Tuesday, July 29, 2008

YRG CARE - Desire Society

Click on the title to view the pictures from our grant partner YRG CARE's work with Desire Society in Medak, AP. This organization also works with OVC (orphan and vulnerable children)


Click on the title to see the pictorial details of our work with CHUM Society as part of our grant support to YRG CARE.

AIF Public Health - Our partners work

Click on the title to view the pictures. These pictures are from our grant partner LEPRA's work on the ground. This is part of the exciting work that we do where livelihoods is also a core program intervention with PLHAs. This program is in Andhra Pradesh, in and around the capital city of Hyderabad.

Monday, January 28, 2008

AIF Board of Advocates HIV/AIDS - Public Health in India

AIF – Board of Advocates HIV/AIDS- Public Health in India

Author - Mira Kamdar

To listen and watch the podcasts please click on the above title.

I want to tell you about a unique opportunity to help address one of the critical problems facing a resurgent India; an opportunity for Americans, including Indian Americans, to make a real difference in helping India realize the promise of this incredible moment in its history.
No doubt, this moment belongs to India. Annual growth, pegged at 9.8 percent in
2007, is pushing double digits. More Indians – 36 – are listed on the Forbes billionaire list than citizens of any other single country. Foreign investment has reached an all-time high and Indian companies are expanding abroad at a rapid rate. The buzz in the international business world is that India, already known for its leadership in the area of services, may soon replace China as the preferred location for global manufacturing. Indian film, music, food and fashion have gone mainstream in the West, with Shah Rukh Khan and Aishwarya Rai becoming household celebrity names on a par with Brad Pitt and Nicole Kidman. Yoga is the fastest-growing leisure activity in the United States.

On its 60th anniversary as an independent democracy, India has much to celebrate, and Indian Americans can feel justifiably proud that the land of their ancestors is forging an Indian renaissance for the 21st century.
The rapid change happening in India, especially in urban centers, has fired the imagination of India’s youth – the largest youth population on Earth. Fully half of India’s 1.2 billion people are under the age of 25. That’s 600 million people. Their aspirations for a better life than their parents, a life of dignity that allows them to realize their full potential, have been kindled by India’s rapid transformation.

But, unfortunately, there is another side to the story of a resurgent India. A side that may see many of these young dreams of a better life dashed.
India remains a country divided between rich and poor. Alarmingly, that division does not appear to be narrowing. A report released by the government of India the week before the 60th anniversary of independence this past August 15 carried the disquieting news that up to half of working Indians earn 20 rupees per day or less. Twenty rupees: that’s 50 cents. Imagine trying to survive on 50 cents per day.
Forty percent of the malnourished children in the entire world call India home. China has an adult literacy rate of 90 percent. India’s is 61 percent. China’s youth literacy rate is 98 percent; India’s only 73 percent. According to UNICEF, only one in six rural schools in India has a toilet. This is a simple but powerful obstacle to girls’ education.

India has recently shown it can deliver healthcare equal to the highest quality in the world, at a fraction of what that costs in the West. Premier hospitals such as the Escorts or the Apollo chain are attracting an international clientele. Yet, access to basic healthcare for most Indians remains woefully inadequate. Infant mortality in India is unacceptably high: 34.6 deaths per thousand compared to 6.4 in the United States or 2.8 in Sweden. In fact, India’s spending on primary education and public health is among the lowest in the world.

Against this backdrop, India is facing a significant HIV/AIDS epidemic. Between 2.9 and 3.2 million Indians are infected with the disease. Economists have projected the potential loss to India’s annual rate of growth at up to one full percentage point if the epidemic is not contained. Wives and children of infected men often face terrible social ostracism, especially if they are found to be HIV-positive.
Fortunately, the most recent research indicates that the epidemic of HIV/AIDS in India remains largely concentrated among high-risk groups: sex workers and truck drivers among them. This, coupled with the National Rural Health Mission, means there is still a chance of intervening effectively to prevent the spread of this terrible disease into the general population. And effective strategies to combat the spread of HIV/AIDS can be leveraged to align India’s health delivery systems to provide the basic services so many of India’s people need.

Many of the dreams and hopes kindled in India’s youth by this extraordinary moment will be tragically dashed unless solutions are found to the country’s pressing problems, including the threat of HIV/AIDS.

