DAPCU EAST Delhi Response : DAPCU- Stigma & Discrimination

Roles and responsibilities of DAPCUs with respect to Stigma and Discrimination relating to HIV.

The District AIDS Prevention & Control Unit plays a important role to reduce stigma and discrimination related to HIV in the district. DAPCU is conducting various activities to reducing stigma & Discrimination with the Coordination of District Administration & other Government Department.

v  Provide better services to HIV-AIDS positive clients.

v  Monitoring and supervision of HIV/AIDS facilities in the district.

v  Sensitization Program for M.Os, Hospital staffs, ANM & ASHAs, also trying to do sensitization program for  Private Practioners & Nursing Homes.

v  Awareness program in Schools, I.T.Is & Coaching Institutes.

v  Sensitization of Police personals.

v  Condom Promotion activities & Nukkad Natak.

v  Sensitize youth & students through Awareness campaigning.

v  Planning to sensitize Industrial Area.

Measures initiated to facilitate reduction of stigma and Discrimination in

      Access to services: Involvement of   counselor, ASHA and anganwadi worker is necessary to provide better service with out any discrimination and stigma at any stage.

                   Health Care Setting: DAPCU has organized full site sensitization workshop in the Health Facilities of ‘B’ & ‘C’ Category.

        District Administration and it Departments: DAPCU has organized a quarterly Meeting of DAPCC & DCC of TB-HIV and in the meeting, Issues related to stigma and discrimination is discussed with District Administration and is resolved with the support from them.

      PLHIVs are facilitated to obtaining the benefits of Welfare Schemes with the help of District Administration.

           Community Settings:

·         Creating awareness of community towards PLHIVs IEC (Information, Education & communication) through participation and activities in Health Camps, Mega Camps.

·         Awareness through Community Event organized by Tis with the coordination of DAPCUs.

Complaints from PLHIVs regarding Stigma and discrimination

One lady went to hospital in labour pain and some part of child has been come out at the out side the hospital gate , her husband carry her in hands due to non availability of stretcher. When he entered the labour room then sister on duty address him in a bed manner. Client husband phoned to DPM about the incident and due to out of station, DPM instruct to the concerned counselor to solve the issue. In mid night counselor try to solve the problem and next day DPM also meet to HOD & Sister on duty in charge. She apologizes about her behavior. 

Achievements of our district in fighting stigma and discrimination:

·   Attend Advocacy Meeting.

· Organized awareness meeting with various stakeholders& departments and sensitized   about HIV-AIDS and Stigma & Discrimination present in Society about the epidemic and PLHIVs.

·    Mainstreaming of line departments

·    Attend community meeting of TI’s.

DAPCU KHORDA Response : DAPCU-Stigma & Discrimination

Role and responsibilities of DAPCU

DAPCU being the decentralized unit needs to address any discrimination against the PLHA and simultaneously to enhance education against stigma and discrimination against PLHA. Basing on the theme-“zero discrimination “ DAPCU has represented one IEC stall at the local festival and also in World AIDS Day observation. DAPCU has responded some of the issues in the district to reduce the discrimination against the PLHA through conversations and facilitation in various aspects. The Role of the DAPCU in this aspect is as follows

· Sensitizing youths in school and collages , organizing events where they can participate in the discussion and can share their views like in competitions , mass Rally in the events like National youth day, world AIDS day etc.

·  Facilitate to reduce stigma and discrimination on health services  

Access to services

DAPCU has been facilitating to avail Pension scheme (MBPY) to the PLHIVs of all 10  Blocks and one  Munsipality and  one NAC. Initially the concerned officials in the block were not supporting for disburse the fund to their accounts stating that they have not received any letter from the District  authority although the District Social Welfare Officer has already communicated to the respective blocks. Based on the problems DAPCU has visited all the Blocks and discussed with the Block Development Officers and concerned section to disburse the pension now we are seeing a good result on it.

In the DAPCC meeting DAPCU has raised issue regarding non providing travel concession for the PLHIVs by the Govt. Bus conductor while going for ART treatment. The DSP has assured that he will communicate the massage to all the Block level Police station to file cases if any PLHA complain against the bus conductor for non giving concessions

Health care setting

·  Various sensitization programmes were organized at the DHH, CHCs in coordination with NGO s and DLN

·  Full site sensitization programmes has been organized in the CHCs  

· Counselors and DIS of DAPCU district has been instructed to attained ASHA sector meetings and mass gatherings for sensitization regarding HIV AIDS , stigma and discrimination.

