Beruflich Dokumente
Kultur Dokumente
STUDY ON THE
PROBLEM OF SERVICE DELIVERY
OF THE PEOPLE LIVING WITH
HIV/AIDS OF FOUR BLOCKS OF
INDORE DISTRICT
A Study Conducted in Four Blocks of Indore District
(Indore, Mahu,Hatod and Depalpur)
Research Superviso:-
Submitted
Mr.Hemant
Roll.No:-
CERTIFICATE
This is certify that Mr.Hemant Singh Sisodiya student of
Master Degree in Social Work from Mahatma Gandhi Chitrakoot
Gramodaya Vishwavidhyalaya
Place :
Date :
Indore
DECLARATION
I hereby declare that the desertion entitled as "A Study on
the Problem of Service Delivery of the People Living with
HIV/AIDS of Four Blocks of Indore District" submitted by me for
the partial fulfillment of Master Degree in Social Work to
Mahatma Gandhi Chitrakoot Gramodaya Vishwavidhyalaya is my
Place : Indore
Singh Sisodiya)
Date
:
(Hemant
II
Acknowledgement
I express my gratefulness to P.C. Mohapatro, Director of
COATS, Indore under whose supervision and guidance I have been
able to complete this work.
I epitomize my deepest sense of gratitude for his valuable
guidance, keen interest innovative ideas and persistence endeavour
throughout
the
course
for
investigation
and
supervising
for
Place :
Indore
III
(Mr.Hemant
Singh
IV
Abbreviation
STI
HIV
AIDS
BPL
APL
NREGA :
SOVA
NGO
MPSAC :
NACO
VCCTC :
ICTC
INP+
PLHIV
Contents
Certificate
Declaration
Acknowledgement
Abbreviation
Contents
Tables
Map of Madhya Pradesh
Map of Indore Block
Map of the Study Area (4 Blocks)
I
II
III
IV
V
VII
VIII
IX
X
1
2
3
5
5
8
9
11
12
14
14
14
15
15
Chapter
Three
Chapter
Four
20
23
24
25
27
28
VI
30
32
33
37
Chapter - Six
42
Questionnaire
Bibliography
Reference
Project Proposal
Chapterisation
A
E
G
H
L
VII
Tables
TABLE
NO.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
TABLE TITLE
PAGE
1
2
3
16
17
17
18
18
23
23
24
24
25
26
26
26
27
27
28
28
VIII
IX
XI
Chapter - One
Chapter - One
INTRODUCTION
Aids Cases
15099
13
37
155
1934
2759
1
0
Sl No
9
10
11
12
13
14
15
16
17
18
19
20
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
Aids Cases
657
6873
655
302
258
2
4345
1769
0
1729
14325
641
736
2946
106
302
454
1153
8
52036
5
79
1751
2397
726
0
10362
124995
Source : www.nacoindia.com
Modes of Transmission
Sexual
Perinatal transmission
Blood and blood products
Injecting drug users
Other not specified
Total
No. of Cases
106669
4755
2563
2930
8075
124995
Percentage
85.34
3.80
2.05
2.34
6.46
100.00
Age group
0 to 14 years
15 to 29 years
30 to 49 years
> 50years
Total
Male
3313
23905
54204
6823
88245
Female
2283
15876
16701
1890
36750
Total
5596
39781
70905
8713
124995
Source : www.nacoindia.com
Table No. 1.2 gives the information about the modes of transmission and
the number of affected persons under each age group. The table indicated that
there a total of 110686 cases which belong to the age group of 15 to 50 years.
This indicated that the economically productive group of people is the most
affected people. This table also highlights that 85.34 % of the people are having
this virus through sexual transmission and the others fare less in number
Situational Analysis
Now India occupies the second position of HIV infection rate after South
Africa although the overall prevalence remains low. Some stated experience a
generalized epidemic with various transmitted from high risk group into the
general population. A major challenge is to strengthen and decentralize the
program in the state and district levels to enhance commitment, coverage and
effectiveness
Women are More Vulnerable than Men
It has been proved that women are more vulnerable to HIV infection
because of biological and social reasons. A woman has three times more risk to
infection of HIV. If women are infected with STI she is 13 times more prone to
HIV infection.
pregnant women can pass HIV to their babies during pregnancy or delivery, as
well through breast feeding, people with HIV have what is called HIV infection;
most of these people will develop AIDS as a result of their HIV infection.
HIV (Human Immune Deficiency Virus)
It is a retro virus that causes AIDS. There are four numbers of modes of
Transmission first one is unprotected sexual contact second using of unsterlised
injection, third receiving of HIV blood and last one is transfer through blood
mother to child. Most of these people will develop aids as a result of their HIV
infection.
Following are the body fluid where the virus can exist
BLOOD
SEMEN
VAGINAL FLUID
BREAST MILK
These are additional body fluids that may transmit the virus to those
health care workers who may come into contact with Cerebrospinal fluid
surrounding the brain, the spinal cord Synovial fluid surroundings bone joints and
Amniotic fluid surrounding a fetus.
ORIGIN OF HIV
Scientists have different theories about the origin of HIV, but none have
been proved as cent percent correct. The earliest known case of HIV was from a
blood sample collected in 1959 from a man in Kinshasha, democratic republic of
Congo (how this person was infected with HIV that has not been proved).
Genetic analysis of this blood sample suggests that HIV 1 may have estimated
from
single
virus
in
that
late
1940s
of
nearly
1950
(Source
www.nacoindia.com)
We do know that the virus has existed in the United States since at least
the mid to late 1970 from 1979-1981 rare types of pneumonias, cancer and
other illnesses were being reported by doctors in Los Angels found New York
among a number of gay male patients. These were conditions not usually found
in people whose healthy immune systems
In
1982 public
health
officials
began
to use
the
term
acquired
associated
virus
by
and
International
Scientific
sensitive tests have shown a strong connection between the amount of HIV in
the blood and the decline in CD4 T Cell numbers and the development of AIDS.
Reducing the amount of virus in the body anti HIV drugs can slow this immune
destruction.
