Mainstreaming HIV/AIDS in India’s health sector          Experiences and lessons learnt                      Vijay Aruldas...
India is a country with low prevalence: < 1% among adultsEstimated numbers:2001: 3.97 million2002: 4.58 million2003: 5.1 m...
States categorised as high, medium and low prevalence states according to estimated prevalence of HIV infectionPrevalence ...
% Prevalence   % Prevalence                 among FSW      among ANCAndhra Pradesh   19.4           1.25Karnataka        1...
THE CONTEXT:Strong Public, For-profit and NGO sectors• Government• For-profit• NGOsIndia’s public spending on health:• 0.9...
THE CONTEXT (contd):Health financing:•   15% publicly financed•   4 % social insurance•   1 % private insurance•   80 % is...
Ownership Differences:• Government• For-profit• NGO   • Church / faith-based / religiously-influencedDifferences:•   Finan...
Modes of healthcare involvement:Hospitals• Don’t have a defined community• Focus on individuals and sometimes immediate fa...
Advantages of mainstreaming in the health sector:• High exposure of the health sector to the issue• Reach is high• Recepti...
Mainstreaming HIV/AIDS:• means that the topic HIV/AIDS becomes part of the  ‘mainstream’ of organisations• is about growin...
Mainstreaming HIV/AIDS:In the health sector, mainstreaming should also includechallenging other sectors
Mainstreaming: trends in the health sector1.0 Broadbasing the Involvement•   1.1 Organisation’s own programmes•   1.2 Dial...
1.0 Broadbasing the Involvement:1.1 Organisation’s own programmes• Special team approach• Others get involved• Design chan...
1.0 Broadbasing the Involvement:1.1 Organisation’s own programmes: Challenges:• Relevance    • Is it a significant problem...
1.0 Broadbasing the Involvement:1.1 Organisation’s own programmes: Challenges:• Relevance• Logistics• Competence    • It i...
1.0 Broadbasing the Involvement:1.2 Dialogue with others• Schools and colleges• Faith settings: churches, mosques, temples...
2.0 Broadening the basis of discussion (the messages)i.e. the content of what is discussed:2.1 Biomedical: How the disease...
Core issues in strategising to mainstream HIV/AIDS:a. Understanding of the country situation:    • AIDS situation, epidemi...
Core issues in strategising to mainstream HIV/AIDS:a. Understanding of the country situation:b. Foundations of mainstreami...
Core issues in strategising to mainstream HIV/AIDS:a. Understanding of the country situation:b. Foundations of mainstreami...
Thank you….
Mainstreaming HIV and AIDS in India's Healthcare sector - Bonn Germany November 2004
Mainstreaming HIV and AIDS in India's Healthcare sector - Bonn Germany November 2004
Mainstreaming HIV and AIDS in India's Healthcare sector - Bonn Germany November 2004
Mainstreaming HIV and AIDS in India's Healthcare sector - Bonn Germany November 2004
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Mainstreaming HIV and AIDS in India's Healthcare sector - Bonn Germany November 2004

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This presentation outlines the learnings from Indian experiences in "mainstreaming" HIV and AIDS in healthcare organisations. It identifies 2 categories of approaches - broadbasing involvement and broadbasing messages, discusses the issues and challenges, and highlights the core issues in strategising to mainstream HIV and AIDS in healthcare organisations

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Mainstreaming HIV and AIDS in India's Healthcare sector - Bonn Germany November 2004

