RESPONSE TO HIV/AIDS IN INDIA 2003 E PAN T EME G OU O V AIDS TEXT : Patralekha Chatterjee DESIGN : Sanjit Das/www.sanjitdas.com PHOTO : Cover © UNAIDS/M.Jensen Inside pages Preface, 5, 17: © UNAIDS/Wendell Phillips Page 2,3 : © UNAIDS Page 6: © UNAIDS/M.Jensen Page 14: © ILO Page 26: © CHARCA PRINT : Rajdhani Art Press Published June 2004 This edition copyright 2004 by UNAIDS UNAIDS c/o UNDP 55, Lodi Estate New Delhi 110003 Tel. (+91)-11-24628877 Www.unaids.org.in RESPONSE TO HIV/AIDS IN INDIA 2003 EXPANDED THEME GROUP ON HIV/AIDS CONTENTS Preface Chapter I The HIV/AIDS Epidemic in India 1 1.0 Introduction 1 1.1 Emerging Trends 2 1.2 Low Epidemic Environment: Challenges and Opportunities 2 Chapter II The National Response 3 2.0 Introduction 3 2.1 Goals of National AIDS Control Programme (Phase II) 4 2.2 Prevention Strategies 4 2.3 Capacity Building at the State-Level 4 2.4 Services Delivery 4 2.5 Paradigm Shift 5 2.6 New Donors, New Resources 6 Chapter III The Joint Response of the Expanded Theme Group on HIV/AIDS 7 3.1 The Expanded Theme Group on HIV/AIDS in India 7 3.2 Prevention of HIV Transmission Among Groups at High Risk 9 3.3 Prevention of HIV Transmission in the General Population 10 A. Women 10 B. Children and Young People 11 C. General Population 12 D. Voluntary Confidential Counselling and Testing 13 E. World of Work 13 3.4 Care, Support and Treatment 15 A. Low Cost Care 15 B. Mobilising Communities and New Partnerships in Addressing Stigma and Discrimination 16 against People Living with HIV/AIDS C. Legal and Ethical Issues 16 3.5 Strengthening Capacity 17 A. Greater Involvement of People Living with HIV/AIDS 17 B. Strengthening Network of People Living with HIV/AIDS 20 C. Leadership and Advocacy for Effective Action on the Epidemic 20 D. Increasing India's Capacity for Research on HIV/AIDS 21 E. Mainstreaming Activities 22 F. Engendering HIV/AIDS in policy and practice 22 3.6 New Research Findings 23 3.7 New Directions 24 Chapter IV Innovation: CHARCA, a multi-sectoral, district-level intervention by the UN Co-sponsers 25 Chapter V The Way Ahead 27 ANNEXURES 1. Members of the Theme Group 2. Brief profiles of Theme Group members LIST OF ACRONYMS FOOTNOTES PREFACE The Theme Group on HIV/AIDS is a dynamic and vibrant multi-stake holder partnership that plays a critical role in the HIV/AIDS response in India. It is a forum that brings the cosponsors of UNAIDS, the government, bilateral partners, international foundations and networks of positive people together to coordinate efforts, share experiences and lessons and where possible work jointly with an aim to support national policy and programmes on HIV/AIDS. We all receive the excellent support of UNAIDS in the working of the Theme Group. This report presents highlights of programmes and activities carried out by members of the Theme Group collectively as well as individually on HIV/AIDS in support of the Government of India's priorities. 2003 was marked by the Indian Government's announcement of its decision to provide free antiretroviral treatment to selected categories of People Living With HIV/AIDS in six states with high HIV sero prevalence. There has been a shift in approach to information, education and communication campaigns as well as a determined effort to upscale services for vulnerable segments of the population and people living with HIV/AIDS. Furthermore, efforts have been made to mainstream concerns of HIV/AIDS by reaching out to several key Departments and Ministries like the Department of Youth affairs and Sports, Ministries of Railways and Ministry of Defence. By supporting the HIV/AIDS Parliamentary Forum, the Theme Group in 2003, has been able to bring political leaders at all levels - from the Prime Minster to the Panchayats - to commit on strategies on how best to respond to challenges posed by the HIV/AIDS epidemic. The other key success for the Theme Group during the year has been the facilitation of two major activities - drafting of the Greater Involvement of People Living with AIDS (GIPA) Strategy and preparation of the HIV/AIDS bill. The success of both activities has been the participatory process that has enabled the reflection of concerns and views of key stakeholders. Specifically, the Networks of People Living with HIV/AIDS (PLWHA) and women's groups. As the Theme Group Chair, I look forward to a continued commitment by all partners in the next year to support efforts in the realisation of the national goal on HIV/AIDS of zero level increase by 2007. Dr. Maxine Olson Chairperson Expanded Theme Group on HIV/AIDS INTRODUCTION India is on the brink of one the biggest public health challenges in its history. In a country of over one billion people, between 3.82 million and 4.58 million 1people (15-49 years) are living with HIV/AIDS . This is less than one percent of the country's population and far removed from the double-digit figures in parts of Africa. Still, India has the second highest number of people living with HIV/AIDS in the world after South Africa. India accounts for almost 10 per cent of the 240 million people living with HIV/AIDS globally and over 60% of the 7.4 million people living with 3HIV/AIDS (PLWHA) in the Asia and Pacific region . Given the large population base, a rise of just a few percentage points in the HIV prevalence rates can push up the number of those living with HIV/AIDS to millions. Tracking the epidemic and implementing effective programmes is compounded by the fact that there is no one epidemic in India. Rather, there are several localised sub-epidemics reflecting the diversity in socio-cultural patterns and multiple vulnerabilities present in the country. Heterosexual transmission is driving India's HIV/AIDS epidemic. This route accounts for approximately 85% of the HIV infections in the country. The remaining 15% are accounted to other routes such as blood transfusion and injecting drug use (particularly in India's North East and some metropolitan cities). Young people in India are among those at high-risk of contracting HIV. Over 35% of all reported HIV/AIDS cases in India occur among young people in the age 4group of 15 to 24 years . Since 1998, the Government has been conducting an annual nationwide sentinel surveillance to assess the spread and prevalence of HIV in the country. The sentinel sites cover both high-risk populations like attendees of Sexual Transmitted Diseases (STD) clinics, injecting drug users (IDU), sex workers and men who have sex with men (MSM) as well as low- risk populations such as women attending antenatal clinics. The surveillance data is collected only from public sites. The number of sentinel sites has gone up 5from 184 in 1998 to 455 in 2003 . The annual sentinel surveillance surveys from 1998 to 2002 have divided States and Union territories in India into three broad categories: - High prevalence; Maharashtra, Tamil Nadu, Manipur, Andhra Pradesh, Karnataka and Nagaland States which have HIV prevalence rates exceeding 5% among groups with high-risk behaviour and 1% among women attending antenatal clinics in public hospitals. - Concentrated epidemics; Gujarat, Pondicherry and Goa where the HIV prevalence rate among populations with high-risk behaviour has been found to be 5% or more, but HIV prevalence rates remains below 1% among women attending ante-natal clinics. - Low prevalence; All other States and Union Territories fall into the low prevalence category because HIV prevalence rates among high risk population is below 5 per cent and less than 1% 6among women attending antenatal clinics . The latest available official figures, based on the national HIV sero surveillance survey (2002), show an increase of 600,000 new infections from 2001. This increase has been noticed primarily from Antenatal Clinics (ANC) sites in Karnataka, Rajasthan and West Bengal and STD clinics in Andhra Pradesh, Tamil Nadu, Gujarat, Bihar, Madhya Pradesh and 7Rajasthan . THE HIV/AIDS EPIDEMIC IN INDIA 1 1.1 EMERGING TRENDS Recent surveillance data indicate that in high prevalence states, the epidemic is spreading gradually from urban to rural areas and from high-risk groups to the general population. The epidemic continues to shift towards women and young people with about 25% of all HIV infections occurring in women, increasing the potential of pediatric HIV in the future. WHAT MAKES INDIA VULNERABLE TO HIV/AIDS? v Poverty v Vast country with varied socio-economic norms v Very low levels of literacy in certain parts of India contributing to perpetuation of myths and misconceptions v Huge migrant population v Untreated Sexually Transmitted Infections (STI) due to lack of awareness, hesitation, and also lack of access to health care systems v Vulnerability of women to HIV, especially due 8to gender inequality Women are especially vulnerable due to their low levels of awareness and education, their low status and limited access to resources. Cumulatively, these hamper a woman's ability to protect her self or negotiate safe sex. 1.2 LOW EPIDEMIC ENVIRONMENT: CHALLENGES AND OPPORTUNITIES Though only six out of India's 35 States and Union Territories are categorised as “high prevalence”, high mobility from villages to towns, between states, regions and across borders contribute to the vulnerability of other states. “Worryingly, not enough is known about HIV spread in the vast populous interiors of Uttar Pradesh and other northern Indian States…” notes AIDS epidemic update, December 2003, brought out by UNAIDS and WHO. A low epidemic environment throws up a host of challenges as well as opportunities. Low prevalence casts a veil of invisibility over the problem, making it more difficult to raise sensitive issues related to high- risk behaviour. It also makes it harder to mobilize communities to respond to HIV/AIDS. But this also opens up a window of opportunity. With strong leadership, commitment and anticipatory programming, low prevalence states could remain that way, and the spread of the epidemic can be contained in those states labelled high prevalence. 2 Below: Walk for Life, World AIDS Day 2003 INTRODUCTION One of the most tangible demonstrations of the growing political commitment to address HIV/AIDS came in July 2003, when the then Prime Minister of India Atal Behari Vajpayee opened the first National Convention of Elected Representatives on HIV/AIDS with a call for more political courage in addressing the disease. The event was a milestone as for the first time in the history of the movement of people living with HIV/AIDS (PLWHA) in India, it saw one of their most articulate representatives, P Kousalya sharing the dais with the then Prime Minister Atal Behari Vajpayee and Executive Director of UNAIDS, Dr Peter Piot. Another expression of the political commitment was seen in Andhra Pradesh, one of the designated “high prevalence states”, where the then Chief Minister Chandrababu Naidu instructed his ministers to foreground AIDS in all their speeches, in an effort to mainstream the issue. 2003 was also the year when the Government of India made an announcement that it would start to provide free anti-retroviral drugs to a limited number of people living with HIV/AIDS. The national response to the HIV/AIDS epidemic in India, is led by the National AIDS Control Organisation (NACO), a semi-autonomous organisation under the Ministry of Health and Family Welfare. NACO carries out the Government's National AIDS Control Programme, established in 1987. In its second phase, the National AIDS Control Programme (NACP-II, 1999-2004) has taken several steps to strengthen its focus on vulnerable people. Policy initiatives have also begun to focus on care, support and treatment issues alongside prevention, in response to the growing number of 9HIV infections in the country . INDIA'S TENTH FIVE YEAR PLAN (2002 2007) TARGETS FOR CONTAINING THE SPREAD OF HIV/AIDS IN THE COUNTRY. HIV /AIDS by 2007. v 80% coverage of high risk groups through targeted interventions v 90% coverage of schools and colleges through education programmes, v 80% awareness among the general population in rural areas v Reducing transmission through blood to less than 1%; v Establishing of at least one voluntary testing and counseling centre in every district v Scaling up of prevention of mother-to- child transmission activities up to the district level v Achieving zero level increase of THE NATIONAL RESPONSE "HIV/AIDS requires leadership that is ready to go to the heart of the problem and is ready even to go against the stream of public opinion…" Atal Behari Vajpayee, the then Prime Minister of India, National Convention for Elected Representatives on HIV/AIDS, July 26, 2003 3 Above: Ms. Sonia Gandhi, the then Leader of Opposition, Mr. Manohar Joshi, the then Speaker, Atal Bihari Vajpayee, the then Prime Minister, Ms. Sushma Swaraj, the then Minister of Health and Family Welfare and Dr Peter Piot, Executive Director UNAIDS 2.1 GOALS OF NATIONAL AIDS CONTROL PROGRAMME PHASE (NACP) II The goals of the NACP II, which is mainly funded by a loan from the World Bank, are: I) To shift the focus from raising awareness to changing behaviour through interventions, particularly for groups at high risk of contracting and spreading HIV; (ii) To support decentralisation of service delivery to the States and Municipalities and a new facilitating role for National AIDS Control Organisation. Program delivery would be flexible, evidence-based, participatory and to rely on local programme implementation plans; (iii) To protect human rights by encouraging voluntary counseling and testing and discouraging mandatory testing; (iv) To support structured and evidence-based annual reviews and ongoing operational research; and (v) To encourage management reforms, such as better managed State level AIDS Control Societies and improved drug and equipment procurement practices. These reforms are proposed with a view to bring about a sense of 'ownership' of the programme among the States, Municipal Corporations, NGOs and other implementing agencies. 