CHLP REPORT-Health Learning Experience, JEYAPAUL SUNDER SINGH. S
Item
- Title
- CHLP REPORT-Health Learning Experience, JEYAPAUL SUNDER SINGH. S
- extracted text
-
I
g
8
I
g
J
I
3
3
*
I
3
3
3
3
M Hepwt ©m (B®
Health Learning
Experience
Community Health Learning Programme
June 2008 to February 2009
A journey through the wisdom in
community health
S. Jeyapaul Sunder Singh
Intern, Community Health Cell
This report is dedicated
to millions of children living with HIV and
children orphaned by HIV aids around the world...
2
Acknowledgments
In my journey through the wisdom in community health at CHC, I would like to thank
first of all Dr. Ravi Narayan for his commitment, passion, humbleness and openness to
learn and to make me learn. Truly he is an inspiration to continue the journey with
confidence.
Dr. Thelma, a successful woman in public health, her in-depth analytical and
intellectual lectures were extremely helpful to think through myself during the
fellowship.
Dr. Rakhal, my kind mentor without him, I would not have been able to come through
the fellowship and helped me to think through deeply upon every projects I visited,
every views and observations I presented in every sharing meeting. I sincerely thank
him for his support both personally and in the fellowship.
I would acknowledge Dr. Sukanya, for her encouragement to each fellow from
crystallizing our learning objectives to completing our final report.
If I would say I have understood and learnt about the caste and political dynamics in
any community, my sincere thanks will be to Mr. E. Premdas. I can well remember the
graph that denotes where the movements and NGOs are placed pertaining to any issue.
Overall, I am thankful for all the resource people, which the CHC team worked hard to
bring to share their experiences with the nine of us. Such a rich experience sharing and
wisdom is difficult to get even if one is ready to spend any amount of resources.
Another learning experience by observation is the staff of CHC; truly I saw an invisible
structure without any hierarchy. I would sincerely thank all the staff at CHC who
helped me feel friendly and comfortable during the course of the learning programme.
I am debted to thank my fellow friends, Karibasapa, Aditya, Sabyasachi, Sis. Ria,
Sudha, Savithri, Varsha and Lakshmi. Each one of them from different background and
experience shared so much of knowledge and a true friendship helping me to realize
'together we can'.
I also acknowledge and thank all the directors of the projects I visited and the time each
one took to share with me their immense knowledge and experience in the field they
are in.
Not but not the least, with all of my heart I thank all the lovely children who
participated with me in this fellowship and helped me understand their problems and
the courage each one of them had to live life with dignity and passion for one another. I
bow down before them!
3
Contents
1
2
3
Things that really disturb me...
What inspired me to join CHLP?
My expressions of the five week orientation program
4
My objectives for the nine months Community Health Learning 8
Program
What I did, in line with set objectives
5
6
THE School
Balamandir
Santhosh Siruvar Maiyam, Melur
Bangalore OVC Project
Trainings I participated and facilitated
Life Skills Education
5
6
7
9
9
10-13
14-18
19-20
Children Parliament
Disclosure Workshop for mothers living with HIV AIDS
Comic Workshop
7
Advocacy Events Participated
21-24
National SACS Project Directors Conference
3rd National Consultation of Women living with HIV AIDS
1st State Level Consultation for Children in Kerala
8
Organisations that I networked
24
9
Understanding OVC Policies in India
24
10
11
Building a resource library of children related documents and 25-27
schemes
Learning from Namakkal Visits in January 2009
27-31
12
Looking Inward - What did I learn about myself?
31-34
13
Looking Outward - What did I learn about the community?
35-39
14
Looking Ahead - Towards a Community Health approach to
working with children living with and affected by HIV and AIDS
Books, Documents, Reports and Movies - read and watched
40-44
15
Annexures
I - JLICA Report Brief
II - Child Marriages
III - Concerns of children living with grand parents
4
Things that really disturb me...
The HIV and AIDS epidemic has a long wave length and the limited number of people
accessing Anti-Retroviral Therapy (ART) in India means the impact of orphanhood due
to AIDS will be an ongoing burden. It is important to note that AIDS orphans reflect the
history of the epidemic; therefore health and social support structures must be in place
to accommodate any projected impact
An overview of the most recent estimated numbers of children affected by HIV and
AIDS in India suggests
• 150,000 children were infected vertically,
• 1,500,000 orphaned due to AIDS and
• 7,000,000 with HIV posilive parents.
• 220,000 children currently living with HIV
• Over 50,000 children born HIV every year1
More detailed estimates have not been attempted as the country does not have a
national generalised epidemic. However, the vast population size and prolonged
nature of Orphans and Vulnerable Children (OVC) issues means that its true impact is
widely felt and its scope significant. UNICEF has documented that the estimated total
number of orphans, due to all causes across India (2005) was in the region of 25,700,000.
A fair approximation of number of orphans due to HIV and AIDS equates to 6% of the
total.
This serves as a reflection of the countries status and the challenge posed from children
directly and indirectly affected by HIV and AIDS. Importantly, the number of
'vulnerable children' to HIV and AIDS is deemed so vast, amounting to tens of
millions, that previous studies have found it difficult to incorporate this group into any
meaningful research.
Over these emerging issues among children orphaned by HIV/ AIDS epidemic, the role
of government and civil society organizations was so much limited in providing just
ART, nutrition and education. Unfortunately, the under mentioned issues were
neglected and often not considered by Government and the NGOs implementing
programmes for children affected by HIV and AIDS.
Some of the important issues that affect orphans and vulnerable children includes
• Sexual abuse
• Child labor
• Sickness and burden of drugs and treatment
• Discrimination (school, family & community)
• Early marriage of girl children of positive parents
• Deprived on joy of child hood
• No social security
• Fostered children as domestic workers
•
and the list goes on and on
1 Richard Matthew Lee, UNAIDS, September 2008 - Orphans and Vulnerable Children - Research Study
5
These concerns made me to firmly decide to dedicate my life in supporting and
empowering children affected and orphaned by HIV and AIDS. Support the children
and make their voices heard by various stakeholders and government working for
them and with them in the fight against HIV.
What inspired me to join CHLP?
The information given above is the major reason for me to live. In 2001, personally I
made a strong commitment to support children affected by HIV AIDS in India to the
best possible means and ways.
I was then a businessman along with my brother and my friends, but I decided to quit
from the business and pursued MS (NGO) management. I completed my degree and
landed up with a job in Rural Innovations Network (RIN).
Though I was working with RIN, deep in my heart my desire was to support children. I
started visiting many websites related to children and HIV AIDS, learnt the burden of
HIV AIDS upon children and child headed families. In my self interest, I started
subscribing A to Z of all publications, brochures and booklets from national and
international organizations that work on HIV AIDS through the sites I visited on the
web.
I started receiving parcels over parcels all on HIV AIDS to my residence address. My
father and mother started to stare at me, what's happening to my son? Why such an
interest for him on HIV AIDS all of a sudden? But they never questioned me or talked
with me about it.
After around 18 months of working with Rural Innovations Network, I gave up and
decided to volunteer with Indian Network for People living with HIV AIDS (INP+) in
Chennai. I got to know about INP+ through my well wisher and mentor for life Mr.
Jacob Varghese. Only then I started focusing myself and started understanding lives of
friends living with HIV AIDS and about their families. I got my Job with INP+ as a
miracle. It is definitely a miracle because a national organization giving the position of
Project Manager to me with no health or medical background nor prior experience on
HIV AIDS and that "Positive Living Center" project is the first pilot project at grass root
level for INP+.
Positive Living center is a comprehensive project that aims to address prevention,
treatment and care and support needs of people living with HIV and their families in
the HIV high prevalent district Namakkal by establishing taluk level centers.
It was there through this project in Namakkal; I started witnessing with my own eyes
and started experiencing the lives of children living with HIV and their family situation
of hopelessness and bleak future of their children. I started realizing there are so many
other issues beyond the scope of the project that made me to get passionate about
working with children affected by HIV AIDS. Later I joined World Vision India and
then Positive Women's Network. Whenever and wherever possible I started pushing
the agenda of children into organizations that I came in touch with.
6
B H B v B
i
ii B
w 'In W B
It was then, I strongly felt the urge to learn from experts in public health and improve
my skills and knowledge when I wanted to do engage directly at the field level. And
that led me to apply for CHLP which helped me exactly at the time of burning out on
my job.
My expressions of 5 week Orientation program of CHLP at CHC
Personally, the 5 week break from my regular work and commitments waived away
the burn-out situation I was facing in my work life. I sincerely thank the members of
the interview panel for having mercy on me to select and enabled me to have this
break.
-
Inner Change. The 5 weeks were not just about knowledge, but more about an
inner change. I am a witness, right from day one, when I was observing each
facilitators and staff, I could experience and learn the humbleness and ready to
serve attitude to every one of us. I was moved by this, and am in the process of
adapting myself to that kind of character.
-
Availability. I would like to thank from my heart on the availability of each
facilitator, coordinators and staff to clarify our doubts ranging from silly to
tough ones. I was so glad, when everyone openly agreed that all are in confusion
like me in addressing the public health situation in India.
\U w w w w
i w w w w w w w m 11 m w In n
I
n
In In in
Though there is passion and experience of working with people living with HIV groups
and families at the grass root level, I still felt there is something missing in me that I
need to learn. I found the gap and linkage between HIV AIDS programs by
government and the public health system on one hand; on the other hand, with so
much of resources and effort put on targeted interventions and prevention programs
the prevalence rate is always on the rise.
Learning. Learning. Learning. Introduction of participants and facilitators,
Introduction of each fellows to new facilitators, going around the departments in
CHC, games and sessions at CHLP, field visits at Hanur, Hospet and Raichur,
meeting activists, professionals, staying at Holy Cross convent, discussions and
chat with fellows were all packed with LEARNING LEARNING LEARNING.
Glad to be part of this type of orientation.
-
Remembering Names and Books. I was overwhelmed by the way Dr. Ravi, Dr.
