Grass Root Action - Gender Equality & Rights for Women in Health Services

[Guest guest]

AID

European Union

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AID was founded in India in 1982. The aim is to fight poverty and give strength to people to participate in grassroots democracy in India. It provides support and technical assistance to community working for total transformation.

This project is supported by European Union and Alternative For India Development, UK (Aid UK)

Background

In Operational Area

What AID is doing

AID'S Finding

Activities

Case Studies

Government to Ponder

Links

From Editor's Desk

Realization

Lesson for a Change

Coordination Brings Good Service

Sensitisation Pays

Awareness unites for a cause

Telephonic Counselling by Jharkhand State AIDS Control Society (JSACS)Call : 1097, 25461144, 2230912, 2440844

Paper presented by Ravi Kumar, Ex. Dir., AID UK in Confronting HIV, as well as tuberculosis & malaria: An Asia Stakeholders’ Consultation’’ at New Delhi during 4-7 April 2006

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Do You Know

51 lacs people in India are infected with HIV. One lac of them is full blown AIDS patients. The latest figure is estimated to have reached 54 lacs.

The total number of HIV cases in Jharkhand is 467.Of these 61 are the people living below the poverty line.

According to the report from the State AIDS Control Society (JSACS), about 11% of the families in the state are affected by sexual transmitted diseases like RDI and STI. AIDS is spreading rapidly in the region and the state has been declared as the one of the most vulnerable state.

The estimated figure of HIV infection taking place everyday in India is 1500. 90% of them are totally unaware of the disease.

For the first time, the report says that though the HIV/AIDS epidemic is stabilising in high-risk states like Tamil Nadu and Andhra Pradesh, newer high-risk populations are emerging, including the youth.

States like Bihar and Uttar Pradesh where the HIV-AIDS population is still small, the report has warned that even a small increase in infection rates can lead to an explosion since the epidemic is spreading heterosexually through families.

A study by the Central Social Welfare Board shows that over 60 per cent of the women in prostitution are dalits. Nearly 50 per cent maintain independent households. The average 25-year-old woman prostitute has two children solely dependent on her.

There are an estimated three million women in sex work in about 400 red light areas in India, approximately 30 per cent are children; a majority are dalits and tribals.

Stick awaits brothel clients

Proposed amendments

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Brothel clients to be punished.

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Soliciting and loitering not to invite prosecution.

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Age ceiling of child to go up from 16 to 18.

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Brothel managers’ penalty to be raised.

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Traffickers’ property to be confiscated.

Background

HIV/AIDS is spreading at an alarming rate among women, who now account for half of those infected worldwide. Of the 39 million cases of HIV/AIDS worldwide, 57 per cent are women. In India, of the estimated five million cases of HIV/AIDS, around 20 lakh are women. A husband or primary male partner has infected approximately 85% of them! As a result, not only are their wives infected but also children born after the man had become infected. While the general public continues to believe that most women with HIV/AIDS are sex workers, official numbers indicate that they constitute less than one lakh of the 20 lakh female infections. The stigma surrounding HIV/AIDS is so extreme that the true figures may be much higher. Thus the overall condition in India is very deplorable. The utter poverty and abject hunger creates a condition to sale their body at Rs.5-10.

In the majority of cases, the woman does even know about the possibility of contracting the diseases through sexual relations with her husband. Even if she knows and is aware of the precautions that ought to be taken, she is not in a position to insist. She cannot even protect herself from physical abuse leave aside the question of negotiating the use of condom.

Cultural norms of sexual ignorance and purity for women further block their access to preventive information. Today the reality of women's health status is that they are socialised to hide their disease and not get them treated in time. In India if a woman, who has been infected by her husband, passes on the virus to her child, she is stigmatised and blamed. And if the infant happens to be a boy, then the woman is considered even more of a villain. Although a majority of women are infected through their husbands, they are blamed for their death. In many cases, the woman is accused of causing her husband's illness, and either disowned or deserted by her in-laws. The responsibility of the man in all this is completely overlooked.

Worldwide, adolescents and young women are more than three times more likely to be living with HIV/AIDS than young men. Young women are thus fast becoming the new face of the HIV/AIDS epidemic. It is this feminisation of the epidemic that is raising concerns everywhere. Continuing gender discrimination and the failure of the state to provide women opportunities for education and economic independence is the single largest factor that is leading to HIV/AIDS/STD epidemic. Added by poverty, it is compelling entry of women into prostitution.

But prostitution is not recognized as work; it is seen as a sin or a crime, posing a threat to public health and social order. A natural outcome of this is the denial of basic human rights such as health, housing and the right to self dignity. The culture of silence around sex and the link made between STI/STD and sex work makes health care facilities inaccessible. This further enhances the risk to HIV transmission. Harassment at the hands of the law enforcing authorities in the form of police raids, eviction, threats and torture is also a matter of grave concern. Discrimination and stigma for their children leads to their bleak future.

