Community Experiences and Perspectives on the Initiation of Lifelong ART in P...
End line report_ALLIANCE
1. COMMUNITY–DRIVEN APPORACHES TO ADDRESS THE FEMINISATION
OF HIV/AIDS IN INDIA
END OF THE PROJECT SURVEY REPORT
Submitted to
Submitted by
March 2007.
2. RESEARCH TEAM
PrincipalInvestigator
Ms. Rama Rohini
Field Management
Mr. Nishant Kumar Sinha
Mr. Prabhash Toni Gupta
Mr. Sourav Kumar
Mr. Pawan Kumar Singh
Field Coordinators
Mr. D.Madhusudhan Rao (Andhra Pradesh)
Mr.M.Rajesh (Tamilnadu)
Mr.Dhojo Waghenbam ( Manipur)
Mrs. Santosh Uppal (Punjab)
Mrs. Sunita Arora (Delhi)
On field data Scrutinizers
Mrs. K. Sudha Rani (AndhraPradesh)
Ms. R. Geetha (Tamil Nadu)
Our Special Thanks to
Senior Programme Officer, Monitoring and Evaluation, Alliance India,
New Delhi
ALLIANCE INDIA PARTNER NGOs
Social Awareness Service Organisation (SASO, Mahipur)
Vasavya Mahila Mandali ( VMM, Vijaywada, AP)
LEPRA (Hyderabad, AP)
PWDS (Madurai, Tamil Nadu)
Child Survival India ( CSI,New Delhi)
All India Women’s Conference ( AIWC, Punjab)
ALLIANCE INDIA PARTNER I- NGOs
To all research investigators and the respondents
Ms.Nagalakshmi(VMM) and Ms. Chitra (Pache Trust ) for telling us about
project implementation activities during training
3. Glossary
AIDS Acquired Immune Deficiency Syndrome
AI Alliance India
AIWC All India Women’s Conference
AP Andhra Pradesh
CBOs Community Based Organisation
CSI Child Survival –India
HIV Humane Immune Virus
INGO Implementing Non- Governmental Organization
MVHA Manipur Voluntary Health Association
NGOs Non- Governmental Orgnaisation
OI Opportunistic Infections
PWDS P workers Development Society
SASO Social Awareness Service Organisation
SRH Sexual and Reproductive Health
TN Tamil Nadu
VMM Vasavya Mahila Mandali
WLHA Women Living with HIV/AIDS
4. List of Figures
1. Organ gram of Project Implementation
2 Intervention and expected outcomes
3 Map Showing Study states
List of Tables
1 Sample Size
2 Awareness About Condom: Women
3 Condom Usage
4 Shift in contraceptive choices
5 Source of Condom
6 Health seeking among WLHAS
7 Psychosocial well being of group members: Women
8 Awareness about Condom: Men
9
1
2
Psychosocial well being of group members: Men
List of graphs
Years of residency
STI- Knowledge gains baseline/end line comparison
5. Executive Summary
1.0 Back drop
To check the rapid spread of HIV/ AIDS has been the prime focus of ‘ National AIDS
Control Programme’ (NACP), In its III rd Phase, it is paying attention to specific
groups, women is one of its beneficiaries. It is been an difficult task to check the
proliferation of the HIV/AIDS among women, their low status in the society and lack
of decision making powers in their family life, has often made them vulnerable to
sexual disease and contributes to their misery.
International HIV/ADS Alliance, through the project “ Community Driven
approaches had address the feminization of HIV/AIDS in India” and empowered
women with regard to their, sexual and reproductive rights, legal rights and
relevant laws and policies.
2.0 Objectives
The main objective is to assess to what extent has vulnerable women . the 16 Non-
Governmental Organization (NGO) programmes areas of: Andhra Pradesh, Delhi,
Manipur, Punjab and Tamil Nadu, have benefited through the programme.
Specially
1. To assess the capacity of the partner NGOs w.r.t scale –up innovative and
sustainable community driven responses to reduce HIV transmission amongst
low-income women.
2. To assess the knowledge of the women (and sub groups and
WLHA/vulnerable groups)
3. To assess the access to services and support for women;
4. To assess the capacity of NGO/CBO
3.0 Methodology
The study was conducted in the sites of the 16 INGOs intervention area. A team
comprising of a principal coordinator, monitoring officers, supervisors and twelve
investigators, were responsible for carrying out the study. Before, launch of the study,
in each of the study state, in collaboration Alliance lead partners training progrmme
was organised for the team to get accustomed to the data collection techniques and
the terminologies. The instruments for data collection used by the team included:
1. Women Questionnaire
2. Men Questionnaire.
6. .4.0 Results
Socio- Demographic Profile
This information was collected from all the respondents ascertained their socio-
economic background and the groups formed, met the criteria as outlined in the
objectives.
Fertility and Knowledge
Knowledge has shown significant improvement, especially with regard to
choice of contraceptives. Awareness about condom has increased over the
baseline survey
Ante Natal Care and Post Natal Care
In the intervention areas the need to deliver baby in institution, is widespread and
high usage of institution for deliveries as well as post partum care is reported..
Breasting feeding the baby as long as possible is the norm among the community
members, the need to do so is based on the reasoning of it being important for baby’s
well being.
RTI/ STI Awareness
The women showing vulnerability to one or more symptoms relating to reproductive
tract infection have sought medical assistance and not resorted to self-treatment as
the case earlier was. Discussion on issues of sex is not difficult for women, and
interestingly women have learnt to say no to sex to Husband as the data revealed.
The infection called HIV/AIDS is heard by nearly all of the respondents. While the
awareness on the various route of transmission is well known, including
understanding about homo sexual intercourse transmission route.
Attitude towards PLHAs, Disclosure and protection
The study population while willing to share a meal and provide care and support to
PLHAS does not want to disclose, majority, irrespective of the status have stated
not disclosing if a family member is infected with HIV virus. Moreover, community at
large is against the publicizing the names of Positives.
Prevention of parent to child transmission and Voluntary counseling and
Testing Knowledge
Parent to child transmission is widely known , knowledge of reduction in transmission
from a parent to child is known to all in the study area. The Government hospital
rather than VCTC are known to people to all as place for HIV AIDS testing.
7. LEGAL RIGHTS, PARTICPATION IN COMMUNITY ACTIVITIES AND UTILIZATION
OF VARIOUS SCHEMES
The women groups are aware of their rights especially the medical termination to
pregnancy act.
HEALTH AND SOICALSUPPORT OF PEOPLE LIVING WITH HIV/AIDS
The discrimination is not much of an issue as is the disclosure; only handfuls of
women are members of the support groups. The distinct advantage of being member
of a group and attending the group as meeting participants as brought about some
changes. is felt by the members. A positive change, visible is that nearly all the
PLHAs have participated in some community functions in the past.
8. 1.0. Introduction
The International HIV/AIDS Alliance- is the European Unions largest HIV/AIDS-
focused development organisation. The Alliance focuses on the responses to
HIV/AIDS that combine preventing HIV infection, facilitating access to treatment, care
and support, and lessening the impact of AIDS. The emphasis is on working with
people who are most likely to affect or be affected by the spread of HIV/AIDS. Most
often these are people from marginalised groups who are the most vulnerable and
the hardest to reach.
The growing numbers of women becoming infected with the virus are fuelled by
gender norms and inequality in areas such as unequal access and control over
resources, limited decision-making, and the experience of violence. Women affected
by HIV make up nearly half of the 40.3 million people living with HIV worldwide.1
The increase in the proportion of women being affected by the epidemic continues. In
India, the total number of HIV cases is estimated to be 5.13 million of which 39
percent are women.2
In 2003, the surveillance data indicated that in high prevalence
states, the epidemic is spreading gradually from urban to rural areas, 41.43 percent
and 58.57 percent respectively3
and from high risks groups to general population.
Wide spread gender inequalities and gender-based violence lead to
disempowerment, oppression and isolation and thus greater vulnerability to HIV
infection. In India, women are relegated to lower position than men in their
communities by a complex interplay of social, cultural and economic factors stemming
from the caste system and a patriarchal society, including poverty, early marriage 4
,
migration and lack of education. 5
Such systems have a profound consequence in the
sexual activity and high-risk behaviour of both women and men. For women, they
increase their vulnerability to HIV by denying them rights to education, inheritance
and property rights, financial resources, protection from violence6
and access to
healthcare services. Moreover, women living with HIV/AIDS face greater stigma and
discrimination7
than men and are often left isolated in their communities with the
burden of caring for their sick husbands, children and other family members living
with HIV/AIDS.
Even in seeking HIV prevention, treatment and other related services, women face a
number of barriers. These include embarrassment, fear of rejection and stigma and a
partner’s objection to testing, lack of access to financial resources and transportation
as well as lack of access to financial resources and transportation as well as lack of
access to adequate and reliable information and widespread discrimination from
healthcare providers from whom they seek support. All these prevent women form
assessing their own risks taking preventive measures and seeking early diagnosis
1 UNAIDS (Nov 2005 ) AIDS Epidemic update
2
UNAIDS 2004
3
NACO (2004). Source: http//www.nacoonline .org/facts_hivestimates04.htm
4
National Family health Survey (NFHS II) 1998-99): 64 percent of women respondents were married
before the age 18.