Thelma, Dr. Rakhal, Mr. Premdas, Dr. Sukanya and other facilitators mention
names of people and names of books and authors. I felt so weak in my memory
as I could not even remember some of my classmates names in school and
college.
-
Commitment with Community. Every one including the fellows with me
expressed their commitment to the community. Often we are taken up by the
systems and work pressure, but one thing I learnt very strongly is that everyone
has a deeper meaningful commitment and passion for the community.
7
-
Seeing is Believing. It was all knowledge when we listened to stories and
situations in the training hall, but all that knowledge transformed to experience
when we had our field visits. It breaks our heart and increases the commitment
and passion when we face the realities of lives of the oppressed and challenges
they face in life
-
Inputs from Experts. It is impossible to get inputs from all top experts in
different areas of health. CHLP breaks that and made it possible to get expert
people to provide inputs to the fellows. And the most exciting thing is that all of
the experts can be met in one point (CHC) and all of them are part of People's
Health Movement (PHM). I am glad that I am now part of such a great
movement for People's Health.
My objectives for the 9 months Community Health Learning Program
1. To learn various intervention model programs from selected NGOs and
Activists working on children issues with a rights-based approach
2. To network with many government and non- government organisations
working on children's issues
3. To understand and analyse Orphans and Vulnerable Children (OVC) policy for
India and compare on program implementation at state and national level
4. To develop a child-friendly story-booklet on community health approach for
children
5. Build a resource library of books, reports and publications related to various
children programs including HIV AIDS that would help organisations and
people who work with children and HIV AIDS
In order to continually work on these issues, I also understand I need to learn and
sharpen some skills with in myself. To improve on my personal skills;
•
•
•
•
in developing position/status papers of government programs
in writing to journals and understanding national and international journals
on creating cartoons for social issues
Learn zepi-info' software and analytical skills
Things to focus on my three month final project is
-
to review the Orphans and Vulnerable Children (OVC) policy
develop status/position papers as an evidence for collective advocacy
To form an Advocacy Collective of Individuals and Organisations concerned on
children affected by HIV AIDS
To document government schemes and programs aimed at children in
Tamilnadu and Kerala and at the national level
To share the document with National and State level organisations working with
children and HIV AIDS
8
What I did in the past 9 months in line with the objectives set
To learn various intervention model programs from selected NGOs and Activists working on
children issues on a rights-based approach
THE School
Di. Suchitra is a humble, committed person involved in improving the lives of children
through THE School, Krishnan Foundation in Chennai. I am thankful to Dr. Rakhal for
introducing this person to me in the fellowship. She has tremendous experience of over
13 years working in the areas of child counseling, child participation and more
specifically in child to child approaches in the area of health.
I met her only once, but she made the meeting so wonderful that I felt as if I have
known her for years. In spite of her daughter's ill heed th, she spent over two hours early
in the morning sharing all her experiences and guiding me through my areas of
interest.
I learnt some interesting things about THE school. The children's education and growth
happens close to the nature. Till eighth standard there are no marks and grades in this
school. Children are given freedom of expression and helped to walk in truth in the
pathless world.
One of the strong points that came from this expert is that life skills education as a
stand alone intervention cannot address children's needs or issues. When our
discussion started focusing on engaging children affected by HIV AIDS to support
other children affected by HIV AIDS in a community, she shared her insight on child to
child approaches that she does among government school children in selected villages
near Chennai.
Learn - Do - Teach is the principle behind developing children to encourage other
children. She also assured that she will be able to support in developing practical day to
day needs training module for children that includes SKILL - Reflective Components Evocative Exercises. In her experience, she explained that life skills education alone
may not help children in difficult circumstances.
The key learning that I take from THE School is the Child to Child approach. It is a
practical approach that empowers children and enables them to prove their ability to
convey any type of message to their peers. I believe it is a vital component in
addressing concerns of children affected by HIV and AIDS.
Balamandir
Balamandir is a highly respected organization in Chennai and is over 25 years old with
rich experience of supporting thousands of children and their families. On July 11th
2008, I had a meeting with Ms. Maya Gaitonde at Balamandir. She and her colleagues
shared that "Sometimes care homes with fan, light and access to good water are luxury
for children". The reason for their statement is that when children of the care home go
to their parent's home during long holidays they are not able to adjust. They look down
9
on their widow and destitute mother and decide to come back to the care home even
before the holidays get over. At Balamandir, a network is developed among parents to
share the development of children both in terms of education, moral values and
behaviours.
My key learning from Balamandir is the relationship-building among the parents and
participation in development of the children. Understanding parents7 expectations and
behaviors of children is so important to build families and communities with values.
Santhosh Siruvar Maiyam, Melur
Santhosh Siruvar Maiyam is a child-focussed center in Melur Taluk of Madurai district
in Tamilnadu. This center was initiated by Positive Women Network (PWN+) with the
support of UNICEF with a goal to have a sustained comprehensive community and
home based care model program "Santhosh Siruvar maiyam" for children affected by
HIV in Madurai district.
I spent 5 days (August 18th to 22nd) in Melur Taluk, Madurai District
understanding more about the project goals, staff who are women living with HIV
themselves except a social worker and was able to observe some of the issues in the
taluk related to the work on HIV and its impact on children.
The project has reached to more than 180 children and support services
facilitated through the project has encouraged positive living among children affected
by HIV. This comprehensive model has also facilitated positive response from the local
authorities and stakeholders towards support for children affected by HIV. It focuses
more in facilitating access to essential services like education, treatment and social
welfare.
The Goal of the project is,
To have sustained the comprehensive community and home based care model
program "Santhosh Siruvar mayam" for children affected by FIIV in Madurai
district by strengthening Madurai District PWN+.
Major Activities of the project are;
Formation and strengthening Community based Childcare Committee
In order to strengthen the community response to the issues affecting children, the
community based advocacy team from the "Community based Childcare Committee" was
formed comprising local panchayat leaders, religious leaders, SHG leaders, school
authorities, children and parents, including affected families, in two villages and one
committee at the taluk level.
In their previous phase, the experiences have revealed that women and children are not
comfortable to reveal their status to
their community members due to fear
of being discriminated by formation of
children advisory committee at the
village level for children affected by
HIV. So in this phase it has been
proposed that the committee will be
formed to focus on issues that affect all
children, like education, health and
10
later HIV will be included as one component. Simultaneously sensitization
programmes and information sharing on HIV/AIDS will be organized for all the
members of this committee which will be facilitated by the WLHAs and some of the
members of the "Community based Childcare Committee" in that area. "Community based
Childcare Committee" will meet once in a quarter to address the needs of children
identified by the committee. This will be done by networking with the relevant
departments working in the region.
At the Melur Taluk level and village level where ever child care committee is formed,
comics campaign by children was planned where children will make comics on existing
issues and will campaign at the taluk level to encourage debates and discussions
among the audience to create a supportive environment for Children affected by
HIV/AIDS.
Support for formal education and nutrition of the children in the community
There is a direct support for education of 100 children and nutrition for 50 children
which is expected to stay till end of the project. During this phase, Santhosh Siruvar
Maiyam and the Madurai District level PWN+ have planned to focus more in
generating support from the community and other donors and NGOs locally to sustain
these efforts. In this phase efforts were made to source private sponsors to ensure that
the educational support facilitated through the project will last till the child completes a
certain minimum level of education. The project is also focusing to advocate with the
district authorities to prioritise support to children from poor affected families for
educational support (under the schemes that are currently being implemented).
Nutritional provisions under the ICDS and
mid day meal scheme are to be ensured for
all children as identified above through
advocacy and sensitization of stakeholders
like
local
leaders/religious
leaders/teachers and community workers
like Anganwadi workers under the
government scheme. But the field workers
are finding it tough to negotiate with
certain staff of ICDS and other government
schemes.
Medical care referrals and linkages
Networking and linkages with the district medical hospitals and care centers are
strengthened to facilitate better care and support services for children who are in need
of specialized care and treatment. A Qualitative Survey done by UNICEF in four
villages of Melur block, has also listed several government schemes that would benefit
women and children, these schemes would be made accessible in this phase by the
outreach workers and the volunteers.
11
The total number of affected families that have been reached through the program is
around 120 (with 180 children) from various blocks and villages of Melur Taluk. Many
women were willing to volunteer their time and share the information to other affected
members in their own community. Hence these women were recruited as volunteers in
the community and supported by the outreach workers. Volunteers were encouraged
through training programs, gifts and honorarium to support more children access
schemes from government.
Organizing Peer group meetings at the center
Peer group meetings are organized for children who are affected by HIV within the age
limit of 0-8 years. This is organized at the center in Melur. In order to prevent the center
being identified as center only for HIV AIDS affected children, community children
were also provided with services in areas of health checkup, life skills education and
educational support. Around 50 community children benefited through these
programs.
There have been no specific programmes enabling these children cope with the
infection. In this phase, peer group meetings were planned in order to encourage
support among them and also provide information on positive living. This is organized
on a monthly basis for children between the age group of 8-11 years and 12-15 years.
Life skills education(LSE)
Two groups of children were formed at the village level with representation of children
also from the general community. Each group has around 15-20 children between the
ages of 12-14 years. The Life skills tool kit developed by FHI is used and the LSE
meetings are organized twice a month.
Building awareness and capacity building of parents and caregivers of children
orphaned by HIV in the district
In order to increase the awareness for the parents on HIV sensitization cum training
workshops are conducted especially to increase the capacities of the affected families to
help the child in coping with the situation, in accessing the services and also in
accessing the entitlements for the children and future planning for orphan children.
Support was also taken from legal aid centers and professionals to arrive at the right
form of succession planning for these children, which is relevant and applicable in each
state.
Special support group meetings are organized for mothers to encourage disclosure
within families, promote treatment adherence and better care services for children who
are on ARV treatment.
Taluk and District Level Advocacy on Children Affected by HIV AIDS (CAHA)
issues
Advocacy meetings are organized at Melur taluk and Madurai district to advocate for
the issues of the children affected by HIV. These activities are in the plan but yet to be
done. At the taluk level, 30 members will be invited with representations from the local
administration, school authorities; self help groups. Two meetings are under the plan to
be organized in this phase and these meetings will be organized to coincide with
prominent days listed below.