FOUR STAGES OF HIV INFECTION
Stage 1 Primary HIV Infection
This is the most important cause after infection. The only symptom during
the stage is an illness, commonly mistaken for the flu window period (the window
period is the time it takes for person who has been infected with HIV to react to
the virus by creating HIV antibodies). This is called seroconversion during the
window period, people infected with HIV have no antibodies in their blood that
can be detected by and HIV test, even though the person may already have high
levels of HIV in their blood sexual fluids or breast milk anti bodies generally
appear within three months after infection with HIV but may take up to six
months in some person.
Stage 2
Asymptomatic period while the viruses in this stage, very few symptoms
are experienced. The most common is swollen glands. This is significant because
while no outward signs are felt, the HIV virus is very active in this area here it
kills many helper t cell and spawns large amount of new viruses. Most HIV in the
test tries to measures the viruses that are put aside this area and it may became
instrumental in the next set of anti HIV treatments
Stage 3
This stage is known as symptomatic HIV infection the virus has begun to
defeat the immune system. The virus finally wins the battle against the immune
system for one or more of three reasons are that the HIV caused damage to the
lymph odes where most of its activity takes place. Another is that it destroys
more t cells than the body builds. That possibility is that strain of HIV is created
that is more dangerous to the body either way several years of stalemate
between the Body and the virus are over from here the infection soon precedes
to stage 4.
Stage 4 is AIDS
Oral Sex
Where there is connectivity between mouth and sexual organ this sex is
known as oral sex but this sexual orientation has less chance of HIV
transmission.
Sharing of Needles
Sharing of needles is one of the important reasons for HIV infection people
shares needles during ill health, taking drugs and creating body art that is
peering. These are the risk behavior for receiving unsterilized injection.
Transfusion of Blood
HIV can also be transmitted by the transfusion, of infected blood or blood
product.
Mother to Child
A mother can transmit HIV to her baby during conceive during delivery
and during breast feeding. The percentage of transmission of HIV from mother
to child is 40%.
Symptom of HIV
The only way to determine for sure whether you are infected is to be
tested for HIV infection. You cannot rely on symptoms to know whether or not
you are infected with HIV. Many people who are infected with HIV do not have
any symptoms at all for many years
The following may be warning signs of infection with HIV
Dry cough
Pneumonia
Again, the only way to determine whether you are infected is to be tested
for HIV infection.
Misconception about HIV
Ordinary
social contact, for example shaking hand, hugging.
Travelin
g in the same bus eating from the same utensil.
By
kissing.
By
mosquito or any other insect or animal bite.
It is not
water borne.
It is not
air borne.
Fourthly though there are 30% chances for HIV from mother to child but
this could be reduces almost 0% by proper counseling and taking medicine but
one should remember that here the HIV will be negative to the child not to the
mother .
Sexually Transmitted Disease Facilitate HIV Transmission
Every STD causes some damage to the genital skin and mucous layer,
which facilitates the entry of HIV into the body. The most dangerous are
Syphilis
Cancroids
Genital herpes
Gonorrhea
everyone
is
HIV/AIDS
entitled
to
HAVE
SPECIAL
fundamental
human
RIGHTS
rights
AND
without
discrimination, people living with HIV/AIDS have the same rights as Seronegative
people to education, employment, health, travel, marriage, procreation. Privacy,
social security, scientific benefits etc. seronegative and seropositive people share
responsibility for avoiding HIV infection and re-infection. But many people
including women, children and teenagers, not negotiate safer sex because of
their low status in society or lack of personal power. Therefore men whether
knowingly infected or unaware of their HIV status, have a special responsibility of
not putting others fat risk.
Role of NGO in AIDS Control
NGO have an important and special role to play. The close interpersonal
interaction that NGO have with people in the communities they work is
extremely useful for implementing the behavior interventions necessary for
HIV/aids prevention and care NGOs are also not under the same political
constraints as government programmes are. They therefore have greater
Governments
Chapter - Two
Chapter
Two
RESEARCH DESIGN
aids
The sexually active and economically productive age group (14 45) age
group account for the major HIV/AIDS cases in Indore district.
The high risk group also belongs to SC and ST or socio economically
backward population
The measures taken by government and non government organizations
are not adequate to solve the problem.
Universe
The universe of the present study include Indore district of Madhya
Pradesh for four blocks these it is a back word district with heavy concentration
of ST ad SC and other weaker sections of the society .
Nearly 50% of the people of the district belong to ST and 14% SC (2001
census) in addition to ST and SC there are also other backward people living in
the district who are economically poor and socially backward 78.65% of the
people in the undivided district live below poverty line ( as per human
development report )
Due to poverty and unemployment people generally migrate outside
districts and states in search of employment. Migration of people in and out of
Indore is one of the causes of spread of HIV/AIDS in Indore. The main cause of
spread of HIV is sexual contact transmission from mother to child.
There are
collected for this purpose. Primary sources include data collected through
personal survey interviews and case studies
Tools of Data Collection
The main tool of data collection will be an interview schedule which will be
administered to the patients of area. The interview schedule consists of simple
questionnaire relating to the household particulars, kind of job in which one is
engaged, the level of income and the like. In addition to this case studies shall
also be used as a tool for data collection. Direct observation method shall also be
used for getting required information
Data Analysis
Data shall be coded, verified and analyzed using statistical methods and
processed on computer. Simple average will taken while analyzing the data Bar
and pie graphics are drawn to highlight each coded data.
Limitations
As an individual scholar with limited time and resources at my disposal it
is difficult to cover the whole area on a census method. The scholar has taken
adequate measures to choose the sample which represent the entire universe.
INDORE DISTRICT PROFILE
Geographical Statics
Indore district undivided was created on 1st November 1956. The present
Indore district has a population of 11,80,637 as per 2001 census.
constitute 52% of the total population.
Latitude
170 to 40 - 27 North
Longitude
Geographical area
8379 sq km
Pradesh )
Table 2.1 : Highlights of the District
0
Sub divisions
02
Males
1
0
2
0
3
0
4
0
5
0
6
0
7
0
8
0
9
1
0
1
1
Tahasil
14
C d block
14
Towns
05
Municipalities
NAC
Police station
20
Gram panchayat
226
Villages
a) Inhabitant
b) Uninhabitant
199
8
191
6
82
02
Fire stations
Assembly
constituencies
04
Source: www.indore.nic.in
The above table gives information about the tahsils, Blocks, Gram
panchayat. Total villages etc Indore district is a tribal dominated district. As per
the 2001 census 49.62% of the districts population belong to the scheduled
tribes. The important tribes are parajas. Gadabas. Kandhas. Kotias. Bhumiyas.
