HIV/AIDS Work Across Borders | Epidemiology Of Hiv/Aids

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In India the HIV/AIDS epidemic is more than 15 years old. The national HIV prevalence rate has risen from 0.1 per cent in 1986, to 0.8 per cent in 2001 – an eight-fold increase in 15 years. Conservative estimates by the government say that perhaps as many as 4.5 million Indians are living with HIV/AIDS. In six states, more than one per cent of the population is HIV positive. Given India’s large population, each 0.1 per cent increase in the prevalence rate would increase the number of adults living with HIV/AIDS by over half a million people. As elsewhere in the world, it is poor and marginalized people, and especially women, who are most vulnerable. Oxfam’s work on HIV/AIDS is being implemented through local Indian NGOs partners. This leaflet explores lessons learnt from working with one partner in the State of Manipur.
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  1 HIV/AIDS WORK ACROSS BORDERS Introduction: In India the HIV/AIDS epidemic is more than 15 years old. The national HIVprevalence rate has risen from 0.1 per cent in 1986, to 0.8 per cent in 2001 – aneight-fold increase in 15 years. Conservative estimates by the government say thatperhaps as many as 4.5 million Indians are living with HIV/AIDS. In six states, morethan one per cent of the population is HIV positive. Given India’s large population,each 0.1 per cent increase in the prevalence rate would increase the number of adults living with HIV/AIDS by over half a million people. As elsewhere in the world, itis poor and marginalized people, and especially women, who are most vulnerable.Oxfam’s work on HIV/AIDS is being implemented through local Indian NGOspartners. This leaflet explores lessons learnt from working with one partner in theState of Manipur. Project background The State of Manipur has many characteristics that make it a more vulnerable areafor the spread of HIV/AIDS. It is on the fringes of the country and remains marginal,with little industry and high levels of poverty. This state is highly prone to conflict dueto the existence of different extremists and ethnic groups. It shares a long andporous border with Burma (Myanmar). Beside legal cross-border commerce, thearea is notorious for the smuggling of heroin and other goods. There is constantmigration to and fro between the two countries, insurgent activity, and consequentlya large military presence. Drug addiction is a serious problem and the commercialsex industry is prominent. Women, many of them refugees or those displaced to theborder from further inside Burma (Myanmar), have little power to negotiate safer sexwith partners or clients. The conditions are all present for the spread of HIV/AIDS. Programme The Centre for Social Development (CSD) is an Oxfam partner which has beenworking on development, drug addiction and HIV/AIDS in Manipur for over a decade.It has become apparent to CSD that there are at least three major areas of workwhich overlap and which need to be tackled at the same time:1. Cross-border co-operation: Work has to follow the flow of people and goods,especially drugs, to and from one country to another. It cannot stop at theborder.2. The participation of women in all aspects of programme planning andimplementation is crucial, however difficult that is.3. Divisions among communities in the State have been born out of poverty,marginalisation and conflict, so maintaining a collective voice for rights and justice is difficult.CSD works in the Indian border town of Moreh and initiated an NGO forum there tohelp NGOs working on HIV/AIDS to co-operate to greater effect. But CSD’s mainfocus has become cross-border work. It has formed links with church groups working  2in Tamu, the town on the Burma (Myanmar) side, through the Tamu Council of Churches.The result is that now church groups working on both sides of the border can offer similar assistance to vulnerable people. The beneficiaries of the programmes includeintravenous drug users, people living with HIV/AIDS and their families, widows of  AIDS sufferers, sex workers and their clients, migrant labourers and also youngpeople in general.The programmes promote condom use and ensure the availability of affordablecondoms, they tackle stigma and discrimination, prevent and treat sexually-transmitted diseases, and increase awareness among young people. They have alsointroduced safer injecting practices, whereby disposable needles and syringes aredistributed and used ones collected. They provide home-based care and support for people who are infected and their families.Finally, networking and advocating with local authorities are essential parts of theprogrammes, in order to ensure that government services are delivered moreeffectively, and that policies are changed. All the programmes include senior female staff. A traditional and influential form of women’s organisation exists in Manipur, called Meira peibi  , and the programmeworks with more than 50 of these groups. Several organisations specifically assistwidows through income-generating projects and vocational training. ImpactLessons learned The main impact has been a positive change in attitude by a wide range of importantactors - government officials, law-enforcement bodies, religious organizations,schools, and communities themselves. This has improved services, and greater acceptance is helping people living with HIV/AIDS to have a better quality of life, andto reduce risky behaviour practices. ã  The dialogue with Myanmar Church Council resulted in them initiatingactivities in Tamu area in collaboration with the existing church network calledthe Tamu Council of Churches (TCC). ã  Myanmar Council of Churches started began financial support to TCC inHIV/AIDS intervention programmes. The church body conducts programmeson HIV/AIDS in Church premises ã  Moreh, the border town of Manipur was a neglected area in terms of HIVintervention activities, now Manipur AIDS Control Society has startedintervention in the area. ã  Changes in health service attitude. For example, the Moreh Primary HealthCentre is now co-operating with the programme. It has become easier to refer patients to the centre. ã  A Single Women Forum is actively working among the members who arewidows of people living with HIV/AIDS.  3 ã  School awareness and prevention programmes – such as essay and paintingcompetitions – have become an entry point for HIV/AIDS prevention andbehavioural change communication amongst youths and school students. ã  The government North-east Council started to incorporate HIV/AIDS in thedevelopment programme of the North East region. ã  There is now more involvement of volunteers, peer-educators and CBOs, inthe outreach services. ã  We’ve seen the formation of locally-based people and organizations for sustainability of harm-reduction activity in the project area. ã  And co-operation from law-enforcement groups, including: Border SecurityForce, and Assam Rifles in the intervention programme. Programme challenges The potential scale of the HIV/AIDS epidemic in India and in Myanmar is so huge –and particularly in the danger areas like Manipur, that current responses, whileimproving, still seem singularly inadequate. In particular, the conflicts which plaguethe region need to be resolved, as they create a vicious circle of poverty andvulnerability, particularly for women and girls, which saps collective efforts to solveproblems. Conclusion There need to be greater efforts to enable stakeholders to come together; to developcapacity; to create, replicate and scale-up model interventions and strengthenresearch and documentation. The views of those infected and affected by HIV/AIDSneed to be brought strongly and directly to the attention of policy-makers. Conflictresolution and border security require greater efforts and joint initiatives by bothgovernments, with genuine respect for human rights.
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