12
At the district level, around 50 members will be participating in the advocacy meeting
to advocate for the issues. One meeting will be organized at the end of the year.
Sensitisation programs will be conducted also on other prominent days like:
• Children's Day
• World Aids Day
• Women's day
• Candle light memorial
Organising mothers as self-help groups and access resources from Tamilnadu
women development corporation
One of the pressing needs of Women living with HIV is the economic support.
Women's health and their children's health are deteriorated due to lack of money
to weirds basic livelihood. Hence to promote heedth of children and their mothers, self
help groups are planned to be formed. Self-help group formation training and
maintenance of books and accounts, opening up bank accounts and accessing revolving
fund and economic development fund for businesses were planned for the near future.
Mobilising women as volunteers
It was widely accepted and observed that when Women living with HIV were given
some responsibility and provided with guidance, it helped in building confidence for
their life. Volunteers were selected from selected village to work for the community
based programs. These volunteers are supported by each outreach workers to help
them access remote villages and also in organizing community based programs.
In my experience on those days at Melur, I observed that people at all levels have some
knowledge of HIV AIDS but the issue is the sensitivity to the issue. For an instance, the
headmaster of a government school publicly pointed out an orphan child studying in
his school saying "your parents died of AIDS", when the boy was hiding that fact and
trying to live as a normal child. Such instances create mental stress and loneliness
among children.
While I was interacting with the staff, mothers living with HIV who are unknown to
me shed their tears and shared their concerns of how their children are ill-treated in
orphanages, "If my child is tortured when I am alive, what would be the condition
when I die".
Her issue is that her boy child, who is tested positive got admission in an orphanage
home that is run exclusively for HIV positive children 70 kms away from her residence.
Her child came back home once when she visited the orphanage to see her son. The boy
cried and shared how he was beaten and ill-treated for some mischief he did.
Orphanages are started with good intentions, but as the days go by many do not
adhere to the initial interest and care.
Another fact that I observed and sometimes shared is that women who work as
(including WLHA) field level workers lose the drive to actively reach out and support
children after witnessing problems over problems that are unanswered. Steiff shared
sometimes we feel that we are just reaching out to more children but the situation is not
much changed except for the hope that there are people and a center to care for those
affected by HIV AIDS.
13
Over all this, the government staffs who work as Integrated counseling and testing
center (ICTC) Counselors, harass women living with HIV mentally and sexually. Some
women living with HIV shared that because we are HIV positive the men in the society
always look at us only as bad women and they don't hesitate to approach us with a
thought we should be female sex workers. The stigma and understanding of the
community need to change first for us to live a life with dignity.
On day 4 of my visit, there was a support group meeting for mothers of children
affected by HIV AIDS, almost all of the mother's care is about marriage of their sons
and daughters. Though their son is HIV positive or not, they want to see their
weddings before they die. There are many child marriages happening among families
affected by HIV AIDS in Madurai as well as in other high prevalent districts.
Sometimes, though the children are negative their parent's HIV status stands as a sign
of shame that stops their weddings. In a village, three orphan girls at 19,16 and 14 are
taken care by their uncle. This kind and good hearted man, wanted to get the eldest girl
child to get married, but when the boy's family got to know the status of the dead
parents of that child through a local community member, the wedding was stopped.
Another important matter that the mothers were curious is about the when will the
drug will come that will cure HIV. They also expressed how they could get updated on
the progress of such researches?
Bangalore Orphans and Vulnerable Children Project World Vision India
World Vision India has a focused project among orphans and vulnerable children in the
city of Bangalore at three target wards. It was perfectly a community based approach
where the children from the community were also involved in the project though the
project by itself sounds to OVC and Children affected by HIV AIDS.
The Project Goal is to "Mitigate the impact of HIV and AIDS among the OVC aged 0 to 18
yrs in Bangalore city." With the following outcome objectives.
Outcome 1: Reduce vulnerability to HIV among OVC aged 0 -18 yrs
Outcome 2: Utilization of care and support services to OVC and PLHIV.
Outcome 3: Reduce stigma and discrimination towards PLHIV and OVC
The UNAIDS working group on definitions2 has defined the term orphan to refer to a
"Child below the age of 18 who has lost one or both parents or lives in a household with an adult
death (age 18-59 years) in past 12 months or is living outside offamily care.3" The concept of
vulnerability is a complex construct and may include children who are destitute from
caused other than AIDS.
World Vision defines
2 Report on the Technical Consultation on Indicators Development for Children Orphaned and Made Vulnerable by HTV/AIDS,
Gaborone, 2-4 April 2003
3 Children living outside of family care are taken to include: homeless-street children; children in institutions; and children living
in other country specific settings such as on commercial farms, in brothels, in mining areas, in the military forces, etc.
14
Orphans as children below 18 years of age who have lost a mother, a father, or both
parents to any cause4.
Vulnerable children
• Children whose parents are chronically ill: These children are often even more
vulnerable than orphans because they are coping with the psychosocial burden
of watching a parent wither and the economic burdens of reduced household
productivity and income and increased health care expenses
• Children living in households that have taken in orphans: When a household
absorbs orphans, existing household resources must be spread more thinly
among all children in the household.
• Other children (identified using criteria developed jointly by the community and
World Vision staff): One of the critical criteria will be the poverty level of the
household. In South Asia, these children may include children in extremely
difficult circumstances, such as street children, child labourers, and the children
of sex workers.
Prevention efforts were more focused with the children in the community including
orphans and vulnerable children. The various methods used under prevention strategy
included recreation, exposure visits, PPTCT, Life Skills Education' community
awareness programs among women, youth and school children. During the project
period, over 14000 community members were reached through various prevention
activities mentioned above.
During my visit, in one of the children's group meeting, there were discussions on how
Life Skills Education has helped them. It was observed that children not just at
knowledge level but also have skills to prevent abuse, stress and HIV through life skills
education. Children have learnt to utilize their skills very positively and their attitudes
towards people living with FIIV and their children were very positive and welcoming.
When asked about what benefits they see being part ofLSE group, Children expressed
"We learnt we are able and equipped to solve some of our problems"
"We can protect ourselves from abuse and HIV"
"We learnt we need to think alternatives before we make decisions"
"Initially we thought HIV and AIDS are same, but now we know the difference and will also
care for those affected by HIV AIDS"
"We learnt Communication skills and skills to cope up with emotions and now we are self
confident..."___________________
Some of the key project components that I observed and understood are:
Drop-In Centers
Drop In Centers located in Sriramapuram and Flower garden were providing services
for 565 orphans and vulnerable children that included both children living with HIV
and children affected by HIV AIDS and 375 parents living with HIV. Drop in Centers
4 ADP Toolkit for HTV/AIDS Programming - South Asia Edition, 2005
15
have helped the team as well as the community to be in regular touch which facilitated
not just in providing services but also in sensitizing the community on HIV AIDS and
to provide a supportive environment for families living with HIV AIDS in the project
sites.
Counseling
Counseling and follow up services were provided effectively at the Drop-In Centers by
counselor and community volunteers. The decision to select people living with HIV as
community volunteers and their well-defined roles has helped to reach over 295
families in and around Bangalore City.
Support Group meetings for PLHIV
At the drop in centers the staff regularly organize support group meetings in
partnership with the community based networks and organisations. These meetings
help PLHIV to relate and see other PLHIV living life with dignity and quality that
builds their self-esteem and confidence in life.
Management of Opportunistic Infections
Initially the project had appointed physicians to provide out-patient clinical care to
people living with HIV for opportunistic infections and management of HIV. Later,
this service was brought down to provision of opportunistic infections drugs and re
imbursement of drug bills. And since the government health services are available, the
project volunteers refer the clients to government health centers.
Educational Assistance for affected children
This is one of the most crucial and pressing need, that I have witnessed of the PLHIV
community. The project has very well addressed this component in supporting affected
families to continue their children's education in schools and colleges by providing
educational assistance to children of families affected and poor due to HIV AIDS.
But In spite of this I also noticed that around 15 children are at home out of which nine
were girls. This shows how parents don't want their girl children to study more and
want them to get married. Still the issue of HIV positive children at school is the major
concern everywhere, because most of the children's status is not revealed in school. But
these children end up taking many leaves by falling sick often. This problem still
persists everywhere (Madurai, Cochin, Bangalore and Chennai) I visited.
Nutritional Assistance
Another important need that the project addresses in improving the health status of
parents and children is the nutritional assistance. Discussions with parents living with
HIV revealed that the nutritional support extended by the project has helped them at
the right time to save their lives while on drugs.
Economic Development Assistance (EDA)
52 families of OVC were provided with Economic Development Assistance from the
project, which supported 84 children. The vocational skill building programs and the
assistance provided has substantially improved the quality of life of certain families.
One of the EDA beneficiary who runs a "mobile iron shop" is able to live life with
16
dignity and able to earn nearly Rs. 6000 per month with a simple support of Rs. 6,000
for the mobile 4-wheel trolley and brass iron box. Since the person had prior
experience in this business and hard work of just 4 months has helped him achieve this.
This program component not just improves the economic standard but addresses the
issues around psychosocial support, educational support of children, dignified life,
health and housing of parents and their children affected by HIV AIDS.
Home Visits
World Vision India acknowledges and follows the SA ARC regional framework for the
Protection, Care and Support of children affected by HIV AIDS that promotes familyand community-based alternative care for children affected by HIV AIDS, and ensures
that institutions are not used as a substitute for family care, or used to gain access to
education and other essential services. Hence focused attention was provided that
children are not just put in institutions by the parents, but essential support services
and education is provided for parents on the best family care and environment versus
institutions.
