Saturday, January 21, 2012

HIV policies need a relook (The Deccan Chronicle)

HIV policies need a relook

Kochi, January 18, 2012, By Smitha
http://www.deccanchronicle.com/channels/cities/kochi/hiv-policies-need-relook-542

Schoolchildren perform a skit at St. Theresa’s School, Kochi, as part of the World AIDS Day. (File picture).

It’s nearly two decades since HIV prevention programmes and awareness campaigns on safe sex practices introduced in the State.

Though official statistics shows a considerable decrease in HIV prevalence, there is a general perception that the figures do not reflect the actual situation as there are many shortcomings in target intervention programmes and campaign strategies. While the National Aids Control Organisation (NACO), spearheading the AIDS prevention programmes in the country, is ready to enter the fourth phase National Aids Control programme (NACP), there is a strong demand to have a more effective and comprehensive approach, capable of addressing the new challenges, in target intervention strategies.

For HIV prevention, NACO conceives uniform policies, strategies and programmes for all States in the country. But, there should be decentralized prevention and target intervention programmes and each State should have region-specific flexible projects. “Programme conceived for a North East State like Manipur with high HIV prevalence may not be suitable for Kerala”, opines Babu Joseph, project director of Centre for Advanced Projects and Solutions (CAPS), Kochi, an NGO working in HIV prevention. Social activists and experts working in the sector are of the view that the projects conceived 20 years ago are incompetent to address the changed profiles of the new high risk groups like injecting-drug users (IDU).

Moreover, the street-based sex workers — once a major high risk group – have now upgraded their profile to phone call-based, hotel-based or escort group practices. However, the project capacity of most of the target intervention programmes is only to monitor the street-based sex workers. It is high time to redefine the strategy for identifying high risk groups and target intervention methods, feels Babu Joseph.

“The target intervention mechanism of agencies like Kerala State Aids Control Society (KSACS) has to be upgraded and new tools have to be introduced for addressing new challenges. KSACS and several other NGOs only have the competency to monitor the traditional high risk groups,” he said. Programmes need to be conceived to address the new challenges, the direction change and the changed scenario in the society. There should be mass media campaigns to promote safe sex practices among the youth and teenagers. Campaigns focusing on interpersonal communication will bring good results, he remarked.

The NACO has included commercial sex workers, men having sex with men (MSM), migrant labourers and injecting-drug users in the high risk group. Second high priority in the intervention programmes is accorded to long-distance truckers, prisoners, migrants (including refugees) and street children. However, profiles of the high risk groups have changed over the years which was unaddressed by the NGOs. Moreover, NACO has removed the migrant labourers from the high risk group and categorized them as ‘bridge population’, which according to experts is a wrong-step. “Migrant labourers from far away States like Bihar, Assam, Orissa and West Bengal flock to Kerala where there’s an acute labour shortage.

Their sexual behaviour and practices are unknown and language is another barrier for target intervention. It is necessary to include them in the high risk group,” according to social activists. The well educated, rich, high-market sexual workers are still an unaddressed category. “The high profile sex workers and their clients are equally vulnerable. But, the KSACS has no strategies for target intervention among them,” says Adv. Tito Thomas, director of Centre for Social Research and Development, Kozhikode.

However, according to Dennis Joseph, joint director of Kerala State Aids Control Society, HIV prevalence among high risk group and the general population was showing a considerable decline and the State remains in the safe ‘green zone’. The annual sentinel survey conducted every year shows a gradual decline in the number of affected persons. “As per the 2009 survey report, prevalence rate among commercial sex workers is 0.40 per cent which was 0.87 per cent in 2007. Prevalence rate among MSMs is 0.40 per cent and 5.3 per cent among IDUs. All these figures are far below the national average,” says Joseph. HIV density is high among IDUs compared to other high risk groups.

On the changed profiles and modes of operation of the high risk groups, he said that KSACS was well equipped to address new challenges. “There are more than 25, 000 marked commercial sex workers in the State of whom 19, 000 are in the contact list of KSACS. We have appointed some of them as peer educators who are assigned with coordination and awareness creation”, said Joseph. Regular medical checkup and HIV tests are mandatory for them, every three months. For the injecting-drug users, KSACS provide syringes and needles to check HIV prevalence.

“KSACS is well equipped to meet the changed scenario and we are constantly upgrading the strategies,” concluded Dennis Joseph.

http://www.deccanchronicle.com/channels/cities/kochi/hiv-policies-need-relook-542

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Tuesday, January 3, 2012

An instance of mis-reporting by the media

Note: The highlighted portion from the news report quoted below would have originated from page 12 of the Planning Commission of India Working Group Report on AIDS Control for the 12^th Five-year Plan. However, the report has not included Kerala among the high-prevalent states. What the report says is – “…the low prevalence states of Assam, Chandigarh, Orissa, Kerala, Jharkhand, Uttarakhand, Jammu & Kashmir, Arunachal Pradesh and Meghalaya show rising trends in adult HIV prevalence in the last four years”

‘HIV infection at high among homosexuals’

http://www.dailypioneer.com/nation/31925-hiv-infection-at-high-among-homosexuals.html

Homosexuality may not be leading to the same number of raised eyebrows as it used to till sometime back, but it has surely rung alarm bells. Homosexual men have high prevalence of Human Immunodeficiency Virus (HIV) infection — far higher than in female sex workers, the most vulnerable category. A Working Group, set up by Planning Commission to chalk out formulation of AIDS Control Programme in the 12th Plan, report says that HIV infection incidences in men having sex with men, transgenders and injecting drug users are occurring in greater number across the country (see table).

