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Social Assessment of HIV/AIDS Among Tribal People in India - A Report.
ORG Centre for Social Research, 2006.
EXECUTIVE SUMMARY
1. Background
The National AIDS Control Programme (NACP) Phase III aims to go beyond the high risk behavior groups covered by Targeted Interventions. This would entail extension of interventions to
populations that are vulnerable to HIV such as the tribal population and socially disadvantaged sections of the population in both rural and urban areas. A rural risk/vulnerability assessment has already been carried out, and the present assessment has focused and limited itself to the study of
tribal population only.
2. Objectives of the Social Assessment
The SA among tribal population has the following objectives:
· To undertake a comprehensive SA that documents the prevalence and risk of HIV/AIDS among tribal population.
· To understand their levels of knowledge, social and behavioural causes and consequences of HIV/AIDS (including stigma).
· To assess current strategies used for PDTC of HIV/AIDS in order to ensure appropriate programme design and implementation to reduce the spread of HIV/AIDS and improve its management.
· To provide information for pre-project stakeholder consultations and to design continuous stakeholder consultations in the programme.
3. Assessment Methodology
SA was a qualitative research and the information was collected through;
· Review of literature.
· Primary assessment among tribal population; and programme implementers and service providers.
· Relevant literature survey.
· Analysis of the various policy documents.
· Analysis of NACO Project documents and assessment reports available.
4. Basic Information about Tribal Population
The following are the salient findings regarding behavioral and other practices that are relevant to the programme planners:
· Low awareness and knowledge regarding STI/HIV/AIDS except in Manipur.
· Widely varying sexual practices (high level of pre-marital and extra marital sexual practices) and contact with external high risk population make them vulnerable.
· Specific communication strategy designed to suit the needs and culture of the target group in local dialects would be necessary. The choice of medium for communication would also be critical. Folk media, Inter Personal Communication and messages through influencer groups could be main choices.
· Non-availability and/or lack of access to health care facilities were one of the main factors discouraging health seeking. Trust in faith healers and non qualified private practitioners and easy accessibility made them rely on these sources for seeking treatments for illnesses. Role of such providers in referral needs to be reckoned in
programme design.
· Gender bias towards males for health care seeking needs to be addressed.
· Knowledge regarding STI and symptoms are low and misconceptions that exist
exasperates this situation.
· High level of stigma associated with STI and HIV/AIDS is a challenge that needs to be addressed.
· Youth are emerging as a highly vulnerable group in these areas.
Implications of Basic Information Findings:
· The tribal population is at risk in terms of HIV and hence it is essential that interventions designed specifically to meet the requirements of the tribal population.
· Communication strategies and media selection needs to be done in accordance with the findings of the media habits as outlined in the study.
· The instance of high level of pre-marital and extra-marital sexual practices and sexual exploitation also makes them vulnerable and this aspect needs to be reckoned while designing interventions.
· The communication needs to address in the first stage increasing knowledge and
awareness among the tribal population regarding the STI/HIV/AIDS as well as remove the myths and misconceptions existing in order to reduce stigma.
· The strategy of training and using faith healers and other private practitioners in whom the tribal have faith in to motivate the population for bringing about a better health seeking
behavior.
· The infrastructure of health facilities need to be improved and human resources trained and posted in this geographic area to increase access and use of these facilities.
· The capacity of the NGOs also needs to be built in this region to effectively implement interventions.
5. Policy Environment
The following policies have been examined and analyzed for their implications on the Prevention-
Diagnosis-Treatment and Care (PDTC) for the tribal population:
· National HIV/AIDS Prevention and Control Policy.
· National Health Policy 2002.
· National Population Policy 2002.
· National Rural Health Mission-Vision Document.
· National HIV/AIDS Bill.
· Manipur State Level Policy on HIV/AIDS.
· The National RCH and RNTCP Program Documents.
Overall findings from the review
There are no specific policies that directly impinge or address the tribal issues but there is enough scope to derive from the various policies that there are areas that can be interpreted to be applicable to the Tribal Population. This has been discussed in the interpretation section of each
policy. However, it is concluded that specific issues addressing the requirements of tribal population needs to be developed separately drawing from the different policies that are already in place. This exercise needs to be carried out on a priority basis.
6. Institutional Issues
· A special function at the National and State level needs to be created and positioned to deal with issues relating to policies, coverage and implementation of interventions among the tribal population and other socially disadvantaged sections of the population who are vulnerable to HIV.
· The district level planning envisaged during NACP III needs to identify the vulnerable and socially disadvantaged populations as well as the tribal population that need to be covered
in the different districts of each state.
· The Governing Board and Executive Committee of each SACS can be expanded to include members from the Social Welfare Board and Tribal Development departments for better understanding of the requirements of the populations and appropriately plan for intervention and services in those areas.
· The convergence with RCH II especially in the areas of Tribal Plan, Urban Poor and the approaches to mainstreaming gender and equity can be attempted in order that the service availability and service provision can be linked. The policy and goals can be studied and
the same be tied up with in the state PIP for serving the tribal population and other marginalized and socially excluded population.
· Behavioral studies using a ethnographic approach need to be carried out in different tribal and rural belts to better understand the risk and vulnerability factors of the specific
population in order to design programme and interventions for these populations.
· Capacity building of the NACO and SACS staff on the Social Development issues, gender, equity and Social Exclusion needs to be provided in order that the staff are sensitized and appreciate the necessity to include and mainstream such aspects into the programme.
· District level structures need to be created for planning the district level HIV/AIDS intervention with evidence for planning and capacity needs to be built on different aspects of programme planning and management.
7. Recommendations
· Review of laws and policies and make them specific to tribal population.
· Policy on specific interventions to be taken up with the tribal population and the necessity for the state and the district plans to reflect these over the initial period of NACP III.
· Provision of clear budgetary allocation for working with the tribal population to emphasize the importance.
· Convergence as a strategy with other programmes needs to be worked out in order that cost-effective interventions can be initiated.
· Introducing a function of social development within NACO and train and sensitize staff of NACO on these issues in order that it can be mainstreamed.
· Inter-sector collaboration with ministries such as Environment & Forests, Tribal Development, Social Welfare and Tourism to arrive at certain common minimum programme.
· Constitute a working group at the national level for identifying strategies to work with the tribal population.
· Initiate mapping exercise at the state level in order to prioritize.
· Expand the Governing Body and The Executive Committee at the state levels to include representatives of tribal development and social welfare.
· Develop communication material in the local dialects and languages with a clear focus on changes that are intended to be brought about.
· In states strengthen the NGO advisor with a support unit to effectively handle such interventions.
· Develop appropriate structure at the district levels to implement HIV/AIDS programmes and also plan for priorities at the district level.
· To have mechanisms to generate the disaggregated information regarding tribal population at the district level at different service provision centers.
· Research studies to establish the relationship between migration and tribal risk factors needs to be initiated for evidence to plan for these.
· Initiation of training programmes for service providers to sensitize them to issues of tribal population in order that their attitudes are conducive to the tribal population.
· Carry out a detailed assessment of the private sector organizations that are working in the tribal areas and plan for their involvement through consultations.
