Re: NACO must clean up phony NGOs in India

[Guest guest]

Dear all,

Re: /message/9450

There are several things I find unusual in this situation and it seems quite odd

the Indian Journal Of Medical Research would not require medical/social

services/researchers etc to have the experience and knowledge to make such

sweeping statements.

I'm going to do a bit of checking on the *authors* of this report to see if I

can find some answers. If anyone has spoken to any of the *researchers* please

contact me.

Any information is of course confidential.

Jeanne Hatfield

Chair

HIV/AIDS Education and Prevention Council

ravaids@...

PO Box 938

Victor,Montana 59875

1 406 961 5138

[Guest guest]

Dear Forum,

Re: /message/9450

I agree with Dr. on his 'editor's note' that it is a shame that the

Indian Journal of Medical Research would publish such an inadequate and

superficial piece of work. Such research and its consequent publication raises

several questions.

 

For one, what or who is setting the research agendas within HIV?  What value

does a paper like this add to the existing body of knowledge of HIV in India?

The research methods are ambiguous, the credibility fo the researchers to

conduct HIV research is questionable and findings of the supposed " key culprits "

of the spread of HIV  in India are among those already well established. 

There is nothing in this paper which is new to any of us, except perhaps the

introduction of mangoes and birthday parties into HIV discourse in the country.

Yet such studies are still conducted. Its quite amazing that grants are given

for such studies as well.

Similarly, who are these 'valid entities' that these researchers consulted with

to determine their findings? As members of civil society, we also need to have a

role in HIV research in the country.

We need to be aware of the people doing research with our constituents and

organizations and their agendas.

We must also ensure there is reciprocity in research and ask that research

findings be shared and the people or organizations involved be acknowledged.

 

Evidence based interventions in HIV are imperative and there is tremendous scope

for HIV research in the country.  At this stage of the epidemic in India, we are

beyond just neeeding exploratory research to determine sources of HIV

transmission like the research correspondence in IJMR.

There is a dire need for more participatory methods of research, particularly

involving people living with HIV & AIDS. And we need to make that clear to people

doing research on HIV in India.

Otherwise, similar one-sided " studies " will be produced and published.

 

Sowbhagya Somanadhan

E-MAIL: <sowsom@...>

[Guest guest]

NACO & Phony NGOs in India

Re: /message/9450

Indian J Med Res 128, December 2008, pp 778-779

Correspondence

Sir,

The content of the letter by Pace and Bagasra1 is a repeat of their

letter in Nature Medicine, which they did not cite - both lapses are

unfair in science journalism2. They stated that the National AIDS

Control Organization (NACO) has already " dismissed nearly 350 [phony] NGOs, " but

then superciliously admonish that " NACO must clean up phony NGOs in India " 1.

Their facts are also faulty3.

Contracts were terminated in the case of 176 NGOs as they were found

to be corrupt or inefficient by NACO's internal review3.

Contracts with 172 NGOs were terminated because their activities did

not match the new programme focus in the third phase of NACO

beginning in 20073.

They do not mention the total number of NGOs getting funds from NACO

(denominator) to measure the magnitude of the problem, indicating

shallow research1,2. Instead of measuring or reviewing the degree of

awareness among the population as a result of past efforts, they looked for

billboards which are quite inappropriate for the purpose of promoting monogamy,

safe sex, use of condoms, etc., and particularly for NGOs to spend money on.

Among a plethora of commercial billboards, educational ones will be

misfit. As for TV messages, there were plenty in the past. Why did

they not check sample populations if they were conducting genuine research?

Touring India wide-eyed and attending rich family birthday and

wedding parties do not make serious research1.

Their claim that " we identified several Achille's heels " in 2006/07

is phony since there is nothing new in it1. Many donor-

representatives feed their constituencies with spurious claims that

they were the first to discover details of the epidemiology and to

prescribe interventions many years after they had actually been

identified and acted upon in India.

They wanted to " explore major sources of HIV/AIDS transmission "

exposing their naiveté1. The " source " or amplifying host is

exclusively human. AIDS is not transmitted, HIV is. The distinction between HIV

and AIDS is important in communication and counselling. Conflating them reveals

ignorance or carelessness1. Care must be taken to use correct words in

communication and counselling - to emphasize that HIV infection detected by

laboratory tests is not to be

called AIDS.

India's population is over 1 billion. HIV began spreading since 1984

that we know of. Over two decades later the best estimate is that we

have 2.47 million HIV infected in 20074. Thus India is not one among

the high HIV prevalence countries in the world. How many others among low or

middle income countries have population-sample-based prevalence data on an

annual basis?

Among all the `selective disease control' programmes, the one for HIV

and AIDS is undoubtedly the best performing in India and painting it as

inefficient is just armchair criticism without actual evidence.