2.2 PREVENTION STRATEGIES ational AIDS Control Programme. The strategies are directed at groups at high risk of contracting the HIV virus as well as the general population as HIV spreads from groups with high-risk behaviour to those with low-risk behaviour through bridge populations. The strategies range from information, education and communication to targeted interventions aimed at preventing HIV transmission among groups at high risk (truckers, sex workers, IDUs etc) to interventions to prevent the spread of HIV/AIDS among the general population. The programme also supports research and development of vaccines and microbicides. An important aspect of the national response has been the expansion of HIV-related information and services to the youth through the School AIDS Education Programme, the University Talk AIDS Programme and the Village Talk AIDS Programme. 2.3 CAPACITY BUILDING AT THE STATE- LEVEL With the gradual decentralisation of the National AIDS Control Programme, there is an increasing emphasis on strengthening of the capacities of State AIDS Control Societies (SACS). During 2003, NACO worked towards preparing a team of trainers (TOT) who could become valuable resources for the SACS, when they hold similar training programmes in their respective states. Training programmes targeted specialist doctors of medical colleges, general duty medical officers, nurses, IEC officers, counselors, NGOs, lab technicians, blood bank staff, and district nodal officers. 2.4 SERVICES DELIVERY Service delivery in the national HIV/AIDS programme includes blood screening and safety, prevention and care of sexually transmitted infections (STI), prevention of parent to child transmission (PPTCT), voluntary counselling and testing centres (VCTCs) and care and support for people living with HIV/AIDS. In the past year, the need for linkages between prevention and low-cost care and support programmes has come to the forefront. A combination of prevention strategies is being used during the current phase of the N 4 The increasing number of people living with HIV/AIDS has brought home the need to review existing care and support programmes and look for newer, more innovative approaches. The idea of a “continuum of care” has gained wider acceptance. In policy terms, this has meant recognition of the needs of a diverse range of people --- those uninfected but at risk, asymptomatic HIV positive individuals, those who display early symptoms of the disease, those who have full blown AIDS, those in the terminal stage requiring palliative care as well as the families and communities of those affected. 2.5 PARADIGM SHIFT Key policy and programmatic innovations during the year stemmed from NACO's perception that a more holistic approach is required to address the acute stigma and discrimination hampering an effective response to the HIV/AIDS epidemic. In May 2003, a meeting of Project Directors of India's 38 AIDS Control Societies and their teams to review the National AIDS Control Programme foregrounded AIDS-related stigma and discrimination. The SACS representatives argued that stigma and discrimination were the most important obstacles to an effective response to the epidemic in their states. The changes have led to a more equal emphasis on all four routes of HIV transmission -- transmission through unsafe sex, through contaminated blood, through use of unsterilised needles and through parent to child transmission, mostly at the time of childbirth. New messages have been disseminated in regional languages, seeking to correct some of the commonest misconceptions surrounding HIV/AIDS i.e. that HIV/AIDS is not transmitted through mosquito bites, through touching a person living with HIV/AIDS or eating and playing together with people living with HIV/AIDS. NACO hopes that this approach will go a long way in de-stigmatising HIV at the community level as well as in medical and health care settings, among media and elected representatives and in the work place MILLENNIUM DEVELOPMENT GOAL Halt and begin to reverse the spread of HIV/AIDS GREATER INVOLVEMENT OF PEOPLE LIVING WITH HIV/AIDS In 2003, NACO took several initiatives to put into practice the principle of Greater Involvement of People Living with HIV/AIDS (GIPA) in the country. A key step forward was a letter from NACO Director Meenakshi Datta Ghosh to the Project Directors of the State AIDS Control Society requesting them to involve PLWHA more in prevention as well as care and support programmes for the infected and affected. 5 2.6 NEW DONORS, NEW RESOURCES With additional resources mobilised from the Government of India, international foundations and funds, major bilateral donors and the UN system, the National AIDS Control Programme is moving into an important new phase of implementation. Meeting the challenge of HIV calls for not only a sound strategy but also sufficient resources to turn plans into action. NACO received a US$ 100 million grant from the Global Fund for AIDS, TB and Malaria (GFATM) for a five-year period to prevent parent to child transmission and a US$ 14.8 million grant for the management of HIV/TB co-infection across India. It also secured additional money from the Bill and Melinda Gates Foundation which made an initial commitment of US$ 200 million to upscale activities for the prevention of HIV/AIDS. FAST FACTS Almost 821 Targeted Intervention Projects are being implemented by the State AIDS Control Societies (SACS) through NGOs in different locations in the country today. These are commercial sex workers (197), truckers (164), migrant workers (225), injecting drug users (63), street children (27), MSM ( 24), prison inmates (33), others (88) 35,000 schools are currently engaged in disseminating School AIDS Programme. During 2002-2003, NACO supported two pilot studies in 11 centres of excellence, and succeeded in bringing about reductions in the rates of transmission of HIV from parent to child from 30% to 10%. Over 220 centres for prevention of parent to child transmission (PPTCT) have started providing counseling and testing services. During 2002-2003, the number of VCTCs across the country have been scaled up from 149 to 540 More than 400,000 persons accessed VCTCs during 2002-2003 as against 53,000 during 2001-2002 Source: NACO, A Shared Vision, December 2003, NACO 6 “ ” 3.1 THE EXPANDED THEME GROUP ON HIV/AIDS IN INDIA In India, the UN Theme Group on HIV/AIDS (UNTG) has expanded beyond the nine cosponsors of UNAIDS to include the National AIDS Control Organisation (NACO), the Indian Network for People living with HIV/AIDS(INP+), UNIFEM, NACO and INP+, the Australian Agency for International Development (AusAID), US Center for Disease Control (CDC), Canadian International Development Agency (CIDA), UK Department for International Development (DFID), Swedish International Development Cooperation (Sida) and the US Agency for International Development (USAID). The Indian Government is an active member of the Theme Group, which provides a platform for important policy discussions. The Expanded Theme Group on HIV/AIDS works closely with government, NGOs, community networks and other stakeholders in generating a well- coordinated and enhanced response to HIV/AIDS. Each member of the Theme Group takes the lead in his or her own specific focus area. The Technical Resource Team (TRT) who works closely on joint programming and common themes supports the Theme Group. The TRT comprises of HIV/AIDS focal point from UN cosponsors, UNIFEM and NACO. It meets regularly to develop joint work plans, identify areas of strength and compliment each other's work. The year 2003 was an important year for Expanded Theme Group on HIV/AIDS in India as it witnessed a shift towards greater coordination among UN agencies and other cosponsors in planning and joint programming. Among the UN partners discussions took place throughout 2003 on an 'Implementation Support Plan' a strategy framework to put in place the foundation for joint UN planning. THE JOINT RESPONSE OF THE EXPANDED THEME GROUP ON HIV/AIDS “There are four over-arching priorities in winning the AIDS fight in India and elsewhere attacking stigma, mobilizing the whole of society, championing effective solutions, and fully resourcing the response.” Dr. Peter Piot, Executive Director of UNAIDS and Asst. Secretary General of the United Nations at the National Convention of Elected Representatives on HIV/AIDS, New Delhi, July 26-27, 2003 7 MEMBERS OF THE THEME GROUP SPEAK OUT “The Theme Group has remained the most effective forum for sharing information among stakeholders working with the National AIDS Control Programme.” CIDA ”DFID is part of the UN Theme Group on HIV/AIDS in India and has actively participated in its meeting. It is a very useful forum and we need to continue to work together to ensure harmonization of dialogue as well as of reporting systems. We also need to work with NACO to ensure that the roles of different groups do not overlap.” DFID “Australia has supported the expansion of the UN Theme Group on HIV/AIDS to include NACO, bilateral donor agencies and the Indian Network for People Living with HIV/AIDS. The Theme Group's outreach to NGOs and community networks is important for helping maximize community engagement on HIV/AIDS. We participate in the funding of the joint UN project called CHARCA (Coordinated HIV/AIDS response through capacity building and awareness) with funds earmarked for activity in the north east of India. CHARCA is a good example of collaboration amongst the cosponsors, an issue that must remain high on the Theme Group's agenda.” AusAID “The HIV/AIDS TG the only expanded UNTG consisting of multilateral, bilateral, government and PLWHA has generated a well-coordinated and enhanced response to HIV/AIDS. Sida has benefited through the regular information sharing and also strengthened collaboration” Sida In India, the UNAIDS Secretariat was established in 1996, taking over from the WHO Global Program on AIDS. UNAIDS Secretariat has been playing a key role in providing technical assistance to NACO, coordination of the UN system response to HIV and strengthening mobilization of community responses through advocacy and outreach. To facilitate this work, UNAIDS has received support from DFID for a strategic plan for 2002-2005. The key areas in the strategic plan are: raise awareness and generate support for mainstreaming of HIV into national development efforts; mobilize resources for effective HIV/AIDS action; build capacity; generate strategic information, including best practices; and strengthen UNAIDS India Office. This is a unique collaboration, which has proven to be a viable model taken up globally. UNAIDS TODAY Based in Geneva, Switzerland, UNAIDS today is cosponsored by nine organisations of the UN family - International Labour Organisation (ILO) - United Nations Children's Fund (UNICEF) - United Nations Development Programme (UNDP) - United Nations Educational, Scientific and Cultural Organisation (UNESCO) - United Nations Office on Drugs and Crime (UNODC) - United Nations Population Fund (UNFPA) - World Bank - World Food Programme (WFP) - World Health Organisation (WHO) The mission of UNAIDS is to work together to “catalyze, strengthen, and orchestrate the unique expertise, resources, and networks of influence that each of these organizations offers.” Globally, UNAIDS' mandate is to lead, strengthen, and support an expanded response to HIV/AIDS. Its five priorities are: A) promote leadership and advocacy for effective action on the epidemic, B) disseminate strategic information to guide efforts against AIDS worldwide, C) track, monitor and evaluate of the epidemic and of the responses to it, D) develop partnerships and engaging civil society and E) mobilize resources to finance an effective response. 