Report Of Govt

INDIA

Report on

One Day State Level Training of Trainers for Officials of Government Departments on Mainstreaming HIV At State Institute of Health & Family Welfare Jaipur 26th April, 2008

Organised by

State Mainstreaming Unit 1

State Mainstreaming Unit

RSACS, Jaipur

Agenda for ToT: • Develop common understanding of Mainstreaming HIV issue. • Identify key activities to strengthen Mainstreaming HIV at different Government Departments. • Discuss and identify department specific roles and responsibilities to facilitate the mainstreaming process. • Assist different government departments in developing sector specific work-plans.

Mainstreaming team at RSACS: Mr. Ashok Raisinghani , Project Officer, State Mainstreaming Unit, RSACS • Ms. Ritu Pandya, Sector Coordinator - NGO, State Mainstreaming Unit, RSACS • Ms. Madhu Sharma, Project Assistant(Admin), State Mainstreaming Unit, RSACS •

Resource Persons:  

 

 

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Dr. M. L. Jain, Director (AIDS), Directorate, Medical & Health Services, Jaipur Dr. Pallav Bhattacharya, Consultant- Ministry of Panchayati Raj, NACO-MS Cell, Delhi Mr. Ashok Raisinghani, Project Officer, State Mainstreaming Unit, RSACS, Jaipur Dr. Nupur Prasad, Dy. Director (Sur.), RSACS, Jaipur Dr. Anil Agarwal, HIV Expert, Jaipur Dr. L. Ramakrishnan, Country Director, SAATHII (MRU), Chennai

State Mainstreaming Unit

 

Mr. Dalbeer Godara, Joint Director (IEC), RSACS, Jaipur Mr. Krishn Gautam, Team Leader, MRU Rajasthan

Participants:  60

representatives from Different Government Departments like- Department of Panchayati Raj, Department of Tourism, Department of Tribal Development, Department of Urban Development, Department of Home Affairs, Department of Railways and Department of Women & Child Development from 6 districts i.e Ajmer, Alwar, Barmer, Udaipur, Jaipur & Jodhpur.

Structure of Workshop  Presentations and speech by speakers/presenters  Each session is followed by Q & A, included in the allotted time.  Group task to be facilitated by Mainstreaming Team and done by participants.

Inaugural Session Workshop was initiated with a small welcome introduction and registration formalities of all the participants, facilitated by Mainstreaming team. One display board on concept of Mainstreaming HIV was placed at the workshop premises to inform participants about mainstreaming HIV. This display has helped a lot to improve the participants understanding on the issue. After registration, workshop was followed by a welcome session of the chief guests and key speakers of the workshop. A pre-test was conducted to assess the knowledge base of all participants in context of HIV and their understanding of the Mainstreaming Issue.

Key Note Address & Signature on Oath 3

State Mainstreaming Unit

All participants were asked to note their expectations on the desk for the planned day. With the noted points the session was carried forward by Dr. M.L.Jain, Director (AIDS) RSACS. In his opening key note he shared the Mainstreaming HIV project and strength in a very comprehensive way. A flex having oath printed upon it, was hanged at a prominent place with the objective of 1. Create responsiveness towards HIV/AIDS 2. Initiate discussion on Mainstreaming HIV 3. Help in creating enabling environment to mainstream HIV At the end of his key note, he signed the oath followed by all participants and Key Speakers.

An officer signing the Oath Technical session-1: Basics of HIV/AIDS Dr. Nupur Prasad, Dy. Director (RSACS), presented the indepth understanding of HIV/AIDS in her presentation. She gave a detailed presentation on HIV/AIDS. She explained following topics in her presentation-

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 What is HIV/AIDS?  What is the difference between HIV & AIDS?  HIV Life-cycle and dynamics of HIV Transmission  Clinical Stages of HIV  What does HIVpositive mean?

The difference between HIV and AIDS • HIV causes AIDS • HIV is a virus and AIDS is a disease • AIDS—deficiency in the body’s defence mechanism or immune system • AIDS is acquired, not hereditary • HIV develops into AIDS depending on the body’s defence mechanism

State Mainstreaming Unit

She started her presentation with two games. First of all she gave one piece of paper written Yes or No on that to all participants. Then she asked all participants to shake hand with as many people they can. She asked that how many people got the slip of Yes and how many got the No. Then she asked that the person having paper slip of Yes indicate the HIV Positive person and No indicate the HIV Negative person. Then she askes to all participants to imagine that if you had shaken your hand with some HIV Positive Person that what will happen to you. After that she explained that there are lots of misconceptions and myths prevailing in our society and we need to clarify those and spread the message of love and compassion.

