U-landshjelp fra Folk til Folk, Norge

U-landshjelp fra Folk til Folk, Norge

HOPE - Delhi Annual Report - January to December, 2016 Introduction Prevention is the mainstay of the national strategy to control HIV/AIDS. In the interest of overall control of HIV epidemic, it is necessary to intervene as early as possible. This is done by initiating and supporting Targeted Interventions (TI), which could lessen the spread of infection within high-risk groups and thereby in the general population. HPPI initiated a Targeted Intervention (TI) project for the Female Sex Workers (FSW) of Patparganj area of East Delhi district by the name of Hope Delhi Project. Since 2008, the project aims to provide health and presumptive care services to FSWs with support of Delhi State AIDS Control Society (DSACS). The major objective of the project is to equip FSWs with the knowledge and skill to effectively address vulnerability to HIV/AIDS and thus making their lives healthier and safer. The project is working towards empowerment of FSWs so that they become fully capable and equipped to handle their health and social problems by themselves in the coming future. The project ensures that the FSWs have basic knowledge about HIV/AIDS and must be aware about how and where to seek support for issue relating to HIV/AIDS. It further promotes the reduction of social stigma and discrimination in the community towards HIV/AIDS and enhanced negation skills in the areas of intervention. The activities have been directed at connecting with more and more people, who could fall prey to and should be enlightened about the sensitive issue of HIV/AIDS. Main Activities of the Project People directly reached - To support and facilitate behavioural changes in the community members towards safe sex practices, the project reached out to 30,826 people, to increase their level of awareness related to the issues of intervention. The project staff conducted 130 couple sessions, 190 group sessions and 15,556 one to one sessions to empower the participants to articulate their issues and develop their own solutions or advocate for the needed solutions. The sessions covered topics such as introduction of HIV/AIDS, Sexually Transmitted Infections (STI) and its treatment, behaviour change communication, safe sex practices and proper use of condom. FSWs treated for STI with syndromic management - The project staff incessantly interacted with the FSWs through one to one sessions and group sessions to identify the issues related to sexual health. It has been found that Sexually Transmissible Infections (STI) was the common issue faced by FSWs. In the reporting period, 106 FSWs were facilitated with the treatment for STI in order to treat and prevent these issues from developing into an STD. They were assured for the necessary assistance and guidance by the doctor, so that they can further prevent themselves from developing STD. FSWs accessed clinical services - To enhance knowledge for prevention of STI/HIV/AIDS and encourage health seeking behaviour among FSWs, The project staff and peer educators mobilised the FSWs during field visits for accessing clinical services and HIV testing. They

were informed about the HIV testing facilities at the Integrated Counselling and Testing Centres (ICTC). The FSWs were encouraged to receive clinical services, in order to maintain their health and get treatment for STDs. In the reporting year, 3,508 FSWs received clinical services by Dr Sunita Gupta, M.D. from Russia, who had been associated with the project since February 2013. With continuous efforts of sensitising and encouraging the FSWs, they are now more proactive in seeking clinical assistance whenever required. FSWs given presumptive treatment - Presumptive treatment is a one-time treatment given to FSWs for a presumed STI infection. This treatment has proven to be effective in reducing a high burden of largely asymptomatic STIs. In this year, presumptive treatment was facilitated to 206 FSWs in the STI clinic. They were advised to get a follow-up after six months of the treatment to ascertain its effectiveness. The people mobilised for HIV testing - Mobilisation is an important platform to disseminate information on control and prevention of STI/STDs, HIV/AIDS. The outreach workers constantly reached out to the 20,620 community members and FSWs to enhance their knowledge base for prevention of STI/HIV/AIDS and to educate them on the availability of treatment options for STIs. The project staff mobilised 2,000 FSWs for HIV testing, out of which 1,560 FSWs underwent testing at ICTC. FSWs were encouraged to adopt safe behaviour for sexual interactions and to undergo HIV testing regularly. The community members were motivated to recognise their medical problems and seek timely assistance from certified doctors. In addition, the project counsellor conducted counselling sessions with the FSWs and community members, who needed guidance and had been directed to ICTC for HIV testing. The counselling sessions were required as despite awareness drives, people were not comfortable in discussing these issues on public forum or disclose such problems to their doctor either. Communication (IEC) Material distribution - IEC (Information, Education and Communication) materials act as a catalyst to promote and support positive behavioural changes towards safe sex practices, especially among the population with high risk behaviour. 8,853 IEC materials, including pamphlets, posters, handouts, etc., with the knowledge of HIV and condom, preventive methods, clinical services and treatments available were extensively distributed during the events and interactive sessions with the high risk groups. HOPE Activists With an involvement and support of local community members, the impact of the programme can be enhanced. HOPE activists play a role of those pillars on which the effectiveness of the project relies. They are the local members from the intervention area who are trained in various outreach techniques such as community mobilisation and communication skills. These activists create a conducive and comfortable environment to sensitise the general community members and act as peer educators for the FSWs to discuss about HIV/AIDS, STIs and related problems. During the reporting period, 224 such activists were engaged and trained by the project, who had assisted in project activities. Community Events - The project has organised a community event, which is a one-time activity on 23 rd March for sensitisation and mobilisation of community and institutional actors on Targeted Intervention (TI) Project, HIV/AIDS, its causes, symptoms and preventive measures. Nearly, 530 community members, along with local leaders, Government officials in the area, local NGOs, etc., participated in the event. The event was organised in Gazipur village, an area located on the Delhi-Uttar Pradesh border. During the event, the project tried to create a comfortable environment for the FSWs and HIV-positive people to share their

