Objective="HIV/AIDS awareness, prevention and treatment"
Details for Reform Option "Mobile AIDS Counselling Services, Delhi"
In 1996 the Rajiv Gandhi Foundation (RGF), recognising the consequences of the HIV/AIDS pandemic in India, set up a mutually supportive network of General Practitioners (GPs) and Non-Governmental Organisations (NGOs). This involved a training programme linked with post-programme networking to ensure better longterm impact. Training workshops were organised for GPs in Delhi, Mumbai and the North-Eastern states. The project simultaneously trained field NGOs.
So far (end 2005), the ‘Rajiv Gandhi Workforce’ consists of 1400 trained GPs and 450 NGOs who provide services such as diagnosis and treatment of Sexually Transmitted Infections (STIs), preventive and supportive counselling on HIV, referral and follow-up services for the HIV-positive in their respective regions.
Reports suggest that there are currently about 45,000 HIV-positive people living in Delhi. That number is increasing, especially amongst the category considered ‘high risk’ which includes slum dwellers.
To supplement the efforts of the Workforce, the RGF created a new project, the Mobile AIDS Counselling Services (RGMACS), as an integrated, holistic model for the prevention, control and management of HIV/AIDS. Launched in Delhi in August 1996, it aims to raise awareness through mobile exhibitions and Information, Education and Communication (IEC) activities using folk media. A vehicle equipped with medical aids visits one slum or high risk area every day. One counsellor and an activist travel in the van, while specially trained troupes perform various educative programmes through activities such as street plays or puppet shows, as well as giving audio and video presentations. People suffering from Sexually Transmitted Diseases (STDs) are given medical help. Those wishing to be tested for HIV are offered on-the-spot testing. The project offers preventive and supportive counselling and works at reducing the stigma, discrimination and denial associated with AIDS.
The intervention package also includes:
ii) Networking with hospitals and nursing homes (for management of opportunistic infections)
iii) Tuberculosis treatment
iv) Management of people with HIV/AIDS
v) Social marketing of condoms
In Delhi, the RGF is working with FICCI Socio Economic Development Foundation and covering six areas: Jasola, Madanpur Khadar, Wazirpur JJ Colony, Hastsal, Gandhi Nagar and Geeta Colony. In these areas coverage is ensured by a network of 16 NGOs, Government hospitals, Delhi State AIDS Control Society (DSACS), Voluntary Counselling and Testing Centres (VCTC) and STD clinics.
Thirty slums in Delhi have been covered by the project so far.
By the end of 2005:
(i) The programme has reached 61,772 individuals through various IEC activities
(ii) 31,033 pamphlets, 4,267 posters and 4,202 stickers have been disseminated
(iii) 18,179 people have been counselled in the mobile van and 13,364 during home visits
(iv) In 2005, 38 people were referred to VCTCs, of whom four tested positive vi) Another 1,111 people were referred to STD clinics
(vii) In collaboration with DSACS, health camps were conducted through which 220 STD patients, 129 patients with skin related disorders, 31 TB patients and 642 patients with other ailments were given free medicines.
(viii) 44 condom depots have been set up, and 18 community based groups have been trained on HIV/AIDS issues.
The programme was successfully replicated in Mumbai, where it is being implemented by the People’s Health Organisation (PHO) with the help of Johnson & Johnson Ltd. in an additional 10 slum areas. Since 2000, a total of 41 slums in the city have been covered.
In 2005 in Mumbai:
(i) More than 23,500 people were given counselling on HIV/AIDS related issues
(ii) 834 people came forward for voluntary testing, of whom 15 tested positive.
INR 2.20 per beneficiary.
Vans were donated and GPs provide services voluntarily.
The total cost of running the project is approximately INR 570,000 per annum.
Delhi since 1996, Mumbai since 2000. The programme is also running in several districts of Maharashtra: Nasik, Pune, Sitapur and Ahmednagar.
Twenty-30 days to plan and organise the training for GPs, identify intervention areas, NGOs and institutions necessary to provide links for service delivery.
Holistic: Provides comprehensive services for the prevention, control and management of HIV
Multi-targetted: Main beneficiaries are vulnerable groups but all sections of the community are targetted, spreading focus to remove stigma of HIV
Cost effective: By disseminating messages through street theatre and folk media, costs are kept down and large numbers reached
Intersectoral approach: Impact of the programme is heightened due to complementary roles played by GPs and NGOs in the community
Stigma through visibility: Bold labelling of van led to initial reluctance to approach it
Non-availability of medicines: Due to heavy demand for curative services for STDs, treatments are sometimes in short supply.
Male-heavy team: The Rajiv Gandhi Workforce currently has predominantly male doctors. Women are often reluctant to discuss reproductive health problems with them.
Cooperation and participation of local NGOs and GPs
Cooperation of local nursing homes and hospitals
Trained and dedicated staff
Scientifically accurate and culturally appropriate audio-visual IEC material.
Who needs to be consulted
Local community and GPs at planning stage.
Various stakeholders, who undergo communication and training needs assessment before training strategy is evolved.
To ensure the project is sustainable, community based groups, youth groups and other stakeholders are trained on HIV/AIDS issues. Strong links are established with NGOs and GPs in each project area.
RGF, in partnership with the National AIDS Control Organisation (NACO), has also planned another initiative, the Red Ribbon Express, along the lines of the Mobile AIDS Counselling project. For more information click on the link in References below.
Chances of Replication
The Rajiv Gandhi Workforce is operational in the North-eastern states where the Mobile AIDS Counselling Services are due to start in 2006 – 2007.
The project can be replicated successfully across the country, with necessary adjustments to the model to meet local needs.
The UNAIDS/Royal Tropical Institute Programme has included the RGMACS project (Mumbai model) as one of the best global practices in its toolkit of local responses to HIV/AIDS.
Tessa Laughton, Research Consultant, ECTA, Delhi. March 2005