5
National Family health Survey (NFHS II) 1998-99): 60 percent of women had never hear of AIDS, of
those who had some knowledge 33 percent did not know how to avoid infection. Additionally, only 46. 4
percent of adult females are literate in India compared with 69 percent of adult males.
6
ICRW (2002) Men, Masculinityand Domestic Violence in India
7
ILO (2002):A study to understand the socioeconomic impactofHIV/AIDS on infected persons and their
families: Source: http//www.infochangeindia.org/books andreportss153.isp
9. and treatment for HIV and related opportunistic infections. Such barriers also prevent
women from accessing other important and related information and services including
sexual and reproductive (SRH), health care, legal advice and social welfare services.
1.2 The Challenge Fund Project. 8
ALLIANCE INDIA, through this project aimed at creating informed demand for
information and services amongst women, their families and their communities
(including health care providers) in order to reduce stigma and discrimination and
contribute to creating an enabling environment.
Goal: To reduce the spread of HIV infection and mitigate its Impact in India.
Purpose: To develop and Scale up innovative and sustainable community driven
responses to reducing HIV transmission amongst low income women.
The project focused on the following:
Creating increased informed demand and enhancing awareness and
knowledge of HIV/AIDS and sexual and reproductive health with special
emphasis on increasing access to health, social and legal support services for
women affected by HIV/AIDS or vulnerable to HIV.
Building the capacity of NGOs and community members, especially women, to
undertake project activities and contribute to capacity and long-term
sustainability.
1.3 The project implementation9
Alliance India, worked with 16 partner NGOs in 14 districts across 5 States in India.
It provided technical, programmatic and financial support to lead partners and
implementing NGOs and CBOs. The lead partners in turn provided technical and
programmatic support to its INGOs.
To reach the target audience, each of the INGOs formed support groups in their area
of operation. The following groups were formed:
Vulnerable women
Women Living with HIV/AIDS
Adolescence Girls and boys
Vulnerable Men
The groups was formed based on a broad criteria which included:
Lack of education
Low levels of income
Lack of access to services such as SRH, legal and social welfare schemes.
In the given norm each of the INGO identified the vulnerable target population in their
respective areas of operation. (Fig 1.1)
8 Alliance India, Terms of Reference, dated, Nov 2006.
9 On field Discussion with Lead Partners , NGOs/CBOs
10. Fig 1. Organ gram of Project Implementation
Technical, Programmatic and Financial Support
Lead partners Implementing NGOs Community Based Org
Delhi Manipur Punjab Manipur
LEPRA PWDS VMM (Rural) (Thoubal) (Amritsar) (Imphal)
AP TN AP
(Hydb’d) (Madurai) (Vijaywada)
INGOs INGOs
CSI MVHA AIWC SASO
VMM,AIRTDS, MM,
SHADOWS, GREEN
VISION
PACHE
TRUST,SSH
IMAYAM,NMCT
, AIRD,CAST
FORMATION OF SUPPORT GROUPS IN THE COMMUNITY
111 WG
11WLHA
29AGSG
14M/SM
G
1TSGG
200 WG
21ABSG
35MG
129 AGSG
5 WG
5AGSG
1PLHA
11. 1.4 Vulnerable Groups for Intervention -Study States
Andhra Pradesh ( Hyderabad): Low socio-economic status in urban blocks
Tamil Nadu: The vulnerable communities were based on the criteria as idenfied for
the challenge fund by the AI. In Mellur, Pache trust’s area of operation, Widow -
Women, were considered vulnerable, hence, were the focus for intervention.
Imayam Social Welfare Asoication, Coimbatore vulnerable groups were:
Scavengers
Widow
Unorganized workers (Housemaid)
Arvani’s
Andhra Pradesh (Costal): The vulnerablity criteria was arrived at after visists to the
various operationa area and discussions. The deliberations helped in identfying the
below –mentioned as vulnerable:
Women holding multiple responsiblities
Women unable to access health Services
Fisher women
Women living in relocated areas
Adolescent – Girls
Delhi: Child Survival India formed groups as per the set criteria.i.e communities
with low –socio economic status.
Punjab: All India Women’s Conference formed groups socially and economically
backward communities.
Manipur SASO: SASO identified the following as vulnerable:
Spouse of the IDUs
Spouses who are on the move
Widows of IDUs
Adolescent Girls
12. 1.5 Activities for Intervention
To achieve the challenge fund objectives ( Fig 2), AI and its partners NGOs
ogranised varied activities such as:
Training
Workshops
Organising Cultural Events
Observation/Celeberations of Important Calender events
Street Plays, Rally and Audio-Visual shows.
Through these activites, under the challenge fund project Alliance India and it parnter
NGOs/CBOs created in increased informed demand and enhanced awareness and
knowledge about:
HIV/AIDS
Sexual and reproductive health
Social and legal Support Services for women
Build the capacity of NGOs and Community Members
Expected Outcomes 10
The activites it is expected would lead to :
1 Increased informed demand w.r.t
1.1 Increase in % of women who know that correct and consistent condom use
(even with regular partners) is the most effective means of preventing HIV/STI
transmission.
1.2 Increase in % of women (and sub-groups of women) who demonstrate correct
knowledge of risk factors for HIV infection.
1.3 % of women, especially WLHA / vulnerable groups, who have increased their
knowledge of relevant laws, policies, rights and entitlements (incl. social welfare
schemes).
1.4 % of support groups with at least 70% attendance at meetings by group
members.
2 Increased Access to services and support w.r.t
2.1 Increase in % of women who report knowing where to access SRHand HIV
services (including condoms) in their community.
2.2 #% of WLHA reporting they are currently accessing medical services for HIV
(ART or other).
2.3 # of WLHA who report seeking SRH services from a trained healthcare provider.
2.4 At least 60% of WLHA report that their psychosocial wellbeing has been
consistently met since joining a support group.
2.5 Increase in number of WLHA / vulnerable groups reporting they have sought
legal advice and support.
2.6 Increase in % of women reporting that their partners have accepting attitudes/play
a supportive role in their accessing SRHservices.
10 Logical Frame Work Analysis , received along with Terms of Reference.
13. 3. Increased NGO and CommunityCapacity w.r.t
3.1 # of organisations with increased capacity score (as measured by Alliance tools)
3.2 # of trainings conducted with NGO partners and women project beneficiaries in
a) advocacy at different levels; b) leadership skills; c) gender and rights; d)
basic HIV/SRH knowledge.
3.3 # of local/state level mutual sharing and learning meetings held by NGO
partners.
3.4 # of members of support groups attending leadership training courses.
3.5 # of WLHA / vulnerable groups mobilized and trained in participatory community
assessments/reviews.
3.6 # of WLHA / vulnerable groups supported by Alliance and partners to represent
on HIV/AIDS at national, national, regional and district level on HIV/AIDS.
2.0 Objectives of the End of the project Survey
The main objective of the end of the project survey is to measure the percentage
increase against each of the indicator given in expected outcomes.
3 Methodology
The study team comprised a principal coordinator, 4 Field Supervisors, 4 Field
Coordinators and twelve investigators. In preparation for the study, the twelve
Investigators (9 females 3 male) and field supervisors and field coordinators
participated in a three-day training workshop on data collection carried out by the
principal investigator from AMOGHAH RESEARCH FOUNDATION.. The training
programme covered the following:
a) Survey research general knowledge
b) Background to the study
c) Background of project implementation and activities carried out
d) Sampling procedures and identification of sample source and sample
e) Detailed section by section discussion of the questionnaire
f) Mock exercises with questionnaires for ease in administration
g) Pre-data collection exposure visit.
The principal investigator and 4 supervisors launched the study in Delhi. After
spending two –days on field in data collection and editing the supervisors proceeded
to respective study states. To check and ensure data collection quality of the
questionnaire, spot checks and field editing was done and feedback was given to the
investigators on day-to-day basis.
14. 14
Figure 2: Intervention and Expcted Outcomes
BY ALLIANCE INDIA
HIV/AIDS
Sexual and
reproductive
health
Social and legal
Support Services
for women
Build the capacity of
NGOs and Community
Members
Formation of support
Groups
Training
Workshops
Organizing cultural events
Observation/celebrating
importantcalendar events
Enhancing awareness
and knowledge through
Increased
PROCESS OUTPUT
Expected
Increased Informed
demand
Increased access to
services and support
Increased NGO and
CommunityCapacity.
INPUTS
15. 15
4 Study Sites and Selection
The study was conducted in the five states namely, Andhra Pardesh, Delhi,
Manipur, Punjab and Tamil Nadu. In each of the states data was collected in the
INGOs/CBOs areas of operation. ALLIANCE INDIA- LEAD PARTENR and
Implementing NGO (INGOs) Partners location is shown on the map.