experiences. Furthermore, information pertaining to the causes, prevention, treatment, care and stigma and discrimination related to HIV/AIDS was also disseminated during the community event. Condom distribution - Clients of FSWs are undoubtedly a potential population for transmitting HIV and STIs from high-risk FSWs to the low-risk general population. Consistent condom use is the single most important tool for preventing HIV/AIDS. Therefore, to promote the habit of using the condom in a right way, condom demonstrations sessions, were conducted with the FSWs and high-risk people in the community. In these sessions, condom was promoted as a dual method for protection against both unintended pregnancies as well as sexually transmitted infections. Knowledge pertaining to availability of condoms in local health department and the use of female condoms in the absence of male condoms to ensure safe sex was provided. For better retention of the message, 215,000 condoms were distributed to FSWs and other community members. Drop in Centre (DIC) Level Meeting - The DIC meetings are organised twice a month to provide counselling, psychological support and information to the High-Risk Groups (HRG). The project conducted 24 DIC meetings with a participation of 955 individuals. Through the meetings, HRGs were oriented on causes and prevention of HIV/AIDS. In order to make the meetings more interactive and effective, the discussions were facilitated by screening of short videos on the concerned issues and experience sharing exercises by the HRGs. Networking meetings - HIV/AIDS is an epidemic, which needs to be controlled by handholding among government, non-government, local stakeholders and community leaders. The regular meetings and discussions to strategize the solutions for controlling the epidemic were organised in the reporting year. Through these networking and associations, an enabling environment for the both health officials as well as the target population was created so that information and health services were easily delivered and be more accessible. During the reporting period, 351 meetings were conducted with various government and local authorities. The meetings oriented FSWs about government welfare schemes that can be availed at Directly Observed Treatment, Short-Course (DOTS) and Antiretroviral Therapy (ART) centres and community care centres. The number of meetings with different authorities and local stakeholders is given below: Name of the authorities No. of meetings Integrated Counselling and Testing Centre (ICTC) 130 Facility Integrated ICTC 45 Community Care Centres 33 Local authorities/leaders 49 Government Hospitals 32 District Level officer 18 DOTS Centres 29 ART Centres 15 Total 351 Advocacy meeting - To increase the participation of stakeholders and community members, five advocacy meetings were organised in the months of February, March, September, October and December. A total of 120 participants, including key community stakeholders, decisionmakers and service providers, discussed on women s and citizen rights, along with strengthening the local support to create an enabling environment to prevent HIV and STIs.

Review meetings With an aim to effectively implement the project activities, regular planning and updating of the management system was conducted. In the reporting period, 52 weekly review meetings were conducted with project staff, 17-20 peer educators and the doctors. Through the meetings, project progress and modes of implementation were reviewed wherein the challenges faced in achieving the targets and mobilising the community were also discussed to figure out the solutions for the same. Impact of the Project The project has successfully achieved its set targets during the year 2016. Through different activities, the project could create an enabling environment for the FSWs and community members discuss about their sexual health and also seek assistance whenever required. The one to one and group sessions enabled the FSWs to become conscious about their overall health and follow preventive measures while establishing sexual relation with their partner/s. In the past 12 months, through the intervention and awareness activities, the behaviour of the FSWs and the community towards HIV/AIDS and STIs has changed. Also, through community awareness activities and involvement of HOPE activists, the project was able to increase the community s participation, leading to the desirable impact. The total number of FSWs accessing the clinical services is an evidence to the raised pro-activeness in their health seeking behaviour. The project also targeted youth group since they are vulnerable and at high risk of STDs/STIs. The overall impact proved that more people are being mobilised and participated in various intervention activities contributing in curbing the epidemic. For effective implementation and achievement of the objectives, the project developed a supportive rapport with the government officials, authorities and local stakeholders. The continuous effort to create an inclusive environment for the people affected with STIs/STDs and HIV to openly discuss about the issues and take curative actions for them. The project focussed on mobilising the target population to increase the use of condoms and indulge in safe sex practices. The network meetings and associations with government, non-government, local stakeholders and community leaders created an enabling environment for the health officials as well as the target population for access to and delivery of quality health services for the high risk people, especially the FSWs.