Shouras. Bhatras and pentias etc
Table 2.2 : Demography
Total population
11,80,6
37
Total male population
5,90,74
3
Total female population
5,89,89
4
Percentage of literacy
35.72%
Percentage
of
male 47.20%
literacy
Percentage
female 24.26%
literacy
Literates (male)
2,31,05
5
1,18,98
9
Total literates
3,50,04
4
S
T
population 49.62%
( percentage )
SC
population 13.41%
( percentage )
Total house holds
2,84,87
6
Below poverty line ( BPL 84%
)
Literate female
The tribal constitute 49.62% to the total rural population of the district, the
tribals are generally backward both socially and economically. Poverty, illiteracy,
ignorance and above all simplicity are the major factors which make their
economy mostly marginal. Womens contribution to the economic growth of the
tribal society is quite substantial. Nearly 88.48% of the people in Indore region
live in the villages Indore has an average literacy rate of 35.72%, lower than the
national average of 54.50%, male literacy is 63.24% and female literacy is
45.15%. In Indore 12% of the population is under 6 yeas of age.
Table 2.3 : Agriculture profile
Total cultivated land
Irrigated area ( kharif )
Irrigated area ( rabi )
Area under paddy
Area under pulses
Area under oil seeds
Area under minor millets/coarse
cereals
3,01,000
Ha
78,
000Ha
46,000
Ha
1,13,000
Ha
25,630
Ha
12,610
Ha
1,05,00H
a
Source: www.indore.nic.in
Kilomete
r
high 157
National
way
State high ways
Road
and
building
RWD
P.S road
G p road
Forest road
195
430
1023.80
860
4973
210
Source: www.indore.nic.in
Numbers
school
Primary
1911
Upper primary
230
UGME
236
High school
109
Colleges
18
C.T school
1
Technical school
1
B ed college
1
Central school
1
School for the blind
1
School for the deaf and 1
dump
Source: www.indore.nic.in
of
The above table gives a picture about the schools and colleges in Indore
district. Education holds the key to the socio economic and cultural development
of the society but the tribal female literacy in Madhya Pradesh has continued to
remain at the lowest level. The rate of literacy is only 35.72% as against the
state average of 63.61%. The rural literacy rate in general was 27.30%, which
consisted 39.16% males and 15.61% females (Census India 2001).
Chapter - Three
Chapter
Three
The
It was
reported on 1st December 2005 by the state aids cell that Indore is the high
prevalence district in HIV/AIDS and STI among the truckers, migrant workers in
the district. It was also reported on 1 st December 2005 by the state aids cell,
that Indore is the high prevalence district in HIV/AIDS in Madhya Pradesh
particularly in the rural setting. As per the VCCTC, INDORE IT WAS REPORTED
THAT OUT OF 2145 cases tested HIV 311 cases were found HIV positive. Out of
them 23 children were infected and more than 50 children were affected. Mostly
women and children are more vulnerable because of aids increased vulnerability
Females mostly
lacking alternate sources of livelihood generally prefer to trade their body and
indulge in unprotected sexual activities that subsequently leave them vulnerable
to aids.
High incidence of TB and malnutrition are other important reasons for
HIV/AIDS which is making HIV easy access to their body.
Poverty is one of the major causes making people prone to the HIV
infection. As the people do not find other alternate livelihood sources they are
forced to involve in the commercial sex which make them vulnerable to HIV/AIDS
and at the same time pass the virus to others and so on.
Cultural traditions in the tribal areas are another contributing factor for
HIV/AIDS. The people in rural areas celebrate many festivals and functions in
different seasons.
During the
social functions the Nata (folk entertainment) and information media takes place.
These Natas play a very important role in the outlet of emotions and tensions of
the people and a tool of entertainment for them. This also plays a vital role in
giving many people opportunities to have sex with others.
21
The limited
access to human, Financial and economic assets weaken the ability to women to
protect themselves and negotiate for safer sex.
Stigma towards people infected with HIV/AIDS is widespread. The
misconception that aids only affects men who have sex with men, sex workers,
and drug users strengthens and perpetuates existing discrimination. The most
affected groups are often marginalized. They have little or no access to legal
protection of their basic human rights. Creating an enabling environment that
increases knowledge and encourages behavior change thus extremely important
to the fight against AIDS. These factors play a very important role in the out let
of emotions and tensions of the people.
AIDS
If we will distribute the PLHIV in district of Indore 62% are male and 38%
are female (113 out of 296) and 62% are male (183 out of 296)
Table 3.1 : Age Wise Distribution of PLHIV
Age group
Nos
PLHIV
of
MALE
FEMALE
22
< 14 years
26
18
08
15 to
years
24
42
26
16
25 to
years
49
226
143
83
> 50 years
11
Total
305
194
111
The table reveals that maximum number 226 of PLHIV are found in the
age group 25 to 49 years, distantly followed by the age group 15 to 24 and less
than 14 years.
This shows that the adolescents (13.77%) and young adults (74.1%) are
the most vulnerable to HIV.
economic
Nos
PLHIV
172
133
of
The data collected further reveals that 57 % of the affected people belong
to above poverty line 43% are below poverty line categories in the district under
study. The APL people are necessary rich or well to do people. A majority of
them come under poor categories and they just are above poverty line.
23
Nos of
PLHIV
72
65
31
64
48
11
2
11
1
305
This indicates that with higher level of education can help in the reduce
the number of HIV cases considerable and illiteracy will result in quicker spread
of HIV in the area.
Table 3.4 : Caste Distribution of PLHIV
Caste
Gener
al
OBC
SC
ST
Total
Number of
PLHIV
149
19
71
61
305
24
This table shows that HIV is seen in all castes. General class has the
maximum number of HIV. According to the study nearly 48.85% belong to the
general category.
It is followed by (SC
cases ).