8 Given below are salient activities carried out by the members of the Expanded Theme Group in 2003 in addressing national priorities on HIV/AIDS. It is not an exhaustive list, but provides highlights of the response. The chapter is structured after the national priorities. 3.2 PREVENTION OF HIV TRANSMISSION AMONG GROUPS AT HIGH-RISK Targeted interventions (TI) are at the core of the national strategy to reduce the transmission of HIV among those most at risk. These groups could be sex workers, intravenous drug users, men having sex with men, truckers, migrant labourers or street children. TI aims to inculcate a behaviour change among such segments and thereby also prevent the spread of the HIV virus among the general population. Several members of the Expanded Theme Group are working with high-risk groups. During the year, UNODC worked at the national level with its line ministry, the Ministry of Social Justice and Empowerment (MSJE) as well as the Ministry of Health and Family Welfare to mainstream HIV/AIDS and drug abuse concerns in the ongoing programmes supported by the Government. A new project on formation of peer networks to address HIV risks in injecting drug using populations in the North Eastern States and metropolitan cities in India started in November 2003. The initiative is expected to strengthen the outreach of the already established Regional Resource Training Centres (RRTCs) by using peer educators in the areas they are working in. One of the first activities undertaken by the project was a workshop in December 2003 to familiarize the 8 RRTCs with the aims and objectives of the project. UNODC strengthened the capacity of NGOs who could provide de-addiction cum rehabilitation centers and implement community wide drug demand reduction. The objective of the programme is to reach the hidden population of drug users and people living with HIV/AIDS. During the year, detoxification camps were held by drop-in centers. The peer movement has been a success and a lot of hidden users have surfaced and are being referred to the Drug Rehabilitation Centres (DRCs) for de-addiction and rehabilitation. Self-help groups are being formed by the peers thereby strengthening the outreach of the DRCs. The UK government's Department for International Development (DFID) has been working in partnership with the NACO and SACS in Gujarat, Orissa, Andhra Pradesh, West Bengal and Kerala to reduce the spread of the HIV epidemic through targeted interventions. Partnerships for sexual health in these states target vulnerable groups such as sex workers, men who have sex with men and injecting drug users. In West Bengal, one of DFID's focus states, targeted interventions to date have covered more than 100,000 people through 17 NGOs in 52 sites. Lessons learned from these interventions are now being incorporated into the National and other State AIDS Control Programme. DFID funded States have emerged as National Learning Centres where people from other states come for exposure and learning. DFID funded State AIDS Control Societies have also done a Needs Assessment and Mapping Study of High Risk groups before designing Targeted Interventions. The information has proved to be very useful in designing and targeting interventions. Condom Promotion strategies have been specifically designed for the five DFID supported states and is implemented by professional social marketing organisations. USAID's ongoing interventions have focused on high- risk groups in Tamil Nadu and Maharashtra. In Tamil Nadu, USAID supported AIDS Prevention and Control Project (APAC) has helped NGOs to design and implement strategies to high-risk groups such as truckers, sex workers and residents of impoverished communities. In Maharashtra USAID supported AVERT Project has sought to reduce the risk of transmission and mitigate the impact of STD/HIV/AIDS in the sex industry. A mass media campaign in Mumbai supported by USAID led to critical HIV/AIDS related issues receiving unprecedented attention across the city. The campaign's slogan “Dare to Care” has been picked up by other groups. “Jasoos Vijay” the detective serial with a social message produced by BBC World Service Trust for NACPII, and funded by DFID, won the best thriller award in the Indian Tele Awards 2003 , 9 3.3 PREVENTION OF HIV TRANSMISSION IN GENERAL POPULATION In the earlier years, the HIV virus was most prevalent among sex workers and IDUs. “It then started spreading into segments of society not recognized as being at risk such as wives who are monogamous but whose spouses have contracted the virus from sex workers or other sex partners belonging to bridge 10populations.” The epidemic's spread from groups with high-risk behaviour to those traditionally viewed at low-risk has brought home the urgency for prevention strategies directed towards the general population. An innovative partnership has been initiated between UNIFEM, UNDP, the Indian Railways and NGOs to work through peer counsellors in the Indian Railways schools, hospitals and training colleges towards a gender-sensitive approach on HIV/AIDS prevention and care. In July 2003, a group of 27 NGOs working on HIV/AIDS and gender-related issues from eight districts of the Vijaywada division of the Indian Railways came together to discuss ways in which they could support the railways project. The meeting resulted in the establishment of a referral system for three main areas of support: providing skill-building internships for people living with HIV/AIDS; provision of psychosocial support to those affected or at the risk of HIV/AIDS; and provision of micro-credit to support families affected by HIV/AIDS. A revolving loan fund was also established under the Railway Women's Welfare Association and started operation on 1 September. During the year, the peer counsellors have also partnered with the railway doctors in introducing HIV/AIDS and a gender component in the “health talk” which the doctors give, as part of the railway health care services. Through these varied initiatives, peer counsellors till date have reached nearly 70,000 people in the five entry points of the railway community. A. WOMEN RATIONALE OF THE RAILWAY PROJECT The Indian Railways employs 1.8 million people and covers a population of approximately 8 million people. A large percentage of Railway employees are away from home for more than 9 days in a month, making them vulnerable to the epidemic. Urgent action is therefore required by the Indian Railways to prevent the spread of HIV among its employees and their families. The railway sector has the advantage of an established infrastructure of institutions railway schools, hospitals, trade unions, training institutions, mahila samitis, etc that serve as crucial entry points for a gender sensitive and multisectoral response for HIV/AIDS prevention, treatment and care. The project aims to strengthen the capacity of the Indian Railways in gender sensitive counselling services in order to prevent the spread of HIV/AIDS within the sector and to enhance the understanding on the fundamental link between gender and HIV/AIDS as a strategy to prevent the spread of HIV/AIDS in India. Achievements in 2003 include the setting up and strengthening of the Railway Women's Empowerment and AIDS Prevention Society (REAPS). REAPS focuses on mobilising and strengthening community responses to HIV/AIDS and gender-related issues. REAPS works out of the hospital premises of the South Central Railways in Vijaywada on the premises provided by Railways. Much emphasis is being given to equipping the peer counsellors with the latest information, skills and knowledge to respond to the HIV/AIDS epidemic from a gender lens. As a result of the initiative by UNIFEM/UNDP and the Vijaywada division of the Indian Railways and its project partners, Gender and HIV/AIDS education has been introduced into the curriculum of all the Indian Railway schools from the ninth grade onwards. Building upon the efficacy of the existing curriculum on sex education and HIV/AIDS prevention, the introduction of a section on gender and sexuality aims to encourage young people to question existing gender stereotypes, enable young women to negotiate safer sex and promote male sexual responsibility. 10 UNFPA has established case management services for Reproductive Tract Infections (RTI) and Sexually Transmitted Diseases (STD). About 1500 Primary Health Centres (PHCs) have been strengthened; laboratories were established and provided with drugs and supplies; and doctors and laboratory technicians have been trained. In the second phase of the project, UNFPA will focus on communication activities to make people aware of the availability of services and address gender and other social issues, which should result in increased service take-off. Currently, UNFPA has three major interventions --- promotion of condoms for dual protection, provision of RTI services at the primary health centers and community related studies to orient Panchayat members on HIV/AIDS. Use of condoms was promoted in Phase I and in the second phase, volunteer couples are being oriented on HIV/AIDS issues and being equipped to be promote condoms as dual protection method. In accordance with national priorities, UNICEF's focus in 2003 was on supporting the scaling up of Prevention of Parent to Child Transmission of HIV/AIDS (PPTCT), prevention of HIV infections among young people and encouragement and creation of an enabling environment for an expanded response to prevent HIV and reduce the impact of HIV/AIDS on women, children and young people. UNICEF supported the training of 291 PPTCT teams from Medical Colleges in State and District Hospitals and 225 centres are providing PPTCT services in high and low prevalence states. Monitoring has revealed that an increasing number of partners now agree to come to the PPTCT Centres for counselling and testing. The overall intervention uptake is also very good with 87.6% of the positive women delivering receiving Nevirapine together with their newborns. During the year, discussions were held with NACO on the best approach for a district-based comprehensive PPTCT scheme. The proposed scheme will focus on HIV primary prevention, decentralization and integration of PPTCT services into Reproductive Child Health/Integrated Child Development services (RCH/ICDS), and promotion of care and support to people infected/affected by HIV/AIDS. The districts of Vellore (Tamil Nadu), Dharavi (Mumbai) and Bellary (Karnataka) were identified for implementation. UNICEF's project for Young People is initially being implemented in four states with high HIV prevalence -- - Maharashtra, Andhra Pradesh, Nagaland and Tamil Nadu (2003) and will be phased to other high and low prevalence states from 2004 onwards. The B. CHILDREN AND YOUNG PEOPLE project covers preventive and peer education, and young people as agents of change. UNICEF's initiatives have covered school-going children as well as those remain out of school. UNICEF has supported NACO in developing tools, national draft guidelines and technical capacity for implementing in-school prevention education, as well as in organising and documenting the first National Workshop for School AIDS Education. It has also supported the SACS in implementing scaled up communication interventions in schools in AP, Maharashtra, TN and Karnataka by providing technical inputs for planning, design and implementation; conducting training of resource persons and core implementers; printing materials; and carrying out concurrent monitoring and evaluation to ensure periodic programme review. The interventions in these states cover approximately two million school-age children. 