Fig 3: Map showing the study states
Source : Maps of India .com
4.1 Characteristics of the study participants, their number and
recruitment
In each of the study sites structured one-on-one interviews were conducted with
the following:
1. Vulnerable Women i.e. women at risk
2. Vulnerable Men i.e. men at risk.
AIWC, Amritsar,
Punjab
CSI, Delhi
SASO, Imphal
MVHA, Thoubal
Manipur
LEPRA, Hyderabad
VMM, Vijaywada
Andhra Pradesh
PWDS,
Madurai,
Tamil Nadu
16. 16
From each of the study sites 200 people were interviewed. In the ratio of 7:3 that
is 70 percent (140/200) of the study population are females and the remaining 30
percent (60/200) are males.
Informed consent was taken from all the interviewees before administering
questionnaires. Table 3 provides with a detailed account of the respondents.
4.2 Identification and selection of the respondents
People living with HIV/AIDS (PLHA): The PLHAs registered with the NGOs
were identified and 50 percent of those were selected and interviewed.
Injecting Drug Users: Male and Female injecting drug users registered with
SASO were identified and one- fourth those registered were selected and
interviewed.
Spouses of the injecting drug users: This category was purposively identified
and selected to cover under women and men at risk
Vulnerable Women (women at risk): In the project sites vulnerable women were
identified on the following condition:
Condition 1: Residing in the INGOs area of operation between Feb 2006 and Dec
2006
Condition 2: (Occupation, Husband’s place of stay, Place of work, Frequency of
travel, Duration of stay outside)
Condition 3: Women with any of the below mentioned symptoms:
I. Vaginal Discharge
II. Burning while urinating
III. Pain during intercourse
IV. Spotting after sex when not menstruating.
Women meeting the above condition were taken up for the interview.
Vulnerable men (men at risk): Men, whose partner or wife met condition 2 and
not sampled as women at risk, were taken up for the interview.
4.3 Data collection
The study was conducted using instruments developed by the International
HIV/AIDS Alliance; the tool was bilingual i.e. it had questions in both English and
Manipuri languages for ease in administration and recording of data. The tools
included
1. One to One interviews with women
2. One to One interviews with men
The actual fieldwork was completed within a 25 days, starting from Feb 5 th, 2007.
Both females and male investigators, who were familiarized with the various
issues of sexual reproductive health and HIV/AIDS, carried on the interviews.
Each investigator conducted 4 interviews per day. The interviews were spot-
checked, field edited and back checked to ensure accuracy of data.
17. 17
4.4 Data Processing and analysis
Before the data was entered the all the questionnaires were edited in office to
capture any error in on field data recording; and for development of code list for
open ended questions and any other responses which is different from those
mentioned in the questionnaire.
The data was entered in SPSS version 10.0 and the same package used for the
analysis of the data.
5. Sample Size
INGO /CBO wise sample achieved is given in table 1.
Table 1: Sample size achieved.
NGO NAME
FLHA
Women
at Risk
Total
(F) MLHA
Men at
risk Total (M) Total (F+M)
AIWC 0 140 142 0 60 60 202
CSI 6 135 141 5 55 60 201
SASO 40 102 142 37 23 60 202
MVHA 11 130 141 11 49 60 201
VMM 15 131 146 8 53 61 207
AIRTDS 6 137 143 4 58 62 205
SHADOWS 21 128 149 12 50 62 211
MAHILA
MANDALI 32 109 141 13 48 61 202
Green Vision 21 135 156 12 48 60 216
Lepra 22 120 142 15 45 60 202
Source: Primary Field Survey
6. Limitations
The interviewee had to be currently married and staying with spouse, while this
was possible for identifying vulnerable women respondents. The same was not
possible for the PLHAs as many of those registered with NGO under the
programme were widow.
18. 18
7 The Findings: Socio – Economic background
7.1 Socio – Economic Back ground
This information was collected from all the respondents to ascertain their socio-
economic background and the extent to which groups formed, met the criteria as
mentioned and discussed in section 1.4. The analysis revealed that women living
with HIV/AIDS comprised about 12 percent of the total study population.
One of the criteria for selecting respondents for interview, among other things as
mentioned in section 4.2, was the years of residency. The residency of the
respondent in the area of operation during the project period was essential to
assess the impact of the project. Majority of the respondents had been living in
the area for more than 5 years.
Figure 1
7.1.1 Age of the respondents
In the study area the average age of women respondents was around 30 years.
The age group of the respondents varied from 12 years to 49 years.
7.1.2 Literacy and educational levels
In the study area majority of the respondents can read or write. All those who can
read or write informed having attended formal school. Most of the female
respondents had completed 8 –10 years of schooling.
7.1.3 Marital Status
More than 85 percent of the respondents are currently married. In CSI operated
areas cent percent respondents are married.
7.1.4 Occupation
Across all the study states majority of the respondents informed not working. in
Punjab and Delhi over 80 percent of the beneficiaries of the challenge fund project
were not working.
7.1.5 Husband’s Education
Majority of the women said there husband’s could read or write. Compared to the
other study states, Education levels are poorest in Andhra Pradesh both costal
and Hyderabad, here in, about 65 percent of the women informed their husbands
could read or write.
13
12
810
12
13
Years of Residency
AP Costal AP-hyd Delhi
Manipur Punjab TN
19. 19
7.1.6 Husband’s Occupation and Work related travel/ Mobility
Work related travel is not so common, over 90 percent of the respondents
informed husband’s living in the same household. In Andhra Pradesh both costal
and Hyderabad and in Delhi interviewees informed their husband’s earn a living
as “daily wage labourers”. In Manipur, 40 percent of the respondents’ husbands
have skilled regular service. In Punjab, 19 percent of the women informed their
men cultivate their own land.
7.1.7 Standard of Living
The average monthly income of the survey population family ranges between
Rs2385-Rs 3319. The per capita expenditure per person is in the range of
Rs.577- Rs 668. Very few households own ducks, hen goats and sheep. Very few
households own a Refrigerator. Radio and Fan are the two household goods
commonly mentioned.
7.1.8 Social Status
Most of the respondents belong to schedule caste and other backward
communities.
7.2. Findings: Expected Outputs: Increased Informed Demand
The goal of the challenge fund project is to reduce the spread of HIV infection and
mitigate its impact in India. Towards this, the project focused on enhancing
awareness and knowledge in the community regarding HIV/ AIDS and STI
through correct and consistent use of condoms.
7.2.1 Women knowing correct and consistence condom use and an
effective means for preventing STI/HIV transmission
The indicator “percentage of women who know that correct and consistent
condom use (even with regular partners) is the most effective means of preventing
HIV/STI transmission “ was analyzed to assess a) awareness b) knowledge –
correct usage and source c) consistency of usage- current usage and future
usage and d) means of preventing HIV/STI.
7.2.1.1 Awareness: Heard about of condom and safety rating of condoms
The awareness about the condom was judged by respondents’ ability to recall
“Condom”, on their own or by way of prompting, as a contraceptive method.
Across the study area majority of the respondents spontaneously mentioned
condom as contraceptive method and a few, when prompted informed having
heard of “Condom “ or by its generic name “Nirodh” (Table 1). It is important to
mention that condom by its generic name Nirodh, was identified in rural or interior
areas of the operation, especially in Andhra Pradesh and Tamil Nadu.
20. 20
Table 2: Awareness about Condom
NGO Spontaneous
Response
Aided
Response
Never
Heard
% Variation over
baseline
Spontan
eous.
Aided
N % N % N %
AIWC 123 86.6 19 13.4 - - 13 12.
CSI 116 82.3 25 17.7 - - 3 0.7
SASO 141 99.3 1 .7 - - 14 11.
MVHA 133 94.3 8 5.7 - - 11. 11
VMM 87 59.6 59 40.4 - - 27.77 8.17
AIRTDS 78 54.5 65 45.5 - - 33.07 3
Shadows 75 50.3 74 49.7 - - 22.67 2.07
Mahila
Mandali
89 63.1 52 36.9 - - 17.95 .96
Green Vision 67 42.9 89 57.1 - - 5.08 12.76
Lepra 60 42.3 76 53.3 6 4.2 3.68 9.93
Pache Trust 98 66.7 49 33.3 - - 28.1 10.9
SSH 89 63.6 51 36.4 - - 14.8 6.7
NMCT 122 84.1 23 15.9 - - 39.20 11.4
Imayam 109 76.2 34 23.8 - - 44.6 2.2
AIRD 123 86.6 19 13.4 - - 66.6 14.9
CAST 138 97.2 4 2.8 - - 61.2 28.5
Source : Primary Field Survey
Enhancement in awareness is evident. It shows marginal to significant increase
across the project areas. Project sites in costal Andhra Pradesh show over 20
percent increase in awareness, most importantly the marked improvement is in
spontaneous responses i.e. women on their own recalled condom. This growth in
awareness levels is attributed to both government sponsored “ASHA programme”
and also to the condom demonstrations organized, once every month with the
support group by the lead partner-Vasvayya Mahila Mandali.