"Myself, my brother and my mother, all are HIV positive, but World Vision has supported every
one in my family to stay healthy and continue my studies"
-16 years old girl living with HIV
"I want to talk openly to my sister but I am not able to as she doesn't know her status, but I
know my mother's status. My sister is living with HIV and I want to support her"
-Sri, 16 years old boy affected by HIV
I also saw an endline survey study which showed that stigma and discrimination are
still prevalent in the community. Over 60% of the respondents have shown negative
attitude towards people living with HIV AIDS and their families. The project is now
consciously looking at this issue and is developing appropriate strategies that have
worked in other parts of the country and even other countries to create an enabling
environment for OVC and their families.
Strengthening PLHA Networks
Support group meetings and capacity building programs were found to be the two key
strategies planned in strengthening PLHA Networks. The support group meetings
were focused on healthy nutritional diets, managing opportunistic infections,
motivating members to form savings groups and in strengthening relationships among
members and members in the local community. This has found to be useful for the
participating members and the goal of strengthening the network towards advocating
for issues affecting their families including children.
17
Channels of Hope
Channels of Hope is a unique program developed by an HIV positive church pastor
and his team in South Africa. Channels of Hope aimed at Church leaders provides basic
knowledge and helps the participants to reduce negative attitude towards people living
with HIV AIDS. This has worked well in African
countries where majority are Christians. Now
World vision India also implements these with the
Indian church pastors so as to prepare the
congregation and the leaders to accept people living
with HIV and not merely condemn them as sinners.
In the city it has impacted the congregation and the
leaders to respond positively to the increasing
concerns of HIV prevalence and needs of people
living with HIV AIDS. Church Leaders had started speaking about it in the Pulpit
Ministry; it was been taken up as one of the prayer concerns for the city. Pastor of
Methodist Church in Koramangala added that during the first week of December they
were planning to have a week dedicated on awareness on HIV. This is a major change
brought by Channels of Hope in one of the mainline churches in Bangalore.
One independent church pastor is actively visiting people living with HIV AIDS at
their homes and are praying for them at their church. There are church members living
with HIV AIDS who are referred regularly to the project for follow-up and some have
become community volunteers of the project.
Capacity Building of PLHIV/OVCs/Cominunity Volunteers
Days of commemoration are best utilized to be as capacity building programs for
PLHIV, OVCs and Community volunteers. Family Camp and Children Camp has
empowered children and their parents in self-confidence and relationships.
Bangalore HIV AIDS Forum
Bangalore HIV AIDS Forum, is formed to advocate the concerns of HIV AIDS in
Bangalore City with the involvement of over 25 NGOs that includes Bangalore OVC
Project of World Vision. This is an excellent opportunity and platform to include the
agenda of raising the concerns and needs of children living with HIV and affected by
HIV AIDS for the project.
Challenges
Some of the challenges faced during the implementation of the project were expressed
by the field level team,
• Sensitizing parents to send children for Life Skills Education was a major
challenge
• Since almost all of the staff were women in Srirampuram DIC, bringing in boys
for LSE was found to be difficult at initial stages
• Eve - teasing by community youth was a major challenge in implementing
interventions at the community level.
18
Issue of Foster parents - a complete orphan +Ve child under the care of a relative,
nutrition and education support is provided, but we are not sure whether it reaches the
child. Foster parents do not care for HTV+ve child. They do not take them to hospitals
for ARV or CD4 count or for any other OIs. They don't even give 1 rupee for him to
make a call to me - community volunteer
Another major issue was the ability of adolescent children to see life beyond their
current status. The impact to HIV AIDS is so strong that they are able to see themselves
only as simple day to day workers to bring in money at the earliest to home than do
higher studies and then do great things for the family. I would say the grown up kids
are "Living for Today with No dreams".
Trainings that I participated and facilitated (some) during the fellowship
Life Skills Education
Life skills education training in HIV/AIDS was organized for four days for alliance
partners at Trichy. Having previous experience on attending and implementing life
skills in namakkal, this training provided me a space to learn and even train the
representatives from the non government organizations.
In addition to the training, interaction with the NGO representatives revealed the
impact HIV has on children and widows, The stigma is so high that even the
representatives are mocked as AIDS patient by the community .They also expressed
that some of the colleagues had problems because there was a rumor spread that those
engaged in the work on HIV/AIDS were sexually promiscuous that affected their field
visits.
Life Skills Education for children helps children in developing their skills on knowing
about themselves, communication skills, decision making skills, coping with emotions,
preventing and living with HIV and in setting goals for life.
Since the sessions with children are activity and games oriented, children enjoy these
sessions and naturally develop their skills in the above said areas. This is very vital in
the approaches adapted to work with children in vulnerable conditions and those
orphaned by HIV AIDS.
Children Parliament
It has been my passion and interest to empower children to voice their concerns that
affect them. From my experience working with networks of people living with HIV, I
have learnt that the representative and advocacy of issues is very powerful when it is
directly represented by the people who are affected by it.
Personally from the training I have learnt one approach to involve children and
ensuring child participation. This approach also benefits children to represent and
advocate issues better. I had the opportunity only on the orientation of the concept of
children parliament, but I personally look forward to participate in the one week
19
training program where the entire concept of Children Parliament from formation,
operation and advocacy will be explored.
Disclosure Workshop for mothers living with HIV AIDS
This has been a major issue that is affecting many
women to disclose their status to their own
children. In the discussion held in Madurai
district and my previous experience working in
Namakkal and Kerala, most of the women living
with HIV expressed that disclosure is very
essential but the fear of being discriminated by
their own children affects them to take the
initiative to disclose.
In Madurai, for around 17 mothers living with HIV, two day training was organsied
with support from UNICEF consultant who the facilitated sessions.
The Women expressed their concerns in disclosing;
• Fear of being discriminated or perceived as bad woman by their own child
• Fear that children may disclose their status to other in the community
• Stigma about the disease
• Lack of family and relatives support.
Though there are these fears, at a point everybody agreed that disclosure is essential
and they needed support to disclose the status to their children.
In August 7th and 8th 2008, I attended two days workshop for Caretakers of Children
living with HIV AIDS at Cochin organised by Kerala Positive Women Network
(KPWN+).
Some of the major issues shared by the mothers gathered there is of disclosing the HIV
status of the mother as well as the child; they also expressed that there is lack of moral
support from family and community for women living with HIV and the stigma is so
high in that high literate state that some women need to vacate their houses and settle
in different town without disclosing their status. I observed that such caretakers
education sessions should happen regularly, so that that would help them prepare
themselves to disclose their HIV status to their children, give better care for HIV
positive children.
These trainings helped me understand that once a person makes a decision the role of
the social worker, or counselor should be at the support level. One successful case
study was that of one woman who had disclosed her status to the child and with the
positive response from the children other women in the group are motivated to attempt
disclosure with their children. At the same time, it is also important that children also
are prepared with the basic information on HIV and AIDS and treatment with life after
HIV which will help them accept the status better.
20
Coinic Workshop in New Delhi - World Comics
The three day training was a wonderful experience. During my fellowship programme,
I have been exposed to different approaches to work with children, one life skills,
second children parliament and the last one comic workshop. This workshop also
helped me to use my personal skill in drawing towards advocacy related work.
In the comic workshop, I observed children learnt the process easily because it is one
that involves colours and funny figures that children learn easily. Using this approach
as an effective tool for advocacy was one that impressed me very much. Almost all the
drawings depicted what children experience in their day to day life situation. One
instance is from a child from Manipur who depicted picture on stigma and
discrimination faced from relatives because of the HIV status. This showed the extent
of impact children are experiencing due to HIV.
Advocacy Events that I participated
National Project Director's Conference
From July 14th - 16th, 2008 Positive Women Network (PWN+) organized a National
level Workshop for Women living with HIV AIDS in Chennai where around 25 women
living with HIV AIDS from at least 9 states of India participated. The objective of the
workshop was “Looking back on achievements and failures and re-energizing for
proactive actions".
As the workshop was coming for a closure on 16th, the leaders of the network were
actually promised to be visited by the Director General of NACO. But since at last
minute they cancelled the plan, all the 25 women living with HIV and some of us went
to meet the Director General who came down to Chennai at the same time to attend the
three days Project Directors Conference organised in a star hotel in Mahabalipuram,
Chennai.
The team reached there during the lunch time and demanded the needs of women and
children affected by HIV and AIDS. The DG, NACO and some Project directors were
upset about the way the group entered the premises, but remembering the need to
involve people living with HIV and the commitment given on GIPA, they rearranged
their schedule and gave ten minutes for the leaders to share their concerns and needs to
all the project directors present there. DG, NACO promised to support the women's
network with specialized drop-in centers for women and children in 59 districts of
India.
Key Learning:
- It was a sudden plan to approach the DG, NACO and the project directors at a
conference with out proper agenda or demands
- Each women started expressing different things once the DG was available to
listen to them but there no concrete demands were set in
- But fortunately, DG agreed openly to support PWN+ and its district and state
level networks to set up Drop in Centers in the list of districts they would submit
to NACO
21
Follow up action from PWN+ and its member networks is absent
uz
Consultation of women living with HIV AIDS in Delhi: A decade of
Women's voices and positive thinking
Hon. Minister for Labour Mr. Oscar Fernandes, presided the National Women's
Consultation organized by Positive Women
Network (PWN+) on the occasion of the World
AIDS Day, to address the increasing need for
prevention, treatment and care of women living
with HIV and their children. He stressed that
the National Council on AIDS, headed by the
Prime Minister of India, is giving importance to
the issues faced by women living with HIV
AIDS and the parliamentarian forum is
committed to address this through HIV
mainstreaming. There is focuss on providing a healthy environment for women to
uphold their rights. He said quality of women living with HIV can be improved
through Yoga and other means of alleviating stress in life along with medical care and
support needs of women.
He also added that together with the support for women living with HIV AIDS, it is
also important to ensure that no more new-born become HIV positive. He also added
that when women are given correct and complete information it would reach
maximum number of people in the country. He pledged the complete support for the
efforts of positive women network who have started their signature campaign on
'prevention for women'.
Ms. Anne Sten hammer, Regional Director of UNIFEM encouraged women and
appreciated the vision of Positive women captured in the video released to mark the
10th year celebration of Positive Women Network. She appreciated that both UNIFEM
and PWN+ were natural partners with the development and upliftment of women
being the center of the core response to HIV and AIDS.