11 UNICEF also supported NACO in initiating the processes for developing a national strategy for reaching young people out of school. These included: setting up an inter-ministerial national group to discuss national strategies; organising the first National Consultation on Out-of-School Children; initiating discussions on linkages with National Literacy Mission, Continuing Education, Ministry of Youth Affairs and Sports; and preparing a draft background concept note of strategies for reaching young people out of school. The project also supported SACS and NGOs in implementing district- wide demonstration projects for reaching young people out of school in AP, Maharashtra and Haryana. In support of NACO's AIDS Control Programme, the World Bank has worked in partnership with India's Ministry of Health and Ministry of Home Affairs to provide HIV/AIDS education initiatives in schools and prisons. The Bank in collaboration with the Association of Indian Universities in November 2003 also launched a campaign aimed at fighting HIV/AIDS among youth. In a videotaped speech at the inauguration of the initiative, World Bank President James D. Wolfensohn, said half of the people who contracted AIDS were in the age group that attended universities and colleges. He said because of this, the Vice Chancellors had a vital role to play in terms of leading the fight against AIDS. 11UNDP has entered into a partnership with NIIT , a premier IT education institute, to raise HIV/AIDS awareness among young people. In 2001 UNDP-NIIT launched a small pilot project on HIV/AIDS education for NIIT career students to create awareness through peer educators and to demonstrate the benefits of such programmes to the NIIT management. Based on inputs from intensive consultations to identify knowledge gaps about HIV/AIDS amongst the student community, a `Peer Educator' model was developed for creating awareness among the youth and their extended communities. After successfully field-testing the module, the initiative was expanded to include all the 36 NIIT centres in and around Delhi reaching a population of approximately 30,000 students directly and through them to the larger community. The response from the students across centres has been overwhelming. After the initial sensitization workshops, the students have come up with innovative methods to replicate learning. Given their IT skills, they have designed screen savers giving information about HIV/AIDS for installation in cyber , cafes, designed posters to be used within the NIIT campuses as well as the schools and colleges where most of the NIIT students study full time, prepare power-point presentations to be used with staff of call centres, staged short street plays in colleges and schools. As a next step, NIIT will take the model to other parts of the country. NIS is also exploring possibilities of making awareness about HIV/AIDS as a `non-negotiable' in all their future corporate deals nationally and internationally. The India-Canada Collaborative HIV/AIDS Project (ICHAP), a five-year project funded by Canadian International Development Agency (CIDA), is providing technical assistance to strengthen national programme implementation in Karnataka and Rajasthan. In Rajasthan, ICHAP has developed an innovative community based model for HIV prevention and care for rural migrant men and their families. The HAMARA (HIV and AIDS and Migrants in Rajasthan) demonstration project covers 133 villages in three districts in Rajasthan (Churu, Sikar and Jhunjhunu), which have witnessed significant out migration in recent years. The project conducts intensive awareness and advocacy sessions among those planning to migrate as well as providing information to potential migrants in project villages. As part of HAMARA's gender strategy, wives of migrants and potential migrants are also provided with information and services. ICHAP's other demonstration projects in Rajasthan are Saksham an intervention for traditional sex workers, and Sehat Sabki, aimed at developing a district-wide comprehensive prevention, care and support model for Ajmer. ICHAP has also assisted the Rajasthan AIDS Control Society to strengthen and intensify its IEC activities. In Karnataka ICHAP works in close partnership with the State AIDS Prevention Society to help establish sustainable systems, including those for selection and supportive supervision of NGOs implementing targeted interventions, capacity building of health care providers for improved STI management and effective IEC. Demonstration projects to develop and test effective interventions in both rural and urban settings are also being implemented. One notable achievement in 2003 was the upscaling of VCTCs in Karnataka from 6 to 31, ensuring that every district in the state now has a functioning VCTC with necessary infrastructure, testing kit and trained male and female 12counselors . C. GENERAL POPULATION 12 D . VOLUNTARY CONFIDENTIAL COUNSELLING AND TESTING Being diagnosed with HIV/AIDS or recognizing the possibility that one may have contracted HIV has profound emotional, socio-economic and medical consequences for any individual. Providing access to confidential counselling and testing which equips a person with the necessary information (including care and support services) and emotional support is a key priority of the National AIDS Control Programme. NACO's ongoing programme to expand and upgrade VCTCs (Voluntary Counselling and Testing Centres) in the country was supported by WHO which assisted in strengthening the quality of voluntary counselling and testing services. By the end of 2003, 'model VCTC centres' were functioning at three sites Stanley Medical College (Chennai), RIMS (Imphal) and KEM Hospital (Mumbai). In all the three demonstration sites, there were NGO partners who facilitated the operations. MODEL VCTC AT STANLEY MEDICAL COLLEGE, CHENNAI During 2003, 3373 clients came to the VCTC for pre-test counselling. 90.7% consented to undergo HIV testing. The total client number of pre-test counselling increased from a monthly average of 275 clients in January to March, to 340 clients in October to December 2003. Of the 924 direct walk-in clients who consented to HIV testing, 91.3% returned for post-test counselling, indicating a high quality of counseling and overall services 20 VCTC teams from other districts in Tamil Nadu visited the Stanley Medical College. This was facilitated by the Tamil Nadu State AIDS Control Society. There were also visits by Stanley Medical College VCTC facilitators to other selected VCTCs to provide technical advice for strengthening VCTC operations in 2004. E. WORLD OF WORK Out of the estimated 3.82 4.58 million people living with HIV/AIDS in India, nearly 89% of infections have been reported from the most 15-49 age group, a large percentage of whom are part of the world of work. ILO, in consultation with its Indian tripartite constituents and NACO, is implementing a three- phased programme, aimed at establishing a sustainable national action on HIV/AIDS prevention, care and support in the world of work. The project, supported by the US Department of Labour, aims at preventing HIV/AIDS in the world of work, enhancing workplace protection and reducing its adverse consequences on social, labour and economic development. The key project partners include the Ministry of Labour, NACO, V.V.Giri National Labour Institute, Central Board for Workers' Education (CBWE), employers' and workers' organizations, 13UNAIDS, ILO and People Living With HIV/AIDS . During the year, key activities of the project have included imparting education on HIV/AIDS to workers in the organized and unorganized sector throughout the country through a collaboration between the ILO and the CBWE, an institution of Ministry of Labour. A Resource Manual has been prepared for the Education Officers of CBWE to undertake training and integrate HIV/AIDS within their education programme for workers. ILO Posters have been translated and reprinted in seven regional languages by CBWE. IEC materials (booklets and leaflet) in regional languages for organised and unorganised sectors are being developed. Above: An advocacy cum training package has been developed for employers and trades unions. 13 As part of the Project, ILO has supported V.V. Giri National Labour Institute (NLI), an autonomous body under the Ministry of Labour, to set up a HIV/AIDS cell. NLI is undertaking capacity building of trade unions leaders, labour inspectors and some research activities with support from the ILO Project. A national workshop on “Reducing HIV related Stigma and Discrimination in the world of work” was organised to highlight stigma and discrimination issues confronting people living with HIV/AIDS. From January 2003 till March 2004, interventions were initiated in 55 companies by ILO Project, which together reach more than 100,000 workers. The ILO funds none of these enterprises, providing only technical support in terms of training of master trainers/peer educators and IEC materials. The UN Country Team, with ILO as the lead agency, has in 2003 initiated a work place initiative in the UN Workplace. The objective of this project is to ensure that all UN officials in India are trained and aware about HIV/AIDS and its prevention, that they have access to HIV/AIDS related information, care and support, and that they are protected from discrimination on the basis of HIV. As part of the UNDP supported project with the corporate sector, Gujarat was divided into three geographic divisions with activity hubs in Bhavnagar, Surat and Vadodra. Lead NGOs in each of these centers were contracted to work closely with the private sector and facilitate/initiate interventions in order to mainstream HIV/AIDS into their work. After a yearlong work with different private sector companies of varied size (from Reliance which employs thousands of workers to small units employing 4-5 persons) there are several achievements. In Surat, the Reliance Group has agreed to sponsor one workshop a month on HIV/AIDS for its own staff or for the neighbouring community. In addition, Reliance has also set up an STD and DOTS center that will also be available for the larger community. In Bhavnagar, State Bank of Saurashtra is `the bank', which grants loans to industrial units once approved by the Gujarat Maritime Board (GMB). The Bank and GMB have now committed that loans will be given only to those units, which have HIV/AIDS prevention, care and support activities on the ground. In Vadodara, the lead NGO has mobilized private companies to come together and support each other in creating AIDS awareness within their own shop floors as well as the neighbouring community. Above: Master Trainers' Training for seven enterprises conducted by ILO No. of enterprises having initiated HIV/AIDS workplace programme with technical assistance from the project 55 22 14 19 State Total Madhya Pradesh Jharkhand West Bengal Total workforce being reached 1,01,245 33,261 18,765 49,219 Number of master trainers/peer -educators trained 628 232 289 107 14 3.4 CARE, SUPPORT AND TREATMENT A. LOW COST CARE While prevention of HIV/AIDS remains a high priority, India now confronts a great challenge in responding to the needs of people already living with HIV/AIDS. Care and support needs are expanding quickly and the current care centers can only provide services to a small percentage of those in need, and are not fully accessed and not always integrated with community resources, including prevention services. During the year, discussions took place between NACO and other partners to develop new approaches and more comprehensive models of care. Such models are expected to ensure that existing resources in the health and social sector are fully utilized and that communities are engaged. WFP BECOMES THE NINTH COSPONSOR OF UNAIDS In 2003, on the World Food Day (16 October) when attention was drawn to the more than 800 million hungry people across the globe, the Joint United Nations Programme on HIV/AIDS announced that the World Food Programme (WFP) has joined UNAIDS as a Cosponsor. Together, with the eight existing cosponsors, WFP hopes to strengthen the UN's response to the growing HIV/AIDS epidemic. As the world's largest humanitarian agency, WFP focuses on fighting HIV/AIDS through its food aid programmes. As additional resources are found to make AIDS drugs more affordable, WFP is working to ensure that food is also available as good nutrition is as essential support to people living with HIV/AIDS. In May 2003, NACO and ICHAP (India-Canada Collaborative HIV/AIDS Project) with support from CIDA and UNAIDS organized the National Consultation on Community Based Care and Support for HIV/AIDS. The consultation aimed at charting out an action plan to ensure that every person infected and affected by HIV/AIDS had access to quality care and support at low cost. The main part of the consultation was devoted to reviewing experience in care and support, with specific attention to the strengths and limitations of existing models hospital based initiatives, care home initiatives, PLWHA-led initiatives, and community-based initiatives. 