  1. 1. Mainstreaming HIV/AIDS in India’s health sector Experiences and lessons learnt Vijay Aruldas Christian Medical Association of India Bonn, Germany 29 November 2004
  2. 2. India is a country with low prevalence: < 1% among adultsEstimated numbers:2001: 3.97 million2002: 4.58 million2003: 5.1 millionBased on data from surveillance centres:455 centres in 2003 and 44 targeted intervention sites• 271 ANC clinics• 166 STD clinics• 13 IDU• 3 MSM• 2 CSWs
  3. 3. States categorised as high, medium and low prevalence states according to estimated prevalence of HIV infectionPrevalence High Antenata No of states HighCategory Risk l women Prevalence groups DistsHigh >5% >1% South - 3 45Prevalence West - 1 North east - 2Medium >5% <1% South – 1 4prevalence West – 2Low <5% <1%Prevalence
  4. 4. % Prevalence % Prevalence among FSW among ANCAndhra Pradesh 19.4 1.25Karnataka 14.4 1.00Tamil Nadu 8.80 1.00Maharashtra 54.29 1.25Manipur 12.5 1.25
  5. 5. THE CONTEXT:Strong Public, For-profit and NGO sectors• Government• For-profit• NGOsIndia’s public spending on health:• 0.9% of its GDP (rank 171/175 in UNDP Human Dev. Report)• Rs 5,720 crores (2002)• Strong public health infrastructureIndia’s private healthcare spending:• 4.2 % of its GDP (Rank 18th)• Rs 69,000 crores (2002)• For-profit sector mostly clinics and hospitals• NGO involvement in hospitals and community programmes
  6. 6. THE CONTEXT (contd):Health financing:• 15% publicly financed• 4 % social insurance• 1 % private insurance• 80 % is out-of-pocket expenditure• 2/3 rd of all cases access private care; 90% of them are from poorer sections• 50% of the bottom quintile of patients (poorer), sell assets or take loans to access private hospital care
  7. 7. Ownership Differences:• Government• For-profit• NGO • Church / faith-based / religiously-influencedDifferences:• Financial Resources• Power of the professionals• Value systems• Linkages with communities• Impact of HIV/AIDS on their work• Ability to insulate themselves from HIV/AIDS
  8. 8. Modes of healthcare involvement:Hospitals• Don’t have a defined community• Focus on individuals and sometimes immediate family• Focus on the disease and the symptomsCommunity-oriented initiatives• Sensitivity to needs of the Community • Service provision approach • Empowerment approach
  9. 9. Advantages of mainstreaming in the health sector:• High exposure of the health sector to the issue• Reach is high• Receptivity of clients is high • Condition of client • Availability of time • Goodwill of counsellor towards client is assumed • Confidentiality presumed • Community need not know• Credibility with other sectors
  10. 10. Mainstreaming HIV/AIDS:• means that the topic HIV/AIDS becomes part of the ‘mainstream’ of organisations• is about growing organisational consciousness and culture towards integrating HIV/AIDS• involves bringing the issues surrounding the pandemic into all strategic planning, and internal day-to-day operations inside an organisation, in its programmes, and in its relationships with others• the process of analysing how HIV/AIDS impacts on all sectors, now and in the future, both internally and externally, to determine how each sector should respond based on its comparative advantage
  11. 11. Mainstreaming HIV/AIDS:In the health sector, mainstreaming should also includechallenging other sectors
  12. 12. Mainstreaming: trends in the health sector1.0 Broadbasing the Involvement• 1.1 Organisation’s own programmes• 1.2 Dialogue with others2.0 Broadening the basis of discussion (the messages)• 2.1 Biomedical• 2.2 Individual• 2.3 Societal, cultural and economic norms and issues
  13. 13. 1.0 Broadbasing the Involvement:1.1 Organisation’s own programmes• Special team approach• Others get involved• Design changes (possible only when there is internal conviction and common understanding of the issue)Challenges:• Relevance• Logistics• Competence• Institutional• Moral• Self
  14. 14. 1.0 Broadbasing the Involvement:1.1 Organisation’s own programmes: Challenges:• Relevance • Is it a significant problem in my area? • It is not a significant problem among the people I see in my work • It happens only to “them”• Logistics • If I care for them, how can I say I cannot treat them? • If I cannot offer them help, why get involved at all? • Where will I admit them? •Technical reasons •Class of patients (CSWs and IDUs)
  15. 15. 1.0 Broadbasing the Involvement:1.1 Organisation’s own programmes: Challenges:• Relevance• Logistics• Competence • It is a specialised area • I am a social mobiliser, not a ‘carer’ • If I cannot offer them help, why get involved at all?• Institutional • Other patients will stop coming; hospital will close • Too costly for the hospital • Who will pay for them?• Moral • They enjoyed themselves .. now let them suffer • Why should we spend our limited charity on them? there are more deserving cases• Self • I / my staff will get infected • Will you pay for my care if I get infected ?
  16. 16. 1.0 Broadbasing the Involvement:1.2 Dialogue with others• Schools and colleges• Faith settings: churches, mosques, temples, gurdwaras• CompaniesChallenges• Denial of the problem• Keeping within the sensitivities of the ‘organisers’• Convincing that it should be talked about in faith settings and by faith leaders
  17. 17. 2.0 Broadening the basis of discussion (the messages)i.e. the content of what is discussed:2.1 Biomedical: How the disease spreads, etc• Highest level of comfort• Neutral ground2.2 Individual / personal issues• Questions about sex and sexuality, ABC• requires taking a ‘stance’ and some are uncomfortable• “hosts” may be uncomfortable2.3 Societal, cultural and economic norms and issues• ‘cutting edge’ of “broadening the basis of discussion”• questions notions of masculinity, gender structures, social and cultural practices
  18. 18. Core issues in strategising to mainstream HIV/AIDS:a. Understanding of the country situation: • AIDS situation, epidemiology, etc • Understanding of the sector players and their dynamics • Understanding of people’s relationship with the sectors and the players
  19. 19. Core issues in strategising to mainstream HIV/AIDS:a. Understanding of the country situation:b. Foundations of mainstreaming: • Change perceptions of prevalence • Enable understanding of the dynamics of the issue • Stimulate acceptance of the implications of the issue • Inculcate conviction of “I must act”
  20. 20. Core issues in strategising to mainstream HIV/AIDS:a. Understanding of the country situation:b. Foundations of mainstreaming:c. Strategies must be people centred: • “Players” • “People”
  21. 21. Thank you….

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