·  Availing free health services in the hospitals for the PLHIVs ( all tests are free for the PLHIVs) in the medical

·   One PLHA( ANC +Ve) was denying to give TT at one of the CHC of Khordha district. Through the intervention of DAPCU and Concerned ICTC in support of Network the matter has been addressed.

· One Positive pregnant women after diagnose was denied to delivery at DHH Khordha. In response of this DAPCU and Concerned counselor had advocated with ADMO (Ph) and CDMO to conduct delivery at DHH and finally the delivery has been conducted at DHH.

Dist. Adm and its departments.

·  Two sensitization programmes has been organized at the Jail in consequence of discrimination occurred in the sub  jail, Khordha by the inmates and the jail officials.

·  No issues  of  discrimination has been reported from the jail since that.

·  DAPCU has sensitized about HIV AIDS , myths on HIV AIDS and against discrimination to the concerned officials of Khordha Block and BMC Bhubaneswar, Banapur and Jatni has been along with this  advocated to issue various schemes like MBPY and MKY, AAY for PLHIVs.  

·   District Social Welfare Officer (DSWO)  has been agreed to include CLHIVs(having single parents , orphans) in to sponsorship  programme

Community settings

A discrimination case has been reported at DAPCU and DLN by positive couple who were denied for health service (Immunization) at one of the CHC of Khordha District. Her husband was also denied to access any social services like use of Saloon, Shop etc.  The couple were about to segregate from their village. In the mean time DAPCU, Concerned Counselor in support of DLN intervenes in the matter and visited the village with representative of the CHC along with the concerned personnel of OSACS and shorted out the issue.

Village meeting organized and sensitized the community the details of the report is attached.

SENSITISATION  PPROGRAMME

            The sensitization programme was organized in the Haja Vilage by DAPCU , OSACs and Link Worker Scheme Project of Kalinga Network For People Living With HIV(KNP+).In this Sensitization programme The GIPA coordinator,  OSACS,  DPM DAPCU, Khordha,  and President KNP+, Sarapanch of the village, SEO were  also presented in this programme apart from this more than 60 participants  from the community were presented along with ICTC Counsellle Botoloma, Lab Tecnician  Botoloma,  ASHA, AWW,SHG Members, Ward Members, and general  people.

The DPM DAPCU warm welcome to all the Guest persons and  participants  and discussed the importance of the meeting where he apprised the community not to create any discrimination against the PLHIV. Addressing the myths related to transmission he suggested there is no other way except 4 cause of transmission so there should not be any discrimination against the PLHA. He also asked the  Sarapanch and Naib Sarapanch  to address the community about the role and responsible for PLHA as they are also the fellow being of the society and  their own village..

The GIPA Coordinator to give his valuable information regarding the discrimination. He focus on,

§  Why the people discriminate PLHIV?

§  What is the impact on the PLHIV?

§  What’s impact on the Community?

§  Rights of the PLHIV.

In the meeting the President, KNP+  as pa positive speaker described the life story from identification to discrimination and segregation  by her laws house and from the community. She has been discriminated but sustained till today she has build up positive thinking and positive living with her and now working against the discrimination.

Her presentation has contributed much to the participants to understand the feelings of the person who have been discriminated by the community. After that  she has requested to the villagers to cooperate with the PLHIV and not to discriminate. However the myths and  misconception has been addressed and in some extend the present community has been aware about HIV and AIDS. 

DAPCU BHADRAK Response: DAPCU -Stigma & Discrimination

              

 Roles and Responsibilities of DAPCU respect to stigma and      discrimination

·        Strategies for reduction of stigma.

·        What are the services accessible to reduce stigma.

·        In the health care setting.

·        District administration and its department.

·        In the community setting.

·        Please share any achievement in reducing stigma and discrimination.