Ms. Anandi Yuvraj, Representative of International Community of women living with
HIV AIDS highlighted the transmission of HIV among married women and wanted the
National AIDS Program to take a proactive role in HIV in marriage initiative led by
UNAIDS, UNIFEM and UNDP. She also highlighted the compromises that happen
towards women's issues when networks which highlights both men and women's issue
and strongly emphasized the need for an exclusive space for women living with HIV
within the National Program. She also congratulated the concentrated efforts of PWN+
towards Positive Prevention among Women living with HIV by initiating a signature
campaign today to mark the need for focused prevention with millions of women who
are at risk of acquiring infection from their spouse and their intimate partners who are
at high risk. PWN and its partner networks at state level will have to be involved in
designing meaningful interventions for this initiative. NACO and UNAIDS co-sponsors
22
must involve them in all their policy and programme developments to demonstrate
their commitment towards G1PA with women living with HIV/AIDS.
Ms. Kousalya, President of PWN+ says, as women living with HIV, every day is a
World AIDS Day for us. 150 Women gathered here have braved floods, blasts and HIV
AIDS to be here from nook and corner of this country to find and raise the common
voice to the issues of women living with HIV AIDS which is a grave concern. As a
beginning to an end, Mr. Oscar Fernandes inaugurated the WE shop, an effort by
Positive Women Network to provide socio-economic empowerment for women living
with HIV AIDS.
The demand set in by PWN+ during this consultation was to actively and meaningfully
involve women living with HIV in decision making processes at all levels. NACO
agreed to it, but now PWN+ do not have adequate skilled women to represent for
GIPA at various levels.
First State Level Consultation for Children at Ernakulani organized by KPWN+
On February 14th and 15th, 2009, Kerala Positive Women Network organized a two
day state level consultation for children affected by HIV AIDS at Rajagiri College of
Social Sciences, Ernakulam. Around 25 children from two age groups (9-12 years and
12-15 years) participated in the consultation. The objective of the consultation was to
help children learn the basics of HIV and AIDS and bring a feeling of togetherness
among themselves and to enable children to represent the issues that affect them and
advocate for better services and programmes to the stake holders.
The activities for children had sessions on understanding more about HIV AIDS,
improving health, positive living and setting goals for future. The consultation had lots
of participatory activities, games, question time, time to build friendship with other
affected kids, talent evening and curious
questions in secret box. Children enjoyed
the two days consultation and expressed
their desire to have such get-togethers at least
every quarter.
On the second day, various NGO
representatives and the Director from
Women and Child Development department
23
a
f
-fl a
f f aa aa a f aa a a a f af f
-a -g
participated to understand the issues faced by children by seeing the charts, plans they
have made and by interacting with the children. The director of W&CD also gave
commitments to support KPWN+ for pioneering its work with children in at least two
districts in the next quarter.
ITPC Research Application
In October 2008, there was a call for research and advocacy proposal from International
Treatment Preparedness Coalition (ITPC). I discussed this idea with my mentor for his
views on it. He encouraged me to apply for the same and also assured me of his
support to do the research and analysis of the same. This is the brief of the research
question and justification of why we attempted to try it. Though I applied,
unfortunately I didn't get through this research project.
Discussion of why you are interested in researching and advocating on these issues, with
reference to the status of HIV prevention and treatment services for women and for children in
your country.
Our Key Concerns on this topic that interests us to research and advocate are;
• Women constitute over 40% of HIV infection in the country
• Prevention of Parent to Child Transmission and Targeted Intervention on
Commercial sex workers are the only core prevention strategies for women. The
research and advocacy will focus on increasing HIV prevalence among women
in general community
• Increasing trend of HIV among young girls and women and lack of womenfriendly sexual and reproductive health services
• Inadequate palliative care services for women and children
• Lack of provision of second-line ARV
• ARV provision for children are more number oriented and there are no
programs over child counseling and support for children on ART
• No program to reach out of school and specially challenged children on HIV
prevention
• There is no data on children living with HIV or affected by HIV at state or
national level
• To monitor the status of OVC policy framed by NACO and UNICEF in 2007
1.
2.
3.
4.
5.
6.
7.
8.
9.
The School, Chennai
World Vision India, Chennai and Bangalore
Kerala Positive Women Network (KPWN+)
Santhosh Siruvar Maiyam
Karnataka Network of People living with HIV AIDS
CHES, Chennai
Balamandir, Chennai
HUNS, Namakkal
CFAR, Chennai and Delhi
■o
i
a q
Organisations that I networked with during my fellowship
24
10. UNICEF, Chennai and Delhi
11. UNAIDS, Delhi
Understanding OVC Policies in India
In September 2008, Richard Lee from UNAIDS was making a study to ascertain how
does the provision of public goods and services affect the response to Orphaned and
Vulnerable Children (OVC) due to HIV and AIDS?
In this regard, he made a visit to Chennai and luckily I was also a respondent in his
research on the above. This enabled me to get more understanding of HIV AIDS issues
and his report also focused more on Tamilnadu and its services for children orphaned
by HIV AIDS epidemic. This also encouraged me to collect various documents and
data available on OVC policy framework by UNICEF and SAARC. I was also able to
read and understand the National guidelines for Protection, Care and support for
children affected by HIV AIDS.
These policies and guidelines are well developed, but there are still gaps and issues that
are unaddressed at the ground. UNICEF and NACO are working on model projects to
implement and monitor how the guidelines given are realized at the grass root level.
There should be mechanisms to monitor the policy implementation through programs
and there should be space to align the policies at every learning level, at least once in a
year.
Building resource library of children related documents and schemes
One of the objective, I set during the initial stages of my fellowship is to build a
HOME
CONTACT US
"CHILDREN AND HIV AIDS | E-RESOURCE CENTER"
resource library of books, reports and publications related to various children programs
including HIV AIDS that would help organizations and people who work with
children and HIV AIDS
This idea came up while discussing with my mentor Dr. Rakhal in Chennai. I was
sharing with him that over the past five years of my work in HIV AIDS and my wife
Julie's work around nine years, we have collected several books and PDF documents
which are of Training Modules, Information Education Communication materials,
25
H fl fl fl fl fl fl fl 0 fl fl fl
Research papers, Policy documents, advocacy papers and links of many organizations
working with children and HIV AIDS around the world.
Then he suggested, that why don't we make those collections to be useful for all those
who want to pursue working with children. That's when we decided to build a website
which will be pool of resources on children and HIV AIDS.
With the support of my friend who is a web-designer, I designed the above page and
developed the home page content, but when I was in touch with the webspace service
provider, he alerted me about the copy right issues of these collections of resources.
Also the web space required was also very high and it demanded annual budget of
around Rs. 1 lakh plus the maintenance charges. That's the end, I set aside the idea of
web space, but continued to do the activity to have it in a DVD or CD and provide only
to people who may need it as a collection of resources rather than creating a brand of it.
l
fl fl 0 fl fl JL fl fl fLflJ! fl fl B fl. B B B B- R B fl
Following is the home page content of this e-resource center.
KIDS and AIDS | e-resource center
Welcome to Kids and AIDS | e-resource center!
Kids and AIDS, e-resource center is an online collection of comprehensive resources on
prevention, treatment, care and support programmes on children and HIV AIDS
around the world. It shares valuable tools that help assess, design, plan, implement and
manage programmes that are of high quality and sustainable in the developing world.
E-resource center fosters sharing of relevant, effective and innovative resources and
constantly update to enhance the delivery of programmes for children living with HIV
AIDS and affected around the world.
Explore! Enrich!! Empower!!!
Because my document and my focus are completely on children and HIV AIDS, it
doesn't mean that I see the issues of children affected by HIV AIDS independently. I
have learnt well that children in a community need to be protected and supported in
social, economical, cultural, political and environmental areas. But the reason to focus
is that many a times the special needs and issues are unheard, so a special attention is
provided to highlight the concerns amidst other concerns of the community.
This activity is still under preparation, and it needs some more time in arranging the
collected documents and to create an e-library in CD or DVD format with technical
assistance.
26
Government Schemes for Children in Tamilnadu
s is emother area, where I felt there are so many schemes and programs from the
fcO\emment but the knowledge and information to these are very limited. Hence
uring my interim meeting at CHC, I decided to work on this too. I searched on
internet and got some good documents from Tamilnadu government website of
various schemes for people of Tamilnadu.
With the support of a volunteer friend, we are now segregating those schemes for
children. Class 1 to 10, 11 and 12, above 12th and general are the four categories under
which we are collating the government schemes. This activity is in the process and is
expected to complete by March and print 10 sets to be used at grass root level.
Learning from Namakkal visits - January 2009
This Namakkal trip in January was an interesting and turning point in my life. We
wanted to meet with the families and staff members we served during 2003 to 2005, so
myself, my wife Mary Julie and my 1 year 10 months old son John Elijah packed our
things and started our trip to Salem and Namakkal.
Namakkal district that accounts to more than 9000 people living with HIV registered
and accessing the government ART center. Of the people accessing the centre 300
children living with HIV are benefited through the center.
We visited Salem Government Hospital - ART Center, where one of our ex-colleague is
the ART doctor providing services to around 10,000 PLHA in the district and
neighboring districts.
We also met women living with HIV who were our ex-colleagues in Namakkal when
we worked on Positive Living Center project and learnt about situation of children in
the district. Following are the list of people we met during our voyage to Namakkal
and Salem.
Ms. Prema
Ms. Muthulakshmi Ms. Rajeshwari
Ms. Amaravathy
Mr. Nackeeran
Ms. Vijayalakshmi Dr. Arunachalam
Dr. Ramesh
Mr. Karunanidhi
VCTC Counselor, Salem
Counselor - Children Project, YWCA Salem
ICTC Counselor, PHC, Erode District
Outreach Worker, HUNS, Namakkal
Board Member, HUNS, Namakkal
Counselor, ART Center
Medical Officer, ART Center, Salem
Medical Officer, ART Center, Namakkal
Board Member, TNNP+
Key observations:
Treatment has been very positive and even could see cases of children in the age group
18 and 19 years. This has encouraged children (especially young adults) for marriage.