In Tamil nadu the increase in spontaneous response has risen by more than 60
percent in AIRD areas, it is not clear whether, the low condom awareness (20
percent) reported during the baseline survey drove the NGO to go for intensive
condom promotion campaign, among other activities as part of the project.
The awareness and the consequent usage depend on the “no side effects” i.e.
safety factors of the contraceptives. The low “condom” usage11
as study shows
was more due to “no pleasure factor” than the side effects. The condom is rated
as “ very safe contraceptive” by about 82. 75 percent of the female respondents,
which is about 19 percent increase from the baseline survey.12
In SASO
intervention sites 99 percent (141/142) say condom is very safe, which is about 11
percent increase from the baseline survey.
7.2.1.2 Knowledge: Using condoms, correct method and source of
availability
11
Study on Unmetneeds ofRubber Contraceptives: By AMOGHAH RESEARCH FOUNDATION,
20002,for Swedish Trade Commission and MAMTA.
12 Baseline survey shows 76.78 percent respondents across 5 states rated condom as
very safe.(highly safe+ safe)
21. 21
The increase in awareness also had its impact on the usage of condom. The
usage shows an upward trend across the states. The growth is most in Manipur,
with 78.4 percent (116/148) of women as against 53.2 percent (67/198) during
baseline survey informing it as the “method currently being used by husband”.
The appreciation in usage in Manipur possibly is due to focus of the MNP+
condom promotion campaign. In other states condom usage varies. (Table 2).
Condom usage remains unchanged in Tamil Nadu, notwithstanding high
awareness reported.. Delhi is the only exception, showing a decline in condom
compared to the base line figures. At the same time there is a corresponding
increase in use of other contraceptive methods, thus making it a shift in choice of
contraceptive methods, rather than a decline in Condom use in CSI operated
areas. (Table 3)
Table 3: Condom usage: Baseline and End of the project: A comparison
Figures - %
State Baseline End of the project Trend
Andhra Pradesh 1.2 3.4 2.2
Delhi 45.8 32.2 13.8
Manipur 53.2 78.4 25.2
Punjab 28.9 36.6 7.7
Tamilnadu 12.8 12.2 33.4
Source: End of the project data: Primary field survey, Baseline figures: Alliance India
Andhra Pradesh (costal + hyderabad)
Table 4:Shift in contraceptive choice in Delhi: Baseline and End line
comparison
Figures - %
Contraceptive Baseline End of the
project
Difference
Female sterilization 27.7 44.8 17.1
Male Sterilization 1.2 - -
Pills 12 5.7 6.3
Copper T/IUD 8.4 3.4 5.0
Injectables - .7 .7
Condom 45.8 32.2 13.6
Periodic Abstinence - - -
Withdrawal 4.8 7.8 3.0
Source: End of the project data: Primary field survey Baseline figures: Alliance India
Despite the shift in choices in Delhi, it is important to mention for 66.7 percent
(4/6) of Women living with HIV/AIDS, informed using condoms only. The condom
usage among both WLHAS and Vulnerable groups varies. Of those, mentioning
using condoms only 16 .3 percent (19/116) of the WLHAS reported using it, in
Manipur, the percentage is much lower in costal Andhra Pradesh with only about
2.1 percent (2/95) of the WLHAS respondents informing using the rubber
contraceptive. None of the WLHAS spoken to in Hyderbad informed using
Condoms.
The duration of the using condom range from as recent as 6 months to more than
3 years, while few females failed to recall the time of usage. However, the
duration of use is not an indicator of the consistence use.
22. 22
7.2.1.3 Correct method of Use
In Manipur, more than half (54 percent: 149/274) demonstrated correct method
on “ how to use a condom”, i.e. a) Use it every act of intercourse b) use it on erect
penis before penetration c) Role it tight on to erect penis up to the end. Whereas
only 35 percent, (258/735) 31 percent (43/136), 28 percent (33/116) and 13
percent (19/142) interviewees in VMM operational area, Lepra, CSI and AIWC
intervention sites respectively.
The further analysis by type of the respondent i.e WLHAS and vulnerable women
reveals that far less percent of WLHAS as compared to vulnerable women know
how to use a condom except Hyderabad. Here in, 81.8 percent of the WLHAS
know the correct method - how to use condom, but none of them informed using
the same.
7.2.1.4 Source of Availability
Majority of the women who informed using condoms were aware of the source
availability. Currently, most of the respondent informed procuring it from -
Government medical sector, NGO, Chemist. (Table 4)
Table 5: Source of Condoms Figures %
Source Andhra
Pradesh
Delhi Manipur Punjab TN
N % N % N % N % N %
Govt. Medical
Sector
11 91.6 7 25 11 9.5 6 16.2 27 96.4
Vt. Medical
Sector
- - 4 14.3 5 4.3 6 16.2 1 3.5
NGO 1 8.3 3 10.7 96 82.8 8 21.6 - -
Chemist - - 11 39.3 3 2.6 12 32.4 - -
Friend/Relative - - 1 3.6 - - 1 2.7 - -
Other –AWW - - 2 7.1 - - 2 5.4 - ---
Don’t Know - - 0 - 1 .9 2 5.4 - -
Total 12 100 28 100 116 100 37 100 28 100
Source: Primary Field Survey.
7.2.1.5 Effective means of preventing HIV/STI transmission
Understanding of “condom “as an effective means of preventing HIV/STI
demonstrates a growth over the baseline survey. The enhancement in the
knowledge about condoms dual protection i.e protection against .STI and HIV is
clearly established.
7.2.1.6 Knowledge gains: Condom as mean to prevent STI
transmission
The knowledge gains for condom as mean to prevent STI, although visible across
the states, it is more so in Andhra Pradesh both costal and Hyderabad, where in
the awareness has almost doubled. (Fig 5).
23. 23
Fig 5
7.2.1.7 knowledge gains: Condoms as mean to prevent HIV
transmission
Percentage increase in condoms as a mean to prevent HIV transmission
knowledge compared to STI is less. The percentage increase in condom as
means for preventing HIV over the baseline survey is in the range of 10 percent to
12 percent, in the state of Delhi, Manipur and Punjab. It is interesting to note that
in Andhra Pradesh condom as means to preventive HIV was not at all recalled by
any of the beneficiary of the programme, during the baseline and end of the
project survey. However, the response to “ Can people protect themselves from
the HIV- virus that causes AIDS by using a condom correctly every time they have
sex.” Shows a gain of 31.3 percent in costal Andhra over the baseline survey.
(Baseline: 68.3 % End line: 99.6 %).
7.2.1.8 Women demonstrating correct knowledge of risk factors for
HIV infection
All the respondents across the project site have heard about HIV/AIDS.
Percentage of women with the correct knowledge of HIV risk factors has
increased. Information about “Homosexual intercourse transmission” route of
HIV was very low at the time of baseline survey with only 10 percent of
respondents knowing about it.
End of the project analysis for correct knowledge of risk factors for HIV infection
shows, marginal gain in Punjab, as against significant increase in correct
knowledge of homosexual intercourse transmission route, other study states.
In Punjab the gain has been of 0.7 percent only i.e. from 3.5 percent during the
baseline to 4.2 percent in the end of the project survey. By the time of the end
line survey the knowledge about “ homo sexual intercourse” transmission route
has shown a growth of 27.6 percent, 81.4 percent and 42.1 percent in Andhra
Pradesh, Delhi and Manipur respectively.
Among the other transmission routes knowledge about Mother to child
transmission route has shown considerable increase. The percentage of recall of
this transmission almost triples in Manipur (Baseline 33.3 % End line 88. 7
percent). The “ hetro-sexual intercourse transmission route and infected blood
0
20
40
60
80
100
Andhra
Pradesh
Manipur Tamilnadu
48.8
67.1 82.8
69.4
40.9
84.2 68.8 88.3
79.3
76.6
%
a
g
e
States
STI: Knwoldge gains Base line /End line Comparision
Baseline Endline
24. 24
transfusion route “ knowledge was high at the time of baseline survey and in the
end line percentage of response has increased only by few point percentages in
all the project sites.
It is note worthy to mention that the WLHAS and vulnerable group women
knowledge in the past 11 months has shown an increase. The information about “
Homo sexual intercourse transmission route” hitherto not recalled, it has been
mentioned as transmission route by more than 20 percent of the WLHAS and
vulnerable women in the end of the project survey.
7.2.2 Women, especially WLHAS/Vulnerable women who have increased
their knowledge of relevant laws, policies, rights and entitlements
(including social welfare schemes
The baseline figures showed abysmally low knowledge about relevant, laws,
policies rights and entitlements. The knowledge of the women was limited to their
inheritance of property after her husband’s death. The end line survey analysis
reflects by and large women know about their right to inherit husband’s property. .
There is increased awareness, about laws, policies and rights relating to women.
