Empowering the Vulnerable in Urban Slums in India

1. The need for the work

Orissa, the project area and beneficiaries

The state of Orissa, in south-eastern India, is one of the country’s poorest states. Government inefficiency has led to prevalent poverty, with academics and activists predicting that Orissa will not meet the Millenium Development Goals by 2015. An incredible 57% of the state’s population live on less than 17 pence per day.

HIV: an indicator of marginalisation

An estimated 2.5 million people are living with HIV and AIDS in India: -- more than the entire populations of HIV prevalent countries like Botswana or Lesotho. Whilst the HIV response has been scaled up, it has not prevented an acceleration of the injecting drug-use-driven epidemic, the growing feminisation of the epidemic and a fast increase in the number of children affected by HIV. Prevention, treatment, care and support services are hampered by lack of political commitment, insufficient capacity of coordinating bodies, weak healthcare services and severe stigma and discrimination associated with HIV.

Vulnerable communities: the most marginalised

The three slums targeted – Patharabanda, Saliasahi and Malisahi, have a very high prevalence of sexually transmitted infections and reproductively transmitted infections (55%), combined with low condom use and a lack of knowledge regarding protection. HIV infection is currently concentrated among poor, marginalised groups and ‘key vulnerable communities’, e.g. migrant workers and young girls. Many health institutions are outside the economic reach of the majority of people living here and also due to the social marginalisation experienced by vulnerable populations. Key vulnerable groups are: female sex workers, men who have sex with men, and intravenous drug users. People living with HIV and AIDS and affected family members often belong to these key vulnerable communities. To this end they are doubly stigmatised. Studies conducted by LEPRA and the Government of India have shown that these people have a demonstrated need for correct information about sexual and reproductive health and HIV and AIDS services.

2. What the project will achieve

The project has three main areas of activity:

1) Educating and spreading awareness of sexual and reproductive health messages

2) Bringing vulnerable people together in networks and support groups

3) Helping local NGOs, the government, health workers and the media to act in a less stigmatising way

This is very much a holistic project that works hand in hand with government health centres and staff and seeks to have a multi-pronged approach to improve the health status of vulnerable groups (female sex workers, men who have sex with men, and intravenous drug users). In addition to supporting HIV positive networks, the project carries out the following activities:

Educating people living in slums on HIV and AIDS, sexually transmitted diseases, gender, stigma and how to access government schemes

The project operates ‘health resource centres’ in each of the slum areas. They serve as a base for Community Mobilisers and Peer Educators who can coordinate activities from there. Here, people can get information and advice on HIV and AIDS and sexually transmitted infections (STIs), become aware of issues like gender and stigma, and receive advice on accessing government poverty reduction schemes. Network and support group meetings, and trainings, also take place here. For those who are not yet empowered enough to want to attend the centres, a van, equipped with ‘Information, Education and Communication’ materials, including props for street plays, will visit different community events and locations. Also, leaflets and posters will be widely distributed. Condom promotion activities such as training condom retailers in promotion will also take place this year. To truly encourage behaviour change, more intense educational activities will be done, such as group discussions, role play and drama, home visits, small focused meetings, and debates. Two drop in counselling centres will be operated by support groups from the target communities. These will facilitate access to treatment, care and support. They act as a ‘one-stop shop’ making it easier to access. Mobile STI clinics will operate in areas with no alternatives. They will operate on fixed days, at fixed intervals to promote attendance over time. Basic medical checkups will be provided and referrals made if necessary. Government health workers will be trained in items such as sex and sexuality and clinical management skills. This will improve the technical skills, attitudes so that services can respond better to the demands for HIV testing.

Empowering people living in slums so that they feel supported, engaged, able to access services easily and able to take part in activities which assert their human rights

Support groups have been created from key vulnerable communities. They act as a forum in which marginalised groups have a voice and are recognised and respected. Special sessions will take place to increase members’ confidence to negotiate with mainstream health services (and other government departments). The recruitment of 22 peer educators and 8 community mobilisers will act as a catalyst of change in each target group, encouraging the community to engage with project activities and respond to/act on new knowledge and skills. Community-based organisations, such as youth clubs, and local NGOS have been brought together and trained on issues like project management. In this final year, they will be responsible for the follow-up of all awareness raising activities. LEPRA will be on hand to give guidance and support before the final handover. Documentation of stigma and discrimination cases. Links with organisations working on rights such as the State Human Rights Commission will be strengthened so that human rights issues are taken up and addressed.

Creating the kind of environment whereby people’s sexual and reproductive health rights are upheld by policy and in practice by institutions

Advocacy workshops for stakeholders will be held so that key policy makers can, with the community, come up with area-specific micro plans for dealing with the problems the project is trying to solve. In order to strengthen coordination between different groups, networking meetings will be held with local NGOs, municipal authorities, the state AIDS control society, the department of health and family welfare, and the positive persons network. Meetings, workshops and seminars with local media representatives will be held to raise awareness about vulnerable groups. These will promote dissemination of correct factual information about HIV in the media. Development and dissemination of best practice models for integrated prevention and care and support for each target group, e.g. tools, manuals and these will be widely shared at state and national levels.

Power in numbers for those living with by HIV and AIDS

In 2007, LEPRA established a network for people living with HIV and AIDS (called Kalinga Network). It is a state-level network and is comprised of HIV and AIDS ‘clubs’ – many of which are youth-led. So far the project has persuaded district-level networks to become part of it, and now in this final year the project will link it with the Indian Network of Positive Persons to have more influence and a national and global voice. In order to do this, activities such as training these clubs and groups on home-based care and support; training them on documentation and report writing; linking them up with trained community mobilisers; and organizing coordination meetings with other clubs.

3. Monitoring and Evaluation

A monitoring and evaluation framework is well established and the logical framework used as the basis for project management. Data collection instruments range from project records of training, financial records, client cards, beneficiary interview, and endline assessments of behaviour change. The community-based monitoring system will monitor the project at two levels, a) the level of activities planned and b) the level of output/outcome. At least 90% of indicators come from beneficiaries themselves. At the end of the project, a Project Completion Report will be completed and disseminated and sent to you if you fund this project.

The Story of Kailash

Kailash was only 9 years old when he lost his father. After his father’s death, his uncle started to take care of him sometimes. His uncle was very fond of singing and dancing, and loved to attend marriage ceremonies held nearby. As he grew up, Kailash began to meet young boys at these ceremonies and experience sexual relationships. He rarely used protection. Once, he was raped by multiple boys at a marriage ceremony he attended. After almost 20 years, Kailash became ill. He felt as if he was suffering from piles and underwent treatment. But the problem came back, and, after coming into contact with the Sakhyam staff, he was identified as having an STI. He was linked with the community Mobiliser who referred him to the STI/RTI Camp organized in the area by the project and subsequently to an integrated counselling and testing centre for HIV. He was found to be positive. At first he was so depressed that he lost his will to live. The Sakhyam project staff gave him intense and ongoing counselling as well as a lot of information about the disease. He still experiences periods of sadness and often cries. The project staff are continuing his counselling in order to support him in leading a normal healthy life.