Many questions the doctors, that if they can live so long and healthy with ARV, why
they should not be married off?
27
So this puts a question to us on how to help children, especially issues around informed consent
ana issues like marriage and future for children living with HIV AIDS who are in their adult
hood.
°
Understanding children s education needs, Salem government hospital and Namakkal
hospital have scheduled children's ARV treatment day for Saturday, but no specific
programmes or get-together is arranged to help children. Staff also reported that when
there is a visit then there is a make up of toys and children's activities during that time.
On the day of our visit children were also standing in line with the adults for treatment
and receiving ARV drugs. They also had to go through the process of visiting doctors
with the medical records and collecting medicines.
We were concerned that whether the child knows his or her status and the need for child
counselors at the center as there was no attention or care given for children. The patient load is
very high in both Salem and Namakkal, so proper counseling is not ensured.
In Salem, with CIFF programme and partnership working, follow-up is made by
NGO's in the field, while in Namakkal now there are no NGO's for follow-up, so
clients who come on their own avail treatment. Currently, the district level network in
Namakkal covers few areas, but not all clients are reached.
The death percentage told by the ART Medical officer shocked us that even after taking ARV it
is 10% death rate among those on ART. And people who have not started or not on ARV the
death percentage is about 13-14 %.
Majority of children who avail treatment in Salem hospital are from the grandparents,
while the turnover of children from Namakkal who are with grandparents are less. The
working hour of the hospital is 8am -12noon and approximately 150 attend the clinic
every day.
From personal experiences and client observation the counselors (who are also women Living
with HIV) expressed in the initial 3 months of ARV treatment if supported with good nutrition
and vitamin B complex tablets of good standard, recovery from side effects and adaptation to
drugs has been found very effective.
Regarding the topic on disclosure, mothers often think the children do not know the
HIV but children are inquisitive and have previous knowledge of the status before the
actual disclosure.
Community children observation:
In any intervention programme, the community s culture also needs to be observed. In
vellakalpatti, Rasipuram Taluk, Namakkal a schedule caste village, children are
married of at an early stage. Girls from the HIV affected families have more pressure
for marriage and are married of at an early stage (between 14 to 16 years old). Due to
culture pressures, two girls who have just completed 10th standard had eloped from
home and got married.
28
Challenges ahead of us:
• p? °?Lr ^u^ance' coun$eling and programs are essential for adolescent boys and girls
arents pressure on children to get married at an early stage affect their plan and
in eres an even resulting in risk conditions like running away from home.
ncourage adolescents to plan through LSE programme and even facilitate a center for
grievances or supportfor children who are in such difficult conditions.
Psycho-social issues
1. Mother, especially trained peer counselors have found it difficult to express their
status to their own children. The child is also HIV positive and now has recently
started on ARV.
- Rajeshwari.
2. In one instance they have taken the support of another peer counselors and
trusted person of the child in disclosure process. The child has been able to
accept and support towards the mother has been more positive.
- Ganthimathy
3. Fear of stigma has been found less among the women that we have interacted
and family support has helped most of the women to adapt to a healthy and a
planned future.
- Muthulakshmi and Amaravathy
4. Children availing treatment do not have special care or even opportunities to
come together. It has been found shared feeling help cope better, but there are no
opportunities for them in namakkal district.
5. Side effects caused by treatment also affect children, but the sharing between the
mother and child helps them to cope with the stress.
6. Fear of disclosure is very prevalent among mother, but all want to disclose
7. Stigma about HIV is experienced by children only around the age group of 14
and 15 years, if proper support mechanisms are available it helps them cope
with the stress easier
Economic issues:
1. HIV does affect the economic condition, but family support helps one cope with
the situation.
Eg. Muthulakshmi's brother has supported her with land and she could use the
produce of the land to manage the expenses and even her children's future.
Support from family is more seen in rural settings.
2 Concern over children's education and future is found mostly among parents,
especially among widows.
3
Due to poor economic conditions, compromises have been made in putting the
‘ children in hostels and Tamil medium schools (where expenses are less)
4. Food style is compromised due to poor economic condition.
29
Support systems in the district
There are few agencies like Christy factory that provides nutrition support for children
in Namakkal district
Key Issues that affects children living with HIV as expressed by ART Medical officer in
Namakkal are:
1. Children living with HIV under the care of Grandparents and foster parents
(relatives) do not come for center though they are eligible to receive ARV
2. Most of the children are under ART without knowing their HIV status or not
prepared for knowing one's status
3. No support mechanism for adolescent children to accept their HIV status and
move towards a positive life
4. Supply Chain of Pediatric ARV drugs are often affected. In last 2 years the
Adults and pediatric drugs have been changed four times
5. Most children on ART are less than 11 years old and are not much aware of HIV
status but children who are now in teenage and adolescents adamantly deny
taking ARV
6. Over 4600 PLHA are on ART with 6 counselors and no time for child focused
services or counseling
7. Psychological issues are high among children affected by HIV AIDS
From Mr. Karunanidhi, TNNP+ on his experience of working with children in Krishnagiri
District
Over 800 positive children are registered in this district. Even here most of the positive
children are under the care of their grandparents. Here outreach workers are given the
designation of Children Protection Officers at the block level that has elated their
dignity and response to children affected by HIV AIDS.
District Administration is very supportive to the initiatives in the district. Caretakers
are trained on how to care for their positive children, but there is no specific developed
module in that area.
Looking Inward - What did I learn about myself?
When I joined the fellowship, my mental state was that I was deeply troubled in the
work that I was engaged. Many questions ran through my mind of my commitment in
social work and work with children, but later I realized that I have burnt out
completely and I needed a break free from my work.
Thank God and thank CHC that I got through this fellowship. One solid month of
orientation at CHC, though week ends were taking me away from my family and my
one year old beloved baby John, it was the best break I had with inspiring leaders,
motivating sessions, questioning systems and immeasurable learning to my spirit, soul
and body.
30
The regular introspection of the inner man to use the knozvledge and skills with a right
attitude in serving our community is essential for every community health steward.
"The eye see only what the mind know..."
Dr. Ravi, said this and added "many a times we see things in very superficial mode but
one needs to go deeper to see things beyond our mind...so the best way is to learn
more and renew your mind"
This really struck me strong, because after having worked in Namakkal, Positive Living
Project for almost three years, I always believed that the work that I do is the best one
as there was no such projects in the district by any other NGOs. The project really got
attention of many working in HIV AIDS Care and support programs and took me to
various platforms and conferences to share our experiences and learning. I think that's
where knowingly or unknowingly the pride took hold and my eyes could see only
what the mind knew.
Though I have visited many projects, my mind always blocked me from learning from
good and bad experiences of other projects and people in community work. This has
rooted deep in my mind, but Dr. Ravi's group learning exercise helped me to unleash
my thoughts and strong holds of my mind and helped me to renew and revive my
spirit to focus once again on the barely reached services for children.
Many questions kept coming to my mind throughout the learning sessions at CHC.
Some are given here for the benefit of myself and those reading my report.
1. Am I strongly convicted on my vision and add strength to it by all possible
means?
2. Do I walk my talk?
3. How many children and their families affected by HIV AIDS have I really
supported and helped them lead a life with dignity?
4. Do I need to learn more or do I need to start doing with what I have known
already?
5. How much did I unlearn to learn more?
6. What are the things I need to sacrifice to belong to the community?
7. Will there be constant reflection and encouragement to see beyond what I see
now?
8. Do I criticize or critically analyse and reply? - from group lab
9. what are the values you are really following on a day to day basis/
a. sincerity
b. integrity
c. honesty
d. equality
e. simplicity
f. justice
g. truth and genuineness
h. humility
i. compassion
31
10.
11.
12.
13.
j. openness to listen or dialogue
k. sensitive to nature and people around you
What are the values that are still lacking within me?
How do I manage my family?
Or should I leave all this and take up a good position in any NGO?
How much am I self seeking? And how much should I die to self?
Group Learning Experiences
We are conditioned
When Dr. Ravi, revealed this learning that we always share only what our MIND
thinks and very rarely on what our HEART feels. How true it is, that we share only our
thoughts about a situation and never share the feelings we have upon certain issues
that has affected our heart. Every team must have a value framework and from time to
time we need to check whether we are really there in the values we have set in. And
prepare ourselves to share what our HEART feels.
We are not able to share negative or things that we feel sad about
Two reasons that we are not able to share our negative feelings, firstly we are
conditioned in life like that and secondly we do not have a trustful environment to
share. I often personally felt that I am mixed with both these factors. I am also
conditioned, may be as a gender role that as a man I shouldn't cry or express my sad
feelings which would put my dignity down and sometimes when I have felt that I
should share, the environment wasn't that trustful to express my feelings and even cry
when I want to.
I can personally count in my life after 18 years of age, how many times I have really
cried about certain things that have affected me. As I type this, I also remember while I
was doing my class 10, when I cried watching "Anjali", a tamil movie when a child dies
in a family of love, joy and affection. In 2006, after marriage again I cried one night
watching the same movie in television. The environment was so private that I was able
to cry aloud ventilating out my feelings that was so twined within my heart for
children.
Share your negative feelings, more positively
This is still another challenging area and a lot of practice that I need to share my
negative feelings, more positively. I have seen myself, expressing my negative feelings,
so sharply to those who cause it and those around them. I have understood personally
that I need more perseverance to withstand injustice and fight for justice. What I have
done many times is always expressed my anger and frustration and have lost some
good friends. Now I am in the process of learning to share more positively.
You are mentally ill - if you are "CASTE" bound
32
I acknowledge and appreciate such powerful words from Dr. Ravi, "You are mentally
ill - if you are CASTE bound". I could experience his words in many humiliating
instances I personally see in the lives of my friends who belonged to dalit community.
And during orientation of CHLP, we also witnessed the same in our field visits to
villages in Raichur.
