Rapid Situation Assessment and Analysis of the HIV/AIDS Epidemic ...

Rapid Situation Assessment and Analysis of the HIV/AIDS Epidemic and
Response in Delhi
January, 2002
A Report prepared for the India HIV/AIDS Alliance 1
1. Background
Delhi as the capital city of India is an urban city made up of a number of large
urban settlements or towns. New Delhi is one of the fastest growing cities in the
country with a population estimated to be in excess of twelve million people.
Demographic indicators
The cultural and political history of the state indicates that it has permitted the
entry of many diverse cultures. It is cosmopolitan in character, drawing people
from all parts of the country and the world. Hindus constitute nearly 84 percent of
Delhi’s population, Muslims 8 percent, Sikhs 6 percent, with smaller Christian,
Jain and Buddhist communities. The majority of the population speak Hindi, but a
sizeable population speak Urdu and Punjabi. (1991 Census)
Physical spread and density of population
Delhi has an area of 1,483 square kms, 798 rural and 685 urban and consists of
one district and two rural tehsils, Delhi and Mehrauli; three stationary towns
(Delhi Municipal Corporation, New Delhi Municipal Committee and Delhi
cantonment) (1991 Census). At the time of the 1991 Census, Delhi was a Union
territory and achieved statehood in 1994. Majority of the population, almost 90
percent reside in the urban agglomeration of Delhi, which constitutes only 42
percent of the total area. The highest densities are registered in old Delhi and in
Shahdara, east Delhi, across the River Yamuna. Delhi is a rapidly modernising
city, with above average infrastructure by Indian standards and is well connected
to the rest of the country by surface and air routes.
In 1996, the population of Delhi reached 11.4 million with a population density of
6352 per square kilometer. According to the National Family Health Survey – 2
(1998-99), the estimated population as on July 1, 2000 is 14.1 million. The
growth rate of population has been one of the highest among the large cities of
India and it has the highest population density among all the states. Migration of
workers from other parts of India, especially from Bihar, Orissa, and Bangladesh
is a major reason for the high density in many areas. Much of the population has
settled in slums and shanty towns. It is estimated that 40 percent of Delhi’s
population currently lives in these settlements (1991 Census). In recent times,
1 This report has been prepared by Renuka Motihar, consultant, India HIV/AIDS Alliance with
inputs from Dr. Asha Rao and Anand Kurup.
1

ural regions of Delhi have had to absorb a large number of migrants, who have
either come directly to settle in these parts or have moved from the Delhi urban
agglomeration due to congestion. The sex ratio of the total population of Delhi
Union territory was 827 females per thousand males, with a lower ratio in the
rural (807) as compared to the urban (830) areas (1991 Census). This represents
a differential pattern of growth with a marked imbalance in the sex ratio, in part a
consequence of migration patterns and in part representing the lower status of
women.
Table 1: Demographic Indicators in Delhi
Population (million), NFHS-2 14.1
% urban, 1991 89.9
Density (pop/sq.km.), 1996 6352
% Schedule caste, 1991 19.05
% Hindu 78.8
% Muslim 8.9
% Sikh 4.6
Rural (per 1000)
Birth rate
Death rate
Urban (per 1000)
Birth rate
Death rate
24.9
4.9
23.2
6.1
Natural Growth rate, rural (%) 20
Natural growth rate, urban (%) 17.1
Slum population, as % total urban population, 1991 41
% Literate, 2001 87.37% - males
75% - females
% Labour force participation rate (2001) 54.3 - males
10.2 - females
Sex ratio, 2001
821 females per
1000 males
Source: Census 1991, Census 2001, NFHS-2 (1998-99)
2

A survey carried out by several NGOs including Bachpan Bachao Andolan,
Navjyoti Foundation and Prayas under the banner of Ashray Adhikar Abhiyan
(AAA), found that there are 53,000 homeless people in Delhi living off the
streets. 2 The largest number of homeless people was in the walled city area of
Old Delhi. Here the pavements, were home to 15,000 people, though, unofficially,
the figure is believed to be 1,00,000. Most of the people live on the roadsides, at
abandoned bus stops, under unused bridges, railway platforms, deserted lanes,
in parks and under flyovers. These people are not represented by any
government Census exercise.
Table 2. Health Indicators
Total Fertility rate 2.40
Infant Mortality rate 46.8 per 1000
Maternal Mortality rate 3.2 per 1000
Women aged 15-49 who have ever
heard of AIDS
Contraceptive prevalence rate among
married women
Source: NFHS-2, 1998-99
79.2 %
63.8%
2. HIV/AIDS Epidemic
The National AIDS Control Organisation (NACO) describes Delhi as a low
affected state (HIV prevalence in any of the high risk groups is still less than 5
percent and is less than 1 percent among antenatal women) (NACO, 2000-2001).
Most authorities agree that because of under-developed epidemiological systems,
surveillance in India is challenging and AIDs cases are under-reported in India.
State Number of Sites HIV Prevalence %
Delhi STD 3
ANC 3
IVDU 1
3.26
0.25
5.00
2 Dorabjee et al. Rapid Situation Assessment of Drug Use in Delhi, Sharan, New Delhi.
3

