HIV / AIDS Intervention of SEVAI
SEVAI has been working in the field of HIV/AIDS intervention for the past 10 years. Currently it implements four projects with the support of APAC in Trichirapallai, Nagapatianm and Karikal and its neighborhoods:- TI Project in Trichy city covering core group population of 1500 persons.
- Link Workers program for the entire Trichy District in 120 villages in 14 Blocks.
- Resource and Training centre for 11 districts..
- Livelihood and rehabilitation of PLHIVs involved in unsafe sex activities.
- SEVAI also implements awareness building for SHG members of Trichirapalli District covering around 100000 women SHG members both rural and urban areas.
The Indian State of Tamil Nadu and the Union Territory of Pondicherry are “hot spots” (Hot spot is a place where the FSW/ MSM solicit clients (pick up point) or involve in encounter (encounter spot) or congregate with in a geographical area. If the target people have a frequent mobility within few (places) hotspots will have be considered as a single hot spot only so that duplication will be avoided. Hence the hotspots will be bigger ones. Or in general terms a hotspot is a broad area where one can walk & reach other places within the areas in a maximum of 20 mins. Hot Spot analysis is a process that follows the broad Mapping. This analysis is to find the dynamics of the hot spot analysis towards the saturation of coverage and efficient out reach. From this analysis the outreach team could find out how to reach more target community that frequents that particular Geographical Area, and to plan the reach towards saturation) for HIV/AIDS in India, which has 2.47 million HIV infected persons, the third highest number in any country, as per the sources of APAC, Chennai.SEVAI – with the support of Voluntary Health Services – helps most-at-risk vulnerable populations (sex workers, men having sex with men,), to provide primary, secondary and tertiary care to People Living with HIV/AIDS (PLHAs). SEVAI has brought substantial changes into the lives of many individuals.
HIV and AIDS affect all segments of India’s population, from children to adults, businessmen to homeless people, female sex workers to housewives, and gay men to heterosexuals. There is no single ‘group’ affected by HIV. However, HIV prevalence among certain groups (sex workers, injecting drug users, truck drivers, migrant workers, men who have sex with men) remains high and is currently around 6 to 8 times that of the general population.
SEVAI Educates target populations on the disease, removing myths and stigmas about HIV/AIDS; ‘HIV, or the human immunodeficiency virus, attacks a person’s immune system and weakens it in such a way that it loses its ability to fight infections and cancers
Being HIV infected is not the same as having AIDS. AIDS is the advanced stage of HIV infection when the number of immune cells called CD4 cells drops
to a very low level and the person begins to develop certain infections and cancers. HIV infected people can live for several years before developing AIDS. Though HIV and AIDS cannot be cured, but treatment can help HIV infected people lead a healthier and longer life.’
- Supports HIV counseling and testing that lets people know their status;
- Strengthens mechanisms that improve prevention and care interventions;
- Trains health providers in STI/ HIV/AIDS treatment and care; Builds the capacity of Self Help Groups commitment to HIV/AIDS.
- SEVAI believes strongly in involving the whole community in the implementation of targeted intervention programmes.
- People’s commitment, it says, is necessary to convert its efforts into a people’s movement.
- SEVAI involves local voluntary peer educators who represent various areas; volunteers who are part of cultural teams that organise street plays and programmes in the intervention areas; and community-based organisations such as self-help groups, youth associations.
- SEVAI involves private doctors to provide quality treatment and care for sexually transmitted diseases, ensuring their support on a permanent basis so that they provide non-stigmatized treatment to those in need.
- SEVAI considers peer educators central to reaching out to the people. The reason: “Peer education is an important way of imparting non-professional education at a small cost in short periods by which culturally sensitive messages are delivered successfully for the benefit of specific groups.”
- Peer educators disseminate basic facts on STDs/HIV/AIDS, and provide care and support to those infected; educate high-risk groups on safe sex practices, condom use, and condom negotiation with sexual partners; help in the free distribution of condoms to specific groups on the basis of their need and popularise social marketing of condoms; identify those afflicted with STDs and motivate them to take early and complete treatment along with their partners; identify cases of repeated STD infections and /or treatment failure and refer them to appropriate health centres; and participate in SEVAI activities such as preparation of IEC (Information Education Communication) materials, monitoring, training, and so on.
Peer educators play a crucial role in linking
The condom outlets and service providers; generating demand for counselling and voluntary testing; disseminating information to bring about behavioural changes; and identifying HIV-positive persons and helping them get medical intervention and support services. It is thought that HIV has spread among the general population in India because the epidemic has followed what is known as the ‘type 4’ pattern. This is where new infections occur first among the most vulnerable populations (such as injecting drug users and female sex workers), then spread to ‘bridge’ populations (clients of sex workers and sexual partners of drug users) and then finally enter the general population.“The overwhelming majority of infections in India occur through heterosexual sex. overwhelming majority of infections in India occur through heterosexual sex; women now account for
COMMUNITY Health Educator:
In many cases married men have acted as ‘bridge populations’ between vulnerable populations and general populations; women who believe they are in monogamous relationships are becoming infected because their husbands have had multiple sexual partners. Often social norms restrict women from making decisions about their sexual relations, contributing to their vulnerability to HIV.