PROFESSION CATEGORIES OF THE PLHIV
The table below presents distribution of cases according to their
professional activity in Indore district.
Table 3.5 : Profession Categories of the PLHIV
Profession
Driver
Private jobs
Business
Daily labour
Govt . lob
Agriculture
House wife
Widow
Children
Un
employed
Total
Number of
PLHIV
53
36
34
34
17
10
73
2
22
20
305
The table shows that out of the 305 cases maximum PLHIV are housewives
(73) followed by drivers (53), those who are in business and who work as daily
wage laborers reported equal number of cases each ( 34 and 34 ) respectively in
private jobs. Even 22 cases are children below 14 years who are suffering from
PLHIV.
Numbers of death of PLHIVs
The Table 3.6 represents the number of deaths of PLHIVs ( 14% ) in of the
total number of PLHIVs. Most of the deaths are in the age group of 25 to 55
years.
Table 3.6 : Number of death of PLHIVs
25
Total
PLHIV
306
number
of
Total
number
deaths
63
of
26
30
6
29
6
23
2
30
6
32
27
Chapter - Four
Chapter
Four
tabulated.
Table 4.1 : Table showing socio economic status of PLHIVs in the sample
Socioeconomic
status
Above
poverty
line
Below poverty line
Number
PLHIV
21
of
42
All the APL people are not necessarily rich or well to do people.
Majority of the affected people belong to poor families, who work for their living
either as daily laborers or migrant workers
Table 4.2 : Distribution of PLHIV (sample) persons according to their
caste and sex
Caste
ST
Mal
e
18
Femal
e
08
Tota
l
26
SC
Other
s
Total
9
6
5
4
14
10
33
17
50
sample cases 26 cases (52%) belong to S.T., 14 cases (28%) belong to S.C. and
10 cases (20%) belong to general caste. Another important finding of the study
is that the male outnumber the females in the table.
Table 4.3 : Profession categories and caste wise distribution of PLHIV in
the sample
Profession
Drivers
Self employed
Daily labourers
Govt jobs
Agriculture
Dependant
Un employed
Total
SC
12
8
8
2
11
8
6
55
Caste Categories
ST
10
6
4
2
6
3
4
35
Total
Others
6
4
3
2
3
6
3
27
28
18
15
6
20
17
13
117
The above table explains the professional and caste wise distribution of
PLHIV in sample taken. The table shows that HIV is seen in all castes. out of the
infected cases 20% belongs to general categories 52% ST and 28% belong to
SC . most of them are daily labourers and self employed .18% are drivers and
20% are dependant ( house wives and children ) . Only two of them are Govt
employees
Table 4.4 : Mode of transmission of HIV virus among the sample
Sl no
1
2
3
4
Modes of transmission
Pre and extra marital unsafe sexual practices
Through infected partner
Unsterlised syringes and needles equipments
Through blood transfusion
Male
42
12
5
0
Female
08
14
3
0
Total
50
26
8
0
28
Parent to child
Grand Total
10
69
4
29
14
98
29
Out of the sample not a single affected person got free treatment , free Xray and investigation, the only medicines given to them free of cost were for the
Opportunistic Infection (OI) when ever available. Only 70% of the sample got
these medicines. The medicines purchased for OI from outside were not
reimbursed till date. ART (Anti Retro Viral drug) are not available in the govt.
hospital. The study reveals that doctors prescribing ART medicine to the PLHIV
only those who are economically sound that is (1%) could purchase drugs from
local chemists.
received medicines.
Socio economic and psychological problems faced by PLHIV
The opinion of PLHIV sample regarding their accommodations are as
follows the treatment by family members found close relatives has been
sympathetic in 60% of the cases but in some cases especially females (14%) of
cases they have been kept in separate rooms one family (mother with two
positive children) has taken shelter in new hope shelter home at Muniguda
( Rayagada district ) the treatment received from villagers has been different in
different places. In about 60% of the case of the villagers are sympathetic
towards the PLHIV and also help them. In about 10% of the cases the villagers
are
not sympathetic
towards PLHIV.
In
some
very
discriminative, so much so that the PLHIV does not dare to nurture out in the
village for bringing anything. They depend on what is brought to them by their
close relatives and family members.
Out of the sample 60% of the PLHIV have lost their jobs due to ill health.
10% of the PLHIV have been supported by the local NGO (SOVA, EKTA, LEPRA
INDIA) the organization provides sewing machines to the PLHIV, it also
encourages poultry, goatery and kitchen garden as per the skills of the PLHIV.
None of them have turned to begging till now.
Other problems of the people living with HIV/AIDS
The PLHIV are subjected to various psychological and economic problems.
The interview has brought some interesting and shocking opinion which is
narrated below. There is a lot of stigma involved in waiting outside a testing
30
center which is testing only HIV. People who come to hospital for testing have to
wait outside the VCCTC in the hospital and are looked at suspiciously but others
both male and females are usually asked to wait for their test in a single room
with a small curtain separating them and there is no privacy in hospital premises.
Most of the cases tested are referred from within hospital or from the TB
ward and their HIV status in wards does not remain confidential. Almost all the
staffs know about the status. Although consent for HIV testing is taken on paper
by taking thumb impression of the concerned persons but what is written is not
clearly explained to them
Counseling at VCCTC centers and in hospital
It is alleged that the Pre-Test and Post-Test counseling is not of good
standards. Patients invariably go into depression and do not know where to go,
whom to approach and what is their future.
If
31
at Indore on 26th January 2009, this is supported by BILT Seva Paper Mill. The
other nearest ART center for Indore people is Vishakhapatnam there is no proper
referral system in place for ART center especially the one in Vishakhapatnam.
Out of the 15 cases of PLHIV referred to ART at Vishakhapatnam only 9 patients
are receiving ART now.
Majority
of
the
PLHIV
cannot
afford
to
travel
to
ART
center,
Vishakhapatnam. The PLHIV are very poor and cannot afford to travel to
Vishakhapatnam. The PLHIV are very poor and cannot afford to travel to
Vishakhapatnam and stay about five days on the first visit and then go for follow
up every month.