15 SOME KEY RECOMMENDATIONS FROM THE MAY 2003 CONSULTATION 1. NACO should modify its focus on the high prevalence states, and ensure that equal attention and resources are directed towards the low prevalence states. 2. Multiple models providing comprehensive HIV care, which integrate it into the existing health infrastructure are necessary. Public and private partnerships can contribute to better coverage and universality 3. It is necessary to locate VCTCs appropriately within institutions and link them to the rest of the care system 4. Prevention and care interventions should ensure that people vulnerable to and affected by HIV remain in the mainstream through the creation of a supportive environment 5. Training of physicians requires a change in strategy and approach. Training would perhaps be more effective if it was concentrated on those who already provide care, especially within the private sector. For these groups, training should be a continuing process and linked to different levels of care. 6. More efforts should be directed towards advocating with the private sector and getting them to buy into activities involving care and support. 7. Increasing the capacity of families and communities to care for the infected and the affected will reduce the load on care centers, making them more sustainable. 8. The work of PLWHA networks should be integrated into HIV interventions B. MOBILISING COMMUNITIES AND NEW PARTNERSHIPS IN ADDRESSING STIGMA AND DISCRIMINATION AGAINST PEOPLE LIVING WITH HIV/AIDS One key way to tackle stigma and discrimination facing people living with HIV/AIDS is to engage the civil society and mobilize new partnerships in the battle for recognition of the rights of people living with HIV/AIDS. UNAIDS supported a partnership between Nagaland SACS, NGOs, Nagaland Network of Positive People and Naga People's Movement for Human Rights in addressing HIV/AIDS related stigma and discrimination. A rapid study of the current situation in Nagaland was conducted and the results were presented at a state-level workshop held 31 October - 1 November 2003. The workshop brought together representatives from all spheres: Legislative Assembly, NGOs, the tribal structure, student organisations, the church, media, lawyers etc and had participation of UNODC, NACO, Lawyers Collective and UNAIDS. The workshop aimed at sensitizing the participants on the issues and to develop an action plan to address stigma and discrimination through community involvement and partnerships. The action plan and recommendations are being widely disseminated in 16 Nagaland and a committee has been set up to follow up on implementation of the recommendations that emerged from the event. During the year, a major initiative was the development of a draft legislation on HIV/AIDS. NACO has requested Lawyers Collective to prepare a draft, which is presently undergoing a comprehensive consultation process with the support from UNIFEM, ILO, WHO and UNAIDS. In November WHO and UNAIDS supported a consultation with health care providers and in December ILO supported a two-day consultation with representatives from the world of work. The consultations enable different stakeholders to articulate their concerns and apprehensions about the legislation and Lawyers Collective gets crucial feedback and critical inputs to make the draft law more effective and relevant to the needs of the community. Further, the extent to which the community will embrace the legislation on HIV/AIDS depends on the support that is mobilized for the same among affected groups and stakeholders. This will also ensure compliance and better implementation at the institutional level once the same is enacted. In 2004, UNIFEM is supporting a consultation with women's groups to examine if the legislation is addressing gender issues adequately. Further support will be given by UNAIDS to six regional workshops that will involve civil society and local government representatives. The Swedish International Development Cooperation (Sida) supports Lawyers Collective, which has been working in the area of legal and advocacy of human rights since its inception in 1981. The project "Legal intervention in HIV/AIDS and related contexts in India" aims for an expansion and initiation of new interventions, with focus on PLWHA and vulnerable populations such as women, men who have sex with men, sex workers, and injecting drug users. The project focuses on three broad components: i) legal advice and litigation; ii) advocacy and capacity building; and iii) documentation. The project aims to empower and enable the legal community to respond to HIV/AIDS and the needs of vulnerable populations, to create an enabling legal environment for people living with HIV/AIDS and vulnerable population and to increase the awareness of target groups to seek the legal services. C. LEGAL AND ETHICAL ISSUES , 3.5 STRENGTHENING CAPACITY The GIPA (Greater Involvement of People Living with HIV/AIDS) principles were established at the Paris AIDS Summit in December 1994, and were enshrined in an Official Declaration signed by 42 governments, including India. Since then, the GIPA principles have brought about a strategic shift in the public discourse on HIV/AIDS across the world. Today, there is a growing acknowledgement of the need for a more participatory, inclusive approach that recognizes the importance of involvement of people living with HIV/AIDS in policies and programmes connected with HIV/AIDS. In Namakkal, Tamil Nadu, USAID/Family Health International (FHI) supported the 'Positive Living Project' that is managed by the Indian Network for People Living with HIV/AIDS (INP+) in collaboration with its state level partner: HIV positive people's welfare society Tamil Nadu (HPPWS); and its regional A. GREATER INVOLVEMENT OF PEOPLE LIVING WITH HIV/AIDS level partner: Positive Women Network of South India (PWN+). For the actual implementation of the project at the district level, the Namakkal district level network partner, HIV Ullor Nala Sangam (HUNS), will be the implementing arm of INP+. The project focuses primarily on improving access to quality care and support services to PLHA and their families. The project interventions broadly include center-based and home-based services combined with outreach activities addressing prevention to care and support needs of men, women and children in and around three sub-district headquarters namely: Paramathi Vellore; Rasipuram; and Tiruchengode. 17 MAJOR OBJECTIVES OF THE POSITIVE LIVING PROJECT v To strengthen the capacity of PLWHA networks for management of prevention and care efforts and to serve as advocates for PLHA issues at the district level. v Provide comprehensive prevention to care and support services for people living with HIV/AIDS in the district through Positive Living Centers, outreach interventions and by building linkages with existing services and programs. v Address economic and legal needs of infected, affected and vulnerable women by organizing them into self help groups. v Provide care and support services for children infected and affected by HIV/AIDS and address needs of children vulnerable to HIV/AIDS. v Create an enabling environment through advocacy and multi-sectoral linkages. This project has proven the success of meaningful involvement of people living with HIV/AIDS at planning, execution and monitoring at all levels and at all components of continuum of care. INP+ has also partnered with Centre for Disease Control's (CDC) Global AIDS Program and Tamil Nadu State AIDS Control Society to implement a project titled “Strengthen Indian Network for People Living with HIV/AIDS (INP+) by strengthening linkages for support and care for PLWHA The project, launched on 1 September 2003, and being implemented at the Government Hospital for Thoracic Medicine, aims to supplement and enhance the efficiency of care of PLWHA in South India by establishing a pre-discharge family counseling and education center at the GHTM that will provide information on life after infection, to increase family participation in providing care and to center services incorporating GIPA Principles. Addressing issue of stigma and discrimination are key to any effective strategy to facilitate GIPA. With support from UNDP, the Gujarat State AIDS Control Society has undertaken a comprehensive need assessment in six urban settings in the state. People who are themselves living with HIV/AIDS have collected data from a total of 810 HIV positive .” persons after going through intensive training in conducting research and in-depth interviews. SACS, NGOs and representatives of the Gujarat network of positive persons are currently analyzing the data. While data collected is important in itself, the process of data collection has resulted in building networks, capacities in research and investigation and most importantly given a morale boost to the researchers. In order to strengthen linkages and networking of HIV Positive women's groups, with the women's movement, UNIFEM has also supported the participation of three HIV positive women representatives from PWN+, KNP+ and PATH to a National Consultation on the Protection from Domestic Violence Bill, 2001, organised by Action India in collaboration with Lawyers Collective, a legal rights NGO. The positive women used the occasion to foreground the violation of their human rights with reference to property, family violence, abandonment, marriage without consent, which was a first-time learning experience for many of the participants who were working on women's issues. In February 2003 INP+ launched the Positive Speakers Bureau with support from UNAIDS. The project seeks to reduce HIV/AIDS related stigma and discrimination in the general population by empowering PLWHA to tell their own stories and give a human face to the epidemic and, thereby, complement National and State level HIV/AIDS prevention efforts. The project is an important step towards bridging the gap that persists in every level between PLHWA and the general population. The Positive Speakers now address youth in schools and colleges, NGO gatherings, industrial and corporate sector audience, associations, medical colleges and practitioners as well as religious centers. The Positive Speakers have come up with their own innovative ideas about approaching their audience. , 18 “Just revealing one's HIV status is not enough. The way we articulate our issues is very important. I think we, the Positive Speakers, are giving a face to the epidemic. I remember one of our speaking tours in a Pune college. At the end of our presentations, when we divulged our HIV status, one boy came up and started shaking my hand. He was so moved, he held onto my palm for 5 minutes and he wished us luck in our campaign to secure ARV for all HIV positive people in India. I think the Positive Speakers training programmes should continue and an assessment of our experiences as Positive Speakers should be factored into future training programmes.” Manoj Pardesi, Network of Maharashtra by people living with HIV/AIDS (NMP+) and one of the trained Positive Speakers “The Positive Speakers training programme has helped me a lot with my body language while addressing a public gathering. During the training, we were filmed and then it was played back to us so that we knew what mistakes we were making. It was after watching myself, I realized I needed to make much more eye contact on stage. Six Positive Speakers from PWN+ have spoken to students in colleges in Chennai following the training programme.” P Kousalya, Positive Women Network of South India (PWN+) Total number of trainings conducted: Total number of Positive Speakers trained: Target areas: Total number of Positive Speaking assignments till date: 1 national level 30 in five states Mumbai, Pune, Chennai, Cochin, Imphal, Bangalore 105 speaking out... 19 The Indian Network for People Living with HIV/AIDS (INP+) has also played a key role in the Asia Pacific Initiative for Empowerment of PLWHA in close partnership between UNDP and Asia Pacific Network of HIV Positive People (APN+). The initiative aims to