Studies have shown that intimate sexual partner violence is also a risk factor for women. Another significant trend is that most of the people becoming infected are in the sexually active and economically productive 15 to 44 age group. This means that most people living with HIV are in the prime of their working lives. Many are supporting families. The stated aim of the third phase of India’s National AIDS Control Programme (NACP III) is to halt and reverse the spread of the HIV epidemic in India by 2012NACO aims to achieve this with targeted interventions that focus on high risk groups and ‘bridging populations’. The high risk groups identified are female sex workers, men who have sex with men, and injecting drug users. The bridging populations, those who are the most likely to spread HIV into the wider population, are migrant workers and truck drivers.
SEVAI Target intervention project in Trichirapalli
The main goals of TI is “To promote sustainable network models for STI/HIV/AIDS Prevention programme coordinating with Care & Treatment to enhance the Tiruchirapalli District’s response to halt and reverse the STI/HIV/AIDS epidemic focusing core groups ”
The basic purpose of the Targeted Intervention of SEVAI HIV/AIDS program is to reduce the rate of transmission among the most vulnerable and marginalized populations in Trichirapalli City of Tamilnadu, India with support of APAC/TANSAC. One of the ways of controlling the disease from further spread is to carry out direct intervention program among these groups through multi-pronged strategies, beginning from behavior change communications, counseling, providing health care support, treatment for STDs and creating an enabling environment that will facilitate behavior change. It envisages a comprehensive and integrated approach to marginalized and vulnerable populations such as sex workers, intravenous drug users. It has been commonly found that particular groups of people are more vulnerable than others to the HIV/AIDS epidemic. These groups, because of their behavioural attributes, are prone to contract the infection more quickly and spread the disease in a very short period.
Focused Objectives
- Prevention of STI/HIV/AIDS among core groups (FSW, MSM, and IDU) through network models in Tiruchirapalli District.
- Prevention STI/HIV/AIDS among core groups in Tiruchirapalli District in a composite manner with emphasis on ABC approach.
- Linkages between Prevention and Care programs to ensure continuum of care.
- Appropriate strategies for reaching the unreached and saturate coverage among core groups.
- Interventions to address the spread of the epidemic into rural areas.
- Involvement of CBOs, FBOs, Corporate sector and other private players.
- Extensive utilization of counseling and testing services for early identification of at-risk population and building linkages for the comprehensive care program.
- Leveraging resources through strategic partnerships with Government and Private sector.
- Systems for ensuring
- People living with HIV in India come from incredibly diverse cultures and backgrounds. The vast majority of infections occurs through heterosexual sex (80%), and is concentrated among high risk groups including sex workers, men who have sex with men, and injecting drug users as well as truck drivers and migrant workers.
i) Focusing FSW
- knowledge on HIV/AIDS/RTI among FSW
- A desired behaviour changes among FSWs, to adopt safe sexual options in their living style.
- Strengthen the FSW network, organizing support group meetings, to provide a right platform for FSWs, to learn from each other and lead a life with confidence.
- Peer educators among FSWs and providing training to enable them to act as a community agents to carry out interpersonal communication activities to communicate to their peers thereby saturating coverage.
- HIV counseling, testing, and referral, and partner counseling and referral, with strong linkages to medical care, treatment, and prevention services
- Counseling on HIV/STI related issues and psychological support
- Health seeking behavior for STI Management
- Information on different vocational trainings available and coordinating with other institutions for organizing training and arranging for employment.
- Quality services for sustainability.
ii) Focussing MSM
- awareness on HIV/AIDS/STI/Condom/VCTC among MSM
- capacity among MSM
- a Desired Behavior Change among MSM, to adopt safe sexual options in their living style.
- strengthen the MSM network, organizing support group meetings, to provide a right platform for MSM, to learn from each other and lead a life with confidence
- Counseling on HIV/STI related issues and psychological support
- Identify peer educators among MSM and providing training to enable them to act as community agents to carry out interpersonal communication activities to communicate to their peers thereby saturating coverage.
- Health education and risk reduction activities
- health seeking behaviour for STI Management
- Accessible diagnosis and treatment of other STIs
- HIV counseling, testing, and referral, and partner counseling and referral, with strong linkages to medical care, treatment, and prevention services
- Information on different vocational trainings available and coordinating with other institutions for organizing training and arranging for employment.
- Quality and Training services for sustainability.
