India’s Lesson for Battling AIDS: Wide- Ranging Civil Society Consultations
India’s partnership with civil society in tackling HIV/AIDS has attracted international attention. The consultative process that went into the design of the Third India AIDS Project (NACP III) has been wide-ranging and all-embracing. It is being disseminated as best practice to other countries in the region and the world.
July, 6, 2007: Since the first case of HIV in Indiawas discovered in 1986, the number of HIV infected persons in the country has increased to around 2.31 million (between 1.8 and 2.9 million).The growing epidemic is concentrated among certain groups which are at higher risk of contracting and transmitting the HIV infection.
These groups include commercial sex workers and their clients, injecting drug users, and men who have sex with men. The sexual networks of these groups are known to be wide, increasing the potential of spreading the epidemic to the wider community.
Today, India’s efforts to work with civil society to reach these marginalized populations, tackle stigma and discrimination, and provide support and care for people living with HIV/AIDS has caught international attention.
As the Government of India drew up the third phase of its National AIDS Control Program (NACP III), it undertooka complex consultative process that included nationwide consultations with various national stakeholders, as well as international development partners.
UNAIDS has documented India’s all-embracing consultative process as best practice for dissemination to other countries in the region and the world.
The changing face of AIDS in India
Although India’s population has remained largely protected from HIV so far – less than 1 percent of young adults between 15 – 45 years of age are infected – there is no room for complacency.
The AIDS epidemic in Indiais at a critical juncture. As the country experiences rapid economic growth, the social landscape is changing.Risky behaviors continue and ‘bridging’ populations carry HIV from the eye of the ‘cyclone’ into the wider community. Stigma and social taboos prohibit discussion of sex and sexuality.
As a result, India’s current and future workforce - its youth - is at greatest threat from the epidemic. With the narrowing window of opportunity, the government has recognized that the widest participation of society-at-large is essential to deal with the epidemic effectively.
Civil society’s vital role
Given the special circumstances of the HIV/AIDS epidemic, a government – civil society partnership has painstakingly been built over the past 5 to 7 years. This partnership also showcases the maturity of the government’s own program that builds on the advantages that NGOs bring. In tackling the epidemic, civil society has taken on the following roles:
Providing prevention and support services to high-risk groups: Civil society is best able to deliver prevention services to groups that are least likely to seek them. This is because the groups among whom the epidemic is raging are seen to be beyond the social pale. They are also often criminalized as some of their activities contravene Indian law. For example, legal provisions drive sex work underground, making it difficult to reach male and female sex workers through public health systems.
Indiahas therefore approached these high-risk groups through NGOs, and collectives of these groups themselves. Of special mention is the sex workers’ collective in the Sonagachi area of Kolkata, where the empowerment of sex workers has helped promote the use of condoms.
Others such as the Humsafar Trust and Naz Foundation address the informational and support needs of men who have sex with men. And as the number of people with full-blown AIDS (which appears after several years of HIV infection) increases, NGOs and networks of people living with HIV (PLWH) are best able to blunt the panic among affected people and provide them much-needed support.
Helping define government policy: The epidemic affects, in greatest part, the most marginalized groups who need to be represented by civil society. Working with these populations has helped civil society develop a close understanding of the issues involved in tackling HIV effectively. Their voice is therefore vital in both defining government policy and for developing a robust plan that would find universal acceptance and widespread application.
These groupsalso need to be a part of the massive effort that is needed to equip everyone to protect themselves from infection through appropriate knowledge and easy availability of condoms.
Protecting human rights of affected persons:And finally, HIV/AIDS brings many prejudices to the surface which demand a societal response but are unlikely to be championed by anyone other than civil society. Civil society groups can therefore address the issues of stigma and discrimination in the wider community such as in the workplace, in medical establishments, and in community areas such as schools and social events.
Citing the importance of civil society in the battle against HIV/AIDS, Suneeta Singh , the World Bank’sSenior Public Health Specialist based in New Delhisays, “NGOs bring variety and context to work with high risk groups; their intimate knowledge of these groups can help the government in designing its program. Their close involvement during the implementation phase would be crucial to ensuring that the best possible results are achieved.”
Government and civil society partnership
In recognition of civil society’s vital role in tackling the epidemic, it was made an integral partner in the design of NACP III. Civil society groups occupy a prominent place on the Steering Committee designed to steer the planning process.
About 40 percent of the 200 persons involved in providing advice to the government on future strategy were from civil society organizations. An e-forum set up to provide an open space for comments on the draft strategy received the greatest number of contributions from members of civil society.
Over 60 civil society organizations, including PLWH participated in a path-breaking consultation to review the draft Strategic framework of NACP III organized jointly by government and civil society.
Importantly, civil society itself has come of age in the past few years in the area of HIV/AIDS. It has developed a common voice in its relationship with government. An interim committee has been formed to interact with government on NACPIII and a federation with elected representation is proposed.
Today, civil society is poised to undertake its ‘watchdog’ role seriously during implementation of the next phase of the National AIDS Control Program.
RSS