NACO Behaviour Surveillance Survey for Delhi, 2001
Awareness of HIV/AIDS
Male Female Total
Ever heard of
HIV/AIDS
Transmission
through sexual
route
Transmission
through blood
transfusion
Transmission
through needlesharing
90.6 85.9 88.2
88.1 82.1 85.0
89.5 82.7 86.0
88.1 80.7 84.3
Awareness of Sexually Transmitted Diseases (STDs)
Male Female Total
Linkage between
STD and
HIV/AIDS
28.1 19.9 23.9
STD Symptoms
among women
32.7 32.1 32.4
STD symptoms
among men
33.1 35.4 34.3
4

STD Prevalence and Treatment Seeking Behaviour
Male Female Total
Treatment in Govt.
Hospital/Clinic
during last
episode
21.3 9.6 13.7
Aware of
someone infected
with HIV/AIDS
2.3 2.0 2.2
Aware of
someone who has
died of HIV/AIDS
1.8 2.2 2.0
Aware of HIV
testing facility in
the area
21.1 14.9 17.9
Report on Sentinel Surveillance for HIV Infection
No.
of
sites
1999 2000 2001
No.
of
HIV
+ve
cases
HIV
+ve
%
No.
of
sites
No.
of
HIV
+ve
cases
HIV
+ve
%
No.
of
sites
No.
of
HIV
+ve
cases
HIV
+ve
%
STDs 1 2 0.8 3 11 3.04 4 41 5.35
IDUs - - - 1 5 5.0 1 4 2.39
ANC 2 2 0.25 3 2 0.16 4 2 0.12
According to the Ministry of Health, there are 646 cases of AIDS reported in the
city so far. While 167 patients have died, there are over 22,000 HIV positive
cases in Delhi. Out of the total 646 cases, 557 were male, 89 female, 18 in the
5

age group of 0-14 years, 234 in the 15-29 years, 282 in the 30-49 years, 66
above 50 years and 46 have not specified their age. The sentinel surveillance
survey was conducted at seven sites in the city in 2000 which revealed that in
general 25 per cent of the population were HIV positive, among STD patients,
3.73 percent were infected and among drug users it was five per cent. According
to their statistics, 73.58 percent people had been infected due to unsafe sex,
5.18 percent due to transfusion of infected blood, 4.08 percent due to injectable
drug use, 1.72 percent due to prenatal transmission and 15.40 percent due to
other reasons. 3 According to the ministry, some of the reasons that have
contributed to the high risk of HIV transmission are increase in migrant
population, street children, commercial sex workers, and intravenous drug users
in the city.
People living with HIV and people suspected of being HIV positive still face
severe stigma and discrimination from the medical community. There are reports
of people having been denied care and complete lack of confidentiality.
Evidence from Epidemiological and Clinic Studies
BBC World Service Trust and ORG CSR recently conducted a formative
research and baseline survey under their project “Promoting HIV/AIDS
Behavioural Change in low prevalence states of North India – Uttar Pradesh,
Rajasthan and Delhi”. 4 The research explored issues of interpersonal
communication regarding sexual matters; knowledge, attitudes and perceptions
on HIV/AIDS and STIs and finally, sexual relationships and behaviours in the
community.
According to their findings, adolescent girls were hesitant to share concerns on
sexual issues, after repeated probing they identified multiple sexual relationships
as a major mode of transmission of HIV/STIs. There was virtually non-existent
self-perception of risk. Adolescent boys knew more about HIV/AIDS than girls.
However, they could not distinguish between myths and correct information. The
self- perception of risk was high but only in comparison to other groups. Some of
the participants boasted about multiple relationships. Adult women were not
aware of the causes of HIV/AIDS, were shy in discussing condom use, had no
discussions on sexual matters with the spouse; after repeated probing identified
multiple sexual relationships as the most common route of transmission of
HIV/AIDS. They reported “brothel” visits as resulting in multiple sexual
relationships. Adult men considered HIV/AIDS to be a western disease. They
were aware about condoms for family planning but did not favour use. They were
unwilling to discuss pre-marital or extra-marital sexual relationships. They
3 “Anti-AIDS drive in the city in February”, The Asian Age, January 4, 2002, New Delhi
4 “Research Findings (Formative Research and Baseline Survey): Promoting HIV/AIDS
Behavioural Change in low prevalent states of North India”, BBC World Service Trust and ORG
CSR. Presentation, January, 2002
6