The Working Group, headed by Sayan Chatterjee, Secretary, Department of AIDS Control in Ministry of Health and Family Welfare, says that this would be a great challenge in National AIDS Control Programme (NACP) IV to be launched in the 12th Plan (2012-17). Besides this other challenges in the 12th Plan would be transmission through migrants and spouses. Migration is increasingly identified as an important factor driving the epidemic in several north Indian districts. Spousal transmission in the general population has also emerged as an important source of new infections in these states, warranting a special focus and approach to address the same during NACP-IV.

In addition, there is need to shift focus on low prevalence States now from high prevalence States. While the declining trend is evident in most States, some low prevalence States have shown an increase in the number of new infections over the past two years.

Thus there is need to focus more on these States with low prevalence, but high vulnerability. Of the 1.2 lakh estimated new infections in 2009, the six high prevalence States (Tamil Nadu, Manipur, Andhra Pradesh, Karnataka, Maharashtra and Kerala) account for only 39 per cent of the cases, while the States of Odisha, Bihar, West Bengal, Uttar Pradesh, Rajasthan, Madhya Pradesh and Gujarat account for 41 per cent of new infections.

The report says that NACP programme has contributed to a steady decline in overall prevalence of AIDS and there is nearly 50 per cent decrease in new infections over last 10 years. The recent HIV estimates highlight an overall reduction in adult HIV prevalence and HIV incidence (new infections) in India. The estimated number of new annual HIV infections has declined by more than 50 per cent over the past decade. It is estimated that India had approximately 1.2 lakh new HIV infections in 2009, as against 2.7 lakh in 2000.

The group has estimated a total budget of `12,824 crore for NACP IV. However, this quantum of budget would be difficult considering the global economic meltdown since most funding of NACP programme in India comes from Development Partners. During NACP III (2007-12) external resources were substantial and Domestic Budgetary Support to the Department of AIDS Control was less than 5 per cent of the Department’s budget.

“However, in light of the global economic recession external funding for HIV will shrink dramatically. Therefore, the next phase of the programme will primarily depend upon domestic resources. Therefore, one of the critical challenges is to move towards more effective and efficient approaches through convergence and integration of programme components such as basic HIV services, comprehensive care, support and treatment with National Rural Health Mission and general health systems to the extent possible,” says the report.

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Actor Turned Director at IFFK in Thiruvananthapuram (The Hindu)

Dreams of Nick Reding

Sangeetha Unnithan, 15 December 2011

http://www.thehindu.com/news/cities/Thiruvananthapuram/article2717458.ece

When English actor Nick Reding, got bored of life in Hollywood after two decades of acting career, he decided to do something different with his life. He did, and in the process touched the lives of thousands of people in far away Kenya.

'Dreams of Elibidi’, the sole film from Africa included in the Competition Section of 16 International Film Festival of Kerala (IFFK), is in many ways the result and reflection of the change that he brought about in his own life and in the lives of those he met in Kenya, the country that he now calls home.

The Swahili film, which is Mr Reding’s directorial debut, deals with poverty and HIV infection, two of the most pressing issues in the African country. Originally conceptualised as a play and performed all over Kenya, `Dreams of Elibidi’ is Mr Redings effort at combating the lack of awareness and superstition surrounding AIDS and HIV infection in the country.

"I first went to Kenya in 2001 as a volunteer to a Kenyan Indian doctor from New York who specialised in paediatric HIV and wanted to start a clinic in Mombasa. Volunteering for him thrust me into the frontline of the whole public health scenario of the country, which was actually a failure. I was shocked to find that 20 years into the epidemic the people of Kenya were still shockingly illiterate about AIDS. That is when I decided to make use of my profession to do something about it,’’ said Mr Reding speaking to The Hindu.

That led to the birth of Sponsored Arts For Education (SAFE), an organisation that works on spreading awareness on AIDS and HIV infection using theatre as a medium. Together with Kenyan theatre actor and co-director of the film Kamau Wa Ndung’u, Mr Reding gave shape to the play `Dreams of Elibidi’.

``I discovered Kamau from a play performance in a Nairobi slum. While associating with him I realised that there is so much talent in the slums. We then decided to conduct auditions for actors from the slum. The audition went on for days with over 150 people auditioning per day. Finally we zeroed down 17 actors, although the script originally needed only 12,’’ said Mr Reding who has acted in films like `Croupier’, `Boon’ and the television series `The Bill’.

The play portrays the story of a family’s struggle with poverty and HIV by combining humour, hope and reality. The idea was to capture people’s imagination and help them relate to the issues surrounding the epidemic.

"Apart from illiteracy, stigma and superstition are two major issues related to AIDS in Kenya. We basically wanted to break the silence and start a debate on the issue. At the same time we wanted to do it in a very professional manner. Only if we delivered quality performances could we convince the audience and deliver the message, which is most crucial for the whole project,’’ said the actor turned director adding that awareness classes and testimonials were also included after every performance.

The play, which has already been watched by more than two million people, drew tremendous response. It was the success of the play that led to the idea of a movie. With the favours and support from friends back home, `Dreams of Elibidi’ the film became a reality.

The film follows a unique narrative in which scenes from the play are juxtaposed with the film scenes. As a result the ghetto audience is also a character in the film which has had a successful release in Kenya.

"We also won awards in quite a few film festivals. But more than the success of the film it is the success of the whole SAFE project that is most overwhelming. Today people in Kenya are more open about HIV infection and the patient attendance in clinics have also increased. But the most inspiring are the stories that you hear from family members who were initially scared to tend to their HIV infected relatives,’’ Mr Reding said.

He added that SAFE is now working on projects to address the issues of female circumcision and peace building in the country.

http://www.thehindu.com/news/cities/Thiruvananthapuram/article2717458.ece