                    Some strategies for reduction of stigma :

·        AIDS is a life threatening disease that a person carries the HIV virus throughout his/ her life till death. Now days such disease has created a morbid fear in the mind of common people as such no permanent remedy has developed in medical science. Stigma is a social attitude / thought emerges from own culture and belief. In view of the above DAPCU has taken some strategies to reduce the stigma in different situation. Stigma stands in the following situations/ levels :

a.      Community level.

b.     Family based.

c.      Health care situation.

d.     Religion & Culture.

e.      Media.

f.       Educational Institution.

g.      Work place (Corporate / industrial sector, where group of people work together).

h.     Administration (where some duty bearers have ill attitude towards the HIV infected people in discharging their services).

   DAPCU has made the following strategies to reduce the stigma in different level as follows:

 Community level campaign:

a.      Campaign for AIDS for NO AIDS.

b.     IEC/ Advocacy.

c.      Sensitization workshop on HIV/AIDS.

d.     Fixing hoardings on HIV/ TB/STD.

e.      ARSH training to adolescent girls.

 Besides that DAPCU has made the following action plan to reduce the stigma in different levels…..

1.     Need assessment.

2.     Vulnerable Mapping.

3.     Strengthening service delivery structures.

4.     Targeted intervention strategies.

5.     Condom promotion.

6.     Developing health seeking behaviour.

7.     Family strengthening programme.

8.     Farming Red Ribbon club.

   Other strategies/ services are being planned to reduce stigma, especially health, education and administration level.

                          

o   Priority on hospice care.

o   Priority on palliative care.

o   Day care, home care, hospital care and hospice care.

o   Counselling through ICTC and other service delivery points like DOTS Centre, EID Centre, Link ART/ ART Centre, STD clinic, Doctors clinic to the patients and his/ her family members.

o   Sensitization training to all the health care providers in the hospital.

o   School AIDS education programme.

o   Awareness through Red Ribbon Club.

o   Blood safety programme.

o   Health camp and STI screening programme.

o   Observing World AIDS Day by the responsibility / involvement of District administration.

o   Convergence with different line Depts. and make aware the duty bewares.

o   In the DAPCC review meeting, any topics/ issues related to HIV/AIDS are discussed to the members of the committee.

o   Work place intervention like awareness/ workshop in different factories / industries/ corporate sectors.

o   Advocacy to different stakeholders/ civil society partners/ Govt. officials through mainstreaming.

o   Media sensitization programme for writing on stigmatizing and no discriminating words.

o   Focussing on moralizing writings.

o   Motivating people for not engaging in high risk behaviour.

o   Providing administration and service providers with correct information on HIV/AIDS.

o   Campaign for togetherness in melas/ religious place/ cultural festivals.

o   Folk campaign/ Radio jingle playing.

o   Walling/ painting leaflets and its promotion in community level.

o   Involving the HIV affected people in the social benefit scheme as they think their rights rather discouragement. All the above strategies are the ongoing process of DAPCU to reduce the stigma and discrimination in different levels.

EXPERIENCE –I.

  Two school going orphan CLHIV were victimised with stigma during their school. DAPCU and TI partner and District Administration made the awareness programme in the concerned school, on HIV/AIDS, after that the school and the students accepted the children as normal.

  This was happened in Barabhagia sasan under Bhadrak Block.

EXPERIENCE – II.

  One family and the patient were discriminated by the villagers due to stigma in the Guamal village under Tihidi Block. After the massive awareness programme in that particular village, on HIV/ AIDS with the help of PRI members, the villagers accepted that family and treated them as normal.

                                     

Stigma always facilitates discrimination. Due to stigma, people suffer from discrimination. Once stigma is reduced, the discrimination cannot be happen. Everyone behaves to HIV/AIDS affected people differently and does not accept them as normal only due to stigma. Stigma is harmful but Discrimination is more painful. Stigma is the cause but Discrimination is its effect.

DAPCU UDUPI Response : DAPCU-Stigma & Discrimination

Stigma is a common human reaction to disease. Throughout history many diseases have carried considerable stigma, including leprosy, tuberculosis, cancer, mental illness, and many sexually transmitted diseases. HIV/AIDS is only the latest disease to be stigmatized. But HIV related stigma is attitude based. Changing attitudes are not that easy. Eliminating stigma completely remains at this stage only a dream, but an overview of the interventions does suggest that something can be done through a variety of interventions, such as focused information dissemination, counseling, coping skills acquisition and direct contact with someone that is living with HIV or AIDS. But in our District through a fair amount of interventions in every nook and corner, proven that the stigma is getting reduced.

