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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.

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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

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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

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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

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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

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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)

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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

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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.

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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).

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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.

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• 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

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