The orphan and the semi orphan are not cared for improper food, clothing
and medicine will result in early deaths.
rehabilitated by the local NGOs as per the study, children are not getting ARV
therapy.
CASE STUDY 1
ROHINI ( name changed ) a young widow aged about 35 is living with
three girl semi orphan children. Now her profession is preparing leaf plate and
selling it. Rohini had a wonderful and happy family. Her husband was an interstate driver who was transporting fishes from Andhra Pradesh to Madhya Pradesh
every day. Due to pressure he had habituated with alcohol and after some days
he had regular sexual behavior with commercial sex worker and infected with
HIV.
But it is the most fortunate part of Rohini life that Rohini and her three
children were not infected with HIV. It was impossible to her adolescent child but
it was possible for Rohini. Now Rohinis life became very hard after death of two
year of her husband. Her health condition has decreased because of family
burden and tension. She sold many domestic appliances like almirah, utensils,
wood bed etc for survival of her family and children her brother and the family
member of father in laws house are not responding to the pain and grief of
Rohini. They are telling it is your headache, you maintain it, we are also poor to
feed to your children lack of money Rohinis house has broken it was not
repainted due to heavy rain one wall side of the house has dropped down so the
32
local NGO SOVA has supported to up keep her house and given a Sewing
Machine with training fees to earn something by tailoring.
CASE STUDY 2
Dhanmati a widow tribal lady aged about 27 years is staying with her only
son aged about 3 in a tribal village five kilometer away from the Indore district
head quarter town.
country wine. She lost her husband since five year. Her only son also infected
with HIV. Dhanmati is illiterate. There is a saying in English that "ignorance is a
bliss". Tribal people are ignorant about the consequences of HIV. So stigma and
discriminations has not touched to the life of Dhanmati. Her villagers and family
member are so cooperative towards Dhanmati because she is absolutely
independent earning her own. The local NGO SOVA supported her with two pairs
of goat but unfortunately the two goats died suddenly. Now she has two to four
goats. SOVA is supporting her drug cost. Her confident level has increased after
repeated counseling. Now she is sending her child to school.
CASE STUDY 3
Raghuram (name changed) a converted Christian tribal origin was very
poor fellow. He was leading his life as a daily labor and was living with his wife
and two children. Once diamond ore was discovered in his locality people rushed
secretly to collect diamond ore stone. Some people were died because of land
slide while collecting diamond ore stone by boring.
diamond ore and went to Andhra Pradesh for its trade. Day by day his financial
condition improved and he made his own shelter and purchased a motor cycle, a
colour TV and many domestic home appliances.
condition, he got married to two women in his locality. Now he has three wives
and five children. After year Raghuram became weak and got infected with HIV.
He went to hospital at Andhra Pradesh and tested HIV positive and he came back
to his homeland and was suffering with some opportunistic infection. One day
he become serious his family members took him to Andhra Pradesh and finally
he died there. Now his three wives and five children are having no source of
33
income came to Indore hospital for testing HIV. The result was declared with one
is HIV positive out of eight members that is his first wife.
CASE STUDY 4
Sangeeta an adolescent girl is now studying at intermediate in Science
stream. She scored first division in high school certificate examination. Her aim
is to become a pilot because she is very much interested to fly in aeroplane.
When aeroplane and helicopter flies over her head she dreams to became pilot.
But now she is living with HIV since two years. She does not know about her HIV
status except her parents and brother and sisters. When she was in standard
eight, she fell down from upstairs from her house. One teeth of her teeth broken
she required blood.
After this
blood transfusion she became weak day by day she fell in sick with different
symptoms like weight loss, chronic cough, prolonged fever and some times
headache. She visited repeatedly to hospital, finally doctor advised her parents
to test HIV.
It was
unbelievable and unacceptable to her parents. However, they recalled that she
received blood from one of their relative.
infection of HIV. After frequent visit to hospital she asked to her parent why she
is getting ill repeatedly and many times.
given you a small organ inside your body which is of a big size so you have to
visit doctor as long as you are alive.
34
CASE STUDY 5
Personal Detail
Sunil (name changed) a young man aged 27 years, belongs to general
category and stays in Jeypore. He was working as an accountant in an office. He
was earning Rs 3000/- per month.
Family Background
Sunil stays with his parents and sister at Jeypore. Seven years ago he was
studying in Andhra Pradesh, where in the company of friends, he had premarital
sex with sex workers. Last year, he developed fever and was treated by doctors
in Jeypore and later referred to Vishakhapatnam where he was admitted in
nursing home and tested HIV reactive, his CD4 count were 50 only.
He was
prescribed ARV drugs and since then he was spending more than half his salary
on ARV drugs.
A few months ago he noticed hoardings of SOVA in Indore and he
approached SOVA, in SOVA he was counseled on hygiene, diet and given
opportunistic infections drug and also referred to ART centre, Vishakhapatnam.
At Vishakhapatnam he did not get ART medicine and he was very much
depressed and he even wrote e-mails to NACO. He returned to SOVA and he was
asked if he could attend a 6 week training program on "LEADERSHIP AND
MANAGERIAL
PROFICIENCY"
PLHIV
in
Xavier
Institute
of
Management,
Bhubaneswar in collaboration with UNDP. He took some time and later decided
that he should attend the course.
Current Situation
After attending the said course, he is now a changed man. He gave up his
job and decided to work with SOVA dedicating his career to the care and support
of PLHIV of Indore. Recently he had been to ART center Vishakhapatnam and
now is getting his ARV drugs there. He has also helped other PLHIV to ARV drugs
from ART center, Vishakhapatnam. Since then he has been actively participating
in HIV and AIDS awareness programme and counseling of PLHIV and helping in
the formation of the network of Indore people living with HIV (NKP+).
35
Conclusion
Now Sunil is leading a normal and healthy life and has dedicated his life in
the service of PLHIV.
people living with HIV (NKP +). He now attends a number or meetings of INP+
and OSACS.
CASE STUDY - 7
Laxman a young man of 35 years is living with his wife and a two year old
daughter. He belongs to kotpad. He is a daily wage labor. His daily wages is Rs.
