourers from the state. At least 30 per cent of them are seasonal migrants and the others live in the slums of Surat around the year, in conditions that carry high risks of unsafe sex leading to HIV

transmission. The medical community of Orissa confirms the alarming increase in AIDS among migrant labourers. Brothels flourish as much as jobs and this is one reason why Surat is a sitting duck for an AIDS bomb. Large-scale proliferation of premarital promiscuity, multiple sexual partnerships with commercial sex workers and high homosexuality are part of labour life. The commercial sex workers are the AIDS carriers in Surat. The menace of AIDS is graver than usually understood since migrant workers return to their native places taking the risk across several hundred kilometres to their families. Again the myopic gendered view puts a curtain on the left away women and on their sexual desires. The men fall prey to the distance from their wives, vice versa stands applicable for the women. Though in contrast to the women left behind by the army personnels. These women feel proud in awaiting their husbands, the sense of which is absent in migrant families. We, also, seek to regard ‘feminization of poverty’ as a cause for perpetuating poverty because the syndrome increases the burden on women once the male member falls prey to HIV. Alongwith taking care of the sick member, the women have to play the role of family breadwinner as well. The main identifiable reasons for high HIV/ AIDS prevalence in Orissa is: ■ Ignorance about the transmission of the disease ■ Low literacy ■ Migration ■

Poverty

The National Health Policy document of the Government of India – 2002 states in paragraph 1.5, “A new and extremely virulent communicable disease – HIV/AIDS – has emerged on the health scene since the declaration of the National Health Policy – 1983. Since there is no existing cure or vaccine for this infection, the disease constitutes a serious threat not merely to public health but to the economic development of the country.” Involvement in promoting HIV/ AIDS mainstreaming Awareness Programmes (i) BISWA staff puts up HIV/ AIDS as one of the main agendas to be discussed at the Self Help Groups (SHGs) meetings. Among the total SHGs, women SHGs constitute 84% which becomes a strong platform for promoting awareness – prevention and control on HIV/ AIDS on a regular basis. At present, BISWA is working with more than 25000 SHGs across Orissa and Chhattisgarh which becomes the most important vehicles to spread awareness and further carry forward programmes conceived on HIV/ AIDS. (ii) BISWA has been observing ‘World AIDS Day’ across all 30 districts of Orissa every year by means of organizing rallies, community and staff meetings. On the occasion, BISWA distributes Information, Education and Communication (IEC) materials against discrimination of HIV/ AIDS affected people and on safe behaviour. (iii) Pre-marital Counseling sessions are regularly provided to the girls and women who come to the BISWA Family Counseling Centre and in the near by colleges. Implementing Programmes (i) Blood donation camps are organized by BISWA, most often quarterly to ensure safe blood transfusion. These camps are administered by medical practitioners and Government doctors. (ii) BISWA operated as the implementing agency on Reproductive and Child Health (RCH) program of Government of India since 1999. The activities were carried out in 20 Gram Panchayats of Sambalpur district, covering a total population of more than 80000. Till date BISWA has implemented programmes pertaining to Reproductive

and Child Health benefiting more than 150000 population spread throughout the district. BISWA has implemented the programme in Chhattisgarh as well. The trainings and workshops conducted under the programme involved sessions on STIs and prevention/ diagnosis of HIV/ AIDS. BISWA has worked with the vulnerable groups such as the truckers, MSM, FSW and IDU on awareness generation and with special focus on the FSW group on economic promotion through micro finance. Every year, more than 1000 health camps are organized in several districts of Orissa which include check ups on gynecological diseases, STIs and STDs and also creates a platform for counseling and referrals on HIV/ AIDS.

