In India the HIV/AIDS epidemic is more than 15 years old. The national HIV
prevalence rate has risen from 0.1 per cent in 1986, to 0.8 per cent in 2001 – an
eight-fold increase in 15 years. Conservative estimates by the government say that
perhaps as many as 4.5 million Indians are living with HIV/AIDS. In six states, more
than one per cent of the population is HIV positive. Given India’s large population,
each 0.1 per cent increase in the prevalence rate would increase the number of
adults living with HIV/AIDS by over half a million people. As elsewhere in the world, it
is poor and marginalized people, and especially women, who are most vulnerable.

Oxfam’s work on HIV/AIDS is being implemented through local Indian NGOs
partners. This leaflet looks in more detail at work with one partner in the State of

Programme background
Koraput district in Orrisa is a centre for industries both large and small, and the hub
of a highway network. Many young men migrate there from rural areas seeking jobs.
The population is very mobile and there is a high demand for commercial sex. These
conditions are risk factors for the spread of HIV/AIDS and other sexually-transmitted
infections (STIs).

Oxfam’s partner organisation, South Orissa Voluntary Action (SOVA), has been
working in and around Koraput since 1996. SOVA’s research showed that
knowledge of HIV/AIDS and of STIs was low and that safe sex was not practised.
Truck drivers were identified as a key high-risk group on which to focus. However,
experience has shown the value of widening this focus.

SOVA selected and trained committed truck drivers as “peer educators” on HIV/AIDS
and STIs, with 72 drivers trained so far. It involved both the truck drivers’ union and
the truck drivers’ employers’ association to take more responsibility for enabling
drivers to seek information and support services, including condoms and treatment,
with 800 drivers so far having been assisted.

But SOVA realised that focusing on “high risk” groups failed to address the risks to
larger population groups, notably the wives of men who may have multiple sex
partners. It therefore decided to work to reduce high-risk behaviour across all groups
in both rural communities and in towns. In order to reach these wider groups, and
respond to the different ways in which people learn. It uses a wide range of methods,
including stalls at weekly markets, and theatre.

It had already worked to establish self-help groups (SHGs) in tribal villages, with the
initial aim of helping villagers, mostly women, to save money collectively to purchase
seeds or fertilisers or manage the government ration scheme. These SHGs have
helped to empower women with greater individual and collective strength, and SOVA
realized that they could play a major role in increasing people’s knowledge about
reproductive health and HIV/AIDS, and this is happening.

The SHG structure has enabled women to achieve greater autonomy in their sexual
relations. For example, wives concerned that their husbands may have visited
commercial sex workers are more able to negotiate safe sex.

There is increased demand for condoms. Initially, SOVA distributed condoms free-of-
charge but now sells them, at a low price, through the peer educators and through
small shops, youth clubs and other outlets. Commercial sex workers are much more
likely now to refuse to have sex without condoms.

There has been a reduction in HIV-related social stigma because of greater
awareness that simply having an infected member in the family need not lead to
other family members becoming infected.

Lessons learned
It is important to recognise the need to reduce high-risk behaviour through working
with the extended community, rather than focus on so-called “high-risk” groups.
Indeed, focusing just on “high-risk” groups may actually increase fear and stigma
and push them underground. It is a challenge to maintain contact with truck drivers
and the community approach is particularly useful in this regard. Integrating
HIV/AIDS into general reproductive health-care programmes definitely increases the
coverage and impact. Partner treatment of STIs is critical for prevention and
reducing risk. This type of work requires a good understanding of the communities
and their structures.

Taking action to prevent HIV/AIDS infection requires a degree of autonomy in sexual
relations, so it is important that programmes contribute to the empowerment of

Peer education is a key strategy for sustainability and impact.

The epidemic is in its early stages in Orissa. One of the biggest challenges SOVA
faces is sustaining interest in its work in areas where HIV/AIDS is not visible. On the
other hand, many truckers have been infected already but treatment is hindered by
lack of resources both in the district health authority and among non-governmental

The programme approach has to be inclusive. It has to cater to the needs of the
infected and the affected and strengthen the capacity and skills of whole
communities. People living with HIV/AIDS need programmes that address rights and
legal issues, and also information and training for alternative livelihoods. Peer
education is a key strategy for behaviour change. HIV/AIDS work needs to be
integrated with reproductive health care.
But for this to happen, the programme providers also have to work inclusively. That
means government doctors, health workers and other authorities, NGOs and
traditional providers have to work more closely together and reinforce each other’s
skills. This in turn also requires networking and advocacy with district legislators and
other political stake-holders who can establish policies and resources from the top in
order to create “friendly” services.

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