Linking the Vulnerable: HIV/AIDS in Rural India

This oath was signed in 2007 on World AIDS Day by members from various sectors of society led by the then State Health Minister Digamber Singh.
Photo: Samrat Mandal/UNDP India

A unique government scheme that engages district level functionaries to link those vulnerable to HIV in rural areas with local health services, encourages behavioural change, and advocates for policy change is strengthening social protection of people living with HIV(PLHIV) in a country where an estimated 2.4 million are living with HIV.

Durg, Chhattisgarh: “They call me the leader those only talks about HIV/AIDS,” laughs Nirmala Devi the newly elected village leader of Pauwara village in Durg district in the central Indian state of Chhattisgarh. In her early 40s, uneducated and married with two children Nirmala would appear an unlikely advocate, for what many in this part of India refuse to acknowledge even exists. She had never heard about HIV before being approached by members of the district link workers scheme, a community-led intervention to address HIV prevention and care needs of the rural community.

Highlights

  • The Link Worker Scheme, a unique government scheme supported by UNDP, has been instrumental in expanding social protection to people living with HIV (PLHIV) in rural Chhattisgarh
  • The scheme identifies people at risk in rural areas and links them to local support services
  • As a result of regular testing introduced in 2003 as part of the scheme, the state has witnessed a ten-fold increase in those that tested positive
  • UNDP's support to the inclusion of PLHIVs in the Antyodaya Anna Yojana scheme in the state has helped PLHIV households access food at subsidized prices
  • Nearly 300 paralegal workers in the state have received sensitization training as part of the scheme

The link worker scheme identifies populations at risk and vulnerable to HIV in rural areas and links them to support services – both preventive and care. As one of two link workers for 100 villages, Nirmala walked from home to home identifying vulnerable households and providing information on care facilities available locally. Nirmala had always been active in social initiatives in her village but training as a link worker helped build her confidence and empowered her to a decisive victory in the local elections, polling more than the other four candidates put together.

In India 2.4 million are estimated to be living with HIV. In Nirmala’s home state of Chhattisgarh, over 6,000 people are diagnosed with HIV. In the seven years since testing began in 2003, the state has witnessed a ten-fold increase in those that tested positive. With Government of India-UNDP support, the state mainstreaming unit in the Chhattisgarh State Aids Control Society (CGSACS) along with partner CARE has been instrumental in adopting a multi-sectoral approach to enable the social protection.

The link worker scheme is one programme geared towards rural India. Two link workers (one male, one female) map 100 villages to identify vulnerable households, build linkages with local health services and mobilise Panchayati Raj and allied Institutions including red-ribbon clubs to play a cohesive role in behavioural change. In addition to the link worker scheme, other efforts include strengthening district networks of positive people, training paralegal workers and advocating for policy change.

“When I was first diagnosed I felt I was the world’s only HIV patient” says Mukesh the thirty-two year old coordinator of the District Network of People Living with HIV (PLWHIV) in the nearby industrial town of Durg. Mukesh was able to channel his despair into collectively mobilizing what is now a 300-strong network of positive people. “By helping people get tested, monitoring follow-ups on anti- retroviral therapy, and providing counseling, we try and address the harsh discrimination we face in society and advocate for our rights. ”UNDP has supported the establishment of 29 district level networks of people living with HIV in India.

A progressive step towards greater inclusion of PLHIV concerns has recently come through a landmark decision - the department of Food and Civil Supply of Chhattisgarh has ordered the inclusion of PLHIV in the Antyodaya Anna Yojana scheme, launched in 2000, that provides special food-based assistance to destitute households. Given a special ration card, PLHIV households are now entitled to food grains at highly subsidized prices.

Similar efforts supported by UNDP across states in India are paving the way for greater social protection of people living with and affected by HIV/AIDs. This includes improving medical care and nutritional security for PLHIV household. The Jeevan Raksha Fund in Rajasthan meant for families below the poverty line has been extended to PLHIV giving them access to free medicines and diagnostics. Like Chhattisgarh, several states such as Orissa and Rajasthan have included PLHIVs in ration support system for BPL families meaning they can access subsidized grain. In Uttar Pradesh, the state has recognized the need to encourage greater inclusion of PLHIVs in the Mahatma Gandhi National Rural Employment Guarantee Scheme that provides 100 days of manual labour to any rural household that demands it. A recent state order mandates that PLHIV be given less strenuous tasks in the world’s largest employment guarantee scheme.

Providing the ability to PLHIVs to successfully advocate for their rights necessitates greater awareness both within and of the legal system. Nearly 300 paralegal workers in Chhattisgarh have received sensitization training and 21 anti-stigma counselors will help overcome discrimination.

Community leaders like Nirmala Devi concur with the importance of legal awareness and greater social protection but want to go one step further. “As an elected representative I will take legal action against anyone who discriminates on the basis of HIV/AIDS but my hope is that one day very soon my neighbor nearby who is positive has the courage to talk about it freely”. This says Nirmala Devi is her five-year plan.

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