SEHAT-The Health Initiative Supported by: INDIA VISION FOUNDATION Presented by C. R. Garg Amrita Bahl
Background HIV in India 1,065,070,607: Population of India (July 2004 est.) 5.1 million: Estimated number of people living with HIV in 2003. (IMPORTANT: see footnote on revision of estimates in July 2007) 0.4-1.3%: Estimated percentage of adults living with HIV/AIDS by the end of 2003 Routes of Transmission Heterosexual contact Intravenous Drug Use At-risk populations Commercial Sex Workers Truck Drivers Incarcerated population May get infected due to drug abuse, sexual episodes Released into the community Note: According to NACO's new estimates, 2.5 million people in India are living with HIV.
Planning & Strategy Development
Social Diagnosis Target Population: Convicts and under trials (both male and female) in the age range of 18-40 years incarcerated in TIHAR prison complex At present: -No voluntary counseling and testing facilities available -No health education program -Overcrowding in prisons -Prevalence of infectious diseases such as TB, HIV -Lack of communication about sexual issues Methods used: Interviews, Surveys
Epidemiological Diagnosis Health Issue: The Spread of HIV among the incarcerated populations In India, a pilot study conducted by Singh et. al, (1999) indicated that sexually transmitted and blood-borne infections are highly prevalent in jail premises and pose a threat of rapid spread of these infections through intravenous drug use and homosexuality
Behavioral & Environmental Diagnosis Behavioral factors: Unprotected sexual intercourse Sharing contaminated needles Beliefs about masculinity Lack of negotiation skills for safer sex Environmental factors: No needle exchange programs Lack of condoms availability Poor/No access to testing facilities Lack of health education
Educational & Organizational Diagnosis Predisposing factors: Lack of knowledge about routes of transmission Cultural beliefs about gender specific roles, masculinity, etc. Taboo topics of discussion-sex, homosexuality and drug use Reinforcing factors: Stigma associated with the disease Ignorance and biases present in the culture
Administrative & Policy Diagnosis Administrative: - Existing infrastructure provided by the Foundation - Established rapport and credibility with prison officials & prisoners - Utilization of resources present within community Policy: - Mission statement of India Vision Foundation is to save the next victim - Increased focus on HIV prevention by the Indian Government
Social Education and Health Advocacy Training @ Tihar Program Goal : To induce behavior changes and empower prisoners to engage in positive health behaviors during incarceration and after release Setting: Within the prison complex Total 225 Participants: (15 peers * 15 participants/class) Duration: Thrice a week for 2 hours for 12 weeks Delivery Channel: Given the literacy levels of the majority of the target audience, this program will be a peer-led intervention in small groups
Program Outline 12 Module Training Program Outline Module 1: Introduction to Peer Health Education Module 4: Introduction to the Immune System Module 7: Hepatitis Module 10: Presentation & Communication Skills Module 2: Health and Self- Awareness Module 5: Common Skin Infections Module 8: Tuberculosis Module 11: Practice Sessions Module 3: Cultural Awareness & Counseling Skills Module 6: HIV/AIDS & Sexually Transmitted Diseases Module 9: Harm Reduction Module 12: Closure and Graduation
Sample Training Agenda Building Understanding that Leads to Cross-Cultural Competence Training Overview AM Creating Cross Cultural Understanding Introduction 8:30 8:40 am Opening Ceremony / Ice Breaker 8:40 9:00 am Cultural Influences, Values & Identities 9:00 10:30 am Break 10:30 11:00am Gender, Sexuality & Sex 11:00 12:00 pm Lunch 12:00 1:00 pm PM Building Cross Cultural Competence Introduction 1:00 1:05 pm Communication Pitfalls, Tips & Strategies 1:05 1:50 pm Cross Cultural Healing Elements 1:50 2:35 pm Break 2:35 2:50 pm Integrative Approaches 2:50 4:05 pm Closing Talking Circle 4:05 4:30 pm Housekeeping: 4:30 5:00 pm Distribute Participant Manuals Evaluation Forms
Developing Concepts, Messages & Materials
Develop culturally appropriate communications Primary cultural factors: Language Religious beliefs Secondary cultural factors: Educational levels Gender Sexual orientation Societal beliefs about sex
Materials to develop Simple, easy to read handouts Use of visual aids Vignettes to trigger discussions Role plays Culturally sensitive PSA s Demonstration e.g. condom use Photo novels Posters
Implementing the program
Program Phases Phase 1: Needs Assessment Phase 2: Peer Educator Training Phase 3: Inmate Education Program Phase 4: Outcome Evaluation
Assessing Effectiveness & Making Refinements
Process Evaluation Feedback from participants on the content Feedback from participants on delivery of content The total number of participants attending full 12 weeks of the program Number and quality of activities Activities completed on time Review of the final creative project
Impact Evaluation Self-assessments to gauge changes in predisposing, enabling and reinforcing factors Pre test to gauge existing knowledge levels Post test to gauge factual knowledge acquisition
Outcome Evaluation Evaluate adherence to positive health behaviors introduced in the program Survey conducted after 60 days after attending the program Survey conducted after 120 days after attending the program
Organizational Infrastructure India Vision Foundation: -Over 30 Staff members -Srinagar, Amritsar, Gurgaon & Tihar Prisons -Vocational Training Centers, Adult Education -Day care, NTT, Crime Home Child -Sustainable development Navjyoti -308 Staff members -Community Development -Drug de-addiction -Adult Education -Health centers -Project Mamta
References CIA World Factbook(2004) Kaisernetwork website (2004) Making Health Communication Programs Work: National Cancer Institute Planner s guide National AIDS Control Organization, India website (2004) Singh, S., Prasad, R., & Mohanty, A. (1999). High prevalence of sexually transmitted and blood-borne infections amongst the inmates of a district jail in Northern India. International Journal of STD & AIDS, 10, 475-478 Tihar Prisons website (2004) UNAIDS 2004 Report on the global AIDS epidemic (2004) UNAIDS 2004 Report on the global AIDS epidemic: Factsheets(2004)