In the end of the project survey 89 percent of women respondents vis –a- vis 5
percent at the time of baseline in Andhra Pradesh reported having heard about
laws, policies and rights related. The lead partner VMM, informed during the
training programme, Booklet and directory consisting all the relevant information
was developed and given to the beneficiaries,
Similar increased awareness is seen in Punjab and Manipur, in both these states
little over 40 percent, as against less than 10 percent at the time of baseline, gave
an affirmative reply to “ Do you have knowledge of relevant laws, policies rights
and entitlements (including social welfare schemes) especially for persons
affected by HIV/AIDS”.
In Delhi percent age of interviewees having heard about the relevant laws, rights a
has gone up by a few point percentages i.e. from 40 percent at the time of
baseline survey to 46 percent at the end of the project survey.
However, only one respondent from Costal Andhra Pradesh, in Shadows operated
area could recall having learnt about “Medical Termination of Pregnancy Act”.
It is important to mention, WLHAS exhibit slightly better awareness about the
relevant laws, policies, rights and entitlements, vis-à-vis vulnerable women
although the difference is not significantly high. Nonetheless, it is higher than the
vulnerable women and improved over the baseline figures..
7.2.2.1 Support groups with increased attendance at meetings by
group members
Number of WLHAS and vulnerable women, have joined the support group in the
past 7-12 months. (Table 5). The groups in project areas on an average meet 2-3
times in a month.
25. 25
The attendance at the group meetings has improved; almost all the interviewees
informed attending the meetings. Majority attends meeting “some times “. Nearly
two- thirds women informed “ always” 13
attending the meeting.
Table 6: Membership of Support Group: baseline-end line comparison fig%
Members Period (End line Data)
NGO Baseline End line Membership Time Period
(months)
WLHA W@risk WLHA W@risk < 6 7-12 13-24 >24
AIWC - 0 - 88.0 26.8 59.2 .7 1.4
CSI 66.7 5.2 100 96.3 21.3 45.4 19.1 10.6
SASO 37.3 6.1 95 93.1 69.7 28.2 1.4 .7
MVHA 0 0 100 99.2 82.3 14.2 2.1 1.4
VMM 42.9 5.9 73.3 84.7 30.8 41.8 4.8 6.2
AIRTDS 22.2 6.9 100 96.4 8.4 81.8 4.2 2.1
Shadows 59.1 22.7 100 100 13.4 49.7 10.7 24.8
Mahila
Mandali
52.2 4.3 100 100 2.1 83.0 8.5 6.4
Green
Vision
37.8 1 100 100 14.1 77.6 3.8 4.5
LEPRA 71.4 38 100 94.2 30.3 54.2 8.5 2.1
PACHE
trust
38.5 14.4 111 77.7 27.9 30.6 12.2 3.4
SSH 47.8 9 99 74.4 17.9 27.9 15.7 9.3
NMCT 61.5 6.7 126 89.4 25.5 53.1 7.6 1.4
IMAYAM 75.0 0.7 102 71.3 18.9 41.3 10.5 -
AIRD 12.5 6.1 125 88 7.7 56.3 16.2 6.3
CAST 68.8 5.2 122 85.9 12.7 52.8 - 21.8
Source :Endline : primary Field Survey Baseline : Alliance India
7.3 Findings: Expected Output 2: Increases access to services and
support
This section tries to find the outcome of the demand creation. To what extent has
the demand creation translated into a) health seeking behaviour and where from
are these services being accessed. b) Result, in psychological well being c) useful
ness of the legal education provided and; d) Attitudinal, change if any in men
towards partners/spouse accessing SRH services.
7.3.1 Increase in percent age of women who report knowing where to
access SRH an HIV services in their community.
7.3.1a Live births
In the intervention areas, In the baseline as well as in the end line 92 percent
(2127/2302) of the respondents had given birth to child during their life. Over three
-fifths (77.7 percent 1652/2302) and 73 percent (1153/2302) of the interviewee
have sons and daughters respectively. Out of 2127 females who have delivered
baby, 13.9 percent (295/2127) of them stated, they had” given birth to a boy or girl
who was born alive but later died”.
To gain insights into the cause of the deaths, respondents were asked to recall if
any of their “pregnancy end in stillbirth, spontaneous abortion/miscarriage or
13 For the purpose of the study : Definition : Always = without missing, Mostly = missing 1
or 2 meetings , Sometimes= attending 1 or 2 meetings
26. 26
induced abortion”. In the study area 8.8 percent women (202/2302) had lost her
baby due to “miscarriage”, while 8.3 percent (176/2284) women stated having
“induced abortion”, about (4.6 percent; 105/2302) women gave birth to a still child.
7.3.1.b Utilization of Institution services and Knowledge on
termination of pregnancy
Near about 61 percent (230/375) and 31 percent (116/375) women sought ” the
post spontaneous abortion care” from the government health provider at the
CHC and PHC and from Private medical practitioner respectively. Utilization of
institution services either government or private for the “post spontaneous
abortion care has gone up by 15.2 over the baseline figures. (Base line 76.6
158/206: end line 92.2; 346/375) (Table 7)
Medical termination of pregnancy (MTP) is most commonly known, with 86.4
percent (1988/2302) mentioning about it, Pregnancy can “ABORTED BY taking
TABLETS/PILLS PRESCRIBED BY DOCTOR AND CONSUMED AT HOME
(Quinine etc.,) is known to 70 .9 percent (1631/2302) of the females in the study
area. There has been a significant increase over the baseline figures; Knowledge
about MTP has increased by 22.4 percent while ABORTION BY taking
TABLETS/PILLS PRESCRIBED BY DOCTOR AND CONSUMED AT HOME
(Quinine etc.,) has improved by 37.9 percent
7.3.1c Pregnancy and contraceptive usage
In the current phase of the survey, about 11 percent (165/1443) of the total
women respondents informed, “Had been pregnant in the last 24 months” and
about 6 percent of the women were expectant mothers. During the baseline
survey as well about 11 percent of the total women had informed, “had been
pregnant in the last 24 months” and about 6 percent of the women were expectant
mothers.
Around 4 percent (97/2127) of the women in the study area were pregnant at the
time of the interviews. 23.7 percent of the women were in the “First Trimester of
the pregnancy”.(Table 7)
Table 7: Number of Women Pregnant in the Intervention Area
Trimester Percentage (n=97)
First trimester 23.7
Second Trimester 50.5
Third Trimester 74.2
Total 100(97)
Source: Primary Field Survey
Over one -half (57 percent; 1257/2205) of the respondents informed, “currently
doing something or using any method to delay or avoid getting pregnant”.
To understand the population using the contraceptive, marital status of the users
was analyzed, it reveals 58.8 percent of the currently married are using a method
to avoid or delay pregnancy.
Interestingly, 66.5 percent of the female respondents in the study area mentioned
having undergone “sterilization”(832/1251) 18.5 percent mentioned using “
CONDOMS” (232/1251). Methods such as taking Pills, Insertion of IUD,
withdrawal, Periodic Abstinence and male sterilization stated being practiced by
27. 27
about the remaining 15.5 percent of the respondents. It is significant to note 17
percent of the respondents reporting of using a method for delay or avoiding
have been doing so for more than 5 years now.
Usage of method shows a regional variation, “female sterilization” seems to be
common in Andhra Pradesh with both Costal and Hyderabad wherein 90.1
percent and 93.3 percent of the women resepctively respondent informed having
adopted it. 71.5 percent in Tamil Nadu and 44 percent, 38 percent and 6 percent
in Delhi, Punjab, and Manipur respectively.
A cross tabulation was done to asses the usage among the PLHAs and
Vulnerable women, it is interesting to know that over one-half (50 percent,
145/282) of the PLHAs respondents informed currently using “a method to delay
or avoid pregnancy by them or by their husbands”, as against 57.8 percent of
the vulnerable women.
Government Medical Sector have been mainly availed for sterilization, as
informed by 89.8 percent (747/832); of the respondents. This sector services are
being availed for other methods such as IUD, pills and Condoms as well.
7.3.1d ANTENATAL, NATAL AND POST NATAL CARE
The time to start antenatal care according to 61.9 percent (1426/2302) of the
respondents is “WHEN KNOW THAT SHE IS PREGNANT”. Interestingly, little
less than a third of the respondents (31.9 percent;753/2302) stated care should
start “BETWEEN 3-4 MONTHS OF PREGNANCY”, . This shows a marginal
fall over the baseline, which stood at 33 percent.
Nearly three–fifths (73.2 percent; 1604/2171) recognized “ ABDOMINAL PAIN “
during pregnancy as a complication and sickness which needs immediate medical
attention. “Swelling of hands and face” as a complication that required
treatment was reported by 65.7 percent (1427/2171) of the total sampled
respondents.
7.3.1.e Importance of IFA Tablets and breast feeding
Among the sampled population, about 95 percent (2189/2302) of the respondents
mentioned knowing the need for taking “IFAtablets” However, the reasons for,
are to increase blood (44 percent: 967/2189). About 5 percent (113/2302) of
the population do know the importance of IFA for pregnant women. Among
increase, from low of 20 (25/128) percent of women knowing its value at the time
of baseline to 95 percent (91/97) at the end of programme.