Focussing IDU
- intensive awareness education on Treatment for STI/HIV/AIDS and injection related complications among IDU
- capacity-building activities towards safe behaviour change
- Behavior Change dialogue
- Counseling on HIV/STI related issues, psycho-social support and testing.
- Peer educators for saturation of coverage
- Health education and risk reduction activities
- HIV counseling, testing, and referral, with strong linkages to medical care, treatment, and prevention services
- Training and quality assurance
iv) Focused Community Based activities
- To Eliminate Stigma discrimination associated with HIV/AIDS
- To create an enabling environment for the core groups.
- To address myths and misconceptions in-depth to provide a better clarity both among core groups and the community.
D.STRATEGIES:
D(i) Interpersonal Communication
Innovative and effective methods is used for bringing about a behaviour change through Interpersonal communication activities such as One to One, One to Group, Counseling which is carried out both by project team members and peer educators.
It is provided much emphasis on interpersonal communication activities because of the following reasons:
- It is a two way communication
- Ideal for discussing sex and sexuality related issues
- Opportunity for addressing myths and misconceptions
- Desired method for bringing about a behavior change
- Providing need based information, including OI management, ARV Drugs, etc., privacy and to create an enabling environment
One to One
- One to one interaction is useful to communicate effectively with help of communication aids.
- Core group privacy and confidentiality is ensured through inter personal communication
- Each one to one interaction is supported with the relevant IEC materials
- If needed follow up one-to-one interactions is ensured
- Quality interaction is ensured with the one to one interactions
The outreach workers and peer educators reach the core group on a regular basis and initiate dialogue with them with the purpose of promoting hope for core group, to address myths and misconceptions, to provide information on opportunistic infections Management, and services available.
The outreach workers undertake the intervention with the primary target population on a regular and daily basis with specific targets to be reached every day.
One to Group :
- A homogenous group is selected and communication activities are initiated in one to Group interaction.
- As a follow up of the one to group interaction if needed the individuals is provided with one to one communication / referred for counseling. This ensures providing need based information and brings about a behaviour change in an individual.
- Core Group in the respective areas with effective communication skills is identified in these kinds of group meetings to develop them as peer educators.
- The group meetings also help in identifying their problems and look for collective solutions.
- The demonstration of “Nutritious food”, prevention for opportunistic infections management is taken up in the one to group interactions
- Necessary communications Aids, charts, flips booklets, etc., is used to provide right information and to communicate effectively.
- One to Group communication is useful to counter common myths and misconceptions, to provide comprehensive care messages, to provide common input, etc.,
Counselling
- Counseling services is provided by trained counselors
- Counsellors provide effective counseling to core group which will include Pre-counselling and Follow-up counseling at regular intervals
- Each core group members identified is counseled.
- To support core group, APAC IEC material is provided to enable the core group‘s to read and understand and follow in day to day life
- Counselors provide family counseling in the core group family members, if requested by core group.
- Counselling provided to core group members in a privacy situation in the Drop-in Centres or any other place convenient to core groups
- Counsellors provide counseling to the following groups based on the need in addition to provide counseling for core groups on a regular basis.
D(ii) Behaviour Change Communication (BCC) Events
‘AIDS (acquired immunodeficiency syndrome) is a disease caused by a virus called HIV (human immunodeficiency virus). Anyone of any age, race, sex or sexual orientation can be infected with HIV. Sex and drugs/alcohol interact in many ways to increase a person’s risk of getting or giving HIV’Acquired Immuno Deficiency Syndrome or AIDS is a condition that is caused by the Human Immuno Deficiency Virus or HIV which leads to serious destruction and loss of a person’s ability to fight with a infection. In few years slowly a person’s immune system will be unable to fight against infections and various infective agents will conquer over the immune system easily and a person will face a numerous complications due to that.’ HIV infection finally leads to the development of the AIDS.
After the HIV infection it takes some years for the AIDS to set in. Once a patient starts getting opportunistic infections then the stage is termed as Acquired Immune Deficiency Syndrome (AIDS).
BCC events will be organized for the following purposes:
- To eliminate Stigma and Discrimination
- To provide psycho social support for core group
- To provide basic information
- To address general myths and misconceptions
- To create an enabling environment
- To motivate them to avail specific services available for core groups
- To create a demand for availing services from NGO
- BCC events are more useful to create a demand among the core groups to avail services from the NGOs and from other organizations
For organizing BCC events support of the CBOs, PRI members and educational institutions are mobilized to ensure community participation in the implementation of the programme and to mobilize their support for promoting prevention services to core groups.
BCC events such as Street Play Performances, Exhibition, Audio Session, Video Session, Display of Materials, are conducted on a periodical basis in all the interaction area as per the need and desire. As an outcome of the BCC events based on the need of interpersonal community activities are conducted to provide individual based, need based informations.
D(iii) Peer Education
- The Volunteer Peer Educators are identified, selected and recruited from the core groups.