The American India Foundation (AIF) is dedicated to accelerating social
and economic change in India; to contribute to building an India where all people can gain access to education, health care, and livelihood opportunities and where all Indians can realize their full potential; to build a trusted bridge between the dreams and aspirations of individuals who care about India and their realization.
AIF is a trusted bridge for Americans to channel philanthropy towards
accelerating social and economic change in India. Since its inception in
2001, AIF has raised over $45 million and awarded grants to over 90
high-quality Indian NGOs who are working on primary education, women’s
livelihoods and HIV/AIDS.AIF’s goals include accelerating prevention education, and preventing mother to child transmission of HIV. This is an impressive achievement. But the need remains great.

We at AIF invite you to join us in helping forge bridges between Americans and India. We invite you to become part of the vital linkages that connect India’s pressing needs with the resources of Americans who recognize that we must seize this incredible moment for India to, finally, eliminate the obstacles too many Indians still face toward realizing their full human potential and to contributing to the full promise of the world’s largest democracy.

That is why we are creating a Board of Advocates to combat HIV/AIDS in India. The Board of Adocates will be composed of Indian American leaders in entertainment, business, philanthropy and health care who understand the kind of effort that is required to address this terrible scourge in India. Over the course of the next few months, AIF will be rolling out a series of interviews with our Board of Advocates. These exceptional individuals will share their reasons for getting involved, their vision of a fully resurgent India, and their plea for Americans – including Indian Americans – to join them and AIF in building a bridge that can carry all of India’s people to a brighter future.

Tuesday, November 20, 2007

U.N. to Say It Overstated H.I.V. Cases by Millions

November 20, 2007 NYTimes

The United Nations’ AIDS-fighting agency plans to issue a report today acknowledging that it overestimated the size of the epidemic and that new infections with the deadly virus have been dropping each year since they peaked in the late 1990s.

The agency, Unaids, will lower the number of people it believes are infected worldwide, to 33.2 million from the 39.5 million it estimated late last year.

The statistical changes reflect more accurate surveys, particularly in India and some populous African countries. Some epidemiologists have criticized for years the way estimates were made, and new surveys of thousands of households in several countries have borne them out.

In only a few countries, such as Kenya and Zimbabwe, do the figures reflect widespread behavioral changes, such as decisions by many people to have sex with fewer partners.

Excerpts from the report were given to the news media in advance for release this evening, but an embargo on it was broken by other news organizations. Despite the revised estimates, the epidemic remains one of the great scourges of mankind. This week’s analysis predicts that 2.1 million people died of AIDS in the last year, and 2.5 million were newly infected — or about 6,800 every day.

The agency now believes that the number of new infections each year with H.I.V., the virus that causes AIDS, probably peaked in the late 1990s, or by 2001, at about 3 million.

Although new infections have dropped, the number of people with the disease is growing because more people infected with H.I.V. are living longer, thanks to antiretroviral drugs. With the world’s population growing, the agency believes that the percentage of adults who are now infected remains roughly constant, at about 0.8 percent.

“This is not a surprise,” said Daniel Halperin, an expert on H.I.V. infection rates at the Harvard School of Public Health and co-author of an article published three years ago arguing that estimates of infection rates were too high. “The writing was on the wall years ago,” he said.

“But,” he added, “this doesn’t mean the epidemic is going away, everything is fine and now forget about it — not at all. There are still about 10 countries in southern Africa that are real nightmares.”

In the past, global health officials have treated the epidemic as a cyclone spiraling ever upward with no end to new infections in sight.

But better surveys, particularly a household survey in India, have driven the figures down.

Until recently, most national estimates were made by giving anonymous blood tests to some young women who came into public health clinics because they were pregnant or feared they had a sexually transmitted disease; those results were expanded with statistical models.

But epidemiologists have realized that such a method — usually applied in big urban clinics because it was more efficient — oversampled prostitutes, drug abusers and people with multiple partners, and ignored rural women. Then the statistical extrapolations exaggerated those errors.

Recently, the United States Agency for International Development began financing surveys that chose thousands of households at random in both urban and rural areas and sent in health care workers to take detailed medical and lifestyle histories and blood samples; though expensive, they produced results that are considered more accurate.

