Minutes of National Public Hearing at Delhi on 15th NOV-2007 conducted by PWN+.

[Guest guest]

Dear Forum,

Minutes of National Public Hearing at Delhi on 15th November 2007.

In order to generate a response from the government to this alarming

trend at the National level PWN+ conducted a public hearing in New

Delhi on 15 November 2007 with support from the Canadian Government.

25 Women Participated from 8 states to present their cases in the

Public Hearing. More than 250 participants from various Human Rights

Organizations, HIV/AIDS Organizations and Government and bilateral

organizations were participated.

We would like to express our Special Thanks to NACO, NCW, NHRC,

NCCRP, UN Organizations, SACS from all states and International

HIV/AIDS Alliance in India, Lawyers Collective.

Also we would like to Thank in this Occasion to AIDS INDIA E-FORUM

for its support and Guidance and Coalition of Team from SARVOJANA

from Andrapradesh, Karnataka, Kerala, Maharashtra, and Tamilnadu for

its Volunteer support and,

Piyali from Sparsha of West Bengal who took Risk and participated to

raise the voice of West Bengal WLHA though there was an indefinite

Bunth in their State.

Welcome address:

Ms Padmaja-General Secretary- PWN+ India welcomed the delegates and

the panel and expressed the hope that this initiative would help to:

Create awareness among government officials at the national

level regarding the extent of discrimination by health care

providers against women and children.

Result in new policies and recommendations that would bring

about much needed changes in the health care sector, especially with

regard to increased access to better treatment and care at the state

and national level for women and children.

And that WLHA, who are participating in this initiative,

will transfer their learning to other WLHA and advocate with

stakeholders in the health sector in their respective states.

Presided by:

Mr. Norfolk, Counselor- Political Section- Canadian High

Commission - New Delhi, presided and spoke of how every effort must

be made to remove the gender inequalities that were making women and

young girls increasingly vulnerable to HIV/AIDS. " Stigma and

discrimination cannot be allowed to remain unchallenged and

universal access to HIV/AIDS prevention treatment; care and support

need to be put in place with a target of 2010. All people have the

right to higher sustainable treatment of health and women have the

right to make informed choices for their reproductive health.

Therefore access to health programs should be equitable and

responsive to the diversity of woman and children and the community

in which they live. " He also called for the development and easier

access of new prevention technologies that can be controlled by

women. And for making the protection and promotion of human rights

and rights of children the heart of the response. He felt that, ¡§one

of the keys ways of doing this was by the active engagement and

involvement of PLWHA in policy making " .

Presentation of testimonials by WLHA

WLHA from eight states- Andhra Pradesh, Bihar, Gujarat, Rajasthan,

Delhi, Manipur, Nagaland and Assam- gave first hand accounts of:

The denial of medical treatment by doctors and other health

providers in hospitals and nursing homes.

The hurdles faced in accessing treatment and care because

stigma and discrimination.

And of confidentiality being breached and NACO guidelines

not followed in pre- and posttest counseling.

The denial of free medicines to them even if they were

available with the hospital chemist

And the lack of awareness among doctors and other medical

staff.

Open House Interactive Session:

Following the deposition of testimonials there was an interactive

session during which other WLHAs, representatives of NGOs, UN

bodies, Human Rights Commission and other stakeholders raised

related issues and made recommendations.

Mr.Y.S.R Murthy, from the National Human Rights Commission, spoke of

the " need to identify concrete practical action " and said that NHRC

would " welcome any solid cases that PWN+ had identified of

discrimination and denial of access to health facilities. In

addition to this there is needed to advocate with the Health and

Family Welfare Ministry for legislation, which has long been in the

pipeline, on discrimination and access to health care. NACO should

also come forward with concrete guidelines where there are

shortfalls or gaps. "

Some of the other Recommendations that were made from the floor were

that:

Postgraduate students of medicines should be provided with

HIV related training and sensitized to handle HIV/AIDS patients.

Adequate supply of culturally relevant IEC material and

updated information should be available on the Internet.

Posting of female nurses and health care providers in all

STD and ART centers to ensure women friendly services.

Better referral coordination between departments for

reducing stigma and discrimination.

Provision for specialized and sensitive counseling

especially for women living with HIV/AIDS seeking medical

termination of pregnancy.

Counselors who are trained and equipped with knowledge on

handling issues pertaining to women and children living with

HIV/AIDS.

Testing guidelines in second line Therapy need to be

developed for CLHA and pediatricians must be trained on HIV/AIDS

management in children.

Well trained pediatricians on HIV /AIDS Management is

required, especially in the government services should be trained on

issues relating to the treatment and care of Children living with

HIV.

NACO and Health and Family Welfare and Ministry of Women and

Child Department should have better coordination and mainstream

services and programs for WLH/A and CLH/A.

There is an urgent need to produce and make available second

line pediatric dosages.

Panel's response:

Ms. Malini Bhattacharya, National Commission for Women (NCW) said

that since NCW was both a recommendatory and a monitoring body, " if

PWN+ gave it their recommendations arising out of studies at the

ground level the Commission would examine them and forward the

recommendations it saw as practicable and concrete to the

government " . At the same time, it could use the power it had to form

committees, to form one with commission members, experts and

activists, ¡§to act as a monitoring body that would visit hospitals,

PPTCT and ART centers to check whether the women were getting the

benefits they are supposed to get at such centers " .