- Ä Identified Peer Educators are trained in related topics to communicate effectively and to support for the effective implementation of the composite prevention programme towards saturation of coverage.
The peer educators involved in this programme are grouped with the idea of networking to pave way for sustainability.
The sufficient number of peer educators is enrolled to cater to the entire target area proposed under this prevention programme
- To collect information about their activities
- To ensure coordination among project team and peer educators team
- To plan for the proposed programmes
- To provide additional inputs
- To share experiences
Weekly and Monthly review meetings are conducted for the following reasons:
D(iv) Drop-in Centre & Support Group Meetings for CORE GROUP
- This also act as a permanent communication point for all the core group to meet at periodical intervals In addition to the Drop in Centres, SEVAI office acts as a place for better communication and a place for inter personal communication activities.
- Counsellors shall visit the Drop-in Centre on a specific day as per the evolved plan of action to ensure quality services with core group and to ensure to avail services.
- District Chief having community lunch with PLHIVs as a process of stigma elimination.
D(v) Promoting Health Seeking Behaviour
ß Health seeking behaviour is encouraged amongst the core groups since it is the best, appropriate, ideal one. In case, if a FSW, MSM, IDU needs treatment for Opportunistic Infections he/she is linked with care and treatment programme servers through Drop-in-centre.
District collector/PLHIVs in a community Lunch
Referral ServicesCORE GROUP identified, provided with interpersonal communication, in addition, based on their need referral to the appropriate centres / institutions shall also be promoted. The referral services that shall be adopted is depicted in the chart below:
D(vi) Condom Promotion among Core groupCore group members are promoted with correct information on sexual behaviour. To encourage safe sexual practices and to ensure the prevention of transmission, they shall be motivated to use condoms.
As per need condom demonstration, condom negotiation skills is provided to core groups Supplies of condoms are ensured by establishing Non-traditional outlets based on the guidelines by APAC.
D(vii) Training for Multipurpose Health Workers
Provided appropriate training on Prevention programme for the following categories of Multi Purpose Health / Community workers:
The health care needs of core group could only be met by strengthening the health care system at each level in coordination with care and treatment services provided. Changing the attitude of professionals responsible for the management of STI/HIV/AIDS persons is a widely acknowledged goal. The training is provided by APAC to support this programme.
D(viii) Advocacy
Advocacy undertaken on a consistent manner to mobilize the support of policy makers, service providers, law enforcement authorities, development departments, etc., Advocacy shall assist in mobilizing the support of many individuals and organizations to provide care and support for CORE GROUP, to eliminate stigma discrimination. For these purpose SEVAI formed Project Level Advisory Committee. Once in Six months Advisory Committee meetings are conducted.
D(ix) Mobilisation of Press & Media Support
To eliminate stigma and discrimination to create an enabling environment for core group, press and media play a highly dominant role. Hence press and media including local cable TV support are mobilized on periodical basis. Interviews with the positive persons, its network are also being arranged. In addition information on services available for core groups also included.
D(x) Coordination
SEVAI plays a vital role to ensure needed services for core group , to create an enabling environment, it coordinates with the other NGO’s involved in STD/HIV/AIDS prevention, Development Departments, Health Care Systems, Positive Networks, etc.,
Enough care is taken to ensure coordination at all levels keeping in view of providing prevention, care and support for core group. The Project team members maintain a good rapport with the officials and Organisations to mobilize their support.
Workdone in Trichy city:
|
S.No. |
Particulars |
Reach |
|
1 |
FSW |
1430 |
|
2 |
MSM |
79 |
|
3 |
TG |
14 |
|
4 |
FSW regular contact |
1469 |
|
5 |
MSM regular contact |
107 |
|
6 |
TG regular contact |
35 |
|
7 |
FSWs reached with complete intervention packages |
1300 |
|
8 |
MSMs reached with complete intervention packages |
79 |
|
9 |
TGs reached with complete intervention packages |
14 |
|
10 |
No. of individuals who have been identified for STI, tested for HIV |
1611 |
|
11 |
No. of individuals referred to Nakshatra clinics (FSW) |
1469 |
|
12 |
No. of individuals referred to Nakshatra clinics (MSM) |
107 |
|
13 |
No. of individuals referred to Nakshatra clinics (FSW) |
35 |
|
14 |
No. of individual provided any counseling services (FSW) |
1469 |
|
15 |
No. of individual provided any counseling services (MSM) |
107 |
|
16 |
No. of individual provided any counseling services (TG) |
35 |
|
17 |
ICTC tested (FSWs) |
1469 |
|
18 |
ICTC tested (MSMs) |
107 |
|
19 |
ICTC tested (TGs) |
35 |
|
Major Activities undertaken by SEVAI
|
|
E. Baseline Survey and Mapping E1. Inter Personal Relationship E2. Behaviour Change Communication (BCC) Events E3. Peer Education E4. Distribution of IEC Materials E5. Drop in Centre and Support Group Meetings for CORE GROUP E6. Promoting Health Seeking Behaviour and Home Care E7. Condom Promotion among Core group (if needed) E8. World AIDS Day E9. Training for Mutl Purpose Health Workers E10. Advocacy E11. Press, Media Mobilisation E12. Coordination E13. Income Generation Activities E14. Enrolling core groups in SHGs E15. Training Activities E16. Referral for STI/HIV/AIDS Treatment E17. Demonstration E18. Life Skills Education for CORE GROUPs E19. Best Practices to Share with Others E20. Networking
|
E. Baseline Survey and Mapping
While initiating the project, it is undertaken a mapping exercise which carried out for identifying and estimating core groups viz., FSW, MSM, IDU in the targeted blocks for saturating the coverage of the composite prevention programme.