Participants understanding the Basics of HIV In the second exercise, she created a sketch on whiteboard and asked participants to explain what is it? Everyone gave his own response and finally she explained that it is just our imagination and we all need to be careful in it.

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After both exercises, she addressed the process of HIV Infection, causes of infection, myths and misconception related to HIV/AIDS and stigma reduction issues in detail. She briefed the causes about the HIV –AIDS i.e “probable sources of HIV transmission & dynamics of HIV transmission”.

Technical Session -2: Effects of HIV on Common man & their potential role in control of epidemic Dr. Anil Agarwal, HIV Expert took the session on Effects of HIV on Common man & their potential role in control of epidemic. He presented the effects of HIV on Common man elaborating the effects at various levels i.e. At his/her personal level  At Family level

सा मा नय आदमी पर एच. एच. आई वी कई Lrj से प भा िवत करता है . स वयं के स तर पर प िर वा र के स तर पर समा ज के स तर पर

 At Community level

Dr Anil Agarwal Explaining the effects of HIV on Common Man

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He showed some media clippings related to effects of HIV on Common Man and his Family to make them realize the stigma and discrimination associated with HIV.

Technical Session – 3 Conceptual understanding on mainstreaming HIV Dr. Pallav Bhattacharya, Consultant- Ministry of Panchayati Raj, NACO-MS Cell, Delhi shared the conceptual understanding on Mainstreaming HIV. He covered following topics in his presentation• Mainstreaming HIV/AIDS • Differences between Mainstreaming and Integration • What is not Mainstreaming? • Mainstreaming and National Response • Two domains of Mainstreaming • Three basic questions for Mainstreaming HIV He explained that Mainstreaming HIV/AIDS is “a Process of analyzing how HIV and AIDS impact all sectors now and in the future. It is an internal and external process.”

Dr. Pallav Sharing the Concept of Mainstreaming He also explained the difference between Integration and Mainstreaming. He said that mainstreaming is beyond Integration. It is “identifying specific areas of responsibility related to HIV/AIDS and commitment shown for Specific action and financial resources”.

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State Mainstreaming Unit

He cleared that the term mainstreaming is often inter-changeably with

‘integration’

Integration fHIVandAIDS:itswhena MainstreamingHIV:itswhenaprogam eaims progam eaimstomakeHIVrel vant tomakeHIVrelvantchangestoalthe re l velsof changesto nly imtedare swithnagiven policy,peo leandprogam estha wecalthe inst uion’sworking proces mainstreaming.

used or

PROGRAM ES

PROGRAM ES

‘multi-sectoral response.

PEO LE HIVinclude inalimted portin

PEOPLE

In many ways the three

POLICY

POLICY

terms

--

integration,

mainstreaming

and

multi-sectroal response – Difference between Integration and Mainstreaming He also explained that what is not mainstreaming  It is NOT simply providing support for a Health Ministry’s programme.  It is NOT trying to take over specialist health-related functions.  It is NOT changing core functions and responsibilities.  It is NOT business as usual- some things must change. Dr. Pallav emphasized the need for mainstreaming in countries with lower prevalence of HIV. He said that there are strong linkages between local factors like vulnerability to infection, and more visible development problems, such as drug use, stigmatization of homosexuality, gender inequality, and poverty. It is also clear that AIDS draws attention to insufficiently recognized development issues. He also explained the two domains for Mainstreaming HIV. These are:

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State Mainstreaming Unit

Two domains for mainstreaming External domain 



The organization’s mandate and usual work. I ncludes the people it serves.

I nternal domain 



The organization’s workplace. I ncludes its resources, mainly the employees, and internal procedures.

