indianews

HIV and Gender Inequality

2008-12-22T15:31:00.003+05:30

Although HIV infection is rooted in gender inequality, few interventions address this issue in a significant manner. Programmes advocate safe sex through condom use, abstinence, mutual monogomy - all of which are essential to limit the spread of the epidemic. But are they enough? Can programmes really protect men and women from HIV infection without touching on the man/woman thing?

The concepts of practical needs and strategic interests are useful in understanding how HIV programmes can incorporate gender.

Practical needs are related to the condition of women and their present workloads or responsibilities.
Strategic needs arise from the analysis of women's subordination to men and is related to changing the position of women vis-à-vis men.
A developmental programme that brings tube wells closer to villages addresses a practical need: it makes it easier for women to fetch water on a day-to-day level. But it doesn't touch on the gender issue lurking below: why do women have to fetch the water? Addressing this strategic interest would mean changing the position of women, not as individuals, but as a category.

Addressing practical needs
-Tends to be a short-term intervention
-Tends to involve women as beneficiaries or participants
-Can improve the condition of women's lives
-Generally does not alter traditional roles

Addressing strategic interests
-Is a long-term process
-Involves women as agents or enables women to become agents
-Can improve the position in society
-Can transform roles and relationships

A gendered response to HIV: what does it involve?
A gendered response to HIV is one that simultaneously addresses prevention at two levels: practical and strategic. In other words, a gendered response to HIV is one that advocates safe sex while challenging the underlying attitude of 'women are women' and 'men will be men'. This means changing ideas and social norms that keep women in their place - and men on top. It means achieving shared decision making between men and women at all levels: in relationships, community affairs, political and ecconomic bodies. It means creating structural changes to give women equal access to education, training and livelihood opportunities. Needless to say, this is an arduous social agenda that requires long-term institutional support and commitment.

It may be beyond the scope of an HIV intervention - whose mission is to prevent infection - to single-handedly take on the mantle of changing social roles. But interventions must address gender if they are to effectively prevent men and women from getting infected.

A gendered response to HIV could alter traditional gender roles by: Challenging inequalities of information

Educate women and adolescent girls about their bodies, sexuality, HIV and STDs
Promote values that encourage women to question and to seek information as a right
Provide women with skills in negotiating social and cultural barriers to condom use
Pro-actively counsel men on the need to notify partners of their HIV status without violating confidentiality requirements
Ensure that HIV messages and information do not inadvertently reinforce gender stereotypes for short-term gain
Challenging inequalities of access, care and treatment

Counsel families on the need to provide care and support to women
Respect women's withes and needs on pregnancy, breast-feeding, abortion and sterilization
Deal with the potential negative consequences of testing women, but not their partners
Create support groups to share personal experiences and model new behaviours
Challenging discrimination

Provide male and female role models of HIV-positive persons and families coping with HIV
Tackle the tendency to blame women for HIV infection
Push media to promote positive images of infected men and women
Challenging social norms that promote myths about masculinity and femininity

Promote gender training that creates alternative, positive self-images for men and women
Demystify myths about virginity, semen production, male promiscuity etc
Challenge the notion that me will be men
Instill the notion that women also have sexual needs
Address the issue of domestic violence that inhibits women's agency
Challenging women's ecconomic dependence

Establish livelihood opportunities for women, or link up with organizations doing so
Actively provide HIV information through economic interventions already in place, such as credit groups, savings schemes, employment programmes etc
Challenging structures and policies that prioritize men over women

Advocate for research on female-controlled methods to prevent HIV/STD infection
Lobby for better implementation of laws on rape, sexual harassment, property rights, violence
Campaign for the creation of a law against domestic violence
Actively promote the voices of women in policy-making platforms
Continue to uphold fundamental human rights of men and women while pushing for women-centered policies and programmes

http://www.hivaids.webcentral.com.au

Zarina's story

2008-12-22T15:19:00.000+05:30

I was born in Allahabad. My father died when l was seven years old, and my mother brought us here, to Bombay. My mother worked in a company that mad insulation coils. She was not making much money at that time though, and had to leave us with our uncle and move to Dubai, where she earned much more.

I was 14 when l got married. I thought he was a well-bred boy from a respectable family and had no idea he had bad habits. He told me very early that he visited prostitutes though - he'd say he was going out, and l'd wonder what the big deal in that was since everybody goes out. It was only later that l realized that he'd been 'going out' to the red light area. He had also asked me if l had had a boyfriend or lover or any other problems, but l was too young and inexperienced to understand.

He was 20 at the time, and has a business repairing watches. He'd drink a lot and mix with the wrong people. When he didn't drink, however, these people weren't his friends. They were up to no good and would invariably cause fights.

I spent the years before my pregnancy behind purdah in one room...I had a child after two ears of marriage, but didn't know that last thing about children, or even how one has them! I thought people married so that the woman could look after the home, prepare meals.and didn't let my husband consummate our marriage until after the first month. I have not desired 'it' since. He was so sexy, he'd want it at every point, while l had begun to detest it. It was because he was this sexy that he needed to go out. He had forced me for the first two years, and by the end of it, l had begun to hate him as well.

We went on this way until he started to fall ill. He stopped working and started going to the dispensary, but this didn't help. He had even sold his stall to pay for his treatment. He had AIDS, but l did not know anything about it then. He had told me to keep it as a secret - he was scared they would throw us out of the hospital.

Doctors feel that HIV patients are a waste of their time - if they're going to die anyway, let them. Yet they seem aftaid of us and will even wear gloves to take our temperature. Nurses discourage our own family members from sitting by our side. If doctors and nurses have such an attitude, what will happen? It really angers me that we are thrown away for having this problem. He died within six months at GT Hospital.

I remarried in 1996. I was working at a company then and he was my boss. I have told him everything. We use condoms because he is negative. We are friends and lovers, fifty-fifty. He is working in Dubai and sends money for the children. We write to each other and l am happy.

My elder daughter is very sick - woh to last stages main hai. I'm hoping to bring both my children back home. I don't feel alone because l have friends and my mother. Had l not remarried, however, l don't think l could have come this far. I can speak and write English - l have taught myself all this.

By this time Zarina is really fidgety. I asked her sho all knew about her status apart from her mother, her friend and her husband. She said her sister. I asked her which of her sisters and she said - "I only have one sister." Then l pointed out that she had mentioned that she had four sisters. By now l realize that she is fibbing. I asked her if she is making all this up and she continues to laugh. She cannot make up her mind - she says yes and then starts laughing again.

Arre, people have been asking me the same questions for years and l've gotten bored of repeating the same story. Then they ask if l've thought about the future. Will you ask me that too" I've been asking God to take me away, what else? I can't commit suicide, so what shall l do? I am carrying on. I think about my daughter a lot, and the fact that she'll never recover, but people think that l don't care because they see me out and about…..Lekin mera aisa hi chalta hai.

http://www.hivaids.webcentral.com.au/text/ist14.html

Shobha's story

2008-12-22T15:10:00.000+05:30

Shobha is a sex worker. She was tricked into prostitution at the age of 14. She was married in the middle for a while, and stayed out of sex work for a few years. She came back to it after a series of compelling events, and became HIV positive.

I'm from Allahbad. I had a stepmother, and had run away from home. Somebody enticed me to find work in Bombay, and took me to Kamatipura when l was 14. He went in while l waited outside - l have no idea what they spoke about. That evening , the woman there talked to me nicely, fed me dinner, and l fell asleep fairly relaxed. On waking up after a little while, l discovered there was a man by my side. I asked him who he was, and he said he was my aadmi.. When l told him l had no aadmi, he suggested l ask my mother about it. I said that the woman outside was not my mother. He raped me somehow…what more can l say?

Six months past this way, until l met Sayed. He was a Muslim. He took good care of me for 10-12 years, and l changed my name to Samina Sheikh. All he said to my gharwali was that he was taking me out for the day. He showed me a room and said we'd stay there together. I said l'd live with him only if he promised to feed me well.

He had a seekh kabab business, and would pay for my taxi fares. We had three children together; Soni, Moni, and Ravi. I raised them to be Hindu - they live in the village, while we have a place in Mahim. My younger sister and brother take care of them.

I left Sayed out of humiliation. We had to vacate our room because of him - he had raped a four-year-old girl, and was being held by the police. I didn't believe it at first and had him released. It was only later that l found out that he had another wife. Althogh he looked very young, he was extremely cunning, and had cheated his first wife as well. He now lives in Bandra with four women.

I left him and started work at Aasha Prakalp Eye Hospital, distributing condoms and educating women in Kamatipura. But they discharged me for missing a few days of work, and l found a job as a maid at Bombay Hospital, earning no more than Rs 100 after every 12 hour day. If l had been able to work seven days a week, perhaps it would have been worth it. But that didn't happen.

I had also tried to work at a beer bar, but l disliked the work there. They dim the lights in these places so that their customers can do as they please - from the front, from the back, in front of everyone. In dhanda, at least we're in a room, and l can demand the money in advance. I have more power this way. Mein to keh deti hoon, mujbe seedhi tarike se karo.

So l went back. I knew the rules - fifty percent for the gharwali, and fifty percent for me. If l had not gone voluntarily, they wouldn't have accepted me. Nobody buys girls these days. The law can punish gharwalis for five years.

These days we have very few new customers because of the fear of AIDS. There wasn't as much awareness until the last two years, however. Some of them tear their condoms intentionally - ki meine dekho phaad hi diya, aisa. Some of them are young - they don't care; marna hai to mar jaayenge. I tell them they should wear condoms, but they cannot say that l have 'it'. I'll lose my work. If l tell them in jest, they say, "Tu to achhi dikhti hai."

I got myself tested after returning to this dhanda. Mein nashe main itna hoti hoon, ki mein khud nahi keh sakti ki mere saath kya hua hai, kya kiya hai meine, isliye. Yet if l don't drink, my mind will not work. The doctor suspected HIV and l became very upset.