One of the earliest thrusts of intervention was awareness creation and educating

the public - including in schools and universities, work places and industrial

establishments.

Posters with messages regarding AIDS and HIV prevention are

conspicuous in most health care centres. The success of this approach

may be seen in the results of the most recent National Family Health Survey4.

Among urban men and women, 95 and 83 per cent respectively were aware of

HIV/AIDS4. Nationally about 40-45 per cent women and 70-73 per cent men knew

that abstinence, fidelity and condom use were methods of prevention of HIV

infection4. Even among men with no education a third knew that consistent use of

condoms helps prevent HIV infection4. For comparison, half of ourpopulation does

not know how tuberculosis spreads4.

How did spurious NGOs appear in India, known for its innumerable

conscientious NGOs in fields such as education, health care, socio-

economic empowerment, care and rehabilitation of physically and

mentally challenged, care and education of orphans, agriculture, environment,

etc? They were voluntary, not-for-profit and raised their own funds.

They filled the gaps in Government services to people. Even the very

detection of HIV infection in India in 1986 was by such an NGO5,6.

Within a few months a Task Force was established by the Indian

Council of Medical Research to up-scale the pioneering NGO model of

unlinked sample-screening of men with sexually transmitted diseases

and pregnant women annually, formal and informal information-

educationcommunication (IEC), behaviour change messages to minimize risk of

infection, screening of blood donors for recipient safety, non-discriminatory

medical care, hospital infection control, etc.7.

Things changed in the era of World Bank and other foreign funding for

HIV work. As the western world became aware of the early successes of

the Task Force, the World Bank offered a large soft loan to create NACO in 1992.

India's Prime Minister Rajiv Gandhi once famously said that when the

Government spends one rupee only 10 paisa reach the target but when

NGOs spend one rupee 90 paisa reach the destination.

Thus, World Bank (and foreign donor agencies such as USAID) preferred

to fund NGOs for local level HIV projects. State Governments

themselves created new NGOs (as Registered Societies) managed by

their own officers so that funds could be received, thus fulfilling

the letter but not the spirit of NGO movement, the quintessence of

which were volunteerism, altruism and self-support.

New private NGOs also mushroomed to collect the flood of funds. So,

World Bank and foreign donors were unwittingly responsible for

creating phony NGOs. That a crop of new NGOs capturing funds had

appeared on the Indian scene was common knowledge, which could not

have been missed by those who were involved in genuine HIV work in

India and by the representatives of Governments and foreign donors.

The auditing of fund management by NGOs by he World Bank and NACO

was in follow up of the too many leads and trails to have been

missed3.

The Societies Registration Act of India under which NGOs are

registered was passed in 1860 and its monitoring mechanism is too

weak, as there was no need until recently to suspect the credentials

of transparent NGOs catering to local needs8.

However, annual finance auditing and reporting is a must for all of

them8. The urgent lesson is that the Government must review the 1860

Act and revise it to fit the new phenomenon of opportunistic NGOs. There should

be provision to register every research project in India so that quality and

relevance could be subjected to scrutiny

and tourists may not indulge in phony research.

I have no conflict of interests.

T.

439, Civil Supplies Godown Lane

Kamalakshipuram

Vellore, TN, 632 002, India

tjacobjohn@...

References

1. Pace DG, Bagasra O. NACO must clean up phony NGOs in India. Indian

J Med Res 2008; 128 : 87-8.

2. Pace DG, Bagasra O. NACO and the World Bank are correct in their

crackdowns. Nature Med 2008; 14 : 588.

3. Padma TV. India continues crackdown, dismissing hundreds of AIDS

groups. Nature Med 2008; 14 : 227.

4. http://www.nfhsindia.org/nfhs3_national_report.html (accessed on

October 29, 2008).

5. TJ, Babu PG, Jayakumari H, Simoes EAF. Prevalence of HIV

infection in risk groups in Tamilnadu, India. Lancet 1987; 1 : 160-1.

6. Simoes EAF, Babu PG, Jayakumari HM, TJ. The initial detection

of human immunodeficiency virus and its subsequent spread in

prostitutes in Tamilnadu, India. J AIDS 1993; 6 : 1030-4.

7. Indian Council of Medical Research. HIV Infection in India.

Ongoing Research Activities and Future Research Plans. New Delhi:

Indian Council of Medical Research; 1988.

8. Anonymous. The Tamil Nadu Societies Registration Act, 1975 with

the Tamil Nadu Societies Registration Rules and the Societies

Registration Act, 1860 (Act No. XXI of 1860). Chennai: C Sitaraman &

Co. Pvt. Ltd., 2007.