In July, India’s estimated caseload was revised downward, to 2.5 million, from 5.7 million — a change that accounts for about half the drop in the new Unaids figures. Officials said then that India’s epidemic was not “generalized” — that is, it had not spread far from the original high-risk groups like brothel workers and clients, truckers, heroin users and gay men. Also, rates among prostitutes appeared to have fallen as condoms gained acceptance. Instead of being considered the world’s worst-hit country, India fell to third place behind South Africa and Nigeria.

Also, some African countries have seen real drops in new cases. It happened relatively early in Uganda, after an aggressive “no grazing” (meaning no casual sex) campaign started 20 years ago. Similar declines appear to have happened in Zimbabwe and Kenya, especially since people saw many friends and relatives die. Rather than embracing condoms or circumcision, people decided to have sexual relations with fewer people, Dr. Halperin said.

“You don’t need a Ph.D. to figure out that if you reduce your number of partners, you reduce your risk,” he added.

A small decline in new infections can quickly cut a country’s total caseload because large numbers of people infected early in the epidemic are still dying.

AIDS advocates fear that any suggestion that the epidemic is lessening in intensity will cause fatigued donors to contribute less.

In September, for example, the Global Fund to Fight AIDS, Malaria and Tuberculosis received pledges of only $9.7 billion, well short of the $15 billion to $18 billion it had hoped to raise.

“There’s still a huge epidemic out there that still needs huge resources to win the battle,” said Paul Zeitz, executive director of the Global AIDS Alliance, a non-profit advocacy group.

Wednesday, October 24, 2007

Mira Nair's AIDS Jaago presented by AIF - SAHAYA


Friday, September 28, 2007

HIV/AIDS CHILDREN - Their Secret Status and A Risky Schooling

Their secret status and a risky schooling
HIV-positive children are being thrown out of school in Uttar Pradesh by insensitive teachers and parents alike. Many parents are afraid to let schools know that their children are positive, and the state's machinery has failed to raise any awareness, as a major study has shown. Puja Awasthi sounds the warning bells.

28 September 2007 - Dhirendra Varma is 14, but looks just eight.

In Lucknow, under the watchful eyes of his father, he takes his tuitions in an air less back room of his father's hardware store. From school, to store, it is a closely watched routine, which the boy follows with his younger brother Pankaj, seven. The motherless boys have six other siblings and shrug off the need for peers as playmates. Their father has also warned them of the "dangers" that lurk in their middle class neighbourhood to keep them from mingling with the other kids.

Dhirendra and Pankaj are HIV positive, like 70,000 other children in the country. The National Aids Control Organization (NACO) puts the number of full blown AIDS cases in the 0-14 age group at 5,596 as on August 31, 2006.

A march by the Indian Network for People Living with HIV/AIDS (INP+) demanding the introduction of HIV/AIDS Bill in Parliament. The event took place in Lucknow earlier this month. Pic: U.P. network of Positive People.

According to statistics from the Union Ministry of Health and Family Welfare at the current rates, 21,000 children will be added to this number every year. But this disturbing figure might be misleading as UNICEF India pegs the number of infected children at 220,000. This also could be a deceptive figure as the current HIV/AIDS programmes reach only 15% of India's young people.
Like most other infected children their age, the Varma brothers are ignorant of their status. Their father Ramesh Varma reasons that he is only "protecting" his children, both from the burden of knowing and the jibes of peers and teachers. Hence their status remains a secret from even his other children.

This secrecy means the children must take the morning dose of their medicine before they leave home at 7 a.m., often on empty stomachs. The elder siblings, like the boys' teachers are not expected to care for them.

This secrecy also means the boys must often report sick at school, lose out on class hours and then be pulled up by teachers for lagging. Hence, the tutor and the long hours of tuition.

With a sad drop of the jaw Dhirendra says he does not get high marks in class. "I am poor in English", he attempts to explain in surprisingly good language.

The boys are not alone in their predicament.

According to Future Forsaken: Abuses Against Children Affected by HIV/AIDS in India, 2004, a report published by the Human Rights Watch, USA, most positive children manage to attend school only by hiding their status. While this might enable them to gain admission and remain in school, it keeps them from receiving special measures that will prevent them from dropping out or better protect their own health.

Anil Kumar Singh, president of Savera, a Kushinagar-based organisation that works with people living with HIV/AIDS (PLHAs) says that children cannot be looked upon in isolation because of their dependent status. Kushinagar is a district in eastern U.P., best known as the place where Gautam Buddha preached his last sermon in 543 B.C.