I now live with another man named Shivakanth. I met him in this line of work. He works at Mahim Bakery. He understands me - poor girl, she used to work as a social worker and is now a dhandewali. When he invited me to live with him, l said "Tum mujhe quarter pilao, mein tere saath aati boon." I had had too much to drink, but he took care of me. He did not force himself on me at all. We did sleep together, but that was much later. He would tell me that he was very jealous of my customers, and even suggested we buy a room for ourselves. We now live together, and l have told people in my village that he is my aadmi. I work during the day, and come home to our room at night.

I have a lot of respect for him. He does not know that l am positive. But when l tell him that being in this line of work, l could become easily infected, he says, "If you have it, we will die together. If you have it, then it is my destiny." I tell him when we are drunk, and it happens when we are drunk too, but when he is sober, he does not believe me. He is negative for sure.

We don’t use condoms because they are very expensive. The government gives every woman a three-piece packet, but it's impossible for me to get through the day with that alone. If we can't get condoms, how are we expected to use them? Nobody knows that l am positive. If anyone finds out, he won't keep me. I know of many women who are positive. But what is a dhandewali to do? One is drowning in debt, another does not have access to treatment…when l go to municipality hospitals, l get very angry!

I'm on the look out for a part-time job now, but l don't want to give up my dhanda. I need money. I had taken a loan of Rs 24,000 for my daughter's wedding that l have to return. I haven't married Shivakanth, but wear sindoor all the same - every woman needs a man. My children have no idea that l do this sort of dhanda and l will never let them know. Maybe this way they can have a good life.

http://www.hivaids.webcentral.com.au/text/ist10.html

Ratna's Story

2008-12-22T15:01:00.000+05:30

My father is a goldsmith. When he got a job at Masjid Bunder, we moved to Bombay from Calcutta. I was three then, and have lived here since. I studied up to my second year of Bcom at PN Joshi College, which was very nice - they gave me clothes and financial help. Our family, however, did not want to educate its girls too much; they were afraid of not finding grooms who were more educated.
When my marriage was arranged, l was very upset. My Maharashtrian friends would work for a year after graduation and then marry - mera bhi sapna yehi tha. Nobody asked me my opinion though; they knew if asked, l would say no to marriage. My father knew l had all these ideas about social change - l wanted to change the world, and doubted l'd be able to once l was married. Then again, l could understand my father's point - he had four daughters to marry and l was the eldest. If l did not marry first, there would be problems for the rest.

After marriage, my husband got his own room. We did not have any financial problems. He worked at Masjid Bunder as well. As l was the chhoti bahu, everyone loved me a lot. I had no major responsibilities.

Six months after the wedding, my husband started getting high fevers. I was pregnant at that time and with my parents. I had a baby boy at the hospital and everyone, except for my husband, came to see me there. Three days later they told me he had malaria and had been hospitalized. They discharged him shortly, but he did not recover. His fever used to go so high that if you touched him, haath chatak jaata. Daddy thought that he should go to Calcutta for treatment, and accompanied my devar to take him there. He would be better looked after in his own home, since l had a full time job attending to our child here. I was very worried.

A month later, however, he was still very ill, and daddy went to Calcutta and brought him back. I was shocked on seeing him: he had lost his hair, was looking very dark, and had become very weak. He did not even respond to our family doctor's medication, who became suspicious and suggested a blood test. He tested HIV positive.

I asked my jeth for money for his medicines, but he made nothing but empty promises, and provided no real support. He works in a factory and his income is around Rs10,000. Bhai ka farz banta hai dekhne ka. In the meantime, my husband would fight with my saas, who got fed up and went home to the village.

At this point l began to look around for work, which was a very difficult thing. When l said, "l need it, my husband is ill and l have a small child,' they would tell me, "Don't come, your mind will be on your problems at home!" Eventually, l found a job in a school and would work from 7.30 to 4. I had to manage my workload as well as my husband's health. I had had myself tested with him and knew that l was positive too. My attention was on my husband. He was always sad and becoming increasingly weak.

Itna dukh jhelte jhelte, he decided to return to Calcutta. It was my father, again, who organized his travel and took him there. He couldn't even stand, and it must have been very difficult to manage him along with their luggage. One day, they phoned from there to say that he is very, very serious and that l should come instantly. I panicked because there was no money to travel - l had lost the job, as it had been only a temporary one. I was under tremendous pressure and was also getting ill: I would vomit whatever l ate, have a heavy head, and suffer burning fevers at night. I had started giving tuition's at home, but could barely manage with that income.

That Sunday night, they phoned to say that he had expired. My father borrowed more money for me to travel and took care of all other expenses as well. In Calcutta, they did all the last rites. My jeth gave only five hundred rupees. He earns so much money, why couldn't he help? During illness, you really realize who your true friends are - sab ulat jaata hai. The only thing my mother-in-law told me was not to get married. She told me nicely and we did not discuss it.

I got a lot of support from my parents. I sold off my TV, the cupboard, bed, and paid off all the debts my father had taken during his illness. I did this Montessori course and with Dr. Bora's help, have reached here today. I have been through a lot - my brother-in-law did not help at all. On returning from Calcutta, my devar demanded a huge sum of money he claimed my husband had borrowed from him. I did not know of any such money, and that's probably why he approached my father and not me.

Nobody knows that my husband died of AIDS or that l am positive. My parents have taken care to see that it does not spread. I hink my husband's family did not want to spend because they didn't see the point in it. I knew about HIV and AIDS before all this. It is all over TV and in the magazines. But l only knew about the way it spreads. There is a stigma attached to AIDS. Then again, l doubt that my husband's family would have helped if he had cancer instead.

As a diamond setter in Masjid Bunder, my husband was overworked and underpaid. And when he got back home, he had to do everything himself. It could happen to anyone who lives alone. I feel guilty for torturing him. Now l realize that 'going astray' was only normal. He was a nice man. I knew even then that it was not fair to get upset with him, but l would all the same.

My husband was a very emotional person. One day a man came to the house begging for money. He said he would look at our hands and tell us our fortunes. My husband sat and talked to him. I told him l did not approve of all this nonsense palm reading and that he was just fooling us. He made the man tea and gave him fifty rupees! I used to scold him a lot. He had to make voters' cards. He spent one full day going to this office, that office, spent a would lot of money and got nothing done. When l went, l managed it in one day. I was never afraid of him… l was the boss!

http://www.hivaids.webcentral.com.au/text/ist09.html

Ranjana's story

2008-12-22T14:48:00.002+05:30

Ranjana is 25 years old. She stays in Nagpada and has been married for three years. Her husband has a clerical job with a travel agency. They have no children.

I had an arranged marriage and live with my mother-in-law and brother-in-law. In the beginning, l had no idea about AIDS. My husband was tested for HIV only after being ill for a whole year. We were shocked when he tested positive - l realized he could die any time.

Some say that he probably had relations with other women, but he's convinced that he got infected during his hernia operation - unko do bottle knoon chadhaya tha(he had to take two bottles of blood). He was healthy before the operation. Now he has no appetite and has become very thin.

His treatment is going well. At first l was a little afraid of being around him, but now l'm the one to give him his medicines when he feels low. These days he's lost in his own world, and does not go to work. His company wants him to recover completely before coming back and is also paying his medical bills.

Sambandh? (sex)He doesn't feel like it. He's become weak, no? So he can't do it. But it's not like l won't sleep with him again. Pati to bhagwan hote hain. Bas time aane par(husband is like god, let the time come)..let him get a little better. Hame to apne aap par control rakhna chahiye.(we must control ourselves.

There has been no real difference at home. We have not told anybody. He kept his test results from us for the first 5-6 months, as he was afraid of my parents' disapproval. He was also scared that l'd leave him.

My father says that l should leave my husband and get married again. Whatever happens, it's my destiny. I have sworn never to be a burden on my father. I have studied up to my SSC, and had hoped to work at some small job. My husband had also said that l could do whatever l wanted - courses, services - but l was unable to do anything because he fell ill, and l had to take care of him. Although l am negative, l will not leave my husband's side. I have that much strength.

Women will never be free. Men will keep going to them….where there is honey, there are bees. Unless the government tries to remove these women, it's going to be useless. Men are unable to control themselves, but women are. I don't think of myself as free. But as long as l have my husband, l am happy. I don't need anything else. I would have left him if he had beaten me. But it's not like that.

We never fought very much, and this hasn't changed over time;in fact, we're closer and understand each other better now.

http://www.hivaids.webcentral.com.au/text/ist08.html

Monty's Story

2008-12-22T14:47:00.000+05:30

Monty is a 33-year old man from Manipur. He has been taking drugs of different kinds since he was 14. Monty was admitted to a rehab centre for drugs and alcohol. He got to know he was HIV positive when he was tested on entry to the program.
I have many sexual partners. Mostly l pick up students; they do it sometimes for money and sometimes for fun. I never use condoms with them. I used to steal from my business, from my mother, and even smuggle things to support my heroin habit.

I was married 4-5 years back in 1988, and we separated in 1991-92. I have an eight-year-old daughter, Suzanne. She is so big and is not ill- she must be negative. They say positive children only live 4-5 years. Sometimes l feel l should tell her l will die soon, but fear she will look down on me. My mother sends money for Suzanne. I do not earn, but l have enough money to live on.

I have one girlfriend, sort of. I know everything about her, and she knows about me - l tell her everything. She does not know that l am positive. I do not have the courage to tell her, she too will look down on me. There will be the stigma - 'He has AIDS'.

She must be positive. She must also know all about HIV and AIDS. She knows we never use condoms, and she knows about my drugs. I even told her once to get herself tested. "Go for a check up," l told her….she might have another boyfriend. She takes money from me sometimes. Money for sex? No it's more than that - l have helped her get a job, l help her out many times.

If l tell her, she will get mad. She'll ditch me or maybe she will blackmail me - for money and for revenge. She will be very hurt emotionally. She is closer to me than l am to her. Both our parents know we are seeing each other. The only thing is that l do not want to get married to her. Marriage has lots of responsibilities. I have made a mistake once and do not want to repeat it.

