NACP III A public-private partnership is essential (2)

[Guest guest]

A public-private partnership is essential

A Basis for NACP III

While Ashok Row Kavi agrees with my characterization of the Indian

HIV/AIDS pandemic " HIV/AIDS is going to be very hard to eradicate.

Stigma, taboos, sexual transmission, and a very long asymptomatic

period make it a unique pandemic, " [see messages 4676 and 4683 in

forum] he does not support the idea that a public-private

partnership is essential to effectively fight the scourge. He states

that " I'm afraid that the government alone will finally have to " take

ownership " for fighting this disease by integrating it actively into

the reproductive and child care programs within its reasonably

successful family welfare programs. "

In this note I would like to clarify why, given the realities in

India, a public-private partnership is essential to combat HIV/AIDS.

The bottom line is that the government's role and strength is to

create enlightened policy, develop short and long term intervention

strategies, and provide the financial and medical resources. The role

of private organizations (CBOs, NGOs and employers) is to work with

their employees, the marginalized, people at risk and those infected.

It is the combined efforts that will give rise to a holistic and

effective program.

Because of the stigma attached with major transmission

routes/activities, issues of morality, and the need to often step into

harm reduction situations that reside in the grey zone between legal

and illegal it is unlikely that government officials can be effective

agents of change, especially with the marginalized. It is interesting

to note, as an example of the unique and difficult circumstances and

skills required to work effectively with the marginalized, my own

learning came through interactions with Ashok and his colleagues at

Humsafar (please see my report on this experience at

http://t8web.lanl.gov/people/rajan/AIDS-india/MYWORK/beatbombay.2.00.html

). It is very hard for me to imagine that sufficient number of

government officials would be comfortable or effective in such

situations. I will be surprised to find even a few out in the open

recovering addicts or gays in government service willing to work as

peer educators. India is not yet ready for social acceptance of such

brave souls and she cannot wait for this transformation before

tackling HIV/AIDS.

I will now highlight, in some more detail, the strengths and

weaknesses of each of the two sectors by what they can do best.

Hopefully, this partial list will make it clear why cooperation and a

combination of the two are needed. Let me start with what the

government can do best:

Create enlightened policy

Decriminalize prostitution

Decriminalize consensual anal/oral sex between two adults

Provide treatment and rehabilitation centers for alcohol and drug

abusers

Recognize and implement the four equally important pillars on which

intervention should be based

Educate the entire population on sexuality, sex, STIs, HIV/AIDS

Promote harm reduction strategies with respect to sex workers, MSM,

IVD users.

Create adequate numbers of Voluntary Counseling and Testing Centers.

Ensure care and treatment of opportunistic infections and provide

anti-retroviral drugs for all those in need.

Provide adequate training and financial resources to organizations

working on the ground.

Ensure a reliable and adequate supply of condoms to all

organizations working to reduce risky sex.

Ensure a reliable and adequate supply of anti-retroviral medicines,

train enough doctors to treat HIV infected people, and ensure there

are adequate numbers of facilities to treat HIV/AIDS patients.

Conduct surveillance and monitor the efficacy of programs and their

impact on incidence and prevalence figures.

What private organizations (CBOs and NGOs) do best:

Develop and train leaders and peer educators amongst sex workers,

MSM, IVD users, and migrant and slum populations.

Work with the marginalized to address stigma and discrimination.

Prevent exploitation of minors and the marginalized.

Help those living in extreme poverty to develop skills and seek

employment other than sex work.

Help the marginalized access their legal rights and get fair play

from law enforcement agencies

Distribute condoms (and needles to IVDU) and create behavior change

in those prone to risky sex and those addicted.

Help those infected get care and treatment.

Create self-help and support groups for and amongst those infected

and/or addicted.

Help monitor the programs, develop new intervention strategies, and

provide feedback to the government.

Motivate every business and employer to take responsibility for

education and awareness and make sure that means (condoms, counseling)to reduce

risk are easily and freely available.

In short, a public-private partnership and close collaborations are

essential and necessary in every aspect of the fight against HIV/AIDS.

Creating a system of monitoring of the programs by organizations

working on the ground, in addition to the sentinel surveillance and

NACO's analysis, as I had suggested in the posting 4676 in the

forum at

/message/4676, is no

exception.

On the issue of targeted intervention (by geographic location and by

risk groups), I agree with Ashok Row Kavi that the window of

opportunity has passed. My arguments on this issue are contained in

pages 79-80 in the monograph posted at

http://t8web.lanl.gov/people/rajan/AIDS-india/MYWORK/Gupta_HIV_India.pdf.

Lastly, on the issue of integration of HIV/AIDS programs into the

mainstream of successful health and family programs. The issue of

fragmented effort is a much larger structural one and affects most

parts of the government. Clearly, whether HIV/AIDS programs are run

through a separate division under these agencies or a part of them

matters, but what is necessary is that there is integration as there

is much overlap in strategy and needs. The medium term goal (before

eradication) has to be to transform HIV/AIDS into one of the many

serious life-long but manageable conditions and thus eventually an

integral part of the health and family welfare system at all levels.

I believe that since HIV/AIDS is not just a medical problem but also a very deep

socio-economic one, a public-private partnership is essential.

Sincerely

Rajan Gupta

rajan@...

http://t8web.lanl.gov/people/rajan/AIDS-india/

[Guest guest]

Mr. Rajan Gupta's logic was the major driving force in the design of NACP II.

NGOs led on counselling and targeted intervention. But have they been able to

deliver in areas where governments failed? Or were

they co-opted into the middle and upper class agenda that drives governance in

India?

I feel that any outside agency, be they government or NGOs, cannot play the role

that communities have to play. Most of the successful interventions have

happened in situations were NGOs went beyond their

brief and mobilised communities. As against scenarios were NGOs developed a

vested interest in keeping communities out as recievers of condescending

benefit.

When crucial issues of power struggle emerged not only government officials but

also most of the NGOs chickened out leaving communities in the lurch. So, while

governments cannot deal with effectively with issues of marginalised communities

can NGOs be any

more effective?

My experience has been that most of them have been prisoners of the same value

system that drives government officials.

NACP III needs to see the community organisations in charge. SO that they decide

what is good for them and develop programmes to address their interests. This

would also solve the issues of stigma generated by focussed interventions,

adressing the issues of non-sexual health needs of vulnerable sub-populations

and invest in empowerment that an offical or NGO led programme cannot do.

This calls for resources and facilitation. The NACP can fund that. Given the

urgency of powerholders to control the spread of HIV

vulnerable populations have a window of opportunity to force through agendas

that would otherwise not be accepted.

Private public partnerships are needed. But it is time to move beyond NGOs and

towards community led organisations.

Rajeev Sadanandan

E-mail: <rajeev_sadanandan@...>