"Most children begin to face stigma and deprivation even before the death of a parent or before their own status is revealed. Sick parents mean loss of income and children, especially girls are pulled out of schools to play the role of care givers and in many cases wage earners. Orphans of infected parents are often abandoned by the extended family and end up on the streets, open to further exploitation," explains Singh.

In the Indian case, the last problem has been compounded by the lack of community based and institutional care systems. The joint/extended family network which had, for centuries taken in the old and ailing within its folds has reacted with horror to the AIDS epidemic.

A society sans awareness and emphathy

Take the case of Baby Gond, a 32 year old illiterate woman from Kushinagar's Harka village. In January 2005, Gond lost her husband. The in-laws promptly turned Gond and her two children (who are not infected) out of the house, forcing them to stay in the cowshed. With help from a local NGO and the district administration she managed to re-gain entry into the home but was forced to set up a separate kitchen.

Gond's case was further twisted by a property angle as the in-laws were demanding that she and her children give up all rights on the deceased's wealth.

This August, Harka witnessed another case of discrimination when Nirmala Devi a low caste widow cooking the mid day meals in a primary school was ousted from her job when her positive status became known. Her children, an 8-year-old positive son and a 10-year-old daughter, were also hounded out of school.

The district magistrate intervened and reasoned with the school headmaster, the village headman and village elders. While they relented other villagers remained adamant that they would not allow their children to eat the food cooked by Nirmala. They were also scared of their children catching the infection if Nirmala touched the school handpump.

While the children are back in school, government intervention has not been able to get Nirmala her job back. This lack of awareness can be attributed to the dismal performance of the UP State Aids Control Society (UPSACS). UPSACS was set up in 1999, during phase II of the National AIDS Control Programme. It works on counseling, surveillance, testing and clinical management, preventive strategies, capacity building, innovative interventions and developing culturally appropriate messages. In addition it runs school and family awareness programmes.

An Action Aid supported study on the Scenario of HIV Vulnerability and Prevalence in Uttar Pradesh, 2006 found that in a sample size of 17,516 government school students 30 per cent felt that HIV-positive people should be kept in isolation while 78 per cent were of the view that such persons should not be allowed to enter schools.

Perceptions such as these have forced a partial disclosure of five-year-old Avtar and his three year old sister Tanuja Singh's status. The orphaned siblings live at Shanti Niketan, a short stay home and care centre for PLHAs, run by the Medical Sisters of St.Joseph on Lucknow's outskirts. A year ago, they were left at the centre by grandparents who live in Chandigarh.

When Sister Lalita, administrator, Shanti Niketan took the two for admission to a nearby missionary school, she was convinced that the school management had to know of the siblings' status to ensure their physical well being. "Last week Avtar fell off from a swing and scrapped his knees. We have given the school medical gloves for use when providing first aid to the children in such cases," she says.

On the principal's advice however, the children's status has not been revealed to the teachers. Next month the centre will organize an awareness workshop at the school to better acquaint teachers with the issue, but not necessarily divulge the siblings' status.

Teachers are part of the problem, not the solution

This caution is hardly surprising given that teachers have been the strongest opponents of education that will create HIV/AIDS awareness. Earlier this year government schoolteachers across the state made bonfires of social studies textbooks meant for classes 9 and 11. They were protesting a single 10-page lesson on "adolescent awareness" that anyway painted the HIV/AIDS issue in bold moralistic strokes.

In Lucknow, government schoolteachers burn books and flip charts to protest sex education. Pic: Puja Awasthi.

Their chant was one that has been repeated in many other states (Gujarat, Madhya Pradesh, Maharashtra Karnataka, Kerala and Chhattisgarh) that such education would "corrupt" the minds of children and cause "sankritik pradushan" (cultural pollution). The government hastily withdrew the texts and ordered a re-evaluation of the books. The teachers chose to stay away.
College principal Prem Kumar Yadav, nodal officer for the now defunct adolescent education programme expresses alarm at this opposition. "Dealing with adolescent curiosities that come with physical changes cannot be obscene. We are dealing with a population that initiates sexual intercourse at a much younger age. If we don't provide them with information, they will turn to questionable sources, which distort issues. But in this state, so great is the stigma attached to HIV/AIDS that even teachers who conducted the adolescent awareness programme were branded ‘AIDS wali teacher' (literally the AIDS teacher)".