I think that she does not know yet that she is positive. She does not use drugs. Actually, l am not sure if she had another boyfriend or not, l may be justifying my actions thinking so. Fifty percent is justification, and fifty percent l know she goes to parties and has fun. The point is l cannot do anything and neither can she. I have been with her for three years now, and she must be positive. I cannot undo it.

I have used condoms with my girlfriend twice. Once l told her that it was because of my high-risk behaviour, and once l told her that she shouldn't get pregnant - this is only an excuse because she uses a pill, so l told her l have never tried condoms before, and the experience would be new for me. Then l stopped using them because l didn't like the sensation. I thought she was probably already infected, so..

After knowing that l am positive, l thought l should use my own needles. I did not want my friends to get it. But everyone must be positive anyway. In Manipur it is very common for people to be positive. If we are seen carrying a needle here, we can be put into jail, so we take whoever's syringe is available. Nothing strikes when the craving is so much - we don't care, we just fix.

Even before l got myself tested, l was sure l would be positive because of all the awareness programs. Now new complications have emerged: l have TB and diabetes. The programme here is very tough. We even meditate, but l have a problem with GOD, which l am trying to sort out. I am trying my best. My family told me it's either detox or jail. I have been jailed six times and it's much harder than detox. So l am here again.

My relationship with Suzanne is not very good. I was always busy fixing when she was younger and did not have any time for her. I feel she could start hating me, her mother may tell her all sorts of things. My wife refuses to sign divorce papers. I think she keeps hoping to get back with me. We do not live nearby, but we meet through friends. She was a schoolteacher, but now she's at home with parents.

My wife and l broke up because l get very violent when l am drunk. I have creaed a lot of trouble for her. I didn't spend time with her - my friends used to come over, we used to have a party and drink. I did not come home at night. This is the way l am. We had a fight the day we broke up. I told her if she cannot accept me this way….this is my life and she cannot interfere in it….then she has to make a choice. She ran to her sister and l did not see her again for 7-8 months. Her mother came once with Suzanne to patch up. She was also saying that it was my fault. I accept it now, but then l had my pride. She is Hindu; l am Christian. I blamed her religion, her family, mother, everyone. We have been separated since then.

I want Suzanne to stay with me. I have property that l would like to leave her. When she is 10 years old, the father has some rights. I want Suzanne because l hold a grudge against my wife. My resentment is that she never tried to understand me even though she knows my personal problems. I think l still love her, l want to make amends, but my addictive personality says no. I think that l should change first and then think about it. But l don't think l'll get back with her because if she is negative, l do not want to take the risk. Why should l warn her? If she is spreading it unknowingly, then let her. She can carry on doing it.

My mother understands that l am positive, she understands me. I have told my sisters who live there. They have not told anyone else. I just cannot let it out that l am positive. They will kick me out - Manipur is a very small society. I come from a well-known family. We are business people and my uncle is in politics. The stigma there is really strong. If anyone is suspected to have HIV, they are tied up and shackled. They are not given any medicine. In some detox centres, they give you a Bible instead of medicine. In Churachandpur, just south of Manipur, they had to close up a well because the IV users there would commit suicide by jumping in.

http://www.hivaids.webcentral.com.au/text/ist07.html

Maya's Story

2008-12-22T14:37:00.001+05:30

Maya is the sister of Vijay who died of AIDS in 1997. Her sister-in-law Sunita, 24 is HIV positive, but would not speak to us. She said she would rather let Maya tell the story.

I was a nurse, and was very familiar with AIDS. But l had no idea my brother had been infected. We were shocked when we found out, and could not accept it for a whole month. We thought it was a blood bank mix up.

Bhabhi was negative in those days. She did have jaundice once, but we didn't think much of it then. It was only when my brother's health worsened that we found out that bhabhi was also infected. She was seven months pregnant, and the doctor had discouraged her from having an abortion; instead he prescribed some medicines for the unborn child. Now we need to see whether the child's report is negative or not. We're waiting for an auspicious day to pick up the report.

It was l who collected their reports. His second report was positive. I had asked my brother if he'd 'gone out' anywhere, but he would swear on his children and say he hadn't. We knew that he'd drink alcohol and go to parties, but neither our parents, nor l, paid any real attention to these activities then.

It was very difficult for him to accept that he was positive. He was a big social worker - he'd help anyone who had a problem. He once took a bruised and bleeding worker to the hospital. Perhaps his blood infected him then?

We know that bhabhi's life has been ruined because of my brother. People are advising her to remarry. Bhabhi has studied up to her 10th, and has done a Montessori course. She makes very nice dresses. We support her. We keep thinking that it's because of us that she's going through this - humara bhai gaya to gaya, lekin dukh is baat ki hai ki who bhi phas gayi(my brother is dead, but we are sad that this poor girl is trapped). Her parents probably felt that we were a good family to marry into….had they known the truth, maybe they wouldn't have got her married to him.

She does not leave the house much. When my brother was sick, nobody called to inquire about him, and when he died, nobody wanted to even apply choona on his body…

http://www.hivaids.webcentral.com.au/text/ist06.html

Bahadur's story

2008-12-22T14:28:00.000+05:30

I am my parents' only son. They were illiterate, but wanted me to be grow up and be somebody. They sent me to an English medium school, but my father died when l was in the 10th, and l failed in school.

I managed to make it to college somehow, and simultaneously started work as a painter to earn some money. But my responsibilities at work steadily doubled. I was unable to balance the two, so l had to give up on my education.

I gradually started drinking. The paint would give me a headache, and drinking was the only way we could get rid of the odor. People started telling my mother to get me married, and she took me to the village to meet girls. Many of them were unwilling to move to Bombay - in the end l married a girl named Shobha from a poor family with three daughters.

I started drinking more and we'd fight everyday. I started drinking in the afternoon too, and it got so bad one day that she took our child and left for the village. Shortly after this l lost my job at the youth mandal. A social worker sent me to a detox clinic in Malad, where l worked with alcoholics in SUPPORT. I would, nonetheless, have a drink at the end of every day myself.

I've been dry for the last 5-6 years now, and was diagnosed HIV positive five years back too. I would arrange street plays on AIDS in our community, and never expected to be infected. The day l found out l was positive, my wife came to visit me. Her brother was getting married in the village and they had come to invite me. I did not tell her about my health at that time.

My mother-in-law, however, took my best friend to the side and asked him what the matter was. He told her that l had AIDS, and l decided to come clean with Shobha, who had already been asking why l had been wearing condoms. Very late that night, l explained my situation to her, telling her that l had destroyed her life. I told her everything.

"First you were an alcoholic, now you have this illness!" she said, and left for her brothers wedding. I said l'd follow later, but fell ill on getting there and was taken to the hospital. My mother-in-law insisted that l sleep separately that night, either in the fields or in the temple. My wife, who does everything her mother says, did not support me either. What made me really sad was that they'd tell my daughter not to come close to me, not to touch me. In fact, everybody wanted to get me out of there, and it was my saala(brother-in-law) who finally escorted me home.

Everybody knows l have AIDS, and all my relationships have fallen apart. My mother is the only person who supports me still. My wife returned only once - l had sent her a letter saying that l was selling the flat. Her mother had probably sent her to get some cash from the sale. Shobha has been tested twice and is clear.

But how could she be positive - she did nothing but fight all day! It was because of her that l would 'go out'!

http://www.hivaids.webcentral.com.au/text/ist04.html

Basanti's Story

2008-12-22T14:21:00.000+05:30

Basanti's story begins at the age of 17, the year her mother was diagnosed with breast cancer. She was in class 10 at the time, and decided not to take her final exam so that she could help her mother through her illness. They were so poor that Basanti's mother would use the same sari she wore in the daytime to cover her children at night. Her father was unemployed and an alcoholic.

Basanti would accompany her mother to Tata Memorial Hospital, where they would paint diyas for a meager living of Rs 500 a month. There was a man named Rao who used to visit the hospital's printing press. Rao lived only a few houses away, and would often accompany Basanti and her mother both ways. He would listen to her mother's troubles and lend them money whenever they needed it.

One time, when Basanti's mother sent her to get some money from Rao, he insisted that she accept a flower from him. He said he had had a bet with his friends that he would make her take it. Basanti felt a little angry and a little excited. She did not know what to make of the incident, but remembers thinking that the money was more important than the flowers.

As her mother's illness progressed, Basanti took up more and more responsibility at home. Her concern, much like her mother's was to see that her three brothers - then between 9-12 years old - finished their class 10 exams. Her mother would tell her to marry Rao. Basanti always thought that she deserved better. "Mein shahar main reh chuki thi, woh to bikul hi gaon se aaya tha."(I have stayed in a city, he is from the village) Her mother would tell her, "I know you deserve better, but there is no money to get you married. Who would be willing to marry you? Rao is a nice boy…"

Basanti suspected that Rao was in love with her. He would ask her to marry him, but she'd say no because she did not like him. Then one day Rao drank a lot of poison – (Tik 20). Basanti says that she was to naïve to know whether he was seriously ill or putting on an act. She did not know whether to be flattered or impressed, and was concerned about what people would think if word got around. She was also very scared of her father who was prone to losing his temper when drunk. It seemed to her that he did not care that his wife would die of cancer within six months.

The upshot of the Tik 20 incident was that Basanti and Rao began to meet frequently. Basanti would tell Rao she would marry him, but later - she had her mother and their home to attend to first. After her mother's death, Basanti would both cook and clean for the whole family, and work to ensure that the money would keep coming in. Sometimes she would fight with her brothers and father, who would tell her to go off and get married. Basanti began to resent all that she had given up to look after them - she had studied in a good school, lived in a decent environment and thought, "I don't deserve this."