accepted that extra and pre-marital sexual relationships existed but denied
“personal” knowledge.
In the findings on perceptions related to PLHAs, 4 percent respondents reported
knowing anyone who was infected with HIV. Respondents most likely to report
this were urban (73 %), men (61%) between 15-29 years of age, belonging to
high SES (51%). Around 7 percent respondents knew anyone who had been
died of HIV/AIDS. The respondents most likely to know someone who had died
of AIDS were more likely to be urban (62%), men (60%), between the ages of 15-
19 (34%) or 20-29 (40%) and belonging to higher SES (53%).
At face value, over 70 percent of the respondents indicated that the people in
their village/locality would allow HIV/AIDS patients to stay in the village/locality.
However, when asked if AIDS patients could be treated along with general
patients less than half (45%) of respondents answered in the affirmative. When
asked if AIDS patients should be kept in isolation, over 50% responded in the
affirmative. Delhi respondents reported most positive attitudes (53%) and U.P.
respondents reported the most negative attitudes at 59%. In the best case
scenario, only about 50% of the respondents by state supported positive
attitudes towards PLWHA. Urban respondents had more positive attitudes (61%)
in comparison to rural audiences (40%). However, more women (54%) reported
lack of positive attitudes compared to men (32%). Higher age groups and lower
SES tend to lower positive attitudes. (Details of study in annexure)
Injecting Drug Use and HIV
The sharing of injecting equipment among India’s IDU community is widespread
and in many circumstances it is considered the norm. The recent RSA in India
showed that most IDUs had at some stage (often within the past 6 months)
shared their needle and syringe. The rate of ever-sharing in Delhi is 50 percent.
(Sharan, 2001). Estimating the number of drug users in India has for years
proven elusive and this still remains the case. A rapid situation assessment (RSA)
of injecting in Delhi has shown that the estimates of IDUs in Delhi is 25,000-
30,000 (Dorabjee and Samson, 2000). While examining the percentage of opiate
users who are current IDUs the extent of injecting varies from one city to another.
The recent RSA data for Delhi shows 27 percent. The majority of drug users in
India are male and in many drug treatment centers female drug users range from
1 percent to 10 percent depending on the city and the geographic region.
(UNAIDS and UNDCP, 2000). There is a great stigma attached to women
seeking assistance and many cannot go into treatment for long periods of time
because they need to look after their children. A study in Delhi of female drug
users (N=35) shows that 30 percent are involved in commercial sex work (CSW).
While 15% of the respondents admitted to being IDUs, it is not clear if these
same people are also CSW. (Sharan, Dorabjee et al, 2001).
Recent data from the RSA study on drug use shows the onset of drug use in
various cities ranged from 15 to 18 years. Many drug users are from a lower
7

socio-economic background with substantial numbers having poor education and
working in insecure positions or experiencing high levels of unemployment. In
2000, HIV infections among IDUs in Delhi was 44.8 percent. Of increasing
concern is the transmission of HIV infection among IDU to their non-injecting
wives.
Men who have sex with Men (MSM) and HIV
Naz Foundation India is one of the very few organizations who has been working
with men who have sex with men (MSM) in Delhi and had conducted an initial
baseline study and recently a mid term survey as a part of their project. The
findings were as follows:
Condom usage Baseline study (%) Mid Term Survey (%)
Never 59% 33%
Sometimes 30.25% 24.25%
All the time 10.75% 42.75%
Knowledge of Baseline Survey (%) Mid Term Survey (%)
HIV/AIDS
Good Knowledge 13.50% 35%
Poor Knowledge 38% 21.50%
No Knowledge 48.50% 43.50%
STD Levels and Treatment
Experience of STD Symptoms in the last two years
Experience Baseline Survey (%) Mid Term Survey (%)
Yes 43.75% 25.50%
No 56.25% 74.50%
Piles 39% 28%
Previous treatment for STD infections
Yes 84.75% 94.50%
No 15.43% 5.50%
Vulnerable Children
According to the Delhi Government, Department of Health and Family Welfare,
there are at least 5 lakh street children who have no access to any health service
and are prone to HIV/AIDS. There is a high level of STDs among street children.
(website: Delhi Government, Dept. of Health and Family Welfare)
8

