DFID's work on HIV and AIDS in India

[Guest guest]

DFID's work on HIV and AIDS in India

25 November 2009. Words by Renton

There isn't often good news in development work; too often the job of assisting

the world's poorest seems a hard and unwinnable slog. But in India there has

been a major success. " Ten years ago the numbers suggested AIDS was going to run

wild through the sub-continent, " says Emma Spicer, senior programme manager for

DFID in India. " People were talking about a developing emergency. But India has

started to win the battle to reverse the HIV infection rate. "

DFID has spent £140 million over the last 12 years assisting the Indian

government in this fight, working on every aspect of HIV prevention from

tackling mother-to-child transmission to the legal rights of homosexuals. And it

seems to be paying off. " I think we can be proud of the part we've played in

India's success, " says Sabina Bindra , DFID's HIV and AIDS Task Team

Leader.

That success is measured not just in the overall numbers of people living with

HIV, which are less than half what was predicted a decade ago (at about 2.3

million, now, in a population of over one billion).

It also lies in other indicators: the massive increases in the number of

pregnant mothers and other vulnerable people being tested for HIV, and in access

to counselling and treatment for those who need it.

National HIV prevalence rates in India are now about the same as those in Spain

and Portugal, with some states and particular groups having higher rates.

Rishikant Srivastat, an HIV educator among sex workers in a DFID–supported

programme in Delhi, says: " Seeing the figures on HIV stabilise gives us

motivation. Our job is hard, it gives us the energy to continue because we know

what can be achieved. " There is still work to be done. Infection rates are still

high among certain groups, such as men who have sex with men, sex workers and

injecting drug users. Some poor regions of India are " HIV hotspots " .

So DFID's funding is now targeted at these areas. Over the next four years,

Britain is contributing £102 million towards India's National Aids Control

Programme, about 10% of its total budget. We went out into the streets of Delhi

to see this work in action.

First stop was a care home which supports children with HIV. It was lunchtime

when we arrived, and the big kitchen was full of younger children eating a noisy

lunch of dal, rice and potatoes, before running off to rest or play. Pretty

quickly I found myself involved in a skipping rope game with two

seven-year-olds: they were in fits of giggles at my clumsiness.

It's clear that this is no sombre, forbidding institution. Anuradha Mukherjee,

programs manager, says the Naz – the word means Pride - Care Home is " a family " .

She spoke to me over the shoulder of a small six-year-old. Tired-out after a

long morning at a nearby primary school the girl sought Anuradha for a cuddle,

and fallen asleep in her arms. Like almost all the children at Naz she looks

perfectly healthy. The 43 children are between 15 months old and 16 years old

and most are HIV positive.

" Twenty-seven of our children are on anti-retroviral therapy, and they have

access to nursing care and a doctor full time. But the main thing, and this is

something we stress, is that you don't need to do anything different. We take

care of them as we would any child. " She points out a few children who have

visible problems – scarring from skin infections picked up on the street, one

with the distended stomach that is a side-effect of long-term malnutrition, and

in a couple of cases, mental and physical damage.

" Most of the children are orphaned, and were found abandoned in the streets or

left at temples. Three or four have one parent, who was not in a condition to

care for them. "

Looking after these children takes kindness and good care: it costs about 9,000

rupees (£110) a month for each of them. But Naz's work goes beyond this: it is

trying to break down the prejudice and ignorance that condemns HIV positive

people in India to hide, and, in turn, is a crucial part of the job of

controlling the spread of the disease.

" We're the only orphanage like this in India, and we get calls every day asking

us to take children. We try to convince parents or extended family that they can

look after the kids. But it is difficult – there is fear of the disease and as a

result a lot of homeless HIV children out there, and most of them don't even

know their status. " The most awful thing, says Anuradha, is that they have come

across examples of orphanages taking some children from a family but refusing to

take those that are HIV positive. Now Naz is training government orphanages in

how to care for people living with HIV.

DFID globally and in India supports a range of interventions to ensure that

children made vulnerable by AIDS are cared for and supported, enabling them to

eat well, go to school and realise their potential. The majority of children

made vulnerable by AIDS are living in family environments. Across the world,

DFID supports social protection policies and programmes that provide effective

and predictable support to the most vulnerable households, including those with

children affected by AIDS. Care homes are a last resort, for those who face

abuse and neglect, often due to stigma and discrimination, as Naz's experiences

demonstrate.

Addressing the stigma and ignorance around HIV is key to halting the spread of

the disease itself. So while much of Naz's work involves providing education and

counselling to sex workers and men who have sex with men (the one group in India

where HIV infection rates are not yet dropping), it has also had to become

involved with the gay rights movement. Under section 377 of the penal code

introduced in colonial times, homosexuality is not only a criminal offence, but

technically Naz and other organisations' work in counselling and advising

homosexuals on their health is illegal too. Thanks to the lobbying and

campaigning work, " section 377 " is now being repealed.

Elsewhere in India, DFID's works with the Indian government's much praised

National AIDS Control Programmes to target the problems that, according to the

research, contribute most to the spread of HIV. The priority is to rapidly scale

up prevention, treatment, care and support services for vulnerable groups. In

addition, DFID provides support to address legislation that makes it difficult

for vulnerable groups to access prevention and treatment programmes.

One example is the injecting drug users among the huge population of street

people who inhabit the old city centre in Delhi. At a drop in centre close to

the railway station we watched the men arrive from their sleeping places or

their casual jobs as rubbish pickers or street vendors. The Sharan centre sees

around 200 such cases a day – it gives them food, substitute drugs, basic

medical help and counselling. Many of the men are migrants who originally

arrived from rural India looking for work in Delhi.

is a drug injector who earns his living picking rags to recycle. He is

caring for his wife who is living with HIV. He told us the centre was crucial to

him and people like him. " It does a very good job: it helps us with food, gives

us condoms, clean needles, counselling. They found me training to work as a

rickshaw driver. Now I'm too busy looking after my family, but one day I will

try the rehab that they offer: it's hard but I will have to do it. " has

been visiting the clinic for eight years.

Successes are hard won in this world, but the stories of people like and

the others using Sharan add up to India's extraordinary success in tackling

AIDS. And that is also about lives changed for the better. Another beneficiary

of the funding, 34-year-old Rekha, is now a counsellor with the NGO Shakti

Vahini, supported through DFID's HIV programme, helping female sex workers in

India and educating them about HIV prevention.

Rekha's story is typical of many. Aged 17, she was sold to a brothel nearby,

beaten, tortured, and had to service ten to 15 clients in the building for five

years. When she contracted TB – a common complaint among people living with HIV

- the owner refused to let her go to hospital and instead told her she would

die, still working, in the brothel in Delhi's notorious GB Road.

" I met activists working from Shakti Vahini who helped me. They got me medicines

and told me they would support me if I ran away. That gave me confidence and

courage and it saved me, " Rekha tells us.

Delhi's closeted sex work industry – in a country that famously " does not talk

about sex " , as one NGO worker told us – is now at last opening up to the crucial

messages about HIV, safe sex and prevention.

Rekha's job takes her to Delhi's train station, where she spots girls arriving

from the country. They may have been brought to the big city under false

pretences only to be sold into sex work. Which is what happened to Rekha. She

has already saved some girls, and brought about one prosecution. She has even

come face-to-face with the woman who sold her to the brothel.

The work of preventing HIV is many-faceted: but one satisfying aspect is that it

can put an end to some of the other injustices of the big city too. " I tell my

story to inspire other people like me, " says Rekha. " I believe others can escape

that fate, too. "

http://www.dfid.gov.uk/Media-Room/News-Stories/2009/WAD---India/