Basanti gradually began to think of Rao as an escape from her troubles. One day, Rao invited her to visit his sister who had come from the village for a ceremony, so they could fix a wedding date. Basanti went thinking that she would stay with the family, but found that after the ceremony, everyone but a few of Rao's friends remained. Then he made them leave too. That night Basanti slept with Rao. "Usne mere saath zabardasti ki,"(he forced me to have sex with him) she says. After that, Basanti continued to have sex with Rao off and on. She was not afraid of getting pregnant etc; she just did not want the world to think that she had put her own needs before those of her brothers. Basanti asked Rao to wait for three years, until her last brother finished school, to get married. His family, however, was pressurizing him, and one day he came by and showed Basanti an invitation to a wedding - his own. She told herself that if he couldn't wait for her, then he wasn't worth it!

Basanti left her job at Tata memorial Hospital so that Rao could not get in touch with her, and landed a new job earning Rs 2600 a month. Her life improved with the increase in her income. But within six months of his marriage, Rao started to phone and follow Basanti again. He told her his marriage was a mistake, and Basanti became involved with him again. She would not, however, live with him unless he married her. In the meantime, people had begun to accuse her of spoiling his marriage.

One day, he dragged her off in a rickshaw and got her to sign some papers. They were going to the court to get married. She did not want to live with him even then. In any case, he lived in a room with all his male friends, around whom she was invariably uncomfortable. Basanti started to spend more time with Rao all the same. She would get up in the morning and cook for him and his friends. On her way home, she would shop for vegetables and divide them into two portions - one for her father's house, and one for Rao.

Looking back, Basanti feels that she was not really happy doing this. She wanted to get married with a proper ceremony; she wanted Rao to take her from her father's house. She kept asking Rao when he would buy her a mangalsutra. He said he had to get through with his divorce first. Basanti hated the secrecy and the blame she got from society.

Then Rao fell ill, and the doctors said he had TB. Basanti had heard of HIV and AIDS, but the thought did not cross her mind then. She nursed him for almost a year, during which she attended a para-professional course for HIV counseling at the Tata Institute of Social Sciences. She knew Rao was not getting better and wrote to his father in the village to come and get him. After Rao left for the villiage, Basanti realized she was pregnant and had the baby aborted on her own - she was afraid that Rao would not return and marry her. What she did not know, however, was that Rao would die there. She was relieved that she had the foresight to abort the child.

Basanti had herself tested , and is HIV positive.

http://www.hivaids.webcentral.com.au/text/ist03.html

Anjali's Story

2008-12-22T14:00:00.000+05:30

Anjali's husband runs a chow cart and while is a housewife. The couple fell in love and Anjali married him even though he is uneducated. She has studied up to her second year of BA and is financially well off. They have been married for five years.

Anjali's husband had a wound on his penis that was taking very long to heal; he would also get high fevers and diarrhea. Anjali has worked as a compounder(nurse) before and knew about HIV / AIDS. When she suggested he get himself tested, he refused. They had an argument. Anjali threatened to get herself tested if he didn't - she had full confidence that she would not test positive; she had never been 'out' anyplace. He still refused. Finally, she took him to her family doctor, who advised 'some' tests. Her husband did not know that his blood was being tested for HIV as well. He tested positive. Anjali was the one to break the news to him.

The communication between them has been very poor ever since. Anjali used to think she was safe because she trusted him. Although she'd never ask about his whereabouts, she noticed that he had stopped sharing details of the day with her once they were married. She accepted this aloofness as part of the personality then, but does not now. Now she thinks about long ago incidences when he went out all night and didn't tell her - he just walked in the next morning. "If her tells me I will forgive him, but I want him to tell me. I think I love him a little less now. I used to stay up all night when he got a fever. Now I just turn over and go to sleep."

Her biggest concern is that her husband has not confessed to her about 'going out'. She says she fights with him a lot, and is sure he knows why. He is very quiet in front of her. He expresses a lot of love, but never responds to any of her questions. She tells him, "Tum mujhe itna pyar karte ho, zaroor tumbare dil me koi knot hai." He laughs, and does not get angry about it - he just continues to maintain that he never went anywhere.
Anjali has known she is HIV positive for 2-3 months now. She feels that it is okay for her to tell people, but is always advised not to. Her parents and sisters know her status and so does her brother-in-law, who is very understanding. He knows that it is likely that his brother has been sleeping with other women because he is often missing from the chow cart for the whole day. Now they listen to AIDS awareness program's together and discuss them.

Anjali agrees that people should tell each other their status, so that if they are in love, they can make an informed choice However, she does believe that people with HIV should not get married. "It is an incurable disease, you die!" She says she would neither marry a man who was HIV positive, not marry if she knew she was HIV positive. When we said, but "sabke armaan hote bain," she replied, "Mein maar dalti apne armaano ko.."

http://www.hivaids.webcentral.com.au/text/ist01.html

Gender Roles Determine Societal Attitudes to HIV

2008-12-22T13:43:00.002+05:30

Women: facing a disproportionately high risk?
While such attitudes increase the risk of HIV infection for both men and women, they do so disproportionately for women. Few women have the social space or sanction to develop a sense of self - an 'I'. But a lack of self usually means that women are unlikely to take cognizance of 'themselves' at risk. Protecting the husband, of course. The daughter, yes. But protecting the self is just not a concern, let alone a priority.

Gender roles determine societal attitudes to HIV-positive men and women

Single man (+ve)
-He is let off with a 'boys will be boys look'
-He may marry without revealing HIV status

Single woman (+ve)
-She is labelled a slut
-She is not expected to get married

Client(MAN) (+ve)
-He is never blamed for spreading HIV, even though it is biologically easier for him to do so.

Sex worker(WOMAN) (+ve)
-She is blamed for spreading the epidemic

Husband (-ve)
-He is encouraged to remarry
-He is not expected to look after her(wife)
-His sexual needs are acknowledged

Wife (+ve)
-She is suspected of infidelity
-She may face violence or desertion
-She is expected to perform household tasks
-Her sexual needs are neglected
-Her treatment is not guaranteed

Husband (+ve)
-He becomes financially dependant on his wife
-He (typically) won't tell her how he got HIV
-His sexual behaviour may not change
Wife (-ve)-She becomes breadwinner
-She does 'triple duty' - home care, work
-She wants to know how he got it, but can't ask
-Her sexual needs are not acknowledged

Even when women are persuaded that they are at risk of HIV, it is difficult for them to initiate preventitive action. An overall power imbalance between men and women means that women are unable to question men about wexual behavious, initiate a dialogue of any kind within a relationship, or assert their preferences. While men are more likely than women to initiate and control sexual interactions and decision-making, the emphasis on male sexual pleasure also acts as a barrier to sager sex negotiation by women.

Husband (+ve)
-He is usually favoured for treatment & care
Wife (+ve)
-Her care & treatment are neglected

Pregnant wife (+ve)
-She is expected to put her unborn child's welfare above her own needs
-She is either denied an abortion or coerced into it - the choice may not be hers
-She is given medical treatment that often compromises her health and needs
-She is blamed as an irresponsible mother-to-be

Widower (+ve)
-His family may not desert him
-He retains his property
-He is rarely blamed for his wife's death

Widow (+ve)
-She may be abandoned by in-laws
-Her natal family may not accept her
-She may be forced to support herself & her children
-Her property may be unsurped
-She may be stigmatized and blamed for his death

Gender : distributing the HIV burden unequally
If women face a disproportionately high risk due to their social status, women also face a greater share of the HIV burden. All women - single, married , pregnant, widowed or in prostitution - face the whiplash of gender when it comes to HIV. A single woman who gets HIV, for instance, will immediately be labelled a slut, while a single man who is infected will escape societal disapproval with a 'boys will be boys' nod and wink. Similarly, a sex worker will be blamed for spreading infection - not her client, who is anatomically more capable of spreading HIV more widely.

In the same way, married women face many dilemmas on getting infected. To have a child or not? Is a question that assumes monumental overtones, since fertility is a deeply valued personal and social goal that defines the self-worth and social identity of a woman. Married women whose husbands are also infected must often walk the tightrope between balancing their own needs versus those of their partners, while uninfected women with infected partners suddenly find themselves balancing old and new roles of caregiver and breadwinner.

In this, and other ways, HIV/AIDS remains yet another arena where traditional gender struggles continue to be played out at all structural levels - in the family, in the community, and in society at large.

http://www.hivaids.webcentral.com.au/text/iintro2.html

Social Construction of India

2008-12-22T13:20:00.004+05:30

Like every other epidemic, AIDS develops in the cracks and crevices of society's inequalities…"

Most of us are born female or male, but learn to be girls and boys who grow into women and men. While growing up, we realize that men and women are different at the biological level: our bodies differ and men can't reproduce. Most of us also learn that society has different rules for men and women, rules that have little to do with our biological differences.

Society typically constructs men and women almost as if they are flip sides of a coin: dominant/dominating, aggressive/passive, authoritative/docile, tough/frail. These qualities are not just harmless attributes; embedded in them are gender roles and scripts that many of us will play out for the rest of our lives.

SOCIETY typically constructs

Man as
Aggressive, Authoritative, Bold, Breadwinner,
Promiscuous, Proud, Reckless, Tough, Violent

Woman as
Abstinent, Chaste, Dcile, Domestic, Frail
Monogamous, Obedient, Sacrificing, Timid

Gender roles typically place women in positions of powerlessness vis-à-vis men. A 'real' man is one who does as he pleases, never mind the risk to his female partner. A 'good' woman would never dream of asking her husband to wear a condom, even in the age of HIV/AIDS. Ultimately, gender expectations that compel men and women to be 'real' men and 'good' women end up making both sexes more vulnerable to HIV/AIDS.

At risk of HIV infection: a gerdered risk
At the individual level, this social construction translates into typical 'gendered' attitudes and behaviours such as those expressed in the following statements. These statements reveal that the risk of getting HIV is a gendered risk, one that strongly depends on the actions and behaviours of individual men and women playing out gender roles that society has constructed for them.

Playing out the sctipt of dominant/dependant makes women vulnerable to infection in many ways. At the direct level, economic dependence means that a woman who is at risk has no options; she must continue to live in a situation that places her at risk. But living in situations of continuing dependence exposes a woman to risk in a more fundaamental way: she can never develop the sense of self that is necessary for one to even conceive of reducing one's risk.