She also suggested that NHRC and NCW jointly form a committee

comprising of experts, doctors and activists, doctors who will give

policy prescriptions and to find out how the funds were being

utilized. Because " transparency was necessary in the policy outlines

and also in the funding pattern of the government. HIV is an area in

which very large amount of funding is coming. It's much more highly

funded than our malaria, T.B and other programmes. But we are still

in the situation where people can not get proper treatment,

medicines or even get admissions in hospital " .

The other " ad hoc Recommendations " she made based on what she had

heard from the participants were:

Since a number of women said that they have got the

infection through injections. One prescription to the Health

Ministry should be to put in place a system where needles used for

injections are absolutely safe.

The dissemination of information at the grassroots level it

must be on a person to person basis and with interactions at the

Panchayat level rather than through placards and pamphlets. " I don¡¦t

think that present system for disseminating information that we have

is at all what is needed " .

Since evidence shows that women often came to know about

their HIV status only after they were pregnant and in a vulnerable

situation there is need for an environment that will motivate people

to voluntarily test HIV/AIDS. And those who test positive will get

sympathy and support. " If people have prior information they would

be able to choose whether to have HIV+ child or not at the proper

time " and it would reduce the incidence of illegal and dangerous

abortions because of which many women are losing their lives " .

Connectivity between treatments for STDs, which is now being

neglected, with HIV/AIDS programmes.

Training and sensitization of doctors and paramedical staff

because even in PPTCT centers people are not getting the sort of

support they are supposed to give and the staff is disseminate all

kinds of wrong information.

Well-equipped treatment centers that will provide free

medicines and treatment, which is otherwise very costly.

A single window system for examination, treatment, care and

counseling. People should not be sent running from one place to

another.

Provision for medical, psychiatric and legal counseling

because legal redressal is required at times.

Social security schemes for HIV/AIDS widows and children and

HIV orphans.

Direct home service should be available for children with

HIV.

Sandhya Bajaj, National Commission for Child Rights Protection,

conveyed her best wishes to PWN+ for the " praise worthy work it had

undertaken " .

Speaking on behalf of Ms. Sujatha Rao, Director General NACO,

Dr.Geetha Bamezai, Lead consultant NACO, opined that treatment was

an important factor and it was not just about access. But about the

whole regiment of treatment adherence and whether doctors were

prepared to go through the whole regiment adherence with the

patients and said, " I believe that there is a great need for

convergence within the health system, of NACO with and health

system. Presently NACO is the part of health ministry but since we

don¡¦t have our own structure at the district level there is need to

converge with the health system, which has whole lot of system

functioning right up to the grass root level " .

She also mentioned two initiatives that were in the pipeline. One

was the bringing together of ASHAS appointed by the National Rural

Health Mission in every village. And the anganwadi workers posted by

the Department of Women and Child Development through anganwadi

workers so that these women who are crucial in providing services

and information at grassroots level could work together at the grass

root and district levels. The other was to conduct national level

sensitization and training programmes of CMOs and Medical Officers

because they are the crucial links and role models.

RECOMMENDATIONS

The Positive Women¡¦s Network therefore proposes the following to

achieve our stated goals with regard to access to treatment and care

in the country:

Practical, updated and attitudinal HIV-related training,

women and children related treatment training and sensitization

programmes must be conducted for doctors and all other staff

(nurses, Para-medics, ayahs, ward boys and others) in government

hospitals.

Post Graduate students of Medicine should be given hands on

training to handle HIV/AIDS related conditions so that they are well

equipped to deal with such cases in the future.

Codes of Ethics and professional conduct in health care

provision should be put in place with appropriate forms for

redressal of professional violations.

Adequate supplies of Universal Barrier Precautions and basic

infrastructure must be made available in hospitals and labs for

infection control, hygiene and the safety of health care providers.

Recommend that Tamilnadu SACS initiative of provide a seven

package precautionary kit at PPTCT centers at a cost Rs.300/- to

400/- be replicated.

Updated information on the disease, medication, dosage,

testing, precautions and preventive measures and medicines for women

and adherence should be readily available to health care workers.

Adequate supplies of culturally relevant IEC materials,

electronic and website information on updates should be available to

health care workers.

Information bureau run by health care providers related to

health and treatment information for health care workers.

Short stays homes for women and children especially in areas

where ART centers are located.

Provision must be made for lady doctors or at least a female

nurse in STI department and ART department to ensure women friendly

services.

Better referral and coordination mechanisms between

departments for reducing stigma and discrimination.

Provision for specialized and sensitive counseling services,

especially for WLHA seeking Medical Termination of pregnancy.

Well-trained counselors and equip knowledge on handling

health issues faced by women and children living with HIV.

Testing guidelines need to be developed for Children

affected by HIV. Child friendly Information on ART and HIV information should be

developed.

The Public Hearing concluded with a vote of thanks by Ms. Bindu,

PWN+.

The PIONEER and ASIAN AGE Newspapers from New Delhi had covered the

Event News widely. And we thank PIONEER and ASIAN AGE for their

solidarity.

Also we would like to thank NDTV for their cooperation and News

which led the General public to understand the issues.

PWN+ welcomes the Opinion and Recommendations to add, from the Forum

Members for further move.

Thanks, With regards,

P.Kousalya,

President, PWN+

Mail:suseelaanand@...

Phone: 044-28270204