Guest guest Posted February 6, 2008 Report Share Posted February 6, 2008 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@...> Quote Link to comment Share on other sites More sharing options...
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