Roles and Responsibilities of DAPCU:

  Ø  To protect right of those who are infected and provide access to available care support and treatment.
Ø  To access to condom, treatment of STI /RTI infection, Motivating for HIV testing
Ø  To make available the scope for social security coverage to for HIV positives.
Ø  Issues of contraventions or disturbances with respect to stigma & discrimination in accessing and utilizing the rights, services, provisions and benefits available for PLHIVs have been tackled by DAPCUs.
Ø  Co-ordination among HIV/AIDS facilities of the district to provide better services to HIV-AIDS positive clients
Ø  Sensitization Programme
Ø  Create awareness among students/youths through RRC regarding HIV/AIDS
Some of the interventions are:

• People living with HIV/AIDS need to be educated on their basic human rights;
• These rights will enable them to enforce it through the legal process;
• In order to mitigate the effects of discrimination and stigma, institutions should implement their HIV/AIDS policies based on sound information and taking into account the rights of everybody; and
• HIV negative people need to be educated too, in order to create an environment free of fear of HIV biased social attitudes and no stereotypes towards HIV.
• Attitude and behavior change interventions is highly needed in sensitizations.

Access to Services:

•  PLHIVs are educated with the help from Staff of ICTCs/ ART Centers and TI-NGOs about their rights, services, provisions and benefits granted by Government & Societies.
•  All the stand alone and ppp’s are providing services
•  Link worker scheme is also has predominantly serving the group.
• Bus pass felicity has been provided to all the positives by not disclosing their status.
•   OVC scheme is also linked to the children’s.
•   Availing medical care at hospitals.
• Health Care settings:

All the staffs of hospitals are sensitized.ASHA and Field staffs are making sure that each case of the area are being accessed to the services.

District Administration and its departments:

•    On Quarterly basis A meeting with DC and other DLN and NGO’s, ART is conducted where many issues related to HIV is discussed and sorted out.
•         A Sensitization programme has been conducted to police force
•      A Sensitization programme has been conducted to all the Lawyers and Judges.
•     Inter departmental sensitizations done with Women and child, Education, Health Dept.
•      All the teachers of the High schools are being sensitized.
•    A committee is formed under DC to coordinate and facilitate Social entitlements schemes to the Positives

Community Setting:

  Ø  All the SHG, GP Members and community people are regularly sensitized through DAPCU team, counselors and LW’s and Health staffs and TI, DLN’s.

                      WAP Sensitization at Fish canning Factory

The ever-presence of stigma and its persistence even in areas where HIV prevalence is high makes it an extraordinarily important yet difficult attitude to eradicate.. Given the fact that AIDS stigma caused enormous barriers to public health programs–from the denial and silence, to problems associated with disclosure, health seeking behavior, and to the communal violence

DAPCU Amravathy Response -DAPCU: Stigma & Discrimination

Stigma refers to unfavourable attitudes and beliefs directed toward someone or something Discrimination is the treatment of an individual or group with partiality or prejudice Stigmatization reflects an attitudeDiscrimination is an act or behaviour

Stigma into four loosely defined groups: physical, social, verbal and institutional.

1)      Social stigma

Isolated from community

Voyeurism: any interest may be morbid curiosity or mockery rather than genuine concern

Loss of social role/identity: social `death`, loss of standing and respect            

2)      Physical stigma

Isolated, shunned, abandoned

Separate living space, eating utensils

Violence         

3)      Verbal stigma

Gossip, taunting, scolding

Labeling: in Africa: "moving skeleton," "walking corpse," and "keys to the mortuary." In Vietnam: "social evils," and "scum of society."     

4)      Institutionalized stigma

Barred from jobs, scholarships, visas

Denial of health services

Police harassment (e.g. of sex workers, HIV-positive activists in China, outreach workers in India) 

•         HIV-related stigma is increasingly recognized as the single greatest challenge to slowing the spread of HIV/AIDS

1)      Freedom from discrimination is a fundamental human right

2)      Discrimination on the basis of HIV/AIDS status, actual or presumed, is prohibited by existing human rights standards

3)      Discrimination against persons living with HIV/AIDS (PLWHA), or those thought to be infected, is a clear human rights violation

The basic initiation of District authority is to issues of Infringements or disturbances with respect to stigma & discrimination in accessing and utilizing the rights, services, provisions and benefits available for PLHIVs have been tackled by DAPCU.