3. Responses
Interventions
Government
In the first phase of the National AIDS Control Program (NACO), the nodal
agency for HIV/AIDS prevention and control in India, focussed primarily on IEC
activities. Under phase II, started in 1999, the focus is on HIV/AIDS prevention –
IEC, targetted interventions, condom promotion, PMTCT and care and support in
a limited way. The government supported work in the city is operationalised
through the DSACS (Delhi State AIDS Control Organisation). NACO has
sanctioned 7 Voluntary Counselling and testing centres in Delhi through the
DSACS –
1. All India Institute of Medical Sciences
2. Maulana Azad Medical College
3. University College of Medical Sciences
4. Lady Hardinge Medical College
5. Armed Forces Transfusion Centre
6. NDMC Polyclinic
7. National Institute of Communicable Diseases
8. Safdarjung Hospital
At present, treatment for STDS is being provided in the Skin and VD Dept. of the
following hospitals:
1. Lok Nayak Hospital
2. GTB Hospital
3. Sucheta Kriplani Hospital
4. Ram Manohar Lohia Hospital
5. Safdarjung Hospital
6. AIIMS
7. Hindu Rao Hospital
8. Deen Dayal Upadhyay Hospital
9. V.D.Clinic and Dispensary (MCD), Lal Kuan
10. V.D. Clinic and Dispensary (MCD), Roshanara Road
11 STD clinics have been strengthened, 14 blood banks have been sanctioned,
there are 10 targetted intervention projects through NGO’s and a School AIDS
program with 30 NGO’s who are working in 30 government schools each in
different phases on AIDS education using a peer educator model. Some of the
NGO’s who were a part of the initial UNESCO supported pilot project are Prerana,
YAAR, Ahead, Deepalaya and SPYM. The program is for students of classes 9
and 11. The NGO provides technical support and monitoring and conducts
trainings for master trainers – peer educators and teachers. Also conducted are
advocacy and sensitisation workshops for school principals and parents.
9

DSACS is also implementing Family Health Awareness camps. The Health
department of the Delhi Government is planning to organise the next family
Health awareness camp in February 2002. The focus will be on creating
awareness among the masses through television, radio, video screening,
advertisements, bus panels, hoardings at petrol pumps and colleges, kiosks on
G.B.Road, stickers, messages on electricity and water bills. Awareness camps
would also be organised.
Non Government Organisations
Some of the well known HIV/AIDS organisations in Delhi are Naz Foundation
(MSM, Capacity Building, care and Support, AIDS Prevention and Sexuality
education, Advocacy); Sharan (IDU's and research); Sahara (Care and Support,
running a hospice – Michael’s Care Home, IGP for PLHWAS with support from
CII); AIDS Awareness Group (AAG); Chelsea (Institutional care and support) and;
TARSHI (Sexuality and HIV/AIDS Education through a telephone helpline).
NGOs working with commercial sex workers include Joint Women’s Program
(JWP), STOP (focus more on trafficking issues and vulnerability to HIV).
There is also a group of 7 NGO’s who run the counselling centre at Safdarjung
Hospital – Naz, Sharan, Sahara, Chelsea, TORCH, AAG and JWP. Most of the
NGO response to HIV/AIDS in Delhi is mostly focussed on awareness/prevention.
Many NGO’s are reluctant to initiate programs for care and support of PLHAS
because of societal prejudices, stigma and discrimination and misconceptions.
Community networks
Delhi Network of Positive people, operates out of the Sahara office and they have
support groups for people living with HIV/AIDS including groups of women.
Research
Population Council under its Horizons project 5 is supporting intervention research
in Delhi in three hospitals. Hospitals in India are facing the challenge of providing
medical services to a growing number of people living with HIV/AIDs. While
important steps have been taken to train health care workers in clinical
management of HIV/AIDS, there remains concerns about stigma, discrimination,
and equitable access to care for PLHA. Staff safety is seen as an important prerequisite
for quality care for PLHA and is also a concern. The project focusses on
developing strategies to improve the hospital environment for people living with
HIV/AIDS. The participating agencies are Sharan, an implementing agency in
Delhi, Population Council/Horizons project who provide technical and financial
support; three participating hospitals – 1 central government, 1 state government
and 1 private hospital and an academic institute, Institute of Economic Growth.
5 Population Council/Horizons project documents, presentation abstracts and presentations, 2001
10