STI/HIV/AIDS Link Workers’ Scheme.
LINK WORKER SCHEME- Over the years virus has moved from the urban to rural areas
- From High risk to general population
- Disproportionately affecting women and the youth
- 38% of total infections are among women
- 37% of total infection are among young persons <29 years
- Over 57% of the infected live in rural areas
Link Worker Scheme- LWS scheme makes an effort to build a community-centered model for rural areas. This will include an outreach strategy to address the HIV prevention, care and support and treatment requirements in Tiruchirapalli district. The specific objective of the scheme includes: Reach out to HRGs and vulnerable men and women in rural areas with information, knowledge, skills on STI/HIV prevention and risk reduction.
This entails:
- Increasing the availability and use of condoms among HRGs and other vulnerable men and women.
- Establishing referral and follow-up linkages for various services including treatment for STIs, testing and treatment for TB, ICTC/PPTCT services, HIV care and support services including ART.
- Actor appreciated the yeoman services rendered by LWS Team in SEVAI supported by APAC, Mrs. Percy Lal, District Resource Person of LWS was honoured by Mr. Rajesh.
- Creating an enabling environment for PLHA and their families, reducing stigma and discrimination against them through interactions with existing community structures/groups, e.g. Village Health Committees (VHC), Self Help Groups (SHG) and Panchayati Raj Institutes (PRI).
- The population groups that are at-risk and vulnerable to HIV infection as well as persons living with HIV/AIDS include
Noted Tamil writer, film actor Rajesh spoke among the Link workers shared that it is desired to go for tuberculosis test during medical camp as Tuberculosis, or TB, is a bacterial infection that most often affects the lungs but can affect several other organs. Chronic cough with sputum is the most common symptom of tuberculosis affecting the lungs (pulmonary tuberculosis). Not all people infected by the tuberculosis bacteria develop TB. In a large number of cases the bacteria lies silent causing no symptoms at all. But such latent infection can become active when immunity is lowered. TB was at one point of time though t o be a disease of the past, but the problem has recently resurfaced in an even more serious form called multi-drug Resistant TB.
OUTCOMES OF THE LINK WORKER SCHEME
A cadre of trained local people- the Link Workers and Volunteers, Increase in knowledge on HIV transmission, risk behaviours, HIV prevention and available health services among HRGs and vulnerable young people and women,Increase in knowledge on HIV transmission, risk behaviours, HIV prevention and available health services among community members. Increased use of condoms by HRGs, their partners and clients. Increased utilization of STD management , ICTC, PPTCT and ART services by HRGs, their partners and clients
RATIONALE FOR LINK WORKERS SCHEME IN TIRUCHIRAPALLI DISTRICT
Large no of High risk groups in rural areas, Village based vulnerable youth, men and women .Large no of Bridge population (Migrants and truckers), Challenges in reaching prevention services in rural areas, Emphasize its more on local level (district to village coverage) and Convergence. Reduce stigma and discrimination against PLHA and their families.
SEVAI has rolled out Link Workers Scheme in Trichy district of Tamilnadu with the support of APAC/TANSAC. The scheme proposed by the National AIDS Control Programme (NACP- III) is specifically designed to reach out to the high risk and bridge populations in selected villages. The objective of the program is to create an enabling environment for PLHIV (People Living with HIV) and their families by reducing stigma and discrimination, establish inter-linkages between gender, sexuality and HIV, bringing into focus the vulnerability of youth and women in high risk communities and general populations.
Link Workers’ Scheme, the program targeted.
The ‘link worker’ is a concept by which ranks of middle-level health care workers are trained to become the second important line of defence against HIV/AIDS. They are believed to be especially important in rural India to reach out to high-risk groups and vulnerable population with information, knowledge, skills on STI/HIV prevention and risk-reduction. The link worker forms a credible bridge between the patient and the doctor, and the patient and society, and helps build a community-centred HIV care model. TANSACS is creating a strong cadre of such link workers across the state. This scheme aims to increase demand generation, service utilization by strengthening referral linkages and community mobilization to address issues of stigma and discrimination among core group and people living with HIV/AIDS (PLHA) in the rural areas.