Creating awareness in all the related services which are closely related to the PLHIV like Health Services from Government as well as the Private services.

DAPCU received the complaint about the Stigma and Discrimination first of all we discuss with the together and after that the take next stapes.

In the initiation of DAPCU start in Amravati the case of Stigma and Discrimination of School Children from our district at the same time the same event happened in Latur (M.S.). But in Amravati the event closed within 4 days with the solution of (Villagers welcome all the CLHIV with flowers in School)

Events  on Anjangeon Bari Village in Amravati district
 

Introduction:- 

            Amravati district is situated in middle of vidarbha and adjoining to MP border. Anjangaon Bari is the village which is 15 K.M. away from Amravati city .The population of Anjangaon Bari is 15000 where PHC is working from last 5-6 years and recently converted into 24*7 PHC, 4 General practitioners including homeopath and RMP are working there. Most of the patients and maximum ANC has approach to Amravati for health problem.   

            Jeevean Vikas Sanstha is a NGO which is situated at Paratwada of Amravati district and its Navjeevan Care Center is at Nimbhora which is near to Amravati and orphan center for CLHA is run by the NGO.  That center has 21 CLHA for care and education. Eight CLHA boys are linked to Z.P. Marathi primary boy’s school; four CLHA girls are linked to Marathi girl’s school in Anjangaon Bari in this year, remaining is linked to Janata High school in Anjangeon Bari from last two year. The status of the children has disclosed to school teacher for precautionary major, in case the child get injury or get sick in school then school authority would have to contact to care center so the center will take care as early as possible. 

12^th August 2009:- 

            On the occasion of Youth day DAPCU and Civil Hospital organized the rally in the morning, RTM SAP MANDAL; Amravati is running a PPTCT project with the help of MSACS also organized the Youth Melava at Mozari D.Ed. Collage. On 12^th August 2009 when we had completed the rally and were on way (My self and Dr.Raghunathraoji Wadekar RTMSAP Mandal) to address the youth melawa. The PPTCT ex peers who is now working with CHAHA project has given the message at 12.30 PM that in Anjangeon Bari all parents of Z.P.primary school going children is gathered together to protest against school authority that their children will not attend the school if the CLHA are in school, because our children said us that in our school there are AIDS infected children so possibility of infection to us. 

            We (Ajay Sakhare and Dr.Raghunath Wadekar) finished the Youth melawa and proceed for the Navajeevan Care Center. After getting visit to Care Center’s Program Manager Anthony we got all information which has given above, then we both gone to that village to contact the Sarpanch of that village but she was out of station so unable to meet. After visiting some villagers we came back to Amravati. All details share with the Dr. C. L. Sonkusare Sir Civil Surgeon Amravati. 

13^th August 2009:- 

13th August, I shared and briefing to the  Shri Ramesh Deokar Sir (IAS) Project Director MSACS Mumbai, Dr.Basant Bagadi Sir, Addl. Project Director MSACS, Dr. Tayade madam, Joint Director MSACS,  after given  permission by PD Sir, attend the Meeting conduct by  Block Development Officer at Panchayat Samiti office with the education authority, School Head Mistress and the reprehensive of NGO. After meeting all member decided to Visit the Village. School and health authority with all NGO working on HIV/AIDS has visited to Anjangeon Bari and take meeting with school teacher and some parents who were present in the village. There were lot of confusion and myths and misconception of villagers about HIV/AIDS. After getting answer of their question they were satisfied and come on conclusion that on 15^th August evening all villagers with parents will come together and the NGO authority, health and education authority will sensitize to villagers. Hope that sensitization meets converts in positive attitude. 

14^th August 2009:- 

            Dr.Shri Basant Bagadi Sir Addl. Project Director MSACS visited Amravati on 14^th August 09 in relation to discrimination of CLHA in to Z.P. Boys School & Z.P. Girls School Anjangaon Bari Dist. Amrvati.   We visited on way to Community Care Center and orphan hostel at Nimbhora 7 Kms. from Amravati. There we discussed with Project Coordinator and Medical Officer about the problem of Anjangaon Bari School.