In September, the state's High Court pronounced that sex education could not be promoted "under the guise" of AIDS awareness and instead compulsory moral science education would do just as well.

Fallouts of such pronouncements have compounded problems for the state's PLHAs most of who have declared their status under the umbrella of the UP Network for Positive People (UPNP+).

Among them, Kamlesh Kumari, 33, who lives in a rural fringe of India's leather capital, Kanpur with her 9-year-old daughter Pinki.

Both are HIV positive.

Kumari, forsaken by her in laws, found the courage to acknowledge her status only after coming in touch with the UPNP+. However while she travels across the district to counsel others, she has not come out in her own neighbourhood.

Till two years ago, Pinki attended an English medium school. Then some parents got wind of her status and children refused to play with her or share tiffins. "I changed her school and told the teachers that she was being treated for some weakness. That way her bouts of illness, and her absence from school don't draw much attention", says Kumari.

Like Dhirendra, Pankaj, Avtar and Tanuja, Pinki who dreams of becoming a doctor, studies in a Hindi medium school, as such schooling is assumed to be less taxing than the demands of an English medium education.

Poor progress in child health, UPSACS not doing much

All these might appear to be isolated incidents as UP is still considered a low prevalence state which has reported only 1.47 per cent of the full blown AIDS cases counted in the country. Government figures claim that of the state's 70 districts many are yet to report even a single HIV infection, while others have only single digit cases. But when these figures are pegged against a larger backdrop, the picture becomes gloomier.

UP is vulnerable for a variety of reasons. Among them: one fourth of all inter state migrants in the country are from the state, voluntary testing and the presence of testing centres in big hospitals and medical colleges that are often inaccessible and a generally unresponsive health system.

While there is a dearth of data on the condition of HIV+ children in the state, some calculations can be made from other health indicators. According to the National Family Health Survey-3 (2005-06) the infant mortality rate in the state is 73 per thousand. That is a small improvement over the 89 per thousand reported in the NFHS 2 (1998-99). The figures for vaccination coverage for children between the ages of 12 to 23 months are 23 and 20 per cent, while the numbers of stunted and underweight children at 46 and 47 percent are only slightly better than the 56 and 52 per cent reported earlier.

A general state of poor progress in child health can be further examined against the allocation and expenditure of funds by UPSACS, which as noted earlier, has fared poorly in raising awareness.

For the financial year 2007-08, of the allocated Rs.29.9 crores, the society had till July 2007, spent only Rs 8.7 crores. In 2004, a report of the Comptroller and Auditor General of India rapped UPSACS for poor utilisation of funds. Between 1999-2004 (the period of the National Aids Control programme-II), the society was allocated Rs.146.76 crores, of which only Rs.54.81 crore were spent.

The only thing going UP's way may be that discrimination against children with HIV/AIDs is widespread throughout the country. UP may be yet to report the levels of discrimination that have been witnessed in the South such as the 2003 case of Bency and Benson, positive orphans from Kerala or the more recent case of five HIV positive orphans who were turned out of their school in Kottayam, Kerala. However, there are no special efforts to be seen in U.P. such as one recently reported from Bangalore, where a city-based NGO plans to open, by 2008, a school where HIV+ children will be equally welcome.

Will a law help?

K K Abraham, President of the Indian Network for People Living with HIV/AIDS (INP+), Chennai, points to the proposed HIV/AIDS bill as another important step to counter discrimination.

The HIV/AIDS bill is an effort that dates back to 2002 to bring a separate law to protect the rights of PLHAs and has been drafted by the Lawyers Collective HIV/AIDS Unit. The collective, formed in 1981 consists of professional lawyers, law students and human rights activists, provides legal assistance to the underprivileged and undertakes public interest work. The draft has been prepared after thorough research of HIV/AIDS law in other countries and discussions with various stakeholders. In 2005, the draft HIV/AIDS Bill was submitted to the government. It is yet to be tabled in Parliament.

For Dhirendra and thousands of others like him who need a supportive environment today for a better tomorrow, that hope might be too distant to make a difference. ⊕

Puja Awasthi
28 Sep 2007

Puja Awasthi reports on development issues, and is based in Lucknow. This article is part of a series on education sponsored by Aide-et-Action India, a not-for-profit organisation dedicated to making education the lever for development.

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