The sampled population is aware of the necessity to provide as soon as possible
the postpartum care, In the opinion of 97.4 percent (2241/2302) of the
respondents, a woman should receive postpartum care within 42 days of
delivery.
Little over half (54.7 percent; 1259/2302) of the population in the study area,
informed that breast feeding is important for” baby’s health”, knowledge of
colostrums building antibodies is abysmally low, only 3.0 percent mentioned “
Yellow part is vitamin for the baby” .
28. 28
7.3.1.f Services availed during pregnancy
Across the study states women respondent have informed going for antenatal
check ups. Around 91.4 percent of them stated “ going for ante natal check up
during the last 24 months. There is a baseline 2.4 percent increase over the
baseline figure of 89 percent.
Study population is accessing institutions, such as Government hospitals, Private
clinic and sub –centers. Mention of accessing institutions only by the respondents
is a significant development over the baseline survey. Government Hospital, CHC
and PHC have been accessed by 77.9 percent (256/340) of the respondent
A very high percentage (92.6 percent; 315/340) of the respondents informed
taking “TT shots to prevent baby from the Tetanus “ and also 75.6 percent of the
sampled women informed “getting enough IFATablets during pregnancy
7.3.1.g Advise on care during pregnancy
Women during pregnancy had received advise on diet during pregnancy,
identification of danger signs, delivery costs, breast feeding, new born care and
family planning.
Most of the women informed receiving advise on Diet (95.6 percent), Breast
feeding (8.6.8 percent) and New -born care (82.1 percent), comparatively less
women mentioned receiving information on identification of danger signs 76.2
percent and 60.9 percent on delivery cost. However this a significant increase
over the baseline, where in the figures stood at 53.2 percent and 41 percent for
danger sings and delivery cost respectively.
7.3.1.h Institutional deliveries
Institutional deliveries have been advised reported 85.6 percent of the study
participants, 67.8 percent (184/273) of the respondents mentioned they had
delivered baby in an institution.14
While 32.2 percent (88/273) did not go to any
institution as the cost was too much. and hence delivered at home. Doctor had
conducted these deliveries (73.2 percent, 201//273).
7.3.2 KNOWLEDGE AND INCIDENCE OF RTIs/STIs
7.3.2.1 Awareness about Menstruation Related problems
In the study area 88 percent (2016/2302) of the respondents are currently
menstruating, 4,2 percent (97/2302) are pregnant and about 3 percent have
postpartum AMENORHORIA. In the past 6 months, 31.5 percent (635/2016) of
the respondents had experienced problems during menstruation. “ Painful
periods, delayed periods and scanty bleeding” is the main complaint of about 63.8
percent (405/635), 40percent (254/635).
For these menstrual problems only 63.6 percent (404) sought treatment and
consulted doctors at the government hospitals (64.9 percent; 262). Health seeking
for menstrual related problem is greater than before in all the project sites,.
14
Institution herein includes ,Governmenthospital,,Govt sub cnertre, NGO TrustHospital,/clinic,
private hospital/clinic.
29. 29
Table 8: health seeking Baseline and End line
Figures %
NGO Baseline End line Difference
AIWC 37.8 44 8.2
CSI 62 43 19
SASO 32.6 50.8 17.2
MVHA 18.1 44.8 36.7
VMM 51 60.9 9.9
AIRTDS 20 33.3 13.3
Shadows 26 61.3 35.3
Mahila Mandali 18 59.3 41.1
GreenVision 29 73.7 44.2
Lepra 29.3 65 35.70
Pache Trust 46.2 90.2 56
SSH 38.6 68.5 30.1
NMCT 13.0 67.7 54.7
Imayam 13.8 92.5 78.87
AIRD 3.6 88.4 84.8
CAST 5.2 27.5 22.3
Source: Primary Field Survey
Analysis of the menstrual related problems by respondent type i.e PLHA and
women at risk, shows that little over two-fifth (41. percent and 30 percent0 of
PLHAs and women at risk respectively had problems. Out of the total sampled
respondents less than 48.7 percent of the women mentioned experiencing severe
abdominal pain (1121/2302). For treatment had accessed allopathic doctor.
7.3.3. WLHAS reporting they are currently accessing medical services for
HIV (ART or other)
Almost all the WLHAs mentioned using ART, could reduce risk of HV transmission
to unborn child. All the WLHAs interviewed knew about it vis-à-vis about 80- 85
percent during the baseline survey.
7.3.2.1a WLHAS report seeking services from a trained health care
provider
The health seeking services among the WLHAS across the study states varies.
Not all the WLHAS with SRH problems mentioned going for treatment. In CSI
operated areas, 4 out of the 6 WLHAS spoken to mentioned experiencing
menstrual related problems, however, only two of them stated taking treatment
from doctor at the Government hospital.
In the same way, in Manipur 4 WLHAS reported, “having conceived in last 24
months “ but only 1 WLHA went for ANC. 37 percent of WLHAS in SASO and 40
percent in MVHA have reported having menstrual related problems, while only 40
percent and 25 percent in SASO areas and MVHA respectively consulted doctor.
Nonetheless, increase is seen in health seeking among the WLHAS in Manipur
over the baseline. (Table 7)
30. 30
Table 9: Health seeking among WLHAS Figure %
NGO Women living with HIV/ AIDS Trend
Baseline End line
AIWC - -
CSI 100 50 50
SASO 35.3 66.7 31.4
MVHA 33.3 81.8 47.9
VMM 44.4 81.8 37.4
AIRTDS 25 -
Shadows 46.2 81.8 35.4
Mahila Mandali 31.6 81.8 50.3
Green Vision 53.3 75.0 21.7
Lepra 33.3 66.7 33.4
Pache Trust - 80 -
SSH 54.5 79.3 14.8
NMCT - 50 -
Imamyam 100 -
AIRD 12.5 100 87.5
CAST 33.3 85.7 52..4
Source : Primary Field Survey
The steep rise in health seeking is attributed to the referrals provided by Alliance
India –INGOs to the WLHAS as part of the challenge fund project. Interestingly,
the urban –rural divided among the beneficiaries is evident.
About 65 – 86 percent of the beneficiaries attached to the INGOs, working in the
cities or on the out skirts of the city, such as CSI, SASO MVHA, VMM and LEPRA,
Pache Trust, have mentioned receiving the same from Alliance India–INGOs. Even
in Green Vision, operational area in Vishakhapatnam, less than cent percent of the
beneficiaries mentioned about receiving referrals from AI-INGO. On the other hand,
all the beneficiaries of the INGOs located in the interiors or working in the
hinterlands, such as AIRTDS, Shadows, Mahila Mandali, SSH, AIRD and CAST in
Andhra Pradesh and Tamil Nadu respectively have mentioned receiving referral
support from the Alliance India –INGOs.
The urban – rural divided, how ever, is no reflection of an NGO work or its
commitment, but I it could be due to multiple agencies working in a city and also as
seen in the responses to this question, where in small yet significant, numbers had
mentioned “receiving support for referrals to other health institutions like
government hospitals from other NGOs.” At the same the referrals to PLHAS
living in the villages15
will help in adherence to ART and health seeking.
Increase in number of WLHAS reporting their psychosocial well being has
been consistently met since joining a support group.
Being in a group has helped the WLHAs “ A lot “ (Table 8). The difference in
psychological well being is reflected in their changed outlook, towards life.
15 In the study,” Building Treatment Friendly communities for ARV’s : Rapid Assessment
in Manipur and Andhra Pradesh” by Samiran Panda, Mandeep Dhaliwal, Sangeeta Kaul,
Rama Rohini ,Grace Neimbaiaklun, the PoART had mentioned traveling for long hours
and with out referrals seeking treatment was not easy and it was also a stumbling block for
adherence to ART
31. 31
In VMM operated areas more than half (54.5 percent) of the respondents stated
“None of the time “ to the statement “ I have been worried about when I’m going
to die”, while about same percentage of Lepra ‘s beneficiaries have stated that
they are hopeful about future. Like wise, at other NGOs as well changed attitude is
noticeable, little over one -third (34.5percent) of the respondents in Pache trust area
revealed they at “ none of the time “ worry about there CD4 count and viral load.
About 50 percent of the beneficiaries across all the project sites in Tamil Nadu are
hopeful about their future.
The approach to life is not restricted to the personal well being only; the increase in
number of respondents, participation social activities too gives an idea about the
social health of the WLHAS.
Table 10: Difference in Psychosocial well being of the group member
33. 33
The impact of the “ counseling on positive living or on how to live a normal
life” can be seen.
7.4. Findings: Increased NGO and Community Capacity
This section looks in to the extent of capacity building of the NGOs and thier
capability of NGOs in conducting programmes and organizing events. The NGOs
conducted progrmmes on a) basic SRH/HIV knowledge b) Nutrition and c)
education.
7.4.1 Programmes on basic SRH /HIV knowledge
Over four –fifths (80 percent) of the beneficiaries across the five states informed
receiving information/ counseling on RTIs/ STIs. The RTI/STI information, as
gathered from the analysis of the data, was provided through number of IEC
activities that included Street plays, puppet shows and organizing events such as
World AIDS Day, cultural events and celebrating special days
These channels for communication were widely used to disseminate information
on HIV/AIDS, RTIs and STIs.. Majority of women remembered receiving
messages on HIV/AIDS.