Social construction is translated into

INDIVIDUAL behavious and attitudes

Man - "So what if l'm positive? Don't tell her"
Woman- "My parents decide who l will marry"

Man -"I don't like wearing condoms"
Woman- "My partner refuses to wear condoms"

Man -"I have sex with different women every week"
Woman- "My man sleeps with other women"

Man -"I am a man - l have needs"
Woman- "He may beat me if l ask him where he went"

Man -"I forced her to sleep with me"
Woman- "I was raped last year"

Man -"Arre, why go to a doctor unnecessarily?"
Woman- "My family only takes me to a Dr if l am very ill"

Man -"I support her - she should do what l want"
Woman- "How can l leave him? I have no money of my own"

Man -"I, me , myself…l, me, myself"
Woman- "I? Sho am l" Wife, mother? Self, what self?"

http://www.hivaids.webcentral.com.au/text/iintro.html

UNAIDS Ambassador Salman Ahmad Sends Message of Peace and Solidarity

2008-12-06T03:43:00.000+05:30

UNAIDS Ambassador Salman Ahmad Sends Message of Peace and Solidarity

Salman Ahmad, UNAIDS Goodwill Ambassador, lead singer and founding member of South Asia's biggest rock band Junoon, has sent a message of peace and solidarity on the occasion of World AIDS Day. He has sent the following message to the community:

“On December 1, 2008 we marked the 20th anniversary of World AIDS Day. As more and more people are globally connected to each other through technology, sharing the power of a good idea can help bring about transformational change on our planet rapidly. As a UNAIDS Goodwill Ambassador, I pledge my continuing support to help raise awareness and to shine a light on all the unsung heroes and organisations who have joined UNAIDS to "Lead, Empower and Deliver" the world to a future free from HIV and AIDS. Together we can provide hope, knowledge, treatment and compassion to all people living with HIV and AIDS.”

Ahmad has also expressed his deep grief and shock after the terror attacks in Mumbai. He says:

“We are jolted again by the horrific news of the terrorist attacks in Mumbai. No religion or nation, regardless of race and ethnicity, could ever condone the mass murder of innocents without forever condemning their souls to darkness. My heart goes out to the people who lost their lives and to untold others who have been left behind to pick up the pieces from this tragedy. As a Pakistani-American, I have often enjoyed staying at the Taj Hotel and have been welcomed warmly by Indians of all backgrounds. Having performed all over India with Junoon, including earlier this year, in violence torn Kashmir, tonight my heart is with India and its people. Your grief is our grief, your blood is our blood. Only together can we overcome the darkness of our times.

As a global community, we need to be careful in not pointing the blame against any one religion, race or ethnic group. Fanning the flames of hatred at a sensitive time like this is not only foolish but could be potentially catastrophic. It is important that the media discriminate between peace loving Muslims and terrorists who only bow to gods of hate, bigotry, and fanaticism. The sentiment amongst all Pakistanis that I know is of shocked disbelief. As global citizens, I feel we have a greater responsibility to help create an atmosphere of calm and brotherhood in this emotionally charged environment.

In Islam the taking of one innocent life is like killing the whole of humanity and all people of conscience condemn this heinous act.”

Archana got Married!!

2008-12-05T18:39:00.006+05:30

Archana, volunteered with World Camp India in summer 2007 & 2008.How lovely she is looking...these are some of her wedding pics clicked by her friend Payal Mulchandani(who hopefully is going to be part of World Camp group this coming year)...

we surely did miss the wedding and the food.....

Archana lots and lots of wishes and love from the entire World Camp group!!

Gujarat stands 3rd in AIDS interventions

2008-12-02T13:56:00.001+05:30

Challenges that the AIDS scourge pose have not changed much over the years it's still all about creating awareness,fighting discrimination and providing interventions for prevention and treatment.

Gujarat stands third in the country in number of targeted intervention (TI) projects to tackle AIDS. This is surprising, considering that the state is categorised as a moderate HIV-prevalence state.

As per a UNAIDS estimate, India has the largest number of people living with HIV outside South Africa. However, heartening figures from NACO's 2007 sentinel survey indicate that number of people with HIV/AIDS in India has dropped to 2.31 million from 2.41 million as per the 2006 survey.

Gujarat has 76 TIs as compared to 96 in Andhra Pradesh and 82 in Tamil Nadu, as per 2006 National AIDS Control Organisation (NACO) figures. This was revealed in a recent paper by faculty of Indian Institute of Management, Ahmedabad (IIM-A).

"Targeted interventions, which aim to prevent spread among vulnerable and marginalised populations, involve IEC (information, education and communication) which helps reduce stigma and BCC (behavioural change and control) which helps in modifying risky behaviour," says the paper.

The paper titled Managerial Challenges in Addressing HIV/AIDS: Gujarat State AIDS Control Society (GSACS)' is written by professors KV Ramani, Dileep Mavalankar, Devanath Tirupati and Vijaya Sherry Chand.

Says Dr Rajesh Gopal, joint director of GSACS, "We are fighting two epidemics AIDS and the stigma attached to it. We have to come out of the institutional healthcare model and emphasis should be on communication. All four routes of transmission unsafe sex, infected needles and syringes, infected blood and parent-to-child transmission are preventable."

According to him, Gujarat is moving towards being a low-prevalence state with less than five per cent prevalence among high-risk groups and less than one per cent prevalence among general population.

Currently, there are six ART (antiretroviral therapy) centres in the state at Ahmedabad, Rajkot, Mehsana, Bhavnagar, and two in Surat. The seventh in Surendranagar just received a nod last week.

On Monday, World AIDS Day, three patients will get the second line of ART at Civil, Hospital, Ahmedabad, he reveals. The IIM-A paper stresses the need for behavioural surveillance of high-risk groups like commercial sex workers (CSWs) and their clients, men who have sex with men (MSMs), injecting drug users (IDUs), migrant workers, truck drivers and street children. Inadequate screening of blood and beating opportunistic infections, most commonly tuberculosis, are other problems.

Anjoo Sheth, director of suicide prevention centre Saath, says, "AIDS patients often contemplate suicide because of rejection from their families. When they are in the last stages, relatives are unwilling to care for them as they fear infection. There is urgent need for hospices in the state where those who are terminally ill can be given proper care."

VIGILANCE VITAL
Number of ICTCs (integrated counselling and testing centres):

Ahmedabad 16

Gujarat 211

Andhra Pradesh 752

Tamil Nadu 710

Maharashtra 606

Total in country 4,155

* 2007 Naco figures

Referance:Times of India, December 01 2008

Alcohol, Drugs, Sex and Youth

2008-11-25T12:57:00.001+05:30

Under the influence of substances like alcohol and drugs, the risk of unsafe sexual activity is high especially among youth. A significant number of young people engage in sexual intercourse as well as drug and alcohol use at an early stage in their lives. In India, respondents observed, it is easier for youth to obtain prescription drugs than getting beer or other drugs. Reduced inhibitions lower the likelihood of safe sexual intercourse. Some studies says that youth are three times as likely to have sex that is unprotected when they are drunk, than when sober.

There have gaps identified in knowledge and beliefs about alcohol and drug abuse and HIV among youth. Adolescents are either ill informed or not well informed about their health, sexuality or physical well-being. Youth often engage in unsafe sex as they consider condom mainly for birth control, respondents mentioned.

The need to educate teens is enormous as they are more likely to experiment and risk. It is easier to prevent changing behaviour pattern than to modify conduct once it becomes a habit. So, HIV prevention programmes for youth must focus on alcohol abuse as well as other drug abuse and sexual risk behaviour. It is important to conduct a multi-centric research study with analysis of data including the public health sector. In addition, we need to look at these issues in context of demographic and typical geo-social conditions. Child Line India Foundation gives statistics of the drug abuse among children, as well as, details of the interventions to address the issues.

The socio-economic determinants have an impact over HIV prevention and control. As, in the transition phase or conflict between traditional and modern values, media can play a vital role. Therefore, while designing interventions, the socio-economic groups one is addressing, must be taken into consideration.

Attitudinal change is not easy to achieve, members stated. Experts have experienced that when youth discuss the issue, reflect on their concerns and vulnerabilities, they change their behaviour. When they understand that they have the capacity to stop the spread of HIV, they start taking action. A continuous effort to train and create awareness would be one of the strategies to consider, besides strengthening law enforcement and policy as well as setting up and implementing institutional mechanisms. Similarly, UNODC in India targets young people, taking to them information on drugs and the related risks of HIV.

Parents and teachers face deep-rooted cultural constraints in discussing these issues with children. Systematic training of teachers and parents on developing communication skills to discuss culturally sensitive topics with adolescents is required. Open interaction with children within the parameters of cultural norms can instil strong values and develop social skills, which in turn can minimize their risk of abusing drugs or contracting HIV.UNODC in an Asian Country adopted a two-pronged approach, training and creating peer network and IEC or BCC campaigns. It distributed CDs to those parents who were working or had little time to spend with their young children.

Expert suggestions to deal with issues of substance abuse and HIV in youth:
• Inculcating healthy behaviour in youth through importance of fitness, sports, nature loving helps them live most productively.
• Using innovative cultural and artistic input in peer-education is cost-effective.
• Avoidance of words and terms which are not in accordance with a sensitive approach towards people, especially when the 'community' is a primary stakeholder of the proposed intervention
• Inputs from IEC division of NACO and SACS on the subject

(referance:
solution exchange discussion)

Gujarat Facts/Data-1

2008-11-24T13:02:00.000+05:30

Gujarat with a population of 50.6 million lies on the west coast of India. The state shares international boundary with Pakistan at the north-western periphery and national boundary with Rajasthan in the northeast, Madhya Pradesh in the east, Maharashtra and Dadar and Nagar Haveli in the southeast and Arabian Sea in the west and southwest. Gujarat represents about 6% of the total area of the country with 25 districts and 226 talukas. Gujarat’s unique geographical and socio-economic characteristics have made the state highly vulnerable to the spread of HIV. Some of the factors that contribute to the vulnerability of Gujarat to HIV include:
• busy trucking routes
• high degree of industrialization resulting in influx of migrant labourers from various parts of the country
• high mobility of population between Gujarat and Mumbai in particular for trade and commerce
• renowned educational institutions attracting youth from various parts of the country and abroad
• longest coastline with many ports
• exposure to extensive commercialization
• traditional festivals like Navratri providing ample opportunities for youth to socialize.