Attachment 1: The Project in Numbers - January to December, 2016 S. No Project Activities Plan Result Diff (+/-) 1. People directly reached 30,000 30,826 826 2. People mobilised for HIV testing 2,000 20,620 18,620 3. People counselled and tested 1,600 1,560-40* 4. People organised in positive living groups 4 4 0 5. People in positive living control actions 4 4 0 6. TRIOS for ARV adherence support 4 4 0 7. Hope Activists 200 224 24 8. Monthly meetings of activists 100 205 105 9. Youth in HOPE activities 10,000 10,208 208 10. People trained under HOPE Programme 200 232 32 11. Condoms distributed 250,000 215,000-35,000** 12. People in opinion forming activities 3,500 3,539 39 12.a People in meetings with hope 850 1,233 383 12.b People in one on one or couple counselling 150 200 50 12.c People informed 1,500 1,849 349 12.d People in events 500 530 30 13. FSWs contacted twice in a month 10,000 11,000 1,000 14. FSWs accessed clinical services 3,000 3,508 508 15. FSWs treated for STI with syndromic management 100 106 6 16. FSWs given Presumptive treatment 100 206 106 17. FSWs screened for syphilis 1,000 1,479 479 18. No. of Days Clinic Conducted 200 195-5*** 19. Meeting with ICTC, FICTC, STI Clinics, DOTS Centre, ART Centre, CCC, Govt. Hospital, District 200 351 151 level officer and Local Authorities/Leaders 20. IEC Material distributed 8,000 8,853 853 Comments: *The number of people tested for HIV could not be achieved due to lack of testing kits in ICTC (Integrated Counselling & Testing Centre). **There was a disruption in the supply of free of cost condoms from Delhi State AIDS Control Society (DSACS) and/or from the local partner as well. The condoms supply from DSACS has been disrupted in other projects as well. ***The clinic was not functional for 5 days since the doctor was unavailable.

Attachment 2: Case Story Translation The story is about a 17 years-old girl, Radha. She was young when her parents passed away, because of which she could not continue her schooling. This young girl was sexually exploited in her childhood. Since then, her life changed upside down, and she was approached by a pimp who took advantage of her being young and vulnerable, pushing her into sexual exploitation. With so many customers in a day, she slowly started feeling ill and was diagnosed with Sexually Transmitted Infection (STI). She came in contact with the HOPE Delhi staff during the survey who explained her about the project. Radha expressed her concerns and asked to provide her medicines. The project staff connected her to the counsellor and provided medicines from the STI clinic. After the intake of medicines, she started experiencing improved health. Today, Radha is aware of the consequences of HIV/AIDS, and other diseases caused due to sexual activities. She motivates as well creates awareness among sexual workers. She has discontinued working as a sex worker, now she has a job in a call centre where she earns around INR 12,000 (USD 240). She is extremely grateful to HPPI for making her life meaningful.

Attachment 3: Appreciation Letter shared by Om Pharmaceuticals (Delhi)

Attachment 4: Appreciation Letter shared by Gen. Secretary of a Community Welfare Committee Translation: I, Riyajuddin, General Secretary knew about Humana People to People India since more than last three years. This organisation has been working in Mandawali Fazalpur, East Delhi area for the betterment of the society through free of cost HIV testing of women, treatment of STDs/STIs, syphilis testing and condom distribution. Their work is appreciable, and I am thankful to the organisation for implementing the project.

Attachment 5: Glimpses from the project Peer educator training at the project office Condom distribution with a group Condom distribution Project leader addressing the community on World AIDS Day DIC meeting in progress Counselling session by the doctor

Health camp in progress People s participation in a community event Project s participation in district level meeting Door to door home visit by field officer One to one counselling with HRG member Rally on World AIDS Day