The activities in the Link Workers Scheme
The link workers help establish referral and follow-up linkages for various services, including treatment for STIs, testing and treatment for TB, ICTC/PPTCT services, HIV care and support services including ART.
They help create an enabling environment for people living with HIV/AIDS and their families, reduce stigma and discrimination against PLHAs through interactions with existing community structures/ groups, like Village Health Committees (VHC) Self Help Groups (SHG) and Panchayati Raj Institutions (PRI).
They help promote and dispense condom use among high-risk groups.
The high risk groups identified through these link workers scheme is for promoting behavior change and for linking with other services.
Mapping of the district done for the identification and selection of villages. Based on this, link workers are selected and the implementation of the programme in the selected villages is carried out.
SEVAI’s achievements.
The Link Worker programme is being implemented in three phases
Phase I – Preparing community and local systems in select rural/ urban areas
Phase II – Strengthening community structures and responses
Phase III – Handing over integration into health system and exit.
Focused on
Capacity building of the LWs
Mid-media campaign
Creation of condom depot and one Information Centre
Addition of other components – like TB/HIV treatment convergence, other health and social issues
Strengthen Monitoring & Evaluation
LINK WORKER SCHEME
- Over the years virus has moved from the urban to rural areas
- From High risk to general population
- Disproportionately affecting women and the youth
- 38% of total infections are among women
- 37% of total infection are among young persons <29 years
- Over 57% of the infected live in rural areas
This entails:
Increasing the availability and use of condoms among HRGs and other vulnerable men and women.
· FORMATION OF VILLAGE HEALTH COMMITTEES
· APAC initiated the process of establishing village health committees to address the health related issues especially the STI/HIV/AIDS problems in villages. Village health functionaries, PRA members and other key stake holders in the villages were organized and formed village health committees. So far we have established 100VHCs.
· IDENTIFICATION OF VOLUNTEERS
Volunteers are the key persons in the village who can easily communicate the information to more number of people at a time. The individual who is an active person, who has influence in the village and should have service mind is taken as volunteers. So far we have identified 1235 volunteers.
Progress status:|
Category |
SNA Data |
Reachtill August 10 |
Percentage for SNA Data |
|
FSW |
1743 |
1698 |
97% |
|
MSM |
112 |
120 |
100% |
|
IDU |
21 |
21 |
100% |
|
Vulnerable Man |
4140 |
4055 |
97% |
|
Vulnerable Women |
2880 |
3195 |
100% |
|
PLHIV Male |
472 |
465 |
99% |
|
PLHIV Female |
320 |
389 |
100% |
|
OVC |
0 |
15 |
Additional Work |
|
Condom depots established |
100 |
130 |
100% |
|
Uptake of condoms through comdom depots |
0 |
24718 |
|
|
Uptake of condom through free distribution |
0 |
16179 |
|
|
Identification of volunteers |
1000 |
1481 |
100% |
|
ICTC (Total) Referrals |
2106 |
5006 |
100% |
|
ICTC Total Tested |
2106 |
2683 |
100% |
|
ICTC HRG |
563 |
1841 |
100% |
|
ICTC HRG Tested treated |
563 |
1142 |
100% |
|
STI Total Referral |
2106 |
4135 |
100% |
|
STI tested treated |
2106 |
3040 |
100% |
|
STI HRG |
563 |
1508 |
100% |
|
STI HRG Tested treated |
563 |
1223 |
100% |
|
TB Referral |
0 |
58 |
|
|
TB Tested treated |
0 |
43 |
|
|
TI NGO/CBO(only for HRG Population) |
0 |
7 |
|
|
PLHA network |
0 |
58 |
|
|
No identified positive |
0 |
22 |
|
|
ART referral |
0 |
39 |
|
|
Advocacy meeting with district level stakholders |
20 |
20 |
100% |
|
Meeting with other Village functionaries. (Panchayat / NYK etc) |
0 |
89 |
|
|
Community events and meetings organized with SHG/Youth clubs |
0 |
744 |
|
|
No of information centres establised |
100 |
107 |
100% |
|
No of red ribbon clubs formed and operationalized |
50 |
100 |
100% |
|
Village Health committee |
100 |
100 |
100% |
Noted Tamil writer and Tamil Film artist, Rajesh appreciates the yeoman service of Link Workers team of SEVAI/APAC.
3.Resource and Training Centre ProjectSEVAI Resource and Training centre in Traditional Media for Trichy Region covering 11 districts, is functioning successfully in partnership with APAC – VHS – USAID, Chennai. The Crux objective of this resource and Training centre is to build capacities of agencies /institutions to plan and implement targeted intervention to sensitize the target population in STD / HIV / AIDS prevention, Care and support through traditional media resulting in behavior modification among the target population.