strengthen the voice of PLWHA in the Asia Pacific region for advocacy and develop capacity within selected PLWHA groups to influence HIV/AIDS policy development, prevention and care and support responses. This initiative is expected to provide direct support to 18 PLWHA groups from across the Asia Pacific region. A PLWHA resource center was established in Delhi in 2003 to coordinate regional advocacy and provide technical support to the PLWHA groups carrying out small projects for empowerment. In Tamil Nadu, UNDP has facilitated electronic connectivity among the 15 district networks of people living with HIV/AIDS so as to strengthen coordination; enhance access to latest information about positive living; strengthen information sharing and communication between and with district/state and national level networks. UNAIDS and UNDP has supported the translation of the manual Positive Development, which was created in 1998 by the Global Network for People Living with HIV/AIDS (GNP+) in association with Health link Worldwide, UNAIDS and International Federation of Red Cross and Red Crescent Societies. The manual that intends to help HIV positive people come together as PLWHA groups to advocate for change has now been translated by INP+ into Tamil, Telugu, Kannada and Gujarati. Workshops were conducted to ensure that each of the translated works was accurate and culturally relevant. The Positive Women Network of South India (PWN+) in Chennai, a UNIFEM partner, organised three skill building workshops on Legal Literacy in Karnataka, Kerala and Pune in May and June 2003. The workshops helped consolidate alliances with the three State AIDS Control Societies. Technical inputs for the workshops were provided by MARG, a legal literacy and advocacy group, with support from UNIFEM's human rights programme. This was the first time that such capacity building trainings have been organised for women living with HIV/AIDS. Around 80 women living with HIV/AIDS attended these workshops and B. STRENGTHENING NETWORK OF PEOPLE LIVING WITH HIV/AIDS discussed the concept of fundamental rights, legal services and provisions under the personal law relating to marriage, divorce, maintenance dowry, rape, sexual harassment, property laws, banking insurance as well as the legal situation impacting people living with HIV/AIDS such as consent and testing, confidentiality, discrimination, women in vulnerable situations and children, sex determination and medical termination of pregnancy. The key recommendations included training workshops with police on women's rights, need for implementation of national policy on stigma and discrimination, care and counselling and subsidised treatment. This process has helped in building their personal skills and leadership potential. In collaboration with the Tamil Nadu AIDS Control Society, UNDP has also supported Positive Network of South India (PWN+) to conduct legal advocacy workshops in Districts of Coimbatore, Erode, Namakkal, Perambalur, Madurai and Theni. The aim is to make women aware of their rights and existing laws and policies and protecting them from atrocities and discrimination is therefore very important. One of the lessons learnt in the last decade has been the need to build a strong political commitment -- from the highest national authorities to those at community levels. During 2003, several initiatives aimed at galvanising political commitment in the fight against HIV/AIDS can be credited to the Theme Group's joint response to HIV/AIDS in India. Australia's AusAID led the establishment of the Asia- Pacific Leadership Forum on HIV/AIDS and Development (APLF), launched in 2002, which is 15active in India through UNAIDS . During the year, AusAID worked with UNAIDS to facilitate and fund participation by Indian officials and NGO representatives at international conferences that aim to highlight the threat of HIV/AIDS to development and security in the region. The Parliamentary Forum on HIV/AIDS with the support of UNAIDS and NACO conducted a National Convention of Elected Representatives from all levels of governments on 26-27 July 2003. The then Prime Minister of India Atal Behari Vajpayee, the then Leader of the Opposition, Sonia Gandhi, the then Union Minister of Health and Family Welfare and C. LEADERSHIP AND ADVOCACY FOR EFFECTIVE ACTION ON THE EPIDEMIC , 20 Parliamentary Affairs, Sushma Swaraj, the then Speaker Lok Sabha, Manohar Joshi, President of the Positive Women's Network, P Kousalya and Executive Director UNAIDS, Peter Piot addressed the inaugural session. It also had attendance by Chief Ministers from Delhi, Punjab and Himachal Pradesh, among others. Throughout the two day Convention, elected representatives cutting across the political spectrum discussed strategies on how best to respond to the challenges posed by the HIV/AIDS epidemic. The Convention, which brought together more than 1200 elected representatives from all over India, was the first of its kind anywhere in the world. As a follow-up to the Convention, the Parliamentary Forum is planning to hold such meetings at the district level. “We know that HIV has already made serious inroads in some states, and among vulnerable populations throughout the country. But it would be a terrible mistake to see HIV/AIDS as a problem affecting only the poor, or to dismiss those infected with HIV as immoral.” Oscar Fernandes, Convener, Parliamentary Forum on HIV/AIDS, at the National Convention of Elected Representatives, July 26-27, 2003, New Delhi UNDP HIV & Development Programme for South and North East Asia offered the Leadership for Results Programme to a range of key stakeholders. A state level leadership workshop was organised in Andhra Pradesh from 23-25 November 2003. The PLWHA leadership programme was launched in May 2003 in partnership with INP+, NACO and the Delhi-based Indian Institute of Planning and Management (IIPM). - - bringing together over 130 PLWHAs from across the country. The PLWHA Leadership for Results workshops offered to emerging PLWHA leaders during the year demonstrated the potential and possibilities of people living with HIV/AIDS in different States to inspire hope and lead the change. One of the important lessons, which PLWHA participants learnt during the exercise, was the need to accept that “breakdowns” are an inevitable part of any initiative or project and that leadership demands the skills and capacity to convert such breakdowns into “breakthroughs”. Designed in an interactive format, the leadership training at the second workshop at Kochi provided an opportunity to the participants to tap their creative energy and express their concerns and hopes through skits, songs, poems, role-play, dance and mime. The confidence evident in many performances was the most telling indicator of growing enhanced skills of the participants. Three of UNIFEM's partner organisations worked towards sensitising panchayat members and elected representatives on various aspects of HIV/AIDS. The Hunger Project, India, initiated a dialogue on the panchayats looking at cross-cutting issues of violence against women, including health hazards related with sexual subjugation and “voicelessness.” An initial needs assesments was conducted through a workshop in Sujangarh block in Rajasthan in April 2003 to gain a broad understanding of different kinds of gender-based violence in rural areas as well as map actions that elected and community women can take at the village, block, district and state levels to create violence free villages. Fifty participants representing panchayat samitis, districts, wards, NGOs, media, local government, and international agencies discussed gender-based violence and strategies to address them. An exposure visit to a UNIFEM partner's organisation in Rajasthan working on zero- violence zones was organised for 30 participants and to observe monthly hearings on how cases of dispute are being solved by the tribal communities. UNDP entered into a collaboration with NACO, Indian Council of Medical Research (ICMR), National Council of Applied Economic Research (NCAER) and Institute of Health Systems (IHS) to conduct a study on burden of disease and the socioeconomic impact of HIV/AIDS in six high prevalence states of the country. A workshop was held in December 2003 to outline the study design methodology to estimate reliable estimates of the burden of disease and the socioeconomic impact of HIV/AIDS. The study, the first of its kind, is expected to contribute towards evidence-based planning. PANCHAYAT AND HIV/AIDS D. INCREASING INDIA'S CAPACITY FOR RESEARCH ON HIV/AIDS 21 “The current study will throw light on what we do not know much about, and also about what we need to know, so as to make our interventions more evidence based and hence more effective.” Dr. Maxine Olson, UN Resident Representative, India at the inaugural session of the workshop on 'Burden of Disease and Socioeconomic Impact of HIV/AIDS,' 2-3 December, 2003. Given that the HIV epidemic impacts on the socio- economic development of a country, HIV/AIDS issues and concerns need to be mainstreamed and addressed through different programmes. The Theme Group on HIV/AIDS has sought to ensure a multi- sectoral approach to the epidemic as well as broaden the base of people, communities, systems etc. that are sensitive to HIV/AIDS and its implications. One tangible indicator of the growing acceptability of the human development framework set out by UNDP over the last decade is the increasing influence of Human Development Reports among policy makers. 2003 witnessed a significant achievement in this direction. -- the release of HIV/AIDS and Development in South Asia 2003 A Regional Human Development Report. The Report, which linked HIV/AIDS-related indicators to human development parameters in India and other countries, and drew on inputs from PLWHA networks in the region, is aimed at supporting dialogue with policy makers and stakeholders to set the course for an expanded response. Another equally important accomplishment in 2003 was the reflection of HIV/AIDS related concerns in State Human Development Reports notably the Tamil Nadu State Human Development Report and the Himachal Pradesh Human Development Report, both of which were released during the year. Both were prepared with the support of the Planning Commission and the UNDP, and both noted the initiatives and challenges facing the States as they seek to cope with HIV/AIDS. E. MAINSTREAMING ACTIVITIES F. ENGENDERING HIV/AIDS IN POLICY AND PRACTICE Around 1 million women live with HIV in India and another 3 million are caregivers to people living with 16HIV/AIDS . Gender inequality is driving the epidemic in the country as in many other parts of the world, necessitating the need for gender sensitivity in policy and programme implementation. In August 2003, the National Commission for Women (NCW) with the support of UNIFEM hosted a national consultation for “Working towards a gender sensitive policy on HIV/AIDS” where NACO, the State Minister of Health as well as the members of the Commission came together along with legal activists, women's groups and networks of people living with HIV/AIDS to develop an effective response to issues of HIV Positive and vulnerable women and mainstream strategies for engendering HIV in policy and practice. The consultation was part of a process to bring stigma and discrimination facing PLWHA centre stage and the NCW is now looking at the issue from a systemic perspective. 