The 2006 estimates suggest national adult HIV prevalence in India as approximately 0.36 percent, amounting to between 2 and 3.1 million people (NACO 2007). The HIV epidemic has begun to take devastating toll in the state. Though no separate estimates are made for states, from the data of HIV sentinel surveillance of ANC clinic attendees, a gross estimate suggests that in Gujarat, the number of people living with HIV may vary from 75,000 to 15,00,000 (GSACS, PIP 2007). About 3000 AIDS patients were treated in government hospitals in Gujarat and the commonest opportunistic infections were tuberculosis and oro-pharyngeal candidiasis. With every passing year, number of PLHIV is increasing and with the advent of ART, life expectancy has increased. State spends millions of Indian Rupees on STD/HIV prevention and awareness activities, treatment for STIs, condom promotion and distribution and assisting people living with HIV. Further, gender inequities, low literacy, and poverty have added to the prevalence of HIV. These circumstances have also made People Living with HIV susceptible to stigma and discrimination when they are identified as being HIV-positive. Empirical evidence suggests that many men and especially the women are often stereotyped as having contracted HIV through immoral sexual behaviour. HIV-related stigma and discrimination together have long been recognized as one of the main obstacles to the prevention, care, and treatment of HIV and AIDS. Yet little has been done on a large scale to combat them.

http://www.solutionexchange-un.net.in/aids/resource/res-01-0 61008-01.pdf

Press Council of India Guidelines

2008-11-24T12:59:00.000+05:30

The Press Council guidelines on media reporting on HIV/AIDS, stipulate that:
• Media must inform and educate, not alarm or scare people. The emphasis must be on
the fact that HIV infection can be prevented. The HIV virus, which does not survive
for long outside a body, takes around 10 years to develop into AIDS. It is not spread
by casual contact, hugging or kissing or through food or water or through insects.
• Media must hammer home the point that AIDS through sexual transmission or blood
transfusion can be prevented. Minimum precautions include use of condoms during
sexual intercourse and of sterilising all instruments that pierce the skin, such as needles,and their prompt disposal after use.
• Media must report every case pertaining to AIDS be it positive or negative. There must be constant liaison between the media and the medical profession to report on latest developments and research findings.
• Media must highlight and crusade against such practices as quarantining, isolation and ostracism of AIDS patients. Besides being an affront to human dignity, such practices will not help minimise HIV/AIDS infection, and are injurious to public health as they give a false sense of security to people outside the stigmatised group that the threat of infection has been removed and the need for precaution minimised. Also, such practices will drive the AIDS problem underground and make the campaign against the disease more difficult.
• Community education, supported by behavioural scientists and media experts using the latest techniques of mass education, has to play a crucial role in preventing this dreaded infection. Opinion builders of the society (political and religious leaders, movie and sports personalities, and other famous persons) must take the leadership in educating people about HIV/AIDS and about how to avoid contracting this infection. The innovative use of media and a positive attitude in reporting would go a long way in making the AIDS awareness campaign a success.
• Media must force the authorities to impose rigorous blood-testing norms for prostitutes and ‘professional’ women and issue periodical warnings to the public about areas where there is high incidence of AIDS.
Media must help the authorities in eliminating commercial blood collection and pretesting of all blood donors for HIV and other diseases.
• Media must, as a rule, respect the right to privacy of HIV/AIDS patients and must not subject them to needless exposure and social stigma.
• Every mass medium must observe the terms specified in the final document of the
international consultation on AIDS and human rights and promptly report the violation
of such rights, protecting the basic human rights to life and liberty, privacy and freedom of movement.

http://www.unifem.org.in/PDF/HIV/media_tools.pdf

Guidelines for HIV Media Reporting

2008-11-24T12:41:00.000+05:30

Recently, visuals of two HIV-infected children were shown by the print and electronic media. The visuals indicated that even though treatment was available, children infected with HIV were doomed. However, what was more hurting was the inaccurate report that one of them had succumbed. Although TV channels clarified the next day that the child had not died, the harm had been done. Consequently, a positive network petitioned the Juvenile Court saying that such media reports relayed negative messages. Reports like these also impact negatively on other family members who already face stigma and discrimination. Therefore, the positive network sought guidelines for the media that would protect the rights of People Living with HIV (PLHIV). The court then approached the Press Council of India (PCI) to respond by formulating appropriate guidelines on the issue.

While certain guidelines on HIV and AIDS reporting were made by the Press Council of India in 1993, much has changed since then. There has been a tremendous change not only in the intensity of the infection and its spread but also in the thinking on how it should be reported. Like diabetes and other chronic ailments, HIV is an infection that can be managed especially with the range of drugs now available. So, the fact that PLHIV are leading positive and meaningful lives needs to be conveyed.

On the same note, HIV is not a ‘scourge’ nor is the language commonly used to describe groups with high-risk behaviour as prostitutes considered appropriate. These terms have been discarded. The role of the media as spelt out by the PCI needs to be changed to incorporate the rapid developments in areas like science, technology and terminology. While it can be difficult to change overnight writing styles and vocabulary that portray a doomsday scenario with regards to HIV, the PCI guidelines can provide a framework enabling effective media reporting and factual portrayal of PLHIV.

Framing the Story• When reporting around women from marginalised groups (e.g., sex workers, drug users)
frame the story in a manner that it builds the self-esteem of the woman so that it
empowers her to stand for her rights.
• As far as possible, avoid any immediate linkage of HIV/AIDS with any negative
association such as crime/ perversion as it only reinforces the prejudice that HIV affects
the immoral and sexually perverted.
• Confidentiality of women must be protected in all situations. An expression of consent
cannot be taken at face value. Mediapersons, presumably aware of the consequences,
should rather err on the side of caution and sensitively judge for themselves the social
consequences – for both the interviewee and the community – of such disclosure.
• An interviewer must not probe route of infection as this creates another level of
discrimination among people living with HIV/AIDS. The important thing is not how
one got it but how one is living with it.

Appropriate Terminology• Words with negative associations, unnecessary drama, sympathy, must not be used to
describe HIV/AIDS.
• Use of the word ‘victim’ for a person living with HIV/AIDS is not acceptable as it evokes
sympathy and paints a picture of helplessness. ‘Positive person’ or ‘Person living with
HIV/AIDS’ is acceptable.
• ‘Full-blown AIDS’ is factually incorrect.
• As far as possible media stories must project people living with HIV/AIDS as people
leading ‘normal’ lives as part of mainstream society. This will also help break the myth
that only certain groups are vulnerable.
• The reporter must ensure sensitivity in headlines, blurbs, captions, and visuals.

Visual Representation of People Living with HIV/
AIDS (Photographs and Electronic Media)
• Dignity of subject cannot be compromised at any cost.
• Stories must not paint a picture of hopelessness and helplessness of positive people –
no matter how horrific the situation, the story must present a balanced viewpoint.
• Consent of the individual is even more important in the visual medium.

Suggested Guidelines to Activists for Building
Partnerships with Media• Give the journalist concise, relevant information packaged in a user-friendly way keeping
in mind media’s constraints on time.
• Well-packaged information helps correct information to go out.
• Always give media emergency contact details in case the journalist needs to counter check
a fact after regular office hours.
• Follow-up on misinformation in the media through letter to the editor. Respond to
articles in the press.
• NGO spokespersons must be careful to not reinforce public association of HIV/AIDS
with extra-marital sex, multiple sexual partners and death.

Referances:
http://www.unifem.org.in/PDF/HIV/media_tools.pdf
Solution Exchange:AIDS Community discussion

A Content Analysis of the Coverage of HIV and AIDS in the Print Media of Gujarat

2008-11-24T12:28:00.000+05:30

Background

The geographical, cultural, and socio-economic characteristics of Gujarat render it highly vulnerable to HIV. Sentinel surveillance and other statistics emphasize the need for strengthening HIV response in the state. However, Denial, Stigma, and Discrimination (DSD) are major obstacles in implementing such programmes.

The AIDS Community of Solution Exchange has earlier streamlined advocacy on DSD through discussions in the Community. Eventually it formed the first national advocacy group on DSD called “AAROHI.” At the visioning workshop of the Community, Dr. Rajesh Gopal from Gujarat State AIDS Control Society (GSACS) proposed a similar action group specifically for Gujarat. Based on recommendations from the brainstorming session at this workshop, GSACS and Solution Exchange AIDS Community agreed upon to have a joint Action Group. An e-discussion followed on Solution Exchange to explore the modus operandi of the Action Group.

Research Findings-

General Trends
Like any other development issue, coverage on HIV is increasing steadily over the years. 80 of the 210 articles covered issues of PLHIV. While professional journalists were authors in 93% of such articles, NGOs like GSNP+ authored the rest. Our analysis found an overall negative tone in 3% of the articles. Such articles gave an impression of lost hope and portrayed HIV with death.

Blaming a Group for the spread of HIV
2.4% of the articles directly blamed particular groups for the spread of HIV. Further analyses of the data revealed that sex workers bore the brunt as 60% of the articles held them responsible for the spread of HIV. We also found that such articles used language contributing to DSD like ‘them’ and ‘immoral behaviour’.

Confidentiality
The study found that 7% of articles had declared the identity of PLHIV without consent. Our interaction with members of positive networks revealed that journalists falsely claim that they have obtained consent for disclosing identity. This poses a major challenge in an effective media strategy. Media personnel need to treat every person interviewed with dignity. They also need to obtain proper informed consent before publishing articles with names or photographs of PLHIV.