In Operational Area

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Few brothels are located in the operational area of inter cross border region of the three states. They operate along the highways in this region catering to the truckers as well as local people. It is often found that the dhaba owners or the employees have knowledge about the operation of the Women in Prostitution (WIP) in the adjacent areas and they even act as pimps. These mobile or flying WIP either comes from these brothels or they are inhabitants of shanties or the villages along the roadside. In some cases the female migrant labourers work as prostitutes to earn easy money. In most of the cases these women, to meet their family expenses having no other viable alternative opportunities and skills thereby taking to prostitution. A few of them also belong to tribal community. They have little or no education and are hardly aware of the hazards related to prostitution. In most of the cases these women are the sole bread earners of their respective family.

Mobile WIPs are found to frequent the stretch between Jamshedpur to Baharagora in several important locations like Dimna Chowk, Transport Nagar, Mango, Dharbhungarh and Mushaboni in East Singbhum district of Jharkhand state and the neighbouring districts in the states of Orissa and West Bengal. In all these places a large number of truckers assemble and rest during their onward journey. There is also presence of migrant labourers due to presence of some industries.

Brothel based prostitution exists in Kokpara and Baharagora both lying along the National Highway (NH)-33. The brothel in Kokpara houses about 4 to 5 WIP and the brothel in Baharagora is generally inhabited by 18-20 WIP’s. Some of them, at times, also work as flying along the NH-33, 6 and 5 particularly around Chichra Check Post in West Bengal and Jamsola Check Post in Orissa. Generally these WIP do not permanently stay in this place.

What AID is doing

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Alternative for India Development (A.I.D.) has been working on various issues pertaining to health and women empowerment among the community in different parts of Jharkhand.

The unique project of STD/HIV/AIDS prevention has been launched in inter state cross border areas of the three states-Jharkhand, Orissa and West Bengal. The main objective is the empowerment of women especially sex workers along the national highways in inter-cross border areas to achieve sexual health rights and reduction in STI. Other task is to sensitize target groups like inter-state migrant truckers and roadside villages for behavioral changes for gender equality and equitable partnership.

A.I.D. while working with the traditional community has found lack of viable economic alternative at village level. It has led to unorganized migration of both men and women. This has created emotional insecurity, leading to isolation from family. Such emotional trauma along with poverty has resulted in poor women falling into the deceitful trap of the traders of misery- the agents of prostitution. AID also noted that across the social spectrum women have limited access to health care and information regarding the functioning of their bodies. This has increased their vulnerability and makes them susceptible to STI often leading to HIV/AIDS.

AID'S Finding

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The Knowledge level of community on STD/HIV/AIDS and condom usage is very low especially among Bhumij and Ho tribe in the operational area. Among women construction and quarry workers the knowledge is nil. Knowledge on STD/HIV/AIDS without misconceptions is very low in all the target groups.

As a result they neglect the disease after getting infected. Women tend to neglect the disease very often as they feel it shameful to get infected with diseases related to genital parts. Most of the respondents suffering with STD left treatment halfway as found in the survey. In a good number of cases they approached the village doctor or kabiraj which prolonged their suffering. Lack of information about the treatment, distance factor and non-availability of medicines in PHC’s (primary health service) proved to be a barrier in seeking treatment.

The prevalence rates of STD infections among the commercial sex workers (CSW’s) in all the three states were found to be little over 54%. Most of them spoke about being discriminated on account of STD infections even by their own colleagues and also suffered financially during the period.

It was observed in case of medical service provision, the CSW’s in all the three states depended on the village doctors and registered medical practitioners (RMP’s) than their counterparts at government hospitals due to easy availability of services, regularity and approach.

In matter of awareness, 67% sex workers in Jharkhand, 70% in West Bengal and a meagre 35% in Orissa have heard about HIV/AIDS. Knowledge about prevention too is lacking among CSW in Orissa which is as low as 21% compared to 38% in Jharkhand and 47% in West Bengal.

Meeting with brothel based sex workers in the project area revealed that some of the women in area want to come out of the shackles of prostitution. But the pimps who also act as their, so called, husband cause barriers. These pimps are dependent on women’s earning for their livelihood. These men oppose any alternative source of livelihood for these women. They discourage any kind of step towards forming women’s forum by sex workers.

Activities

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A sizable number of mobile and brothel based sex workers living in the project area have been brought under the purview of program. It is most encouraging that sex workers are able to recognize the risk perception related to STD/HIV/AIDS. They are coming out willingly to know about its preventive aspects and to make their peer aware about the fact. A number of them have become our peer educator and in turn have been bringing in new sex workers under the reach of the programme. They are playing important role in sensitising the issue in their respective areas through personal interaction, supplemented by cultural shows by AID. They are also distributing condoms supplied by A.I.D which is clearly reflected in sharing with Kali (Nickname), one of the flying CSW seen in the area most of the time.See case study : Realisation

More than 50 sex workers comprising of both mobile and brothel based have been trained on spread and prevention aspect of STD/HIV/AIDS and condom negotiation skills. Some of them have expressed interest in formation of SHG and initiating savings account in bank.Trainings conducted among the police personnel (chowkidars and constables) who are in constant contact with high-risk groups of truckers and sex workers has created awareness of the gender perspective and STD/HIV/AIDS prevention aspect.See Case study : Lesson for a change