22 3.7 NEW RESEARCH FINDINGS ILO supported a study on “Socio-economic impact of HIV/AIDS on People Living with HIV/AIDS and their families.” The study was conducted by 4 PLWHA networks in India Delhi Network of Positive People, Manipur Network of Positive People (MNP+), Network of Maharashtra by People Living with HIV/AIDS (NMP+) and Positive Women Network of South India (PWN+) to document the overall experiences of people living with HIV/AIDS and their families ever since the discovery of their HIV+ status and to understand the impact of HIV/AIDS specifically on women and children. It was conducted in four states Delhi, Maharashtra, Manipur and Tamil Nadu. The involvement of networks of people living with HIV/AIDS in this research work had distinct advantages. It became easier to reach out to people living with HIV/AIDS for collecting information. Secondly, since the researchers were living with HIV/AIDS themselves, they were more receptive towards the respondents and did their best to respect confidentiality. The study revealed that HIV has in general made a deeper impact on women. Women diagnosed with HIV have faced more discrimination, more hardships and had to assume more responsibilities to run the households once their husbands died of AIDS. UNIFEM supported Positive Speaking: Voices of Women Living with HIV/AIDS. The study is a primary documentation of experiences of women living with HIV/AIDS in Karnataka, Kerala and Tamil Nadu conducted by the Delhi-based Centre for Advocacy and Research (CFAR) and the Positive Women's Network (PWN+). The findings indicate that the pervasive fear of violence and lack of access to basic services not only compounds the problem of low levels of awareness but also contributes to women's vulnerability. The individual testimonies reflected four dominant concerns. They are unacceptable levels of gender disparity, acute deprivation and discrimination as a girl child, denial of basic right to live a life of dignity, subjected to domestic violence and abuse, absence of guaranteed access to services in the area of information, counseling and health care and denial of legal rights such as right to property, lack of right to entitlements and benefits. 23 3.8 NEW DIRECTIONS The initiatives of the Expanded Theme Group on HIV/AIDS are directed at meeting the national priorities outlined in NACP II as well as the Millennium Development Goals (MDGs) and the United Nations General Assembly Special Session on HIV/AIDS (UNGASS) goals. 2003 threw up new opportunities for action and advocacy as care, support and treatment issues climbed up the national policy agenda. The members of the Theme Group were active participants in the discussions preceding the government's announcement to provide free antiretrovirals to selected groups of people living with HIV/AIDS. During the year, the activities of the members of the Theme Group and particularly among the UN cosponsors there was a stronger focus on joint programming with the Theme Group Chair and UN Resident Coordinator being the lynchpin of the overall coordination. Some of the lessons learned during the year were: v UNIFEM's experience in introducing a life skills module for adolescents in the railway schools in Vijaywada also holds out important lessons. It proved to be a challenging experience as the school authorities initially thought that this would mean additional workload and would be a burden. However, several workshops, Parent Teachers meetings and the solid support of the Divisional Railways Manager proved useful in launching the programme. Secunderabad Division is now eagerly awaiting the transfer of knowledge from the pilot division to their railway schools. v The National Consultation on Community Based Care and Support for HIV/AIDS (organized by NACO & ICHAP, and supported by CIDA and UNAIDS) held in May 2003 offered a valuable opportunity to discuss in depth the strengths and limitations of various models of care and support. Groups were formed to discus policy changes in each of the mainstreams i.e. hospital based care; care homes and community based care and support. Some of the issues, which were discussed during the consultation, provided vital insights for future programming. For instance, it was pointed out that accessibility was a critical factor. v Issues arising out of discussions on how best to set up VCTCs offer key lessons. An important question is: should counsellors be hired on academic qualifications or on a profile that integrates personality with skills strengthened by training? Discussions also highlighted the need for a strategic decision to link HIV/AIDS management with the existing health infrastructure, especially in the context of the low prevalence states. v Funds are not always enough in the response to HIV/AIDS. Several agencies (e.g. World Bank) had provided funds, which was not used, due to lack of management and implementation capacities. 24 One of the most dynamic developments of the joint response to the unfolding HIV/AIDS epidemic in India has been the innovative CHARCA project. CHARCA is an acronym for “Coordinated HIV/AIDS and STD Response through Capacity Building and Awareness In 2003, CHARCA completed a remarkable participatory planning process involving the local communities and other stakeholders. This resulted in the development of the district strategic plans and set the stage for the next crucial stage --- implementation in six districts. CHARCA aims at reducing the vulnerabilities of young women between 13 and 25 and increasing their capacity to protect themselves against STI and HIV/AIDS. It is one of the first instances where the UN system and bilateral donors in India are pooling resources and where eight UN organisations are working together at the district-level. It for a bottom-up, rights-based response .” ORIGIN OF CHARCA In 2001, eight UN Agencies (ILO, UNDP, UNESCO, UNFPA, UNICEF, UNIFEM, UNODC, WHO as well as UNAIDS, in partnership with NACO, the State AIDS Control Societies of six states, NGOs and donors initiated the CHARCA project. The three-year project aims to reduce young women's vulnerability by providing information, improving their skills, and increasing their access to quality reproductive health services. It also aims to build leadership, increase support networks, and create a positive enabling environment. CHARCA is being implemented in six districts in India: Udaipur,, Guntur, Kishanganj, Bellary, Aizawl and Kanpur serves as a global model for a new kind of public-private partnership between NGOs, government and the UN system, as well as urgently required to meet one of the world's biggest challenges. CHARCA's special features include: v Participatory and community-led planning process with involvement of district-level stakeholders v Gender perspectives into the HIV projects and programmes for general population · Partnership with the government at national, state and district level, with NGOs, CBOs, women's groups 18and networks of people living with HIV/AIDS . v Eight UN executing partners, some as lead agencies and some as thematic agencies. In addition, a fund for common activities is placed under the UN Resident Coordinator v CHARCA Management Committee to ensure that the joint programming and interventions add value to the project goals and objectives. The committee is comprised of the Heads of Agency of the involved UN agencies, the UNAIDS Country Coordinator, UN Resident Coordinator and NACO. In August 2003 a National Consultation on CHARCA was called by NACO; this brought together senior officials from NACO, SACS of the 6 CHARCA states (Mizoram, Bihar, Uttar Pradesh, Rajasthan, Karnataka and Andhra Pradesh) as well as district level officials. In 2003, a common Monitoring and Evaluation Framework was developed for the project. In October-December 2003, multi stakeholder meetings took place to address the HIV/AIDS situation in Bellary, where CHARCA will be part of the overall strategy of the State Government. In November- December, preparatory meetings were held on project implementation and administrative arrangements to execute the project in the six CHARCA districts. . . . , INNOVATION: CHARCA, A MULTI- SECTORAL, DISTRICT-LEVEL INTERVENTION BY THE UN COSPONSORS “The CHARCA model shows the new way of working. It is a demonstration project, which has brought UN agencies together and put in place joint planning exercises. It is a global pilot showing how UN agencies can work together on HIV/AIDS. With its district level focus, it also showcases the bottom-up approach to HIV/AIDS.” Kenneth Wind-Andersen, India Country Coordinator, UNAIDS 25 In addition to bringing the comparative advantages of the CHARCA UN partners to the project implementation, CHARCA will use different strategies to reach out to young women in the general population. These include working with the volunteers of the National Literacy Mission in Kishanganj, Church based and secular groups in Aizawl, women's collectives in Bellary and Guntur, with CBOs including people living with HIV/AIDS and NGOs in the six districts. VOICES FROM THE CHARCA FRONTLINE: WHY WOMEN ARE VULNERABLE “My husband insisted on getting our 11-year old daughter married. I kept on protesting but in vain. The result is that she is now sitting at home as her husband has left her…” Urban woman at Udaipur Focus Group Discussion. “When a man gets infected, he goes to the village doctor and gets treated. But when women have any sexual health related problems, they are too shy to get any treatment. First, they will be eyed with suspicion and will get blamed for it. Second, there are no female doctors in the district. I know of young girls who have committed suicide due to fear of what their families would do if they got to know.” 19Woman Panchayat leader from Kishanganj THEMATIC AREAS Care & support IDU & HIV Poverty & HIV Gender equality & women's rights Reproductive & Child Health Capacity building MTCT (now called PPTCT) Youth, adolescent health School based education Out of school / non-formal education Marginalised groups Workplace interventions / Private sector partnerships Legal & ethical issues Children Networking / partnerships / Civil Societies / PLWAs Stigma / discrimination issues Nodal Ministries/Govt.Agency UNDP UNFPA UNICEF UNIFEM ILO WHO UNODC UNESCO X X X X X X X X X X X X X X X X X X X X X X X X X Dept. of Education in MHRD Dept. of Economic Affairs MOH &FW MOH &FW DWCD DWCD, Law & Social Justice Labour Ministry Social Justice & Empower ment 26 X X X X X X X X X X X X X X X X X X In 2003 a historic consensus was reached by the international community to adopt a unified global response to HIV/AIDS. The “Three Ones” are principles for coordination of national AIDS responses and were identified in a preparatory process at global and country level, and initiated by UNAIDS in cooperation with the World Bank and the Global Fund for AIDS, Tuberculosis and Malaria. They are not prescriptive, but are based on lessons learned over two decades and offer guidance on how to leverage available resources to bring about an extraordinary response to the exceptional challenge posed by HIV/AIDS. In India, six states have reached high prevalence and the course of the epidemic in India is likely to have a decisive influence on the global pandemic in the years ahead. Existing and new priorities such as provision of free antiretrovirals to people living with HIV/AIDS require meticulous coordination at the policy and implementation level. Strengthening of state and district level responses to HIV/AIDS is another area, which calls for a synergy between the different members of the Theme Group in a way that brings out the expertise and resources available with each one. This is especially so now that the Theme Group has expanded to include many more members and 20more resources are available for India . In 2003 the NACO made an important announcement of initiating a government-led Partnership Forum on HIV/AIDS. The Forum is envisioned to be a voluntary association of agencies and institutions involved in prevention, care, support, treatment and research in the field of HIV/AIDS. The objective of the Forum is to THE THREE ONES: PRINCIPLES FOR THE COORDINATION OF NATIONAL AIDS RESPONSES ONE agreed HIV/AIDS Action Framework that provides the basis for coordinating the work of all partners. ONE National AIDS Coordinating Authority, with a broad-based multisectoral mandate. ONE agreed country-level Monitoring and Evaluation System. September 2003 co-ordinate efforts of the different agencies and institutions involved in the response to HIV/AIDS. Specifically, to share information about ongoing work, facilitate collaboration, and develop a joint programme for planning, implementation, monitoring and evaluation of the response. The Theme Group has committed its support to NACO to facilitate this Partnership Forum and in November 2003 a brainstorming session on the modalities of such a forum was held. Another development in 2003 was the issue of the new ODA (Overseas Development Assistance) guidelines by the Government of India. The guidelines specified that India would discontinue its direct government-to-government development cooperation with all, but six donors (Japan, UK, Germany, USA, European Commission and Russian Federation). While this has resulted in some bilateral partners phasing out their operations in India, it has also opened up new opportunities for multisectoral programming and partnerships between UN agencies and bilateral donors. In light of this new opportunity to further strengthen UN system bilateral partnerships, the UN Country Team