Experiences of SRH-HIV convergence

[Guest guest]

Converging HIV and Sexual and Reproductive Health Services ¡V Experiences

Alliance India¡¦s programme ¡V Community Driven Approaches for Addressing

Feminisation of HIV/AIDS was supported by the Department for International

Development (DFID), integrate the SRH and HIV/AIDS issues of women. It has

reached out to women who are at high risk of HIV, including women living with

HIV/AIDS (WLHA), and their communities. The programme has focused on high

prevalence and high vulnerability as the corner stones for selecting its

geographical areas of intervention. Amongst its six selected states, while

Tamilnadu, Andhra Pradesh and Manipur have high prevalence; Delhi, Punjab and

Orissa have high vulnerability. Increasing drug use, high migration and

increasing prevalence of HIV amongst women visiting the antenatal care (ANC) and

STI clinics have been seen as crucial in making them highly vulnerable.

A Community Driven Approach

Constant inputs from the community are prerequisite for an effective response to

HIV/AIDS. Alliance India has thus attached high significance to the involvement

and active engagement of the community including PLHA and key population (sex

workers, men who have sex with men, injecting drug users). Enhancing community

action to provide care and support to PLHA and preventing the spread of HIV/AIDS

has been the approach. Training and capacity building of NGOs and

community-based organisations (CBOs), as well as , participatory assessment of

the communities have been some of the means for involving communities. Further,

through collectivization and formation of groups, the affected communities have

come together and voiced their concerns.

Addressing the Feminisation of HIV/AIDS in India

With the pressing need for integration of SRH and HIV/AIDS issues of women,

Alliance India kept women¡¦s needs and rights as centric and brought in their

active involvement. The programme has primarily reached out to women vulnerable

to HIV/AIDS including WLHA within the low-income setting. Since, men¡¦s

involvement and their partnership with women is crucial in promoting gender

equity and enhancing health seeking behaviour within families, some men have

also been brought within the programme reach. Through various activities, the

community has been provided with information on issues related to SRH and

HIV/AIDS. With increased awareness, women have been motivated to reduce the risk

of transmission by demanding access to effective and adequate support services.

The increased informed demand on the part of the community for more and accurate

information and quality services related to health, legal, and social welfare

has created a ground for increased access to services and support.

Women have been linked with SRH and HIV/AIDS services and various support

mechanisms at the community level. Various trainings and capacity building

activities have been undertaken with the implementing NGOs and communities. The

increased NGO and community capacity through skill development and knowledge

enhancement has helped them in contributing effectively to increase informed

demand and increase their access to relevant services and support.

Alliance India¡¦s ground experience, while addressing the issue of feminisation

of HIV/AIDS, says that it is not only the policy makers who feel the integration

is effective to provide holistic services to PLHA and reaching out to general

population, but the community have voiced that financial independence is

critical for them to lead a confident, fearless, less stigmatized and empowered

life.

Various evidence-based studies as well as testimonies of several women reinforce

this. Therefore, an integrated programming, which included components such as

vocational training, financial aid, market linkages, is critical to fight this

epidemic.

The World Health Organisation¡¦s policy briefing on integrating SRH ¡Vcare

services highlights the need for a policy change at the national development

planning level. The brief says that linkages and coordination with income

generating activities for women, community forestry projects, work-based social

insurance schemes and other similar activities implemented by the various

ministries of Indian Government outside the health sector, can serve as entry

points to reach women along with health information, and as a means for

increasing their capacity to have resources so as to access services which could

improve their health as well as that of their families.

The programme was evaluated by using the ¡¥Most Significant Change¡¦ (MSC)

technique. It is a participatory monitoring technique based on stories of

important or significant changes ¡V they give a rich picture of the impact of

development work. The key findings of the evaluation are:

The project has achieved significant impacts on people¡¦s lives where it was

implemented in conjunction with other ongoing programmes of the implementing

organisations. For instance, Child Survival India (CSI) - integrated the project

with its longer term programmes on women empowerment and adolescent girl¡¦s

vocational skills training.

Similarly SASO placed this project in those areas where their Care and Support

programme with IDUs were ongoing. As a result, not only were the existing groups

further strengthened by awareness on sexual and reproductive health issues,

legal rights, and linkages with health care providers, but there was wider

community acceptance and influence, as was seen in Delhi.

In Manipur, this led to the affected women getting the much needed psychological

support, awareness and opportunities for earning an income.

Four out of the six implementing NGOs chose a domain on ¡¥changes in quality of

people¡¦s lives¡¦. The changes reported in this domain included, increased

levels of confidence, enhanced ability to overcome fear of being deserted by

family, and a more positive outlook towards life.

Through stories it came out that total involvement of men in the projects is

very much important to mitigate tensions arising when power structures and

institutional norms are challenged. Adolescent girls and women, who are the

direct ¡¥target population¡¦ have reported facing ridicule and shame in their

communities when they attempted to challenge stereotypes or patriarchal norms.

In terms of building the capacity of iNGOs on different issues, all stories in

the domain ¡¦changes in staff capacity¡¦ reveal an increased level of awareness

and confidence of field staff and volunteers. All staff revealed that they have

undergone a distinct change in their perspectives and mindsets.

Almost all stories from the different domains reveal the critical and

significant role played by peer educators in increasing the project¡¦s sphere of

influence and acceptance within communities.

One year is too less to gauge qualitative impact of a pilot project; however, it

is evident that organisations who have placed this project with their earlier

ongoing, longer term interventions, have shown significant changes in

communities challenging social and cultural norms.

Many stories in the document clearly reiterate the need for a longer term

intervention plan especially on issues related to sexuality, gender and altering

existing power equations. Moreover, the use of this technique has clearly

highlighted that enough efforts need to be invested in mobilizing the whole

community and not just the key population while pursuing such programmes. This

will result in gaining the confidence of the entire community and provide

enabling environment to women including adolescent girls.

For more information about this project and related documents, please visit

www.aidsallianceindia.net

Padma Buggineni

Senior Policy Officer

India HIV/AIDS Alliance

Kushal House, Third Floor

39 Nehru Place

New Delhi 110019

India

e-mail: <buggineni_padma@...>