Several women issues were highlighted during the MEGA PROGRAM, which was aptly used as a platform to represent their problems to the People’s Representative and government officials. As a result of intensive sensitization programmes and networking, alliance with civil societies could be made. The project has able to put forward the message from where the women are being empowered by formation of forums and put forward the claims in form of rights and entitlements. Favourable policy on providing sexual health services at local level was implemented after repeated advocacy with the government. Government officials have started recognizing the importance of multi-stakeholder partnership in development. See Case study : Coordination brings good service

Health workers of AID have been holding regular meetings with the community to bring about gender sensitive behaviour and behavioural change towards female. Though slow but the changes have started taking place in the project area. See case study : Sensitisation Pays

Government to ponder…

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The welfare of the WIP is a rarely thought of issue. The government conspicuously ignores the presence of Red Light Area (RLA) in the state. In a press statement the Jharkhand Government has denied the presence of any RLA in the state.Targeted intervention has been the focus in all states in line with NACO. However there is no specific data on the HIV among sex workers in Jharkhand. Similar is the case for intravenous drug users (IVU) and male who sex with male (MSM), eunuchs and other unspecified categories in the state. There is no mapping data in Jharkhand to understand the trends or the transmission modes. Further, many states have deployed Behvariour Sentinel Survey to understand the behavioural pattern of different target groups. But these are missing in Jharkhand.NACO announced one STI clinic in each district as part of the District Hospital (NACO News:April-May 2005). But such services are far and few in Jharkhand.There is no Prevention of Parent to Child Transmission Centres (PPTC) as on today in Jharkhand. Though, it is one of the important programmes in NACP-II. Jharkhand government action on this front is very slow. This further shows that there is lack of fast track actions to make use of the NACO programmes.The PHC and APHC has very little inpatient services. Though PHC doctors and ANMs (Auxiliary Nurse Midwives) are supposed to stay in PHCs, invariably, this is not happening. Persons living in Beharagora have to travel 120 Kms to Jamshedpur, the capital of East Singhbhum district, for the in-patient hospital services. This creates a breeding ground for TB malaria and STD in the region due to prevalent poverty. There is no system of data collection on STD, HIV or AIDS, as there are no diagnostic facilities available in any of the PHCs or Taluk (sub-district) level hospitals. Though a partial VCTC has been set up in Beharagora, a STI hub in Jharkhand state, it is functioning only for two days. In Jharkhand, appointment of health staff is a big politics. Only half of the sanctioned capacity is appointed and posted. For the entire district of East Singbhum, there are just 38 doctors posted in 27 PHCs and APHCs. Think of the services if they take leave or engage in other non-clinical works! During immunization and other such programmes they are all engaged in campaign works. At that time disruption of service is very common.

From Editor’s Desk

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Gender inequality has supported various forms of discrimination in social status of women whether it is discrimination in sexual relationship or in health seeking attitude. These discriminations are so gravely rooted within the society, that to bring a change there is a need to increase awareness among the community and eradicate it from its very inception. The spread of STD/HIV and its feminisation, suggests that equitable gender relation is very crucial for a healthy society. AID has taken a right step in this direction.

Our experience in the cross border region of three states shows that status of women, particularly those in prostitution (WIP) is very deplorable. They are generally out of the purview of the public health centres in the operational area. The ICDS facilities have been neglected. As a result, number of untrained medical practitioners function in this region. They treat common disease as well as serious ones like STI infections and critical abortions by their crude methods often leading to deaths and spread of vernal diseases. WIPs live in a very unhygienic condition, which is also responsible for spread of various communicable diseases. Although they serve the society, if at all it can be called a service, they are virtually deprived of their basic need and necessity. The WIP generally do not have a ration card which is a source of their valid identity. Their children are segregated from the society; and even at times prevented to take admission in schools. They face police harassment and violence from their clients, madams and casual partners. Their basic rights are violated every day. Even media, political and legal responses to problems faced by WIP have been insensitive and adverse.

Laws, which are intended to be protective of women, have in practice worked against their interests, especially the WIP. In addition to the laws that make women vulnerable to HIV in general, WIP have to contend with the use, abuse and misuse of the Immoral Traffic in Women and Girls Prevention Act, 1986 (ITPA) prompting human rights violation. The ITPA provides the police with power that have been misused and manipulated in such a manner that the law itself is an instrument of oppression.

Therefore all the like minded groups and organisations should call on the government to take immediate action to enact and enforce legislation banning discrimination against women. They should come forward to create an environment where factors which push girls and women into involuntary sex work are addressed and the rights of WIP are respected and protected. Their health services are made accessible and discrimination against WIP and their children is done away with. In short, WIP be considered as human beings.

Increased awareness in the region by AID has lead to the initiation of the process of WIP forum. They have started raising their voices for their rights. This has generated hope in the operational area despite all the negative social attitudes towards sex work. This is a step forward in the long drawn process of empowerment.

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