Dr. Pallav said we always keep in mind three basic questions for the mainstreaming process, these are: How does HIV/AIDS affect our organization and our work, both now and in the future?  How may our work mitigate or aggravate vulnerability to HIV infection and to the impact of AIDS?  Where does our comparative advantage lie in responding to those affects? In the second part of his session he shared some data on HIV and focus how Panchayat can mainstream HIV? He shared that total number of HIV positive in India is 2.5 million and out of this 38.4% are women. Almost 57% of these numbers are residing in rural area. He enforced the involvement of Gram Panchayats for mainstreaming HIV. He said that mainstreaming HIV at Gram panchayat level is the only way by which HIV and development go hand in hand. Gram panchayat can mainstream HIV by –  Talk how it spreads  And how it does not  Know, oversee and monitor access to services – ICTC, PPTCT, and ART Centres.  Cater to livelihood needs He gave the example of South Africa depicting the same in his presentation given below that we need to act right now 9

State Mainstreaming Unit

otherwise our condition would be equivalent to them and we have to face same problems as they have faced. When?? NOW The South Africa Experience 1515-20 years back --- Denial --- Now Where India is today

20% prevalence

Technical Session – 4 RSACS Services (IEC, Treatment, care and support, blood safety, TI, ICTC etc.) Mr. Dalbeer Godara, JD (IEC), RSACS, gave a brief presentation on RSACS Services i.e. IEC, Treatment, Condom Promotion, Care & Support, Blood Safety, TI, & ICTC etc. He described briefly on every component mentioned above as • What a particular service is? • Where it is functioning or operating? • Who will be the beneficiary of particular service? • How a person can get help from a particular service? He represented all services of RSACS in a map of Rajasthan very well. Facilities By RSACS Upto 2007

42 I CTC (G) 74 BLOOD BANK 47 STD Clinic 30 I CTC (P) 4 ART Center 2 Community Care Center

1 Drop in Center

Services of RSACS 10

State Mainstreaming Unit

Technical Session – 5: Vulnerability factors of HIV in Rajasthan & Potential role of Govt. Dept. for mainstreaming HIV Mr. Ashok Raisinghani, Project Officer, State Mainstreaming Unit, RSACS presented vulnerability factors of HIV in Rajasthan & Potential role of Govt. Departments for Mainstreaming HIV very specifically. He took his session in two parts- first is Vulnerability factors of HIV in Rajasthan and Second is Potential role of Govt. Departments for mainstreaming HIV. He presented that Rajasthan has a low prevalence but high vulnerability in terms of HIV, the vulnerability factors include HIV already exists  large population of Rajasthan (56.4 million)  HIV and AIDS is equally rural and urban epidemic  Out-migration  Rajasthan accounts for 19 percent of all mines in India  25,000 trucks travel daily on NH 8 alone  Tourist Destination To ensure active participation and long term learning by all participants regarding the role of Govt. Departments for mainstreaming HIV, he presented a case study of Mr. Gupta working As a District level Officer in Government Setup. The case study isBackground: Mr. Gupta is a District Level Govt. Officer and has been working in same Dept at various levels and in different Districts for last 12 years. Today he is the Head of Dept in his District and is really busy with waves of monthly meetings and further reports and official visits. With all the given regular work, He has no time to think or plan of some new initiative in the office. Issue at hand

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There has been lot of talk going on about HIV awareness, education etc. He came to know of a term recently in this respect i.e. ‘Mainstreaming’, whatever it means. Every other departmental head in his District is coming up with some new plans to include HIV in Departmental issues. He is quite surprised with the efforts taken by his colleagues as he can not find a single HIV affected person or dependent family in his office. On top of all, now the Govt is asking again and again from all Dept Heads to take an initiative and participate in National efforts to mainstream, halt and reverse the epidemic of HIV / AIDS. Problem Now with all the above mentioned pressure to act against HIV what should Mr. Gupta do? What can he do to mainstream? Also consider there is no separate budget for this, lots of regular work pressure, non cooperation or disinterest or cold shoulders or simple ignorance from subordinates, lack of time, challenge of complicated Govt. policies and a delicate subject matter of HIV / AIDS in Indian context. Response I am sure every one has been in shoes of Mr. Gupta at one point or other in our lives, so everyone can relate to this case study. We need to find a solution from the list of good, bad and most appropriate one as it is our responsibility to be proactive and decision maker. Let’s discuss…… THE BIG DECISION Decide if Mr. Gupta needs to and want to Incorporate Mainstreaming in Dept… YES: Contribution in national Efforts, Proactive Image, Act as per State/National Govt. frame of mind, Sooner or later it needs to act upon. NO: Easy way out, It is not time yet