Name of the programme:Training Programme for District Level Model Cultural Teams on STI/ HIV/ AIDS/ Risk Perception and Demand Generation for Existing Services Justification for the programme:
The justification / need for a training programme could be expressed in terms of components such as information, knowledge, skills & competencies, Attitudes and Values.
Information:
As the APAC partner new NGOs from SEVAI R& T centre target region has not received TOT training programme on STI / HIV / AIDS care and support services, there arises a need to organize this TOT programme on Traditional media for seven days.
Knowledge:
Development of Knowledge of each TOT is highly needed so that each trainer.
- Becomes familiar with a range of concepts associated with STD / HIV / AIDS prevention, care and support in Traditional media.
- Acquires the capabilities to critically analyse the Traditional media performances presented during the training programme in the context of his / her work in the future.
- Develops the ability to establish a function linkage between knowledge and action in the field, in pursuance of the discharge of his / her responsibilities / roles; and
- Evolves a base a frame of reference for further development of his / her knowledge in STD / HIV/ AIDS Prevention, care and support in traditional media.
Knowledge by itself is of no use or value, if it remains static or “sits” in the mind of a person. It acquires meaning and assumes an active form when it.
- Becomes the basis of interaction with others:
- Assists in developing responses to various life situations
- Is applied in planning action
- Is transmitted to others and contributes to
- their growth and development toward creating a healthy community
Skills and competencies:
In this TOT training programme their arises a significant need to develop skills of the trainers in performances, voicing, organizing and managing a cultural team. Hence there arises a need to develop skills and competencies through exercise, practice field testing of performance, getting feedback for improvement and developing confidence in their skills and competencies. Along with a repertoire of knowledge and competencies, the participants bring with them a package of personal preferences, attitudes and values. Therefore, SEVAI R&T centre has planned meticulously to make a participant aware of his / her attitudes and values and indicate how these are helping or impeding the performance of their job as a TOT. the programme has included new and more values and attitudes in each participant with a view to engender appropriate behavioral changes. The training has involved In identifying desirable attitudes and values that has contributed to the improvement of work climate and the participants, relationships with team members, coordinators and superiors. This has lead to personal growth. Consequently, a component on personal development in this TOT programme has been immensely helpful in promoting healthily relations within the group, thus facilitating learning.
Outcome of a Programme:
District Collector,Trichy honors’ J.Amala for R&T works of APAC/SEVAI on 15th August 2010- The ToTs under a learner – Friendly Enviroment during these seven days of the training programme has come out with adequate information, Knowledge, skills and competencies, appropriate change in attitudes and values in adopting Traditional media techniques for sensitizing the community in STD /HIV / AIDS prevention, care and support.
- The TOTs acquired proficiency in cultural team formation. Leading the cultural team, develop scripts and songs, community mobilization techniques, establishing rapport, performing skills, feedback and post evaluation study and documentation.
- The TOTs have been strengthening with training competencies as trainers.
- The TOTs are able to analyze themselves and has developed appropriate attitudes and values to function as trainers.
- The TOTs has become skilled with enhanced information, knowledge, skills and competencies in adopting innovative methods.
- The TOTs have imparted with training methodologies and developed with skills in designing, conducting and evaluating street theatre and folk media training and performances.
District Collector motivates the Link workers to reach the unreached in rural areas.
- The TOTs possesses sufficient skill in identifying and selecting street theatre group members and in providing them intensive training to form street theatre group in their area. · Identification of the training needs of NGOs, and the provision of this training,· Organization of advocacy networksM, Initiation of the convergence and integration of services for better delivery of services from NGOs and the government ,· Resource mobilization, where Northern Indian NGOs were motivated to link with other organizations for funding purposes,· Region-by-region assessment of the general vulnerability to drug abuse and HIV/AIDS,·
- Promotion of websites in all of its training programs,· Capacity building (in IT, counseling, documentation, etc.),· Exposure visits ,M· Preparation of training and education materials (like flip charts, resource books, exhibition panels) and translation of this material into regional languages,· Assessment of training needs among NGOs working,· The development of a management and accounting module, Monitoring the trends of drug abuse and HIV ,· Creation of behaviour communications change materials, exhibition panels, flip charts, guide book on peer education and communication, Resource books on harm reduction for HIV/AIDS prevention among IDUs and HIV/AIDS & preventive options etc.
- Exposures visits to various best-practiced projects in the region.· Initiation of the convergence and integration of services for better delivery of services from NGOs and the government
Education to Self Help Groups:
Self Help groups in SEVAI have been imparted HIV/AIDS Awareness and support to the PHHIVS. 2800 women were provided with HIV/AIDS awareness with active participation in the programs women’s self help groups in the community and women’s fellowship groups in Churches. To further enhance grass root level competence local NGOs were given practical refresher training at our centers and the initial program organized by them after the refresher training was monitored by our team in order to help them improve their post training performance.