Derogatory language
4% of the articles in the study used derogatory terms. They include terms like ‘victim’, which often imply passiveness and helplessness, and ‘prostitute’, which has a negative connotation. Use of such terms will further stigmatise HIV.

Discriminatory Language
The study found that 2% of the articles used language directly implying discrimination. Use of such language reinforces stereotypes. Statements like “Huge migrant population in Surat is suspected to be responsible for high vulnerability” and “Migrant workers are known to contract HIV from prostitutes and then pass it on to their wives when they return home” are few examples.

This causes stigmatisation and discrimination of certain key populations. Moreover, such reports have also led to the belief that those who do not belong to these vulnerable groups are safe from HIV. These are instances where the media has failed to observe the much-needed sensitivity while reporting on HIV.

Misinformation
Our study found misinformation in less than 3% of the total articles scanned. Some of the common factual errors were relating to statistics. Often such reports appeared to be quoting reliable agencies without verifying with the sources. Other types of misinformation related to designation of officials and inappropriate terminologies.
Inappropriate terminologies can give rise to wrong ideas in people’s minds. Reporters need to pay careful attention to what they report as a single wrong message can wreck the efforts of all concerned. Hence, they need to ascertain data before publishing.

Use of Complex terminology
Of all the articles, 2% had terminology difficult to understand. In such situations, even if the writer intends to convey the best information, she/he cannot achieve the desired effect. Medical jargon, complex scientific concepts, and unexplained acronyms stand this risk. Media professionals need to be aware of the educational background of its majority readers. Hence, writers need to keep the language used in reporting on HIV simple.

Use of Photographs
23% of articles contained photographs. Out of these 49 articles, 33% maintained confidentiality of the respondent. 53% published it with consent, while 14% of articles published them without consent. Further analysis of these 49 articles revealed that 45% of them had positive gestures like celebrities,sport personalities, and film artists shaking hands and hugging positive persons, or carrying positive children with pleasure.

Use of photographs in articles does have benefits. However, they raise many ethical issues. Hence, the use of photographs needs to be judicious and selective. Journalists need to ensure that they get informed consent to use such photographs. In many cases, they also need to be careful in revealing the identity of the photographed.

Journalists must be aware of the possible consequences for individuals who reveal themselves in such articles, as stigma attached to HIV is still huge in society. Sometimes a person may not fully understand the implications of such media appearances.

Contact Details for further information
The study found that only 10% of the articles carried details for finding further information on the subject. Rest of them did not have contact details of the author or sources to seek further information. We recommend journalists to provide such details so that people can find further information on the topic.

Positive Gestures
Of the articles studied, 26% of them contained reports of positive gestures. Some of the examples include:
• Adoption of Orphans and Vulnerable Children (OVC).
• Community initiatives in HIV.
• Political leaders celebrating festivals with PLHIV.
• Sports Personnel shaking hands with PLHIV and OVC.
• Doctors spreading positive messages.
• PLHIV talking about positive living.
• Positive women tying Rakhi on local businesspersons.

Prevention messages
We found that only five percent of the 210 articles scanned contained prevention messages in them. Generally, the depth of coverage was superficial. Hence, most of the articles limited themselves to ribbon cutting ceremonies, highlighting activities of NGOs or GSACS, and providing statistics of those infected in the state. Important elements like awareness, education, and advocacy on prevention were lacking in most of the articles. Studies have proved the role of media in behaviour change communication. It helps readers to take informed decisions to protect themselves. The Sate’s prevention and treatment efforts would not be effective if no one knows about them.

Concluding Remarks
The reach and influence of media on society is very high. Hence, it can certainly play an important role in our response to HIV. This study establishes that the media’s contribution in generating and disseminating information has increased over the years in terms of quantity and quality. With their active participation through organisations like GSNP+, PLHIV have found ways to assimilate their concerns into media. The support of governmental bodies like GSACS and NGOs has helped it further.
Nevertheless, the findings of the content analysis in this study calls for proactively developing a media strategy in addressing the third epidemic. A single misleading report could tarnish PLHIV and the commendable work done by GSACS and other agencies. Hence, it becomes even more crucial that journalists exercise the power of their pens with care and compassion. They ought to uphold ethical principles in doing so.

World AIDS Day Commemorations 2008

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The 1st of December, World AIDS Day, is the day when individuals and organisations from around the world come together to bring attention to the global AIDS epidemic. 2008 marks the 20th anniversary of World AIDS Day. Whilst we have come a long ways since 1988, there is still much more to be done.

The theme for this year’s World AIDS Day is “Leadership” under the slogan “Stop AIDS, Keep the Promise”. http://www.worldaidscampaign.org/en/Media2/Files/wad-theme-2 007-and-2008

World AIDS Day Commemorations 2008 www.worldaidsday.org.in is a participatory space, where organizers can directly provide details of the event they are organizing.To encourage commemorations in remote areas, the site has been designed to aggregate and display events even at the block level.

This initiative will help in:

-Learning from each other.
-Publicity, for greater participation.
-Providing opportunities for adding more value to the event and clubbing of activities for greater impact.
-Identifying areas of low activity to plan interventions and a bigger mobilization in future.

HIV AND AIDS IN DISASTERS: AN OVERVIEW

2008-11-24T00:07:00.000+05:30

During and after disasers, physical, financial, and social insecurity may erode the caring and coping strategies of individuals and households, rendering communities more vulnerable to HIV infection.

• Loss of livelihoods. -Disasters and emergencies lead to loss of livelihoods and further impoverishment, especially in poor societies. Women and girls become especially vulnerable, as they may find themselves coerced into engaging in sex as a survival strategy to gain access to food, shelter, and physical security. In some emergencies, increased powerlessness and insecurity make this group more vulnerable to rape and other sexual violence.

• Breakdown of social norms - Displacement often leads to the breakdown or weakening of traditional social norms and systems that control social behavior and activities, including sexual relationships. The breakdown of families and communities and exposure of the uprooted population to unfamiliar social and livelihood situations can increase vulnerability to HIV infection.

• Challenges to health care - Disaster situations can greatly overtax the existing health-care infrastructure. The result can be gaps, such as in the supply and distribution of condoms, which hamper HIV prevention. Efforts to treat STIs and other diseases are sometimes ineffective and sporadic in this setting. (STIs are relevant to this research not only because HIV is sexually transmitted but also because infection with other sexually transmitted diseases can increase a person’s risk of contracting HIV.)
The risk of transmitting HIV through transfusion of contaminated blood might also rise due to inadequate screening services at health centers.

• Disruption of HIV-control activities -During disasters, HIV- and AIDS-control activities like awareness campaigns tend to be disrupted or eclipsed by other priorities, like the provision of basic food, water, and shelter, and the treatment of wounds and more acute diseases and infections. Institutions like schools and shopping centers, where awareness campaigns tend to be conducted, are sometimes closed down in emergencies.

• General trauma -Trauma related to an emergency may sometimes lead to problems like alcoholism and high-risk sexual behavior.

• Relief efforts -Paradoxically, relief and rehabilitation efforts by aid providers may sometimes contribute to the risk of HIV and AIDS.3 In the case of the tsunami, for example, the structure and location of the new temporary shelters were major contributing factors.

(Referance: Oxfam Humanitarian Field Studies & Swasti Health
Resource Center of Bangalore-
Understanding the Effect of the Tsunami and Its Aftermath on Vulnerability to HIV in Coastal India )

Rationale for a Specific HIV/AIDS Intervention in Crisis

2008-11-24T00:05:00.001+05:30

Over the last two decades, complex emergencies resulting from conflict and natural disasters have occurred with increasing frequency throughout the world.
At the end of 2001, over 70 different countries experienced an emergency situation, resulting in over 50 million affected persons worldwide. Sadly, the very conditions that define a complex emergency - conflict, social instability, poverty and powerlessness - are also the conditions that favour the rapid spread of HIV/AIDS and other sexually transmitted infections.

The long-term consequences of HIV/AIDS are often more devastating than the conflicts themselves: mortality from HIV/AIDS each year invariably exceeds mortality from conflicts. Most people are already living in precarious conditions and do not have sufficient access to basic health and social services. During a crisis, the effects of poverty, powerlessness and social instability are intensified, increasing people’s vulnerability to HIV/AIDS. As the emergency and the epidemic simultaneously progress, fragmentation of families and communities occurs, threatening stable relationships. The social norms regulating behaviour are often weakened. In such circumstances, women and children are at increased risk of violence, and can be forced into having sex to gain access to basic needs such as food, water or even security. Displacement may bring populations, each with different HIV/ AIDS prevalence levels, into contact. This is especially true in the case of populations migrating to urban areas to escape conflict or disaster in the rural areas. As a consequence, the health infrastructure may be greatly stressed; inadequate supplies may hamper HIV/AIDS prevention efforts.

During the acute phase of an emergency, this absence or inadequacy of services facilitates HIV/AIDS transmission through lack of universal precautions and unavailability of condoms. In war situations, there is evidence of increased risk of transmission of HIV/ AIDS through transfusion of contaminated blood. The presence of military forces, peacekeepers, or other armed groups is another factor contributing to increased transmission of HIV/AIDS. These groups need to be integrated in all HIV prevention activities. Recent humanitarian crises reveal a complex interaction between the HIV/AIDS epidemic, food insecurity and weakened governance. The interplay of these forces must be borne in mind when responding to emergencies.

There is an urgent need to incorporate the HIV/AIDS response into the overall emergency response. If not addressed, the impacts of HIV/AIDS will persist and expand beyond the crisis event itself, influencing the outcome of the response and shaping future prospects for rehabilitation and recovery. Increasingly, it is certain that, unless the HIV/AIDS response is part of the wider response, all efforts to address a major humanitarian crisis in high prevalence areas will be insufficient.