In addition to providing the basic information on HIV/AiDS, the Alliance – INGOs
has also provided information on ART, Safe sexual behaviour, counseling on
positive living and referral services.
It is important to mention that over 90 percent of the majority of the respondents in
VMM operated areas, said having received referral services from Alliance India
NGO followed by 61 percent of the respondents in Manipur.
7.4.2 Programmes on Nutrition
To build home based care for WLHAS and vulnerable women, Alliance India
NGOs organized cooking classes More than half of the respondents in Delhi,
Manipur and Punjab recalled receiving counseling on green leafy vegetables and
eating boiled food as against, over 80 percent in Andhra Pradesh both costal and
Hyderabad.
7.4.3 Programme on Legal Education
The percentage recall of providing legal education is not very high, only about 20
percent of respondents in Delhi and Manipur informed Alliance India INGOs
conducting such activities in the past three months. The figures to this response
are significantly high in costal Andhra, herein around 90 percent of the women
informed organization of “legal education classes”. However, How often the legal
education was provided is not clear from the data gathered.
All these events/ programmes were organized by Alliance India was informed by
more than 75 percent of the respondents
34. 34
8.1 The Findings: Socio – Economic background: Male
Socio – Economic Back ground
This information was collected from all the respondents to ascertain their socio-
economic background and the extent to which groups formed, met the criteria as
mentioned and discussed in section 1.4. The analysis revealed that men living
with HIV/AIDS comprised about 16.5 percent (160/970) of the total study
population.
One of the criteria for selecting respondents for interview, among other things as
mentioned in section 4.2, was the years of residency. The residency of the
respondent in the area of operation during the project period was essential to
assess the impact of the project. On average respondents have been living in the
area for past the 25 years.
Age of the respondents
In the study area the average age of men respondents was around 33
years.
Literacy and educational levels
In the study area little over four-fifths (84 percent, 815/970) of the respondents
can read or write. All those who can read or write informed having attended formal
school. Most of the male respondents had completed 8 –10 years of schooling.
About one-tenth had completed graduation and above. Among the study states,
Andhra Pradesh, has low literacy rate of 71 percent.
Marital Status
Little over 90 percent of the respondents are currently married. About 99 percent
(362/366) and 97 percent (353/364) percent in Andhra Pradesh and Tamil Nadu
respectively are married.
Occupation
Little –over one-third (34.5 percent; 335/970) of the respondents worked as daily
labourers. In Tamil Nadu and Delhi more than two-fifths of the respondents are
daily wage labourers
Work related travel/ Mobility
Work related travel is not so common, over 90 percent of the respondents
informed living in the same household. Of those who travel, informed going away
temporarily for about week to fifteen days
Standard of Living
The average monthly income of the survey population family ranges between
Rs3307.
8.2 Findings: Expected Outputs: Increased Informed Demand
The goal of the challenge fund project is to reduce the spread of HIV infection and
mitigate its impact in India. Towards this, the project focused on enhancing
awareness and knowledge in the community regarding HIV/ AIDS and STI
through correct and consistent use of condoms.
35. 35
Men knowing correct and consistence condom use and an effective means
for preventing STI/HIV transmission
The indicator “percentage of men who know that correct and consistent condom
use (even with regular partners) is the most effective means of preventing HIV/STI
transmission “ was analyzed to assess a) awareness b) knowledge – correct
usage and source c) consistency of usage- current usage and future usage and d)
means of preventing HIV/STI.
Awareness: Heard about of condom and safety rating of condoms
The awareness about the condom was judged by respondents’ ability to recall
“Condom”, on their own or by way of prompting, as a contraceptive method.
Across the study area majority (93.3 percent;905/970) of the respondents
spontaneously mentioned condom as contraceptive method and a few, when
prompted informed having heard of “Condom “ or by its generic name
“Nirodh”..(Tabe1)
Table 11 Awareness about Condom
NGO Spontaneous
Response
Aided Response % Variation
over
baseline
Spontaneous.
N % N %
AIWC 60 100 - -
CSI 50 83.3 10 16.7
SASO 58 96.7 2 3.3 13.9
MVHA 59 98.3 1 1.7 9.6
VMM 60 100 - - 30
AIRTDS 61 100 - - 35
Shadows 62 100 - - 9.8
Mahila Mandali 61 100 - - 3
Green Vision 60 100 6.7
Lepra 59 98.3 1 1.7 3.3
Pache Trust 58 90.6 6 9.4 4.5
SSH 48 85.7 8 14.3 0.5
NMCT 55 87.3 8 12.7 1.6
Imayam 47 78.3 13 21.7 4.5
AIRD 55 90.2 6 9.8 2.2
CAST 52 86.7 8 13.3 8.8
Source: Primary Field Survey
The table shows marginal to significant increase across the project areas. The
awareness and the consequent usage depend on the “no side effects” i.e. safety
factors of the contraceptives. The low “condom” usage16
as study shows was
more due to “no pleasure factor” than the side effects. The condom is rated as “
very safe contraceptive” by about 98.5 percent of the male respondents, which is
16
Study on Unmetneeds ofRubber Contraceptives: By AMOGHAH RESEARCH FOUNDATION,
20002,for Swedish Trade Commission and MAMTA.
36. 36
about 3.2 percent increase from the baseline survey.17
In MANIPUR INGOs
intervention sites cent percent (118/120) say condom is very safe, which is about
2.3 percent increase from the baseline survey.
Knowledge: correct method and source of availability
Correct method of Use
Little over a quarter (26.29 percent; 255/970) of the men interviewed
demonstrated correct method on “ how to use a condom”, i.e. a) Use it every act
of intercourse b) use it on erect penis before penetration c) Role it tight on to erect
penis up to the end. Where as on 6.99 percent (69/987) of the men interviewed
knew how to use a condom. The knowledge levels in the intervention period have
gone up by about 19.3 percent.
Source of Availability
Majority of the men who informed using condoms said “yes” on being asking “Do
you know where you can get condoms, if required”.
Effective means of preventing HIV/STI transmission
Understanding of “condom “as an effective means of preventing HIV/STI
demonstrates a growth over the baseline survey.
Knowledge gains: Condom as mean to prevent STI transmission
Out of the total male respondents 33.5 (326/970) percent mentioned sore or ulcer
on penis or discharge from penis. While all informed their wife about it and more
than half 55.5 percent (181/325) took precaution i.e. not to infect wife” they used
condoms (56.4percent: 102/181)
Knowledge gains: Condoms as mean to prevent HIV transmission
Percentage increase in condoms as a mean to prevent HIV transmission
knowledge is a almost similar. Nearly all had (99 percent; 960/970) had heard of
HIV AIDS. Almost all (96 percent;918/970) said there are ways of getting affected
HV/AIDS. Using condoms as ways of preventing HIV/AIDS was mentioned by58
percent of the respondents (533/970).
Men demonstrating correct knowledge of risk factors for HIV infection
All the respondents across the project site have heard about HIV/AIDS.
Percentage of men with the correct knowledge of HIV risk factors has increased.
Information about “Homosexual intercourse transmission” route of HIV was very
low at the time of baseline survey with only 17 percent of respondents knowing
about it, the increase is by 12.7 percent.
Among the other transmission routes knowledge about Mother to child
transmission route has shown considerable increase. The percentage of recall of
this transmission has increased 2.5 times (Baseline 24 % End line 61. 7 percent).
The “ hetro-sexual intercourse transmission route and infected blood transfusion
17 Baseline survey shows 76.78 percent respondents across 5 states rated condom as
very safe.(highly safe+ safe)
37. 37
route “ knowledge was high at the time of baseline survey and in the end line
percentage of responses has remained high vis-a- vis other transmission routes.
Men, especially MLHAS/Vulnerable men who have increased their
knowledge of relevant laws, policies, rights and entitlements (including
social welfare schemes
The knowledge of the men is high on the right of women to inherit property after
her husband’s death. (98.9percent;959/970) There is increased awareness, about
laws, policies and rights relating to men. In the end of the project survey 47.5
percent of men respondents vis –a- vis 8 percent at the time of baseline having
heard about laws, policies and rights related.
It is important to mention, MLHAS exhibit slightly better awareness about the
relevant laws, policies, rights and entitlements, vis-à-vis vulnerable men although
the difference is not significantly high. Nonetheless, it is higher than the vulnerable
men and improved over the baseline figures.
Support groups with increased attendance at meetings by group members
Number of MLHAS and vulnerable men, have joined the support group in the past
7-12 months.The groups in project areas on an average meet 2-3 times in a
month. The attendance at the group meetings has improved; almost all the
interviewees informed attending the meetings. Majority attends meeting “always“.
8.3 Findings: Expected Output 2: Increases access to services and
support
This section tries to find the outcome of the demand creation. To what extent has
the demand creation translated into a) health seeking behaviour and where from
are these services being accessed. b) Result, in psychological well being c) useful
ness of the legal education provided and; d) Attitudinal, change if any in men
towards partners/spouse accessing SRH services.