25/- per day
Family Background
Laxman stays with his wife and his two year old daughter. He frequently
indulged in premarital sex. He had married four times, the present wife is the
fourth one from whom he has a girl child of two years old. He was suffering from
fever and cough for quite some time and then diagnosed to be suffering from TB
fever and cough for quite some time and then diagnosed to be suffering from TB,
due to irregular treatment, he did not improve and when he was tested for HIV in
Raipur. He was found to reactive, wife also suffered from opportunistic infection,
child was also suffering from cough.
premarital sex and his multi partner sexual behavior he had got infected with HIV
and he later transmitted the virus to his wife. Laxman had spend a lot of money
on his treatment and his family, he had also sold his land for the treatment, he
used to visit Chhattisgarh for his treatment , he spent all his money on travel and
medicines and now he had no money for his food.
36
Current Situation
When counselor from SOVA came to know about this family at Kotpad, she
visited them and brought them to TB Hospital in Indore and got him tested for
HIV from VCCTC and also got them investigated for TB.
TB treatment was
started for Laxman but wife and child were not suffering from TB counselor told
them that proper hygiene should be maintained and they should eat good
nutritious food like Ragi, Vegetables Dal, Milk and Eggs and boiled water. They
were given nutritional support for necessary grocery items for few months by
SOVA they were also given medicine for opportunistic infections.
SOVA gave them four goats and three pairs of hen for their livelihood
support. Presently the condition of daughter is not very good as she is suffering
from TB is also having oral thrush.
Conclusion
Laxman is leading a very tough life and his financial condition is not good.
SOVA is planning to refer the family to ART center at Vishakhapatnam for
antiretroviral therapy.
37
Chapter - Five
Chapter - Five
Some intellectual persons have opined that HIV may be the third Phobia
for the globe after terrorism and nuclear war.
infected with HIV the GDP will be slashed down to 1% (WHO Report). Prevention
is critical as there is no cure for AIDS. However prevention should go hand in
hand with high quality health care.
State Aids Societies shown below indicate the progress in the development of
State Management Teams.
Sate Aids Control Societies
State aids cells were created in all the 32 states and UTs of the country for
the
effective
implementation
and
management of
national
aids control
programme. However over a period of time it was realized that due to many
cumbersome administrative and financial procedures there was delay in release
of financial outlay.
Successful
functioning of these societies led the government of India to advise other states
to follow this pattern for implementation of the national AIDS control programme.
39
wide experience in
developing BCC material and is one of the leading institutions in the state of
Madhya Pradesh, the organization has its own cultural group to perform street
play on HIV/AIDS.
training modules and manuals for various groups. SOVA has the experience in
implementing targeted intervention program for migrant workers of NALCO area
with the support of NACO/ OSAC the organization has the experience of running
STI/RTI clinic and conducting health camps for 5 years.
40
In concern to care and support SOVA has aim to bring all the affected and
infected people to part form called + people network in Indore district in order to
provide basic counseling referral and opportunistic treatment. This project will
support to provide better care to the people and reduce the vulnerability in
Indore district which is now treated as a priority in Indore region.
CONCLUSION
Community development is an integral part of SOVA's core objective of
peoples empowerment and emancipation and enhancement of the living
standard of the people specially children and women. SOVA locates people at the
centre of their development.
41
Chapter - Six
Chapter - Six
groups years before the epidemic began, then the situation changed, people
moved more often and traveled more they settled in big cities and life styles
changed including patterns of sexual behavior, it became easier for HIV to
spread through sexual intercourse and contaminated blood. As the virus spread,
the disease which was already in existence became a new epidemic.
Highlights on HIV/AIDS
There is a lack of data and information in relation to HIV and the links with
migration and sexual practice in Madhya Pradesh. Surveillance data is also not
very representative; under this strategy research will be an important approach
involving the community. The study conducted indicate the target group, the rate
of spread of HIV is increasing at an alarming rate.
HIV/AIDS is not merely a health issue and its impact goes beyond its
sufferers, their families and communities.
economic
social
and
human
development
across
the
full
spectrum
of
role to play, the close interpersonal interaction that NGOS have with people in
the communities they work is extremely useful for implementing the behavioral
interventions necessary for HIV/AIDS prevention and care, NGOs are also not
under
the
same
political
and
administrative
constrains
as
government
programmes are. They therefore have greater flexibility and the capacity to
accommodate changing programmes and public needs and can innovate and
implement new initiatives more easily, they can ensure that those people living
with HIV/AIDS, who are affected by it, have and improved quality of life. SOVA a
Indore based NGOs may be taken as an example in this area of operation.
Most workers face no risk of getting the virus whole doing their work, if
they have the virus themselves, they are not a risk to others during the course of
their work, as explained already, in adults, the virus is mainly transmitted
through the transfer of blind or sexual fluids, since contact with blood or sexual
fluid is not part of most peoples work most workers are safe, those who are likely
to come into contact with blind that contains the virus are at risk these include
health care workers doctors dentists nurses laboratory technicians and a few
others such workers mist take special care against possible contact with infected
blood as for example by using gloves there are no risks involved.
One may share the same telephone with other people in their office or
work in a crowded factory with other HIV infected persons even share the same
cup of tea but this will not expose them to the risk of contracting the infection,
being in contact with dirt and sweat will also not give any infection, for example,
it is not spread by sitting next to someone who is infected, shaking hand,
coughing, or sneezing, HIV is not spread by public transportation, public
telephones, restaurants, food, cups, glasses, plates, drinking water, air, toilets
swimming pools or insects. The virus spreads most frequently through sexual
activity, from an infected person to his or her sexual partner, it also spreads
through contaminated blood in transfusions on needles or any other skin piercing
instruments.
A positive HIV test result does not mean that a person has AIDS. A
diagnosis of AIDS is made by a physician using certain clinical criteria that aids
indicator illnesses an HIV infected AIDS indicator illness. An HIV infected person
43
receives
indicator illnesses, and HIV positive person who has not had any serious illnesses
also can receive and aids diagnosis on the basis of certain blood tests ( CD4
COUNTS ).