The aim of the research study is to improve the hospital environment for HIV
positive clients in Delhi. The project period is February 2000 to July 2002 and the
objectives of the study are: to identify institutional factors and practises that lead
to sound infection control practises and improved services for PLHAs; and to
develop and pilot an achievement checklist which guides hospitals in reaching
these outcomes. The research methodology included a formative phase,
baseline survey phase and now, an intervention phase.
Data from both the formative and baseline survey guided the design of the
intervention phase, which has two components: development of an achievement
checklist and development of hospital specific action plan. The checklist was
developed from pre-existing national and international guidelines and policies. It
delienates “Gold standards” for PLHA care and staff safety. It is aimed to guide
managers in achieving a safer institutional environment that responds to the
needs and rights of HIV/positive patients as well as staff safety. (Details in
annexure)
Achievement Checklist
“Gold Standards” – Guidelines for HIV-positive patient care
Testing and Counselling
• All HIV tests are voluntary
• All HIV tests are accompanied by informed consent
• All HIV tests are accompanied by pre-and post-test counselling by trained counselor
Confidentiality
• Information about HIV status is communicated only to treating HCW’s and is otherwise
kept confidential
• Test results are communicated directly and exclusively to the patient, unless otherwise
requested by the patient
Infection Control
• All staff are trained in infection control and PEP.
• Universal precautions are practised, in the same manner, with all patients
• Sound waste management is practised at all times by all staff
• All staff are informed about and have access to free hepatitis vaccines and PEP
• An infection control team is in place and meets regularly (once a month or more)
Access to Services
• Care for PLHA is not denied, delayed or referred elsewhere for services available within
the institution
• Care for PLHA is of the same quality as the care provided to other patients
• PLHA are neither segregated nor visibly labeled
The Hospital actively links PLHA to sources of ongoing palliative care and social support in
their own communities
Donors
11

Private Foundations
MacArthur Foundation has funded HIV/AIDS initiatives in the past eg. Naz
Foundation, Sahara etc, however, the funding policies now focus on reducing
maternal morbidity and mortality and adolescent sexuality and reproductive
health.
Ford Foundation is supporting a network on HIV/AIDS in the country and is
funding Naz Foundation and TARSHI in Delhi which work on HIV/AIDS issues.
Aga Khan Foundation only funds initiatives on health in Gujarat and Maharashtra.
International Agencies: Multilateral, Bilaterals, and private organisations
USAID began support for India’s HIV/AIDS program in 1990. USAID is one of the
largest donors for HIV/AIDS in the country. They are supporting state-specific
intervention programs in Tamil Nadu (APAC) and Maharashtra (AVERT). USAID
is also supporting CAA projects through Family Health International. Two of the
implementing agencies for CAA in Delhi are Salaam Baalak Trust and Project
Concern International (PCI).
The European Union (EU) supports NGO activities in HIV/AIDS prevention and
care, and funds the Lawyers Collective to implement a project on human rights,
ethics and law.
The Australian High Commission through AusAid, is supporting an HIV/AIDs
Prevention and Care program in 4 states of India – Manipur, Mizoram,
Meghalaya and Delhi. The goal of the project is to contribute to the national
response in reducing the risk and impact of HIV/AIDS. The projects consist of
integrated responses to priorities identified by each state. Another project
focusses on capacity building and project management, supporting the
implementation of the state specific sub-projects and also coordinating inter-state
activities. Each sub-project has a component of integrated response to address
the risk of HIV transmission among defined vulnerable populations through a
program of targetted interventions specific to these identified populations. Further,
in Delhi other components address identified priorities of the special needs of
women affected by HIV/AIDS and the care and support needs of those directly
affected by the epidemic. (AusAid website)
SIDA (Swedish International Development Agency) is supporting HIV/AIDS
interventions (prevention, care and support) in the northeast while in Delhi they
support MAMTA for adolescent reproductive health and sexuality (capacity
building, networking, advocacy and information exchange).
CIDA (Canadian International Development Agency) is supporting state specific
interventions on HIV/AIDS in Rajasthan and Karnataka.
12