Since the number of people requiring awareness and other HIV/AIDS related services is very large it is absolutely essential to train adequate numbers of competent trainers who in turn help train others to provide the required services. With this end in view 30 paramedical personnel were trained during a 3 day communication workshop to conduct awareness programs in their respective localities and among peer groups.
- Positive HIV subjects, their partners, other relatives and caregivers necessitate of a psychosocial support, to cope with death anxiety, stress related reaction, to reduce risk of transmission.
- Moreover the switch of infection from high risk groups (drug addicts, homosexual men) to heterosexual population defines a new group of seropositive people, detached from long standing support networks
- Project: A program of psychosocial intervention for HIV positive individuals with these objectives: 1) Involvement of partners, friends and families in the management of illness 2) positive co-habitation of “seropositivity status”
- Awareness and self-determination toward HIV related problems
- Individuation of opinion leaders
- Self-management, expressing better responsibility toward their own and others health (periodical visits, compliance to therapies, changes AIDS-related risk behavior).
- Self-help groups (using verbal and non-verbal communication like massages and autogenic training) methodology was utilized, with supervision of a trained psychologist and with fortnightly meetings and sometime medical seminars.
- The results are so synthesized.
- Creation of a support network, encouraging outside contact between subjects participants and mutual help in situation of crisis or distress.
- make responsible the persons involved in the program about the spread of the infection (responsable sexuality, safe sex)
- change (improvement) of self-esteem. Lessons Learned: Psychosocial support has been well accepted by HIV positive individuals and their HIV negative caregivers involved in the project. Self-help groups seem to define a good model.
- Reduction of anxiety, a responsible attitude and conservation of self-esteem could ameliorate quality of life, reduce risk behaviour and, perhaps, improve immune functions. SEVAI is using games to train people in rural communities to develop HIV/AIDS prevention and care plans of their own. Prevention activities are integrated into existing community health and development work to the end of caring for HIV-positive people within communities. SEVAI offers follow-up services to each person trained, wherever they are situated. This approach is designed to help them translate new learning into practice.
Communication Strategies
In its community- -based training sessions, SEVAI approaches HIV/AIDS as a developmental issue. This calls for spaced facilitation covering aspects of life skills development, HIV/AIDS prevention, life choices, assertive skills building, communication, self-esteem building, social and emotional development, and gender sensitization. The idea is to enable participants to gain not just knowledge but skills to protect themselves from HIV/AIDS.
Specifically, SEVAI’s training methodology is structured to enable participants to introspect, empathize, experience and apply concepts promoting integration of HIV/AIDS prevention, care, and support into their existing work.SEVAI uses a positive approach – games, puzzles, jokes, simulation, stories, role playing, dances, cultural music – to create a non-threatening training atmosphere. This strategy is designed to encourage participants to really participate in a process of experiential learning. More specifically, the training is characterized by activities that:
- promote positive behaviour through rational inputs and options
- acknowledge the existence of the problem
- stress personal responsibility
- offer different options for behavioral change and risk reduction
- address the needs of particular groups
- provide relevant information about various services and what to do under certain circumstances
- instill confidence about people with problems
- Dispel myths and misconceptions so as to offer an environment of support, acceptance, and empathy.
- In a training organized for SHGs by SEVAI that the proposition being debated was “Positive living is possible after HIV infection”. The purpose of the contest was to create avenues to strengthen an enabling environment that reduces stigma and discrimination and increases collaboration and
- SEVAI implements HIV prevention programmes with SHGs, both non-formal schools. The idea is to create a support structure in the schools to promote safe behaviors by clarifying students’ doubts anonymously. One strategy used in the school is the placement of a students’ question box to make the programme need-based.SEVAI team brings the questions to the office and prepares answers to difficult questions about the physical, spiritual, psychological, social, and emotional realities related to HIV/AIDS.
Rehabilitation FSWs – PLHIVs livelihood promotion.
The worst affected by the epidemic are women living with HIV particularly those who have lost their husbands to the disease. These are usually widows who live through an unending nightmare receiving blows after blows: victims of poverty, illiteracy, social evils such as dowry and a system of marriage where there is neither the power to make decisions nor the freedom to express their will even in terms of intimate physical relationship with their husbands. Most of the women are originally infected by their husbands after the death of their husbands they are not only rejected by the family of the husband but abandoned by even their own parents and siblings. They are forced to fend for themselves and their children who may also be infected. Most of them have no skills to get jobs. They have to take care of their children and also the cost of treatment. Added to all these women to give them an opportunity to regain hope and live with dignity enjoying for the first time in their lives the freedom to make decisions. Sustained counseling for motivation and empowerment combined with skills building programmes for income generation are the main activities of this rehabilitation centre.