(Referance:
GUIDELINES for HIV/AIDS interventions in emergency settings
Inter-Agency Standing Committee Task Force on HIV/AIDS in Emergency Settings
www.humanitarianinfo.org/iasc)

Risk of Transmission in Emergency Contexts

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Although arriving at definitive conclusions is based on the scant HIV prevalence data available in emergency settings, we do know that many of the conditions that facilitate the spread of HIV are common in these settings.

Such conditions include but are not limited to:
• Rape and sexual violence, including rape used as a weapon of war by fighting forces against civilians. This is most often exacerbated by impunity for crimes of sexual violence and exploitation
• Severe impoverishment that often leads women and girls with few alternatives but to exchange sex for survival
• Mass displacement which leads to break up of families and relocation into crowded refugee and internally displaced camps where security is rarely guaranteed
• Broken down school, health and communication systems usually used to programme against HIV transmission.
• Limited access to condoms and treatment for sexually transmitted infections.

(Referance:
GUIDELINES for HIV/AIDS interventions in emergency settings
Inter-Agency Standing Committee Task Force on HIV/AIDS in Emergency Settings
www.humanitarianinfo.org/iasc)

People already living with HIV/AIDS in emergencies

2008-11-24T00:02:00.000+05:30

In general, people already infected with HIV are at greater risk of physically deteriorating during an emergency because:
• People living with HIV/AIDS are more prone to suffer from disease and death as a consequence of limited access to food, clean water, and good hygiene than are people with functioning immune systems.
• Caretakers may be killed or injured during an emergency leaving behind children already made vulnerable by infection with HIV/AIDS or loss of parents to AIDS.
• Health care systems break down (attacks on health centres, inability to provide supplies, flight of health care staff ), and populations have limited access to health facilities because roads are blocked or mined, and financial resources are even more limited than usual.

(Referance:
GUIDELINES for HIV/AIDS interventions in emergency settings
Inter-Agency Standing Committee Task Force on HIV/AIDS in Emergency Settings
www.humanitarianinfo.org/iasc)

Emergency preparedness and response

2008-11-23T23:50:00.000+05:30

Emergency preparedness focuses on addressing the causes of the emergency with a view to avoiding its recurrence or mitigating its impact and strengthening resilience, especially on vulnerable households and communities, and building up local capacity to address the crisis (including pre-positioning of relief items to shorten the time of the response). These efforts are often linked to early warning systems, especially in natural disaster prone areas. Disaster preparedness includes the continuous collection and analysis of relevant information and activities in order to prepare for and reduce the effects of disasters such as:
• predicting hazards by identifying and mapping key threats;
• assessing the geographical distribution of areas vulnerable to seasonal threats; defining which groups and communities are more at risk;
• assessing strengths and coping mechanisms of vulnerable groups and their capacity to respond to a threat; and
• identifying gaps in government preparedness plans and advocating with policymakers to ensure that plans are developed that aim to reduce the disaster’s impact on vulnerable populations.
Emergency preparedness plans are developed in order to minimize the adverse effects of a disaster, and to ensure that the organization and delivery of the emergency response is timely, appropriate and sufficient. Such preparedness plans should be part of a long-term development strategy and not introduced as a last-minute response to the unfolding emergency. In the case of
HIV/AIDS, such preparedness means that all relief workers would have received a basic training, before the emergency, in HIV/ AIDS, as well as sexual violence, gender issues, and non-discrimination towards HIV/AIDS patients and their caregivers. It also implies that adequate and appropriate supplies specific to HIV are pre-positioned. These are crosscutting issues which are relevant to all sectors.

A disaster preparedness plan should put in place certain elements in order to bring about a successful response:
• a solid needs assessments that will allow relief agencies to jointly determine who does what and where, under the umbrella of a comprehensive humanitarian action plan;
• staff properly trained and emergency response tools available on time;
• common tools for natural disasters and complex emergencies;
• funding mechanisms that ensure money is readily available, and
• information management network available to key decision-makers.

Bihar Floods & HIV Vulnerability

2008-11-23T23:08:00.000+05:30

The vulnerability of the millions who are still displaced by the floods in Bihar has only re-emphasized the need for HIV, and Sexual Health services for this displaced population. As the flood affected populace will take months to return to their original lands and many are migrating to cities like Mumbai and Delhi, HIV and sexual health services need to be made available to them.

The nature of the humanitarian emergency determines the degree of exacerbation for the existing HIV epidemic, in a particular disaster affected area. Accordingly, there is no doubt that today in Bihar’s flood there is a far greater danger of increasing the vulnerability of the flood-affected people and their service providers, than it was in the Tsunami-affected coastal belt of South India. The difference between Tsunami and flood is that while the coastal ‘belt’ is severely damaged by the Tsunami, in flood a large broad area is submerged and may remain so for a long time as has happened recently in Bihar. Consequently in Tsunami, aid agencies are able to reach the affected populace much faster than in flood, mostly within a day, as only a ‘belt’ is affected. However, in the Bihar flood the infrastructure of whole districts are submerged and disrupted. Accordingly, it is much more difficult to reach the marooned populace in a flood. As a result, even after weeks some stranded people remain cut-off from rescue and services in flooded situations.

Floods are increasing in incidence and intensity due to the increasing effects of climate change. The Bihar flood is a classic example of an extreme event with disastrous consequences due to climate change. A changing climate is expected to increase the risk of disasters and thereby the demand for aid measures.
Therefore, keeping in tune with the fact that programme interventions on background development factors of HIV vulnerabilities require holistic strategies and multidisciplinary partnership, the following points must be considered:

• The transmission of HIV from person to person through sexual contact or other means may be climate independent. Nevertheless, there is need for sufficient research studies to substantiate the interrelation between climate change and Sexually Transmitted Infections (STI).
• The larger issue of disaster impact mitigation and HIV needs to be a part of the national response framework to HIV at the policy level.
• Almost no one would challenge the fact that climate changes. However, the impact of climate change will not necessarily be floods always. It could be of different in nature as well as in magnitude. Therefore, there is a need to explore strategic dimensions both at micro and macro level to design intervention on HIV, based on the variable of climate. It could be as a early “warning and early response” approach or as a “long term” approach targeted to prevent HIV- integrated within the prevention of human induced climate change.
Finally, it is the outcomes of changes in climate, the vagaries of its impact on the environment and our surroundings, which determine the nature of the stage on which people work, rest and live. That's why, understanding some of these apparently countless, but root causes, is fundamental to designing any type of response in humanitarian emergencies.

Referance: Discussion on HIV and Humanitarian Emergencies - Experiences
Solution Exchange, AIDS community-
1. E. Mohamed Rafique, UNAIDS India Office, New Delhi
2. Jagdish, Telugu Network of People Living with HIV (TNP+), Vijayawada
3. Upahar Pramanik, UNAIDS India Office, New Delhi
4. Kalika Mohapatra, United Nations Development Programme (UNDP), Bhubaneswar
5. Lalit Mohan Mishra, YOJANA , Puri (Response 1; Response 2)
6. Ravishwar Sinha, Independent Consultant, New Delhi
7. Rudra Prasanna Rath, Orissa State Disaster Management Authority, Dhabalagiri, Jajpur District, Orissa
8. Sudha Kalangi, Society for Welfare of HIV infected People (SHIP), Positive Network, Guntur, Andhra Pradesh
9. Avnish Jolly, Consultant, Chandigarh
10. Brijesh Dubey, Rajasthan Network For People Living With HIV, Jaipur
11. Kiran Jayasa, Consultant, Hyderabad)

Tsunami and Its Aftermath on Vulnerability to HIV in Coastal India

2008-11-23T21:51:00.000+05:30

( A MUST READ REPORT)
http://www.swasti.org/main/media/Effect_of_Tsunami_on_HIV_Vu lnerability.pdf

Apart from the devastation and havoc that a natural calamity causes, it has far reaching effects on the lives of the people affected by it. Vulnerability to HIV is one such reality that cannot be ignored. Swasti, Health Resource Center, with the support of Oxfam International conducted a unique study that focused on understanding the vulnerabilities of Tsunami affected communities in India, to HIV. Covering thirty locations across five states, the study found that vulnerability existed in almost all locations and was heightened in two-thirds of the locations. Moreover, physical proximity of displaced populations was established as the primary factor contributing to a chain of events that led to increased vulnerability. Additionally, increased unprotected sex with non-regular partners was recognized as the key risk factor. Also, coastal communities in the tsunami-hit areas were vulnerable to HIV even before the Tsunami. Thus, the effects of humanitarian crises and aid measures influenced the behaviour and practices of the affected, significantly heightening their vulnerability. Consequently, there is a need to mainstream HIV, reproductive and sexual health service components in humanitarian aid, as well as, include communities from disaster-prone areas into national HIV and sexual health interventions.

The massive tsunami of Dec. 26, 2004, caused devastation in 14 countries bordering the Indian Ocean—especially in India, Indonesia, the Maldives, Sri Lanka, and Thailand. About 227,000 people lost their lives and 1.7 million were displaced.

In India, more than 2,000 kilometers of coastline along the southern Indian states of Tamil Nadu, Andhra Pradesh, Kerala, and the Union Territories of Puducherry (formerly Pondicherry) and the Andaman and Nicobar Islands were affected.There were tremendous successes in the humanitarian response to the tsunami, such as the prevention of outbreaks of deadly waterborne disease among those who were displaced from their homes. However, the urgent needs identified by communities and aid providers—to supply food, water, shelter, medical care, psychosocial support, and eventually the means to make a living—tended to overshadow the need to provide information and services that could prevent the spread of HIV.

Yet, even when aid providers prioritize AIDS prevention activities, there is a dearth of information to help them understand what conditions trigger increased risk of infection or how communities and aid providers can best address those conditions.

The research undertaken by Swasti is aimed at discovering ways in which the tsunami and its aftermath affected the risk of contracting HIV. Its purpose was not to measure how many tsunami-affected people are now HIV positive. Instead, the study aimed to identify changes in behavior that occurred after the tsunami that placed community members at greater (or lesser) risk—changes that may have been triggered by trauma and and losses, disrupted communities, and by the aid effort itself.