(iii) (iv)

What we intend to do (i) Internal Mainstreaming - HIV/ AIDS in the workplace. (ii) BISWA is trying hard to establish the State Resource Centre in Orissa. The status will enable BISWA to empanel various projects being implemented on HIV/ AIDS. (iii) BISWA has already established one OPD centre in the urban slum area of Sambalpur, Orissa. And, intends to open more number of OPD healthcare facility centres in the vulnerable areas, especially the urban slums to facilitate diagnosis of the syndrome and early health care. (iv) BISWA intends to initiate a Networking platform for the HIV Positives. Foreseeing the role of NGOs in mitigating HIV/ AIDS BISWA believes that the Civil Society has a major role in ‘HIV/ AIDS – prevention and control’ as these organizations have the advantage of working at the grassroots with the people. As such, NGOs are better acquainted to devise, plan and implement programmes through community mobilization. ƒ ƒ ƒ ƒ

Promotion of safe sexual behaviour Early diagnosis Treatment of STDs Information, Education and Communication

The main hurdle, however, is stigma attached with the identity of HIV/ AIDS which the NGOs can solve through counseling and creating opportunities through employment generation. Therefore, the NGOs can play a pro active role in converting negativism into positivity. BISWA’s Livelihood Framework for the HIV/ AIDS affected persons In the Livelihood Framework for the HIV/ AIDS affected persons, BISWA envisages employment generation activities for the people through a thoroughly planned intervention. This is in view of the fact that the maximum number of HIV +ve cases found is in the 25-39 age group and this group is known as the major workforce of a family or a community. (i) Target Group Mapping This will include mapping the target groups who are the most vulnerable of the lot to intervene with these groups. In field projects the community must be actively involved at all stages including the early stage of goal-setting right through to the concluding stages. Participatory research is essential for maximizing the outcome of research and its sustainability. Mapping will include identifying the livelihood options that can be linked to a particular group. Community Involvement in Awareness Programmes will be a key in these programmes which will also focus on identifying the members to be organized into Self Help Groups.

We intend to divide the target group into: ■ HIV/ AIDS affected persons ■ Women member of the family with HIV/ AIDS affected person. The aim will be to create a socially inclusive programme to let the HIV/ AIDS affected people live a normal life. (ii) Financial linkage for enterprise development The selected target group, organized as the Self Help Group will be credit linked through micro finance programme. This loan assistance will be channelised to create sustainable livelihood options. The group will be provided with technical guidance for business plan development. Coupled with micro enterprise development, there will assistance for product marketing and establishing a saleable brand. (iii) Integrated Health Care and Livelihood The Healthcare can be integrated with the livelihood aspect while we talk of bringing the HIV/ AIDS affected people under one shelter. In this process, the HIV/ AIDS affected people will live through interdependence wherein the responsibilities would be of a shared nature like preparation of meals, cultivation and enterprise work depending upon the physical condition of each inmate. Such a framework will ensure that HIV/ AIDS affected persons do not live a dependent life, rather would be empowered to meet their and their family’s requirement. BISWA’s intervention in similar projects In Hatibari, BISWA is managing a health home for the leprosy cured patients. Leprosy cured patients who have lost their efficient functionality of body organs and emotional strength are working for their livelihood and are getting healthcare as well. Earlier, these people were mostly begging for their living but now they are engaged in enterprises such as sisal fibre products, horticulture development, poultry and dairy farming. Therefore, we can seek a practical example to put forth the example of Hatibari Health Home to compare with a similar intervention for HIV/ AIDS affected persons. And, it is possible to have a similar programme conceived and implemented for the HIV/ AIDS affected persons. BISWA believes that HIV/ AIDS should not stand as a disadvantage to the livelihood opportunity of a person. Conclusion We conclude that the people identified as affected with HIV/ AIDS deserve an equally inclusive status in the society which can be achieved once they are economically sustainable. In the absence of this inclusive strategy, BISWA proposes a common shelter which will work on the concept of livelihood and healthcare interdependence. Note 1: BISWA is registered under the Societies Registration Act XXI of 1860 and FCRA 1976. References: 1. UNGASS Country Progress Report 2008, National AIDS Control Organisation, Ministry of Health and Family Welfare, India 2. Impact Study of NACO Campaign April 2006, National AIDS Control Organisation, Ministry of Health and Family Welfare, India 3. Annual Sentinel Surveillance Country Report 2006, National AIDS Control Organisation, Ministry of Health and Family Welfare, India 4. www.reportingpeople.org/presentations/PII_Workshop_awareness_on_hiv.pps