Infection with HIV can weaken the immune system to the point that it has
difficulty to fight off certain infections these types of infections are known as
opportunistic infections because they take the opportunity of a weakened
immune system to cause illness, many of the infections that cause problems or
may be life threatening for people with AIDS are usually controlled by a healthy
immune system the immune system of a person with AIDS is weakened to the
point that medical intervention may be necessary to prevent or treat serious
illness.
Today there are medical treatments that can slow down the rate at which
HIV weakens the immune system, there are other treatments that can prevent or
cure some of the illnesses associated with AIDS as with other diseases, and early
detection offers more options for treatment and preventative care.
HIV is seen as the result of personal irresponsibility, and as such
individuals are labeled and targeted, by blaming certain individuals or groups,
society can excuse itself from the responsibility of caring for and looking after
these people.
Stigma is a powerful tool of social control which is usually used to
marginalized and exercise power over individuals who do not conform to the
norm discrimination related to HIV has spread rapidly fuelling anxiety and
prejudice while the societal rejection of certain social groups that is MSM
injecting drug users, sex workers may predate HIV and aids , the disease has in
many cases reinforced this stigma MSM and sex workers are not coming forward
for fear of rejection and people are not coming forward for testing for fear of
rejection stigma and discrimination at various levels in society.
Findings about the PLHIVs
44
The incidence of HIV is found mostly in the age group of (25 - 49), (77%)
followed by 15 - 24 years (13%) age group. This shows that the adolescent
and young adults are the most vulnerable to HIV. Hence more preventive
measures need to be taken for the age group 15 to 49 years age group in
particular.
More than 40% for the PLHIV are now below poverty line. The APL categories
majority of the affected persons are assumed to be above poverty. The
sample indicates there are 64% of the sample is below poverty line (BPL).
Hence more care should be taken as regards the livelihoods of these PLHIV.
poverty leads to lack of proper nutrition and medicines and quick
progression of disease and death.
The number of illiterate PLHIVs is very high ( 50% ) and illiterate will result in
quicker spread of HIV in the area.
HIV is seen in all caste categories, general class has the maximum numbers
of HIV cases and the HIV virus is also seen among the tribals. Out of the
sample 52% belong to ST followed by SC (28%) and 10% belong to the
general category in the setting of high illiteracy, poverty and sexual
promiscuity at early age amongst tribals will lead to a faster spread of HIV
amongst tribals.
especially those who are migrating for jobs a long with other persons.
6
Most of the affected PLHIV are daily labors self employed and 20% are
dependants that women and children out of them 18% are drivers who
unknowingly indulge in sexual activity during their leisure time.
The sample clearly reveals that 80% for the affected cases got infected
either due to pre marital or extra marital affairs, it also show s that 18% of
the cases fare parent to child transmission.
Out of the sample taken it was reported that 90% had visited VCCTC for their
testing and the rest were tested in private clinics.
sample, the pre and post test counseling was very poor.
45
Out of the sample not a single affected person got free treatment, free X
RAY and investigation, the only medicines given to them free of cost were for
the opportunistic infections (OI) when ever available.
sample got these medicines the medicines purchased for OI from outside
were not reimbursed till date.
10 The PLHIV are subjected to various psychological and economic problems.
There is a lot of stigma involved in waiting outside a testing center which sis
testing only HIV.
Suggestions
The problem arising out of PLHIV s mainly relate to stigma and
discrimination, ill health malnutrition, poverty lack of education lack of proper
information on HIV and aids these problems can be solved t a greater extent by
the following ways.
Capacity Building of PLHIV
The concept of positive speaker is that a person living with HIV will take
the initiative to speak positive words and the true information and disseminate
the information to the people living with HIV where there will be creation of
enabling environment for positive people for positive life.
Development of communication skills of the people living with HIV is
important, practical sessions on public speaking, communication and positive
living information and knowledge should be provided; the training should include
positive life style that is stress management, management of food and nutrition,
management of ART and OI enhancing knowledge in the health care services
available for PLHIV etc.
Capacity building and positive speaker training is a unique concept.
Through these positive speakers the myths about HIV/AIDS can be dispelled, this
will also help in improving the quality of the life of peoples living with HIV/AIDS.
1. Formation of district levels network this net work will be as pressure
group to implement the all schemes of government.
2. Sensitize to government to for proper access to health services for
PLHIV.
46
47
48
a doctor, even if you do not feel sick. Try to find a doctor who has
experience treating HIV. There are now many drugs to treat HIV
infection and help you maintain your health. It is never too early to
start thinking about treatment possibilities
5. Have a TB (tuberculosis) test done. You may be infected with TB and
not know it , undetected TB can cause serious illness , but it can be
successfully treated if caught
6. Smoking cigarettes, drinking too much alcohol, or using illegal drugs
(such as cocaine) can weaken your immune system. There are
programs available that can help you reduce or stop using this
substance.
Observations,
informal interview and discussions, after collections the interview schedule was
scrutinized, it is really pathetic to observe the poor conditions of the affected
people mostly belonging to the tribal folk
community.
49
society, stigma comes after they are tested positive, and they feel that their
future is vague and uncertain. They believe it as fruits of their bad karmas. They
feel themselves as untouchable as treated by their family and friends and also
discriminated by the hospitals, doctors and staff. The hospitals do not keep any
confidentiality and abuse them too as a curse for society. It is alleged by the
affected people in large number.
The affected families are too poor to buy medicines and no proper
nutritional diet is really available some have no source of livelihood as they are
now dependants mostly (widows and children). Some have lost their jobs too, in
some families both parents are dead and their children are loaded after their
grand parents.
No proper guidance neither proper counseling is there for the target
groups. They fear about maintaining their status in the society and they fear to
form a network too, some are very helpless and rely on NGOs for their help and
support.
The NGOs are a very few in number who look after AIDS related projects as
mentioned earlier SOVA is one such NGO working for these people. They too are
bound by their financial constraints. They cannot afford to provide nutritional
facilities and required medicines to all the affected families, even getting a
widow pension card for a widow is very difficult as she has to undergo a series of
questions which makes life more miserable for them. There are various govt.
schemes like Antodaya Anna Yojana but only a very few are able to avail it.
Among the tribals their Parabas, their traditions entertainment, lack of
awareness about HIV and migration are some of the causes which are directly of
indirectly responsible for the spread of HIV/AIDS. Moreover people are illiterate.