UNAIDS established a Joint Working Group on HIV/AIDS to coordinate the
response of the UN agencies to the epidemic and provide assistance to GOI in
the specific development of activities. The theme group is comprised of members
from the United Nations Development Program (UNDP), the United Nations
Educational, Scientific and Cultural Organisation (UNESCO), the United Nations
Population Fund (UNFPA), the United Nations Children’s Fund (UNICEF), United
Nations Development Fund for Women (UNIFEM), United Nations International
Drug Control Program (UNDCP), The International Labour Organisation (ILO),
the World Health Organisation (WHO), and the World Bank.
UNICEF supports operations research on paediatric HIV/AIDS and vertical
transmission especially supporting a feasibility study on PMTCT of HIV infection
in 11 centres in India; and HIV/AIDS education for school-based and out of
school youth.
UNESCO is involved in school-based education programs, peer education and
empowerment of women.
UNAIDS provides coordination, facilitation and monitoring inputs for all UN
agencies activities on HIV/AIDS. It supports the Technical Resource Groups,
Advocacy, Surveillance, decentralisation and information exchange.
WHO is working to strengthen STI prevention and control through training,
operations research and technical assistance to NACO; improve the provision of
condoms through quality assurance protocols and studies on the female condom;
ensure safe blood supply; improve the clinical management of HIV/AIDS;
improve HIV/AIDS surveillance; increase support to PLHWAs; and increase the
capacity of NGO’s to implement prevention activities.
World Bank provides the largest grant to NACO for the national response to the
epidemic.
ILO supports interventions in the workplace with the Ministry of Labour and
NACO. The V.V.Giri National Labour Institute, Noida is the nodal implementing
agency. Some of the major features of the project are mobilisation of partners
through stakeholders’ meetings/consultations/seminars to put HIV/AIDS on their
agenda; research based advocacy – documentation of corporate responses to
HIV/AIDS, compilation and dissemination of existing research studies on
HIV/AIDS in the world of work, and initiation of action research action projects;
and building response capacity of partners through training programs.
Pathfinder International, a private international organisation is supporting three
NGO’s in Delhi for interventions on adolescent sexuality and reproductive health
(CASP Plan, DISHA and Deepalaya).
13

Networks on HIV/AIDS
There is a network of NGO’s – Networks, supported by Ford Foundation that
consists of 15 NGO’s working to prevent the spread of HIV/AIDS in India and
Nepal. The NGO’s work with diverse constituencies – rural and urban poor,
middle class, truckers, people in prostitution, drug users, blood donors, men
having sex with men (MSM), non-literates, adolescents, community groups,
health providers, military and the police. The network aims to prevent the
transmission of HIV through a range of interventions such as advocacy, peer
education, counselling, training, community mobilisation, providing HIV Care and
Support, information on sex and sexuality, forming collectives and creating
alternate media materials. If we look at the three states where the Alliance works,
in Delhi, the network members are CREA, TARSHI and Naz Foundation. In Tamil
Nadu, the network members are Nalamdana, Prepare, YRG care and CMC
Vellore. While the network has no members from Andhra Pradesh.
4. Key issues
Delhi is a complex metropolis made up of diverse migrant groups speaking
different languages, settled in urban and rural portions. The population is not
evenly spread, concentrated mainly in old Delhi. However, the last few years, the
growth rate has been very high amongst the highest in the large cities of India,
due to the influx of migrant populations primarily from Bihar, Orissa and
Bangladesh. Much of this population has settled in slums, shanty and satellite
towns. It is estimated that 40 percent of Delhi’s population currently lives in slum
settlements (AusAid).
The response to HIV/AIDS in the city has been inadequate in relation to the rapid
spread of the epidemic especially amongst the young, low-income and
vulnerable groups. Factors that contribute to this are high migration, low status of
women, illiteracy, congestion, and lack of access to quality public and reasonably
priced private health services. The informal labour sector also constitutes a large
population of the workforce. There is an increasing trend of HIV infection among
the groups with high-risk behaviours as represented by STD clinic attendees,
injecting drug users, women in sex work and transport workers. Of concern are
the rising rates among women and children. The safety of blood and blood
products is still to be assured (AusAid).
The responses of the government, NGO’s, donors and corporate sector remains
inadequate and small efforts dispersed in a huge population. DSACs is the
primary supporter of interventions in Delhi along with a few donor agencies such
as AusAid, Ford Foundation etc. The major NGO’s are Naz Foundation, Sharan,
Sahara, AAG and more recently MAMTA with its eight partner agencies with
India HIV/AIDS Alliance support. The DSACS supported NGOs include TORCH,
Drishtikon etc. The corporate sector, through the CII is supporting income
14