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State Mainstreaming Unit

Participants thinking what is their role in Mainstreaming HIV YES > HOW?  Can plan some activities without budget or can collaborate in on going activities. Examples…  Sensitization of Subordinates/Employees.  Identification and then Sensitization of key stakeholders with special attention to vulnerable stakeholders.  Set up a Nodal Person / Anti Stigma Counselor in the Dept.  Condom vending Machine.  Stigma and discrimination free environment with equal or more opportunities to HIV +ives.  Support and Motivate for Counseling and testing facilities with provisions for Anti retroviral treatment to HIV positive employees.  TOT  Request Budget from the Department to effectively plan and implement the abovementioned.  Provide financial support to the national response against HIV. 

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State Mainstreaming Unit

Programmatic Entry Po Points… Workplace HIV/AIDS Policy & Programme

Integrated Prevention

BCC

Traditional Vulnerable Groups

ICTC

STI Prevention treatments

ARV/OI Treatment

He also presented some possible ways of mainstreaming as programmatic entry points as represented above.

Technical Session – 6 What we can do for HIV Awareness? Dr L Ramakrishnan, Country Director, SAATHII, and Mr. Krishna Gautam, Team Leader, MRU took a session on “What we can do for HIV Awareness?”. First of all, they described about the project that what it aims to, that, “Rajasthan HIV/AIDS mainstreaming initiative aims to mainstream HIV/AIDS as a critical development issue across government and civil society sectors at state level and in six districts of Rajasthan: Ajmer, Alwar, Barmer, Jaipur, Udaipur and Jodhpur.” They have explained the possible actions that can be taken by different Govt. Departments to mainstream HIV at their

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own

level.

The

PREVENTION AND AWARENESS Eradicate stigma and discrimination Build awareness of how HIV spreads focus on migrants, self-help groups, panchayat leaders Destroy myths and misconceptions about transmission Encourage people to protect themselves ABC Make condoms accessible Motivate individuals to go in for counseling and testing Encourage voluntary blood donations Encourage pregnant women to learn their HIV status and enroll in PPTCT Reduce unnecessary injections, promote use of disposables Institute occupational safety (post-exposure prophylaxis) Treat STI and RTI

possible

ways

are-

CARE AND SUPPORT Eradicate stigma and discrimination in all settings Ensure people diagnosed as HIVpositive get registered with ART Center and go for follow-up (even if they do not need ART) Prevent and treat Opportunistic Infections - can be done at district and sub-district health centers Ensure hygienic and healthy diets Psychosocial support to address depression and suicidality Economic and livelihood support link PLHIV to appropriate schemes Support to keep children in school

Session – 7: Group Exercise- How department will mainstream HIV in ongoing programs and policies

each their

Last session was fully dealt with the actual ground work. It was continued with group task and individual’s action plans on Mainstreaming HIV. How they will incorporate HIV issues in their existing programs, what strategies will they adopt for the same. After having half an hour brain storming exercises and lots of discussion, one representative from each group was asked to present their action plan on the desk. Major points of all groups’ discussion are as follows:  The

people who are trained here will disseminate knowledge on HIV/AIDS with their fellows & collogues.  They will share the issue of HIV/AIDS in their regular meetings.

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 They will advocate for appointment of AIDS counselor and Anti- Stigma Counselor in their own department.  They will distribute IEC Material on HIV/AIDS and display at strategic locations.  They will try to ensure availability of condoms at some places like Public Toilets, Hotels, Railway stations, Retiring Room & Waiting rooms at Railway stations, etc. Finale Because of successful intense interaction and clear message conveying, all participants were highly motivated and pledged to initiate ‘Mainstreaming Agenda’ at department and district levels. Ms. Ritu Pandya, Sector Coordinator (NGO) - SMU thanked to all guests and speakers and especially all department heads for providing their valuable time and inputs to make this training successful and allow their staff to take part in the noble initiative for Mainstreaming HIV. The workshop formally ended with feed back from participants and with good wishes from Mainstreaming unit, RSACS.

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News Clippings

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