There after we visited the school at Anjangaon Bari discussed the issue along with Head Mistress and Teachers and then after conducted group meeting to sensitize then regarding HIV dynamics. We also discussed the issue with Sarpanch Smt. Kamaltai Tayade and Upsarpanch Shri Tingane and about 15 to 20 villagers and got positive response from there side.

 Then we visited the Janata High School in which 8 infected students have already been studying when there was no issue of discrimination. APD congratulate the Principle and the staff of the school for good harmony where by other students were taking keen interest in well being of HIV positive students.

 Lastly we visited Anjangaon PHC and gave necessary directions to laboratory technician for immediately for starting of F.I. ICTC which is 24*7 PHC where the LT is trained in HIV testing. Then we came back to Amravati and meet Block Development Officer, District Health Officer and District Civil Surgeon regarding the issue of Anjangaon Bari. During the meeting with DHO and PPTCT NGO secretary Dr.Raghunath Wadekar we discussed abut the ICTCs in 24*7 PHC of Amravati District. Dr Bagadi sir tried to meet Chief Executive Officer Shri Omprakash Bakuriya. After Dr. Bagadi’s departure I again went to CEO and had given the brief to CEO regarding the issue of Anjangaon Bari.

As per the instruction of Dr. Bagadi APD I meet following officers. The meeting all 4 NGO working in Amravati along with CS, DHO, BDO, & BEO was held on 15/8/09. 

15^th August 2009

On the planning of 13^th August meting the sensitization programmed organized by all the NGO working on HIV/AIDS at Z.P. School Anjangaon Bari. At the time of programmed near about 1000 and more villagers are attend the programmed. Firstly the songs “Hatse Hat Milao” and other songs will play on screen. After that the Mr. Ajay Kulathe Jivan Vikas Sanstha delivered the presentation in Marathi language on LCD. Then Dr. Raghunath Wadekar RTMSAP Mandal Mozari interacts with the villagers and touch to the issue. Mr. Vijay Dange NAP+ (positive speaker) also interacts with villagers. In the session of question and Answer Dr. Shri C.L. Sonkusare Sir, Dr.Shri K.S. Rathod sir, Shri Nikas District Education officer, Dr. Babita Vargia MO Community Care Center, Shri R.M.Bhuyar BDO, Dr. Raghunath Wadekar RTMSAP, Smt Kamaltai Tayade Sarpanh, Dr. Hutake MO PHC Anjangaon Bari, Shri Vilas Tayade NAP+ Aadhar and I answer to villagers’ question.

Conclusion of meeting: - The response is positive and the main thing is that the woman’s and majority of youth in side of CLHA. But few villager against the CLHA and they could not understand so close the meeting. After discussion with CS, DHO, EO, BDO, NGO representative, Sarpanch trap those people and one to one counseling to them.  And next strategy decided after meeting with Collector madam and CEO Sir. In that time we take decision the all CLHA students attend the school from 17^th August 2009.

  

Success story of Mainstreaming with General Population.

—  The DAPCU Amravati introduces the DLN to well known social worker of Amravati District Dr. Govind Kasat. Dr. Govind Kasat attends the get-together, peer convention and other events of DLN and discusses with the PLHIV assessments of their needs. Dr. Govind Kasat discuss with me about needs of PLHIV. Then he decided to collect the donation from different donor (Specialty of Dr. Kasat if he donate 5000 Rs. to  any needy person he collect this amount from 50 person not from single donor, Another specialty is he generate the funds from Raddi (news paper) collect from home to home and generate the funds).

—  Then we discuss with Mrs. Tayade president of DLN and discuss about their need she said they need sewing machines and 1 Bicycle for CLHIV.  Dr. Kasat collects the donation from donor and date fix by DPO, DLN president and Dr. Govind Kasat, also fix the guest of the programme.

—  The DLN take whole responsibility to organize the programmed. The near about all the guest are attend the programme.

—  The all donor attend the programme.

—  Programme start on time.

—  At the tea time the all delegates take the food made by the DLN member without any hesitation.

It is our main motto to mainstreaming of the white color people of the society to mix with the PLHIV.