Nimma - Namma Test
People have to experience you in the community as someone belonging to them. For
instance if we say we are a community worker, the community that we work with
should say he/she is OUR person and not the NGO's staff or person. This is a crucial
and strong lesson that I have learnt, but truly to express sometimes I have had reverse
discrimination for being negative to work among HIV positive people's networks. But
still, its important for me to be unequal to be equal to all.
33
Looking Outward - What did I learn about the community?
Go to the people
Live among them
Love them
Learn from them
Start from where they are
Build upon what they know
But of the best leaders,
When the task is accomplished,
The work completed,
The people all remark:
"We have done it ourselves"
Lao Tsu
Lao Tsu wrote this around three thousand years ago. Various translations of it are
found in http:/ /www.scn.org/cmp/modules/emp-go.htm
Go to the people...
It is more so important to Go to the people, while working with children and HIV. In
my personal experience and journey through these projects, the strategies have tried to
address some of the most vivid concerns of children affected by HIV, but there are still
deeper issues that can be well understood only by going to the people to understand
and help them address it.
Going to the people isn't simply meaning physically being there, but coming/humbling
down from where we are; understand their background, learning their language,
belonging to the community and empathizing alone will help us to progress in the
wellbeing of the community.
Live among them...
Heard and read that two of the interns of CHLP, made this a reality during the
fellowship. Another interesting couple I met are founders of Tribal Health Initiative in
Dharmapuri district. Literally they moved to live among the community members. In
my past experiences, I have gone to the community only as a visitor and monitoring
person, but now I am inspired to live among the community. As this is very crucial to
explore and understand more the day to day issues faced by the community that we
want to work with.
Love them...
I am reminded about what Jesus said in the Bible. The first greatest commandments is
to Love the Lord thy God with all your heart, soul and strength and the second that is
equivalent to it is to Love your neighbor as you love yourself.
34
I know many of us in the world loves ourselves so much, otherwise we would not like
to eat good food, dress up neatly, learn more and so on. Similarly, we ought to love our
neighbors as we love ourselves is what this poem is also trying to tell us.
It is so crucial that unless I love the children that I want to work with, I would be a
machine delivering services to them and very soon I will get weary and will not be of
use for any one.
As we all know a community is comprised of people from different religion, caste,
economical status, education and so on, working among them with love for all is
practically a challenging task. Personally I have experienced when we love all in the
community, some people in the community are not going to be happy about it.
For instance, in my recent visit to a village in Namakkal; to meet children from dalit
community we (myself and my wife) took a woman living with HIV who worked as a
field worker earlier in that area. We were so comfortable talking with the children and
their family members as we were meeting them after 4 years. We found many girl
children of HIV Positive parents have got married at very early age (14 to 15 years) and
are with children now. When we were returning we were discussing about this issue.
The field worker quoted that this is very common in 'this' (dalit) community. She was
demeaning the particular community.
I could personally reflect back, that when I work with children and their families
affected by HIV, I understood that it's important for me to love unconditionally all the
community members that I work with. And it's also obvious that we cannot move to
the next step in the poem (Learn from them) unless we throw personal bias and
conditioning of our mind.
Learn from them
My past work experience in villages of Namakkal actually gave me lot of insights and
understanding about how HIV AIDS has affected families and the entire community. I
have learnt that I have so much to learn from every member of the community which I
long to work with, right from a new born to the oldest person in the community.
There are both negative and positive learning from the community members. For
instance, in my interactions with HIV positive children in Bangalore OVC project of
world vision, a HIV positive girl expressed how she is affected by her handicapped
brother rather than her own HIV status.
She was almost in tears when she said, "I don't have my father but only my mother who is HIV
positive to support us, we want to do operation for my brother but we are unable to do it because
it's very expensive. I don't worry about HIV or taking ART but only when my relatives or
neighbors come to know mine and my mother's status".
That day I took so much of learning from her, that how HIV interventions and
strategies need to be designed more humanely rather than with policies, guidelines and
strategies.
35
Start from where they are and Build upon what they know
50% of my job is completed in the community if I complete all the above steps and
reach to this step of acknowledging that I need to start from where they are.
One experience to quote in starting from where they are and building upon what they know;
In villupuram, while working with the women living with HIV group in the district,
PWN+ had little unspent money from a donor agency, to use it for Income Generation
purposes of women living with HIV AIDS in the district. We had lots of ideas for the
women, but it didn't get their attention or interest, then I asked them to share what
they would do if we give them some loan. Two to three of them expressed they would
do saree business. That's the spark. I worked along with them and developed a plan for
a business unit that would buy and sell sarees and salwars. This business after going
through some challenges and struggles has now received a loan of Rs 3,75,000/- and
has also received a subsidy of Rs. 1,25,000/- from Tamilnadu Women Development
Corporation. 13 women living with HIV AIDS are partners in this business unit and is
doing well completely, initiated and managed by women living with HIV AIDS in
Villupuram.
Looking Ahead - Where do I go from here?
Towards a community health approach to working with children living with and
affected by HIV and AIDS
Principles to work with Children
- from Joint Learning Initiative for Children Affected by HIV and AIDS (JLICA) report,
February 2009
1.
2.
3.
4.
support children through immediate or extended families and
deliver integrated family-centred services;
strengthen community action to support families; and
address family poverty through national social protection.
- from Policy Framework for Children and AIDS - NACO, UNICEF and Ministry of Women
and Child, India July 2007
1. To create a non stigmatising environment, enabling access by children and
young people to prevention services including complete information and skills
to protect themselves from and reduce their vulnerability to HIV infection;
2. To identify HIV-infected parents and children early, and to provide high quality
treatment and support to prolong and maintain the quality of life, and to ensure
they are able to fulfill their potential and responsibilities;
3. To ensure that affected children - whether HIV positive or not - are not
excluded from or treated differentially by service providers in the public and
private sector;
36
4. To eliminate stigma and discrimination by overcoming myths and
misconceptions in relation to HIV/AIDS, and by implementing regulatory and
legal measures to address discrimination wherever it occurs.
5. To ensure social protection measures are in place to prevent and redress
violations of their rights and entitlements.
From NACO Operational guidelines
The opera tional guidelines take account of the two broad principles specified in NACP
HI:
1. Increasing access to all services for most vulnerable children and strengthening
child protection systems
2. Mainstreaming HIV/AIDS in the existing schemes and programmes for
children
37
Models in line with the Policy Framework of NACO, UNICEF and Min of Women and
Children
Policy Framework for Children and AIDS
Intervention Prevention Treatment,
Social
Models
services
care
and Protection
support
and Rights
Santhosh
Siruvar
Maiyam
Model
Life
skills 1. Support for
education
formal
education and
nutrition of the
children in the
community
Advocacy and
Addressing
Stigma
and
discrimination
Formation and Taluk
and
strengthening District
Level
Community
Advocacy
on
based
CAHA issues
Childcare
Committee
Access
to
other
Government
schemes
Organising
mothers as self
help
groups
and
access
resources from
TNWDC
2. Medical care
referrals
and
linkages
3. Organizing
Peer
group
meetings at the
center
Bangalore
OVC
Project
Model
4.
Building
awareness and
capacity
building
of
parents
and
caregivers
of
children
orphaned
by
HIV
5. Mobilising
women
as
volunteers
Drop-In
Life
Skills 1.
Centers
Education
2.
Support
Group meetings
for PLHIV
3. Management
of
Opportunistic
Infections
4. Educational
Assistance for
affected
children
5. Nutritional
Assistance
6.
Economic
1. Strengthening
PLHA Networks
2.
Capacity
Building
of
PLHIV
and
Community
Volunteers
3. Bangalore HIV
AIDS Forum
38
Development
Assistance
7. Home Visits
Gaps Observed
From my field observation, other issues that are unaddressed in the policy and the
intervention models studied are;
-
-
Child Sexual abuse among children orphaned by HIV and AIDS
Child marriages among affected families especially for girl children
Increase in Child labour where the bread winner of the family is lost
Support in disclosure for parents and children
Understanding the desires of HIV positive children above 16 years to get
married and providing appropriate interventions
Empowering children and providing platforms for them to raise their concerns
Support for grand parents taking care of HIV positive and affected children
Uncertain future for children at grandparents headed households
Poverty at grandparents headed households
Issues of adolescent HIV positive children while knowing their status
Sensitivity on care for children among health care service providers, schools and
other public and private services need to improve
Basic Principles of a model that I would evolve
1. Encourage formation and empowerment of children support groups at the
community
2. Age specific prevention and care and support services
3. Address vulnerable factors (like child abuse, trafficking, child marriages etc)
effectively through coordination
4. Encourage family based care and support services
5. Provide special programs for children living with grand parents
6. Well subsidized economic development program for widows and grand parents
managing children
7. Ensure Government and Private services free from stigma and discrimination
All of the above principles will be addressed with the cross-cutting themes of Child
rights, gender and GIPA
Books, Journals, Movies and Reports read during the fellowship
Books, Documents and Reports
1.
2.
3.
4.
5.
History of Child Rights in India
Learning to cartoon
YUVA comic books for children on health
Health Education for Children
OVC Research - UNAIDS Richard Lee 2008
39
6. NACP in - Policy Document [2007-12]
7. GIPA policy document
8. National Operational Guidelines for Children affected by HIV AIDS
9. Policy Framework for children and HIV AIDS - India 2007
10. SAARC Regional Strategic Framework for Protection, Care and Support of
children affected by HIV AIDS
11. Situational assessment of HIV AIDS affected children in four villages of melur
taluk of Madurai district in Tamilnadu
12. Life Skills Education Toolkit - FHI/USAID
13. Research document of CWC on Street Children
Movies
1. The Story of Stuff
2. Story of mine workers in Bellary, Karnataka
3. Story of Gold mine workers in Indonesia/Thailand
4. Flight 69
5. Amazing Journeys - a documentary on migration of birds and animals on earth
40
Annexures
I - JLICA Report Brief
As is so often the case in the provision of health care and deciding research agendas,
children have been sidelined in the fight against HIV/AIDS. According to the latest
UNAIDS figures, nearly 2 million children Eve with HIV worldwide, two-thirds in subSaharan Africa.