generating activities for PLWHAs through the NGO Sahara and hopes to do
more work in the future through the India Business Trust, which will focus on the
corporate sector’s response to HIV/AIDS.
The phenomenon of urban poverty has given rise to many problems of street
children, child labour, sexually exploited adolescent girls and young women, child
prostitutes and drug use.
5. Recommendations
India HIV/AIDS Alliance has a distinct advantage of being known as a supporter
and implementor for Community and Home based Care and Support of HIV/AIDS,
an area where very few international and national, local NGO’s are doing work in
India and in Delhi. The areas where there are gaps in Delhi and need priority are:
• Sensitisation of the general public and the key populations on reducing
stigma and discrimination as that appears to be a huge problem in a
cosmopolitan city like Delhi. The BBC World Service Trust research study
reinforces that impression. This may need a communication initiative,
perhaps linking up/collaborating/developing partnerships.
• The BBC study has shown the complete lack of information on HIV/AIDS
prevention in adolescents and adults especially women who are thus more
vulnerable and at risk.
• Another area for reducing stigma and discrimination for PLHA, addressing
concerns of staff safety is in the hospital environment. There is a major need
to reduce the discrimination, and lack of confidentiality in the hospital setting –
government or private. The main objective should be to try and change
attitudes across the staff, that hospital administrators, doctors, nurses and the
class 4 employees, ie. cleaners etc.
• The populations currently being covered by the India HIV/AIDS Alliance are
PLHA, CAA and FAA. More organisations working with street, working and
vulnerable children need to be involved as well as the current programs
supported to be upscaled to cover larger numbers. There are currently many
organisations working with street children in the city, however, their focus is
not on HIV/AIDS and is a broader integrated approach focussing on
education and vocational training, counselling (eg. YMCA, Don Bosco etc).
Another target group could be adolescents and young people who are also at
risk and research has shown their vulnerability and lack of information.
• The geographic focus currently for the Alliance supported programs in Delhi
are on South and North Delhi and need to be expanded to cover the other
areas where there are vulnerable populations.
• Another area for focus is advocacy, especially on legal issues. For people
living with HIV/AIDS in Delhi, there are issues of property, being evicted from
their houses and guardianship for orphans etc.
15

• Capacity Building is a major need and most of the technical support for
agencies is provided by agencies that are already overstretched. There needs
to be a more structured system for training and capacity building for
organisations especially on issues such as how to conduct needs assessment,
proposal development, how to run a care and support program etc.
• There also needs to be more mainstreaming with other development activities
of organisations such as Prerana, CASP Plan, Disha, Action India, Deepalaya
etc.
• Programs for key populations eg. IDU’s, CSW’s, CAA and PLHAs are
sporadic and focussed on prevention. Care and support needs to be given
more attention
• Strengthening and collaboration with networks and support groups for positive
people as they can influence prevention activities.
References
AusAid, 1998. A Situation Analysis of the HIV/AIDS Epidemic and Responses in
the states of Manipur, Meghalya, Mizoram and Delhi
Anti-AIDS drive in the city in February”, The Asian Age, January 4, 2002, New
Delhi
BBC World Service Trust and ORG CSR, “Research Findings (Formative
Research and Baseline Survey): Promoting HIV/AIDS Behavioural Change in low
prevalent states of North India”. Presentation, January, 2002
Dorabjee, J et al, Sharan, 2001. Rapid Situation Assessment of Drug Use in
Delhi.
DSACS, 2001 Statistics on AIDS Cases in Delhi, Report on Sentinel Surveillance
for HIV Infection
NACO, Combating HIV/AIDs in India, 2000-2001. MOHFW, NACO, New Delhi
NACO, National Baseline General Population: Behavioural Surveillance Survey,
2001. Ministry of Health and Family Welfare, NACO, Government of India, New
Delhi
Networks, 2001. A Family of Concerns, Supported by Ford Foundation, New
Delhi
Population Council/Horizons project, 2001. Presentations and documents on the
hospital study in New Delhi
16