Increase in number of MLHAS reporting their psychosocial well-being has
been consistently met since joining a support group.
Being in a group has helped the MLHAs .The difference in psychological well-
being is reflected in their changed outlook, towards life. (Table2)
Table 12: Psycho social well being
All of the
time
A lot of
the time
Some of the
time
A little
of time
None of the
time
Overall
Function
CD4count 2.5 18.1 43.8 18.8 16.9
Worried about
death
1.9 5.6 25.6 27.5 39.4
Satisfied with
social activity
7.5 25.0 38.8 16.3 12.5
Hopeful about
future
6.3 43.8 30.0 11.3 8.8
Source: Primary Field Survey
38. 38
The impact of the “counseling on positive living or on how to live a normal
life” can be seen on the social life more than 90 percent of the MLHAS have
attended weddings and gram sabha meetings.
Attitudinal, change if any in men towards partners/spouse accessing SRH
services
Women’s accessing the SRH services in India is subjected to the approval of the
family members, especially her husband. Educating and sensitizing men on the
sexual and reproductive health of females is an integral to any women centric
activity. Recognizing this important social-cultural factor DFID challenge fund also
focused bringing about attitudinal change among the men in the project states.
Birth Spacing Contraception and Safe motherhood
Pregnancy, knowledge of women’s menstrual cycle
Around 9.6 percent of male respondents ” wife was pregnant at the time
of interview”. About 46.4 percentage (520/970) of men have no
knowledge about days in a women’s menstrual cycle during which
she cannot get pregnant. The percentage for this indicator registers a fall
by over 30 percent i.e .at the time of baseline survey 78 percent of men
had no knowledge about days in a women’s menstrual cycle during which
she cannot get pregnant.
Termination of pregnancy
Medical Termination of Pregnancy (MTP) is the most known procedure of
terminating pregnancy, with 71.4 percent (693/970) of respondents mentioning it.
Birth Spacing and contraception
Over 90 percent of the respondents (894/970) of the respondents had heard about
the word “birth Spacing.” To them it meant “ using contraceptives 42.6 percent
(413/970), planning for pregnancies 20 percent (193/970); 25.4 percent (246/970)
delivering smaller number of children.”
Perception on family planning and Contraceptive usage
Almost cent percent (96 percent;931/970) of the male population in the study
area agrees with the statement “The women’s ability to choose the number
and spacing of pregnancies plays significant role in the general health and
well-being primarily for women, but also extends to children and family.”
The affect of the large families seems to be dawning upon the respondents, over
half (96.5 percent; 936/970) of the them approved the statement “parents with
fewer children have better financial status”, about 80 percent (777/970) of the
male respondents do agree that “large number of children do weaken the
parental communication.”
39. 39
Men responsibility in planning pregnancies is central to the whole reproductive
and child health programme, in the study sites, 96.1 percent (932/970) agreed
with the statement “Husband's responsibility in planning pregnancies is the
same as his wife's.” When it comes to usage of the contraceptives, 57 percent
(553/970) of the male say “Wife's sexual satisfaction decreases with the use
of contraceptives.” There is a marginal increase in use of contraceptive
over the baseline survey wherein 62 percent of men had informed
dissatisfaction, the reason for not using condom.
While acceptance to information by a health worker visiting the house and
informing the couple is universal. The acceptance to wife attending community
level group meetings to learn more about contraception has shown increase
especially in Tamilnadu, wherein acceptance level has almost doubled. From 46
at the time of baseline to93 percent at the end of the project.
High percentages (94.5 percnetage;917/970) of men are open to the idea of they
themselves attending community level group meetings to learn about
contraception.
The discussion about contraception or birth spacing among the couples has
registered a 11 percent growth over the baseline i.e from 67 to 78. “in the past
few months with wife and with friends or neighbors or relatives the increase is by
9 percent from 37 to 46 .3 percent”
Interestingly 76 percent of the currently married men mention wife approving the
using of contraceptive methods to avoid or delay pregnancy, which clear 16
percent increase over baseline. Little over three-fifths (56.2 percent; 498/888)
mentioned discussing about contraception once- or twice or more often with wife
in past year.
ANTENATAL, NATAL AND POST NATAL CARE
Knowledge about Antenatal Care
The best age for women to bear child according to 93 percent (903/970) of the
respondents is between the age of 20-25 years. When asked about the special
care required by pregnant women, 82.9 percent (797/970) informed adequate
food as special need, followed by 81.3 percent (781/987) saying adequate rest. I t
is important to mention the awareness about the important role of
PSYCHOLOGICAL SUPPORT has gone up significantly over the baseline form
7 percent to 37 percent at the end of the project.
he need for antenatal18
care is acknowledged by all, 95 percent (925/970) of the
respondent stated that “ women need to have ante natal check up”.
It is significant to note that in Pache Trust Intervention area, the need for ante
check up at the time of the baseline was felt just by 68 percent as against moe
than 90 percent, now
Further analysis shows, while agreeing that antenatal care is must for women,
there is no clarity on minimum number of antenatal check up a woman should
receive. Majority (76 percent, 594/987) feels that a woman should receive
anything between 3 to 9 checkups during the pregnancy period.
18 Antenatal: During training it was simplified as care taken during pregnancy.
40. 40
Over half (52.2percent; 467/970) recognized “ ABDOMINAL PAIN “ during
pregnancy as a complication and sickness which needs immediate medical
attention. Roughly 48.1 percent (467/970) of the interviewees mentioned
“bleeding fromVagina during pregnancy” and 38 percent “ Heavylabour for
more than 12 hours” as danger signs for a pregnant women.
Respondents’ opinion on delivery services is collective; they are unanimous (96.5
percent; 936/970) agree that women should receive delivery services from the
health facility/trained health personnel.
The analysis for reasons mentioned for need to receive the delivery services from
health facility/trained health personnel; reveals health of the mother and the
newborn are primary concern of men. Half of the respondents (67.8 percent;
658/970) cited “To check the signs of infection to mother”; followed by 47.6
percent (462/970) saying that postpartum check up immediately is essential “ to
protect child from any kind of illness or infection”.
The sampled population is aware about the necessity to provide as soon as
possible the postpartum care, “ Immediately after birth” has been informed by
83.4 percent (809/970) of the study participants.
Communication among couples is the considered critical for Sexual and
reproductive issues, to assess the communication on such issues between the
couple, currently married couples in the study were asked as to how comfortable
they feel discussing about “sex “ with wife. Overall 56 percent (507/909) of the
respondents mentioned they have “no difficulty” in discussing about sex with
wife.
The male respondents in the study area do recognize that woman is justified in
refusing to have sex with her husband when knows her husband has a sexually
transmitted disease (93.7 percent; 909/970). She knows her husband has sex with
women (other than his wife) (90.8 percent; 881/970); She has recently given birth
(93.5 percent: 907/970); She is tired or not in the mood (90.5 percent; 878/970).
Findings: Increased NGO and Community Capacity
This section looks in to the extent of capacity building of the NGOs and thier
capability of NGOs in conducting programmes and organizing events. The NGOs
conducted progrmmes on a) basic SRH/HIV knowledge b) Nutrition and c)
education.
Programmes on basic SRH /HIV knowledge
Over four –fifths (80 percent) of the beneficiaries across the five states informed
receiving information/ counseling on RTIs/ STIs. The RTI/STI information, as
gathered from the analysis of the data, was provided through number of IEC
activities that included Street plays, puppet shows and organizing events such as
World AIDS Day, cultural events and celebrating special days
These channels for communication were widely used to disseminate information
on HIV/AIDS, RTIs and STIs. Majority of men remembered receiving messages on
HIV/AIDS.
In addition to providing the basic information on HIV/AiDS, the Alliance – INGOs
has also provided information on ART, Safe sexual behaviour, counseling on
41. 41
positive living and referral services 75 percent of MLHAS informed information
provided by ALLIANCE-NGO.
Programmes on Nutrition
To build home based care for MLHAS and vulnerable men, Alliance India NGOs
Provided counseling on green leafy vegetables, eating boiled vegetables and
eating fruits regularly.
Programme on Legal Education
Little over one-half of the respondents informed receiving legal education.
However, How often the legal education was provided is not clear from the data
gathered. The NGOS informed organizing talks by legal experts.
Counseling on safe sex behaviour and Information on HIV/AIDS
Majority of the respondents (87percent, 844/970) informed receiving counseling
on safe sex behaviour and information on HIV/AIDS by Alliance-NGO. Among the
respondents’ slightly higher percent of MLHAs (81percent, 131/160) as against
(78percent, 635/810) vulnerable men informed receiving counseling on safe sex
behaviour.
The difference in percentage of recall amongst the respondents by type about
receiving information on HIV/AIDS is marginal. The data reveals that higher
percentage of MLHAS vis-à-vis men at risk received basic medicines for
Opportunistic infections from Alliance –NGOs.