They cannot read and write and understand about the prevalence causes and
effects of HIV/AIDS. They keep on passing the virus unknowingly as they do not
know what safe sex is.
CONCLUSION ONLY KNOWLEDGE IS THE POWER OVER HIV/AIDS
Concluding Remark
50
India is home to one in seven HIV/AIDS cases. The 2006 UNAIDS report on
the global AIDS epidemic estimated that 5.7 million Indians are living with
HIV/AIDS out of which 35% are young people aged between 15 to 29 years.
In Madhya Pradesh HIV/AIDS epidemic is spreading through poor public
awareness about the modes of transmission and result in high levels of stigma
and
discrimination.
Poverty
migration
and
displacement are
also major
contributing factors for the spread of virus together with poor access to health
service high levels of illiteracy, striking gender imbalance and weak governance.
Many of HIV cases already exist in Madhya Pradesh and likely to increase
in the near future, it is therefore of prime importance that action are taken at this
early stage to try and halt the spread of the virus.
HIV and AIDS are equally so closely linked with the fact that the partners
cannot address issues of HIV and AIDS has attracted much attention of the
people both within and out side the medical and civilized communities. HIV is
attributed to some of the socio economic issues like homosexuality, drug use
poverty etc. although the scientific evidence is overwhelming and compelling
that HIV is the cause of AIDS, the process of transmission and the spread of the
disease is not yet completely understood.
led some persons to make statements that AIDS is not caused by and infectious
agent or is caused by virus that is not HIV this is not only misleading, but may
have dangerous consequences.
Infection with HIV has been the sole common factor shared by AIDS cases
throughout the world among homosexual men transfusion recipients, persons
with hemophilia sex partners of infected persons children born to infected
persons, children born to infected women and
Projects
51
52
Questionnaire
02
03
04
05
06
Does your organization have work place policy for HIV positive people?
07
What are the specific facilities available for HIV positive people?
08
09
10
Do you have any specific facilities for the HIV positive children?
11
Do you have any future plan for integration of HIV with different sector?
12
Do you have any further action agenda for HIV in the district?
-A-
02
Address -
03
Marital Status
04
No. of Children
05
06
07
08
09
Male
Female
a) OI Treatment
b) Nutrition Support
c) Counseling Support
-B-
-C-
-D-
Bibliography
BIBLIOGRAPHY
01. AIDS and LAW
63/96
HIV
sentinel
09. Strategic
for
transfusion
safe
blood
1998
2000
2000
2001
2003
January 2002
-E-
Year 1996
-F-
Reference
REFERENCE
REFERENCE
REFERENCE
1. National Aids Control Organization
2. Madhya Pradesh State Aids Control Society
3. South Madhya Pradesh Voluntary Actions
4. ART Center (Vishakhapatnam, Vizianagaram)
5. ART Center Indore, Madhya Pradesh
-G-
Project Proposal
PROJECT PROPOSAL
PROJECT PROPOSAL
PROGRAMME TITLE
Programme Code
M.A (R.D)
Enrolment No.
062978462
Name
Address
Study Center
Sakuntala Ray
D/o - Ghanashyam Ray
At - Housing Board, Gandhi Nagar
Po/Dist - Indore
MADHYA PRADESH
PIN - 764 020
Mobile No. - 9437272485
E-mail - sray.montu@gmail.com
sray.montu@rediffmail.com
- 2123D
Regional Center
Dr. P . C Mohapatra
PROJECT TITLE
A study on the problem of service delivery of the people living with
HIV/AIDS of four blocks of Indore district.
INTRODUCTION
The study introduces to social determinates of behavior patterns and
practices that facilitate HIV transmission and social dimensions of HIV/AIDS
prevention, some social factors and customs among tribals leading to the
increase in HIV/AIDS transmitting behavior.
STATEMENT OF THE PROBLEM
HIV/AIDS is now becoming a killer disease and spreading very rapidly in
Indore district.
-I-
Transmission of blood
-J-
for this purpose. Primary sources include data collected through personal survey
interviews and case studies.
TOOLS OF DATA COLLETION
The main tool of data collection will be interview schedule administered on
the affected patients of area.
questionnaire relating. In addition to this case studies shall also be used as a tool
for data collection. Direct observation method shall also be used for getting
required information
DATA ANALYSIS
Data shall be coded verified analyzed using statistical methods and
processed on computer. Simple average will taken while analyzing the data Bar
and pie graphics are drawn to highlight each coded data
LIMITATIONS
As an individual scholar with limited time and resources at my disposal it
is difficult to cover the whole area on a census method. The scholar has taken
adequate measures to choose the sample which will represent the entire
universe.
-K-
Chapterisation
CHAPTERISATION
First INTRODUCTION
Gives general introduction about HIV/AIDS its dimension and extent tests
for HIV medicines the modes of transmission, prevention, symptoms and
misconception about of HIV/ AIDS.
Second RESEARCH DESIGN
The second part deals with the conceptual framework and research design
of the present study that is objective hypothesis universe, sample size and tools
of data collection
Indore District Profile
This chapter gives the detail about the district its location number of
population of the district and background of the people. Their living conditions,
poverty, literacy rate, unemployment, customs and traditions are briefly
discussed. This chapter also highlights the scenic beauty of the places, the hills
and the tribals residing there.
Third HIV/AIDS A SITUATIONAL ANALYSIS
The chapter gives the magnitude and incidence of HIV infection in the
district the areas of vulnerability. The analysis is based on the secondary data
collected from the testing centers (ICTC, PPTCT of Indore and Jeypore)
Fourth PROBLEMS OF THE PEOPLE AFFECTED BY HIV/AIDS
The chapter deals with the major and minor problems of the people and
the influence on the society of them. Some of the case studies are also included
in this regard.
Fifth MEASURES TO CONTROL HIV/AIDS
Role of government and non government agencies and networks of positive
people initiative taken by them in handling the situation in Indore district
Sixth SUGGESTIONS AND FINDINGS OF THE STUDY
This chapter deals with major findings of the study area. Some of
the important suggestions are also included.
Signature of Supervisor
Signature of Scholar
Date
[Type text]
Date