Reaching the Unreached Expanding Access to HIVAIDS Services

Reaching the Unreached : Expanding Access to HIV/AIDS Services Bhopal July 4, 2010

Changing Face of HIV Epidemic Movement from … High risk groups to general population • Urban to rural areas • High prevalence states to all states • Feminization • High vulnerability of youth/ migrants •

Background • • • > 10 lac HIV positive people are yet to be reached, scattered in general population, underground Lack of access to information & services Inability to negotiate for safe practices Widespread stigma & discrimination in society Community unaware about its role in prevention & management of epidemic

Towards NACP & NRHM Convergence Major policy decisions taken: • Train ASHA, ASHA facilitators, ANM & LHVs on module “Shaping Our Lives” • Universal HIV screening of pregnant women through rapid blood test at VHNDs, HIV status disclosure only at ICTCs • All 24 x 7 facilities to provide ICTC & PPTCT services • Counselors under NACP program to also counsel non HIV pregnant women on nutrition, STIs, birth spacing • Incentive to service providers conducting institutional deliveries for WLHIV & support to C/ pregnant WLHIV for additional visit to health facility under JSY/ un-tide funds for VHSC • Assured access to STI services & cross referrals with HIV/TB programmes • Strengthening access to quality blood transfusion services/

Shaping Our Lives Companion for Field Level Workers For - ASHA, ANM, LHV, AWW & SHGs Providing information on how to prevent HIV infection Informing about ICTC for couples willing to take HIV test at nearest PHC/CHC Motivating family of PLHA to take ART treatment at nearest ART center in government hospital Counsel family on need for special diet & nutrition for PLHA Mobilize community leader on care & support for PLHA Informing adolescents & elders migrating for work on safe behavior

Contents 1. Learning about HIV/ AIDS and field workers role: Modes of HIV transmission, symptoms & stages of HIV/AIDS STIs and its management Prevention of HIV AIDS, Men’s role & responsibility in protection & prevention 2. Counselling and Testing, Treatment and child care: Pre & Post test counseling, integrated with maternal health & institutional delivery promotion for optimal benefits Helping the client with outcome results What is CD 4 count test? PPTCT & its prevention, role in PPTCT

contd… ART: - Difference in treatment of infants, children & adults Community care centers role ART not required for all HIV positive persons ART if discontinued, leads to resistance Prevention of HIV/ AIDS ART treatment is free in all ART centers Start treatment only after medical advice CD 4 test is only test to tell when to start treatment

contd… 3. 4. Gender Dimensions of HIV/AIDS: HIV & women empowerment issues HIV vulnerability of girls & women, how to address it Impact of trafficking & migration on women Vulnerability of even married women Rights of HIV positive person Interaction with community with role plays & story Fighting stigma & discrimination: Addressing stigmas & discrimination in village Disclosing positive status with spouse/partner Working with others to protect rights of W/CHIV, community mobilization

contd… 5. 6. Nutrition for PLHIV: Importance of good nutrition Nutritious diet Nutritional care for PLHIV: asymptomatic, pregnant women, infants & children, persons on ART, loss of appetite, diarrhea, mouth sore and oral thrush Fighting myths & misconceptions: HIV spreads through shaking hands, eating/ drinking together, working, sharing house/cloths, mosquito bites Blood donation may lead to HIV Safe for PLHA to have unprotected sex with another PLHA Caring for HIV/AIDs is risky Women should not ask for condoms, Sex with virgins may cure STI & HIV

Some Areas for Strengthening women & - Providing platforms to practice skills: VHNDs, community sensitization sessions, VHSC meetings Counseling universal HIV screening for pregnant women, people with STIs. Visit to STI clinics, ICTCs, PPTCT centers, CCCs, ART centers & DICs to have a experience on activities and approach to PLHIV A chapter on HIV and Males, and role of PRIs to address livelihood support, gender, stigma & discrimination, human right issues of children living with HIV. Provision for feedback from health facilities to ASHA on referrals made by her Reporting & monitoring system

Outcome - All pregnant women line listed for birth plan & counselled on nutrition, STI & HIV testing. All pregnant women screened for HIV, if positive, have access to ICT & PPTCT services All women have access to quality maternal care, STI services, safe blood transfusion services W/CLHIV supported for additional visits to health facilities Increased awareness on HIV/ AIDS prevention , care & support in unreached population Community taking lead to address lack of knowledge, livelihood, stigma & discrimination issues of women in general & PLHIV in particular

Thank You