In addition, 12 million children in sub-Saharan Africa have lost one or two parents due
to HIV/AIDS. Many more live with a parent or carer with HIV. A very small
proportion of infected children receive antiretroviral treatment, and prevention of
mother-to-child transmission is only given to a third of women.
Diagnosis in infancy is difficult and therefore often delayed. Child-friendly medication
is lacking. 60% of children in southern Africa live in poverty. Now that HIV/AIDS is
evolving from an acute emergency into a chronic epidemic, the way to deliver
treatment and achieve prevention needs to change radically from an individualistic
approach to a broader strategic one. Children and families need to take centre stage.
In an excellent report, based on 2 years of research and analyses, the Joint Learning
Initiative on Children and HIV/AIDS —an independent alliance of researchers,
implementers, activists, policy makers, and people living with HIV —has presented
recommendations for such a change in direction. Home Truths: Facing the Facts on
Children, AIDS, and Poverty, released on Feb 10, points out three broad policies that
will make an immediate and longlasting difference to children:
5. support children through immediate or extended families and
6. dehver integrated famhy-centred services;
7. strengthen community action to support families; and address family poverty
through national social protection. Such poEcies are AIDS-sensitive but not
AIDS-directed.
The family is the most important support structure for children. The report argues that
the way orphans have been defined (as having lost one or both parents) and have
become the centre of attention for many HIV/AIDS poEcies has been unhelpful, if not
damaging. 88% of children labeUed as orphans have a surviving parent and overall 95%
continue to Eve with extended famihes. Additionally, children who live with HIV
positive parents have needs long before their parents die. Children need to stay within
a family or kinship structure.
Infected children usuahy live with others who are infected with the virus. The whole
family, not the individual, needs to become the unit for support and treatment. The
report advocates home health visiting and early childhood development interventions
together with strategies to encourage children's education. The use of schools as
intervention platforms misses the opportunity to reach children early and to reach
those who are not in education—the majority in some countries. Economic
strengthening of families has to be the basis to allow many of these programmes to
fuUy succeed.
41
The best immediate support for families is given by community groups. International
donors need to work with these groups in partnership to avoid duplication, confusion,
and waste of time and money. The authors suggest that coordination could be
strengthened with a district committee that maintains an active register of community
activities and devises a system of accountability that is understood by all and serves the
community. All activities should be delivered within a framework that is based on best
practice. Communities also have a crucial role to act as a backstop when families break
down or when children live in an abusive environment.
Family poverty and undernutrition can be addressed through income-transfer
programmes, such as Mexico’s Oportunidades programme or South Africa's child
support grants. These projects are efficient and simple, empower women, and can act
as a springboard for other more complex schemes, such as microfinance loans. Such
economic support increases school attendance, reduces illnesses, improves growth, and
encourages uptake of health services. The largest portion of money is usually used to
purchase food.
Extreme poverty, rather than HIV infection, should be used as a criterion to avoid
stigma and resentment. The report argues that "any developing country, no matter how
poor, can afford social protection packages for children". The positive effect of this
policy is now established beyond doubt and no further pilot studies are needed.
To integrate all these strategies, governments need to take the lead with national plans
and frameworks to scale-up programmes for children and families. With this approach,
society as a whole will be strengthened with intergenerational effects that will go a long
way towards, but also go well beyond, tackling the effects of HIV/ AIDS.
Putting children and families at the centre will show long-term vision with guaranteed
future benefits.
II - Child Marriages
The challenge
Marriage before the age of 18 is a reality for many young women. According to
UNICEF's estimates, over 60 million women aged 20-24 were married or in union
before the age of 18.
Factors that influence child marriage rates include: The state of the country's civil
registration system, which provides proof of age for children; the existence of an
adequate legislative framework with an accompanying enforcement mechanism to
address cases of child marriage; and the existence of customary or religious laws that
condone the practice2.
42
A violation of human rights
Ln many parts of the world parents encourage the marriage of their daughters while
they are still children in hopes that the marriage will benefit the children both
financially and socially and relieve financial burdens on the family. In actuality, child
marriage is a violation of human rights, compromising the girls7 development and
often resulting in early pregnancy and social isolation, with little education and poor
vocational training reinforcing the gendered nature of poverty. The right to 'free and
full' consent to a marriage is recognized in the Universal Declaration of Human
Rights - with the recognition that consent cannot be 'free and full' when one of the
parties involved is not sufficiently mature to make an informed decision about a life
partner.
The Convention on the Elimination of all Forms of Discrimination against
Women mentions the right to protection from child marriage in article 16, which states:
"The betrothal and the marriage of a child shall have no legal effect, and all necessary
action, including legislation, shall be taken to specify a minimum age for marriage...".
While marriage is not considered directly in the Convention on the Rights of the
Child, child marriage is linked to other rights - such as the right to express their views
freely, the right to protection from all forms of abuse, and the right to be protected from
harmful traditional practices - and is frequently addressed by the Committee on the
Rights of the Child. Other international agreements related to child marriage are
the Convention on Consent to Marriage, Minimum Age for Marriage and
Registration of Marriages and the African Charter on the Rights and Welfare of the
Child and the Protocol to the African Charter on Human and People’s Rights on the
Rights of Women in Africa.
Source: childinfo.org
CHILD MARRIAGE IS MORE LIKELY IN POOR HOUSEHOLDS THAN IN RICH
HOUSEHOLDS
Percentage of women aged 20-24 who were married or in union before age 18, by
wealth index quintile (1987-2006)
Protection from HIV/AIDS is another reason for child marriage. Parents seek to marry
off their girls to protect their health and their honour, and men often seek younger
women as wives as a means to avoid infection. In some contexts, however, the evidence
does not support this hypothesis and practice. Bhattacharya found that in India, 75 per
43
cent of people living with HIV/ AIDS are married10. In fact, the demand to reproduce
and the stigma associated with safe-sex practices lead to very low condom use among
married couples worldwide, and heterosexual married women who report
monogamous sexual relationships with their husbands are increasingly becoming a
high-risk group for HIV/ AIDS.
Strategies to end the practice of child marriage
•
•
•
•
•
Evidence shows that the more education a girl receives, the less likely she is to
marry as a child. Improving access to education for both girls and boys and
eliminating gender gaps in education are important strategies in ending the
practice of child marriage. Legislative, programmatic and advocacy efforts to
make education free and compulsory, as well as to expand Education for All
programming beyond the primary level, are indicated by the strong significance
of educational attainment in terms of reducing the number of girls who are
married. Increasing the level of compulsory education may be one tactic to
prolong the period of time when a girl is unavailable for marriage.
It is also important to capitalize on the window of opportunity created by the
increasing gap in time between the onset of puberty and the time of marriage by
providing substantive skills enhancing programmes and opportunities. There is
a need to develop methods to protect girls at risk of child marriage and to
address the concerns of girls and women who are already married by ensuring
the fulfillment of their right to a full education and providing them with life
skills-based training to ensure that they can earn a livelihood.
Efforts are also required to protect girls who are in union. Decreasing the
pressure on young women to conceive through education and advocacy on the
dangers of early motherhood should be considered. Similar consideration
should be given to ways to improve access to effective contraceptive methods.
Services for survivors of domestic violence should be accessible. Outreach efforts
should consider targeting women who were married before age 18 as potentially
in need of assistance. Mapping child marriage levels within countries may be a
useful practice for programmatic purposes when determining where to launch
new prevention campaigns. It can also be used to track future progress by
comparing child marriage levels at different points in time.
Further data collection and research is also required to explore the impact of
child marriage on boys and men. The demand-and-supply relationship of child
marriage should be qualitatively explored to illuminate dynamics, such as the
reasons why households marry their children and why men prefer younger
brides, in order to inform programming strategies.
Source for figures: UNICEF global databases, 2007, based on MICS, DHS and other
national surveys, 1987-2006.
44
Ill - Concerns of children living with Grandparents
•
•
•
Poverty:
1. findings suggest that children living in elderly-headed households often do not get
enough food and seldom have access to protein
2. children from elderly-headed households are overworked
3. even though grandmothers and grandchildren see education as very important,
children living with grandmothers do not access education easily because of lack of
money. In addition, if they do get to school, their progress is hampered, again largely
because of poverty
grandchildren as caretakers:
1 another characteristic of the elderly-headed household is that children function as
caretakers. When children have responsibility for the welfare of others they may
become "parentified" - that is, they assume responsibilities performed more
appropriately by an adult, including providing health and personal care, emotional
support, caring for siblings and maintaining the household
an uncertain future:
1. a further stress that is added to the lives of children living in elderly-headed
households is the uncertainty they feel about their immediate futures. They worry
about what will happen to them wizen their grandmothers die. The worry that a child
in this situation faces is that he or she will have to move again and will likely have to
live with aunts and uncles in a situation they know from experience is worse than
their life with their grandmother
2. also, the children fear (quite realistically) that they will not inherit property when
their grandmothers die, leaving them with no means to make a living
•
a generation gap:
1. the gap between the grandparent's generation and the children emerges in the
conflict between grandmothers and children over time to play and to socialise and
rest
2. Grandmothers expect that they will be looked after but the children know that their
ability to do this will be severely hampered because of the missing generation.
Parents would have provided the means for further training and income generation
and would have taken responsibility for the grandparents
45
ccmmuHilj TteA^k ^AfwlH^
\$ lk^ eecowA pkA^
fy lk<? Ccwnuidilj TteAlIk fellow^kip 6o\k&^ (Z003-W01-)
alU ^uppc+W fry
W\& ^ir RaUm IaIa 'Yha^I,
Community Health cell (Functional Unit of sochara)
B5/2, 1st Main, Maruthi Nagara, Madiwala,
Bengaluru - 56CC6B
TEL! +9 1-80-2553 1518/25525372
EMAIL: CHINTERNSHIP@SDCHARA ORG
Position: 2907 (3 views)