in India has proposed to initiate a Knowledge Management Partnership project (KMP). The vision of the KMP is to support the Government of India in achieving the India Development Goals/Targets as articulated in the Tenth Five Year Plan through multi- stakeholder partnership on knowledge management. The objective is to contribute to the efficiency and effectiveness of development programmes through innovative approaches and ideas. In the long run the aim of the KMP would be to work in synergy with the government-led Partnership Forum. THE WAY AHEAD 27 1. Ms Meenakshi Datta Ghosh Additional Secretary & Project Director, NACO Ministry of Health & Family Welfare National AIDS Control Organisation th9 floor, Chandralok Building, 36 Janpath New Delhi - 110001 Tel. 23325331 Fax: 23017706/ (23731746 Chandralok Bldg.) E-mail: mdg@nacoindia.org 2. Dr. Maxine Olson Chair, UN Resident Coordinator & UNDP Resident Representative UNDP 55 Lodi Estate New Delhi 110003 Tel. 24628877 extn: 330 Fax: 24629666 E-mail: maxine.olson@undp.org 3. Dr. Saleem Habayeb WHO Representative to India WHO 533-35, A Wing, Nirman Bhawan New Delhi 110001 Tel. 23018955/23017993/23792779 Fax: 23012450 E-mail: habayebsj@whoindia.org 4. Ms. Erma Manoncourt Acting Representative UNICEF UNICEF House 73 Lodi Estate Tel. 24690401 Fax: 24627521/24691407 E-mail:emanoncourt@unicef.org 5. Mr. Gary Lewis Regional Representative UNODC EP 16/17 Chandragupta marg Chanakyapuri New Delhi 110021 Tel. 24104970-73 Fax: 24103534 E-mail: gary.lewis@unodc.org 6. Ms. Ena Singh Acting Representative UNFPA 55 Lodi Estate New Delhi 110003 Tel. 24628877 extn: 224 Fax: 24628078 E-mail: ena.singh@unfpa.org.in 7. Dr. K Sudhakar Health Specialist The World Bank 70 Lodi Estate New Delhi Tel. 24617241, 24610210 ext: 181 Fax: 24619393 E-mail: ksudhakar@worldbank.org 8. Ms. Chandni Joshi Regional Programme Director UNIFEM 233, Jor Bagh New Delhi 110003 Tel. 24698297/24604351 Fax: 24622136 E-mail: chandni.joshi@undp.org ANNEX 1: MEMBERS OF THE EXPANDED THEME GROUP ON HIV/AIDS 28 9. Ms. Sonam Yangchen Rana Regional Programme Coordinator UNDP Regional HIV and Development Programme 13, Jor Bagh, Ground Floor New Delhi 110003 Tel. 24632339/24632602 Fax: 24631647 E-mail: sonam.yangchen.rana@undp.org 10. Mr. Herman van der Laan Director ILO rdTheatre Court, 3 Floor India Habitat Centre, Lodi Road New Delhi 110003 Tel. 24602101-04 Fax: 2460211 E-mail: vanderlaan@ilodel.org.in 11. Prof. M. Tawfik Director UNESCO UNESCO House B 5/29, Safdarjung Enclave New Delhi 110029 Tel. 26713000, 26711871 Fax: 26713001/26713002 E-mail: m.tawfik@unesco.org 12. Ms. Joanne Reid Health Adviser DFID India British High Commission B-28 Tara Crescent Qutab Institutional Area New Delhi 110016 Tel. 26529123 Fax: 26529296/26529227 E-mail: JM-Reid@dfid.gov.uk 13. Mr. Robert Clay Director (Population, Health & Nutrition) USAID American Embassy Chanakyapuri New Delhi 110021 Tel. 24198406 Fax: 24198454/4198612 E-mail: rclay@usaid.gov 14. Dr. Dora Warren Director (CDC) Global AIDS Program, India American Embassy New Delhi 110021 Tel: 24198570 Fax: 24198612 E-mail: dyw3@cdc.gov 15. Mr. Kerry Groves First Secretary (Development) AusAID Australian High Commission 1/50G, Shantipath, Chanakyapuri New Delhi 110021 Tel. 26888223 Fax: 26887492 E-mail: kerry.groves@dfat.gov.au 16. Mr. Owe Andersson Sida Embassy of Sweden Nyaya Marg Chanakyapuri New Delhi 110021 Tel. 24197155 Fax: 26885540 E-mail: owe.andersson@foreign.ministry.se 29 17. Ms. Eileen Stewart First Secretary (Development) CIDA High Commission of Canada 7/8, Shantipath Chanakyapuri New Delhi 110021 Tel. 26876500 Fax: 26886478 E-mail: eileen.stewart@dfait-maeci.gc.ca 18. Mr. Pedro Medrano WFP WFP Representative / Country Director 2 Poorvi Marg Vasant Vihar New Delhi 110 057 Tel : 26150000/01 Fax : 26150019 E-mail : pedro.medrano@wfp.org 19. Mr. Abraham Kurien President INP+ Flat No. 6, Kash Towers 93, South West Boag Road T. Nagar Chennai 600017 Tel. (044) 4329580 Fax:(044) 4329582 E-mail: inpplus@vsnl.com 20. Ms. Emelia Timpo Team Leader UNAIDS Inter Country Team for South Asia EP-16/17 Chandragupta Marg Chanakyapuri New Delhi 110 021 Tel : 24104972 Fax : 24103534 E-mail : timpoe@unaids.org 21. Dr. Kenneth Wind-Andersen Country Coordinator UNAIDS c/o 55 Lodi Estate New Delhi 110003 Tel. 24649892 Fax: 24649895 E-mail: windandersenk@unaids.org 22. Dr. Wolfhard Behrens Counsellor Head Economic Cooperation and Development Embassy of the Federal Republic of Germany, 6 Shantipath New Delhi E-mail : wolfhard.behrens@diplo.de 23. Inge Tveite Counselor Development Royal Norwegian Embassy 50 C Shantipath Chanakyapuri New Delhi E-mail : inge.tveite@norad.no 24. Mr. Knijnenburg Head Development Cooperation Royal Netherlands Embassy 6/50 F Shantipath Chanakyapuri New Delhi 110 021 E-mail : hans.knijnenburg@minbuza.nl NEW MEMBERS AS OF APRIL 2004 30 25. Mr Toshifumi Sakai JICA ndDLF Centre, 2 floor, Parliament Street New Delhi -110 001 E-mail : toshifumi@jica.go.jp 26. Ms. Frederika Meijer EC Health Advisor European Union 65 Golf Links New Delhi Tel: 24629237 Fax: 24629206 27. Mr Michael Hjortso Minister Counsellor DANIDA 11 Aurangzeb Road New Delhi 110 001 E-mail : bjojrn@um.dk 31 28. Mr. Leonardo Gastaldi Development Counsellor Embassy of Italy 50-E Chandragupta Marg Chanakyapuri New Delhi - 110 021 E-mail : dhindaw@italiancooperation.com 29. Mr. Ashok Alexander Director Gates Foundation A10 Qutub Institutional Area Sanskrit Bhawan Aruna Asaf Ali Road New Delhi 110067 Tel : 51003100 E-mail :ashoka@India.GatesFoundation.org 30. Ms. Anjali Nayar IAVI 116 Ground Floor Jor Bagh New Delhi E-mail : anayyar@iavi.org ANNEX 2: BRIEF PROFILE OF THEME GROUP MEMBERS AusAID Reduce poverty and develop sustainability in the sector of Health and Education. CDC Support HIV prevention, care and support; infrastructure strengthening and capacity building. CIDA Slow the spread of HIV/AIDS and improve the quality of life for those affected by the epidemic DFID Eliminate poverty and contribute to achievement of the MDGs, including supporting efforts to reduce the rate of growth of HIV infection and its impact on poverty in India. ILO Support workplace interventions on HIV/AIDS INP+ Improve the quality of life for PLHA in India. NACO (1) Reduce the spread of HIV infection in India; and (2) Strengthen India's capacity to respond to HIV/AIDS on a long term basis Sida Create conditions for poor people to improve their standard of living. UNDP Facilitate Greater Involvement of People living with HIV/AIDS, support intersectoral collaboration, initiate leadership program for PLWA's and Media. UNESCO Scale up integration of HIV into adult literacy programme UNFPA Integrate HIV/AIDS prevention interventions into reproductive health services with special focus on adolescents and pregnant women by undertaking community level, prevention-education, promote condom use, recognize and treat STI's and prevent gender-based violence. UNICEF Support nationwide scaling up of PMTCT, prevent HIV/AIDS among young people and create an environment for an expanded response to HIV/AIDS prevention and its impact on families. UNIFEM Support development of a gender sensitive strategy for national response and advocate for women's rights in the context of CEDAW. UNODC Integrate HIV into the drug demand programme, especially in the Northeast. USAID Reduce transmission and mitigate impact of infectious diseases especially HIV/AIDS and STD WFP Reduce vulnerability of food insecure people to HIV/AIDS through prevention and nutritional support. WHO Strengthen national capacity to prevent and control STI and support enrollment of treatment through the “3 by 5” initiative. World Bank Support National AIDS control programme UNAIDS Promote leadership and advocacy for effective action on the epidemic; provide strategic information to guide efforts against AIDS worldwide; track, monitor and evaluate the epidemic and responses to it; engage civil society and develop partnerships; and mobilize resources to support an effective response. 32 LIST OF ACRONYMS AIDS Aquired Immuno Deficiency Syndrome APN+ Asia Pacific Network for People Living with HIV/AIDS AusAID Australian Agency for International Development AZT Zidovudine BSS Behavioural Surveillance Survey CBO Community Based Organisation CDC US Centers for Disease Control & Prevention CHARCA Co-ordinated HIV/AIDS and STD Response through Capacity- building and Awareness CIDA Canadian International Development Agency CII Confederation of Indian Industry DFID UK Department for International Development FHAC Family Health Awareness Campaign GIPA Greater Involvement of People Living with AIDS GOI Government of India HDR Human Development Report HIV Human Immunodeficiency Virus IEC Information Education Communication IDU Injecting Drug Use[r] ILO International Labour Organisation INP+ Indian Network for People Living with HIV/AIDS MSJE Ministry of Social Justice and Empowerment NACO National AIDS Control Organisation NACP National AIDS Control Policy NGO Non Governmental Organisation NVP Nevirapine PLWHA People Living with HIV/AIDS PPTCT Prevention of Parent to Child Transmission PWN+ Positive Women Network of South India RTI Reproductive Tract Infection SACS State AIDS Control Society SHRC Sexual Health Resource Centre Sida Swedish International Development Cooperation STD Sexually Transmitted Decease STI Sexually Transmitted Infection TI Targeted Intervention(s) TRT Technical Resource Team UNAIDS Joint UN Programme on HIV/AIDS UNDAF UN Development Assistance Framework UNDP UN Development Programme UNESCO UN Educational, Scientific and Cultural Organisation UNFPA UN Population Fund UNGASS UN General Assembly Special Session UNICEF UN Children's Fund UNIFEM UN Development Fund for Women UNODC UN Office of Drugs and Crime UNTG UN Theme Group USAID US Agency for International Development VCTC Voluntary Counselling and Testing Center WFP World Food Programme WHO World Health Organisation 1 http://www.naco.nic.in/indianscene/esthiv.htm 2 AIDS Epidemic update, December 2003, UNAIDS 3 AIDS Epidemic update, December 2003, UNAIDS. Pg 18 4 “Responding to HIV & AIDS Under the Leadership of Elected Representatives”, NACO 5 http://www.naco.nic.in/indianscene/esthiv.htm 6 NACO: A Shared Vision, December 2003 7 http://www.naco.nic.in/indianscene/esthiv.htm 8 Adapted from 'Responding to HIV & AIDS Under the Leadership of Elected Representatives', NACO 9 Tenth Five Year Plan, Planning Commission, Government of India, Vol. 2, Chapter. 2.8, page. 117. 10 Regional Human Development Report on HIV & Development in South Asia 2003/UNDP 11 About NIIT/NIS: International Data Corporation (IDC) ranks NIIT as one of the top 15 IT Training leaders worldwide. NIIT has 2730 centers where over 600,000 students get trained every year. These IT courses span groups ranging from career seeking students, to business managers and IT professionals seeking advance IT skills and housewives seeking to learn computer basics to enhance their comfort with computers. NIS is the Corporate Social Responsibility and Corporate Training wing of NIIT. The UN System in India especially UNAIDS and UNDP have worked with NIS for capacity building of their own staff as well as to help strengthen capacities of the State AIDS Control Societies. 12 For more details see http://www.ichapindia.org/ 13 For more details see www.ilo.org/hivaidsindia 1414 DOTS is the strategy to control tuberculosis. 15 The APLF, under the auspice of UNAIDS South East Asia Pacific Inter Country Team, arose out of the UNGASS Declaration of Commitment on HIV/AIDS (July 2001) and the Melbourne Ministerial Meeting, which resolved to: “Develop an Asia Pacific Leadership Forum on HIV/AIDS with established support from Australia.” In order to mobilize the response to HIV/AIDS across the Asia Pacific Region, the APLF program focuses on enhancing the capacity of senior policy advisors, senior civil servants and senior women in the ministries of national government in the region to respond to HIV/AIDS. 16 NACO, A Shared Vision, December 2003. 18 CHARCA PROJECT DOCUMENT 2003 (For more details on CHARCA please see http://www.youandaids.org/Charca/index.asp) 19 CHARCA Annual Report 2003 20 In 2004 the Theme Group on HIV/AIDS has been expanded further with the inclusion of the German government, NORAD, the Netherlands government, JICA, European Union, DANIDA, the Italian government, Gates Foundation, IAVI, the French government and the Belgium government. FOOTNOTES UNAIDS c/o UNDP, 55 LODI ESTATE, NEW DELHI 110 003, INDIA TEL: +91 11 2462 8877 www.unaids.org.in