At the village level, ASHAs like Anita (left) are the first point of contact for any mother or children in need of healthcare. They track pregnant women in villages and encourage them to get their ante-natal check-ups done.
By Mehboob Jeelani
PATNA, India, 1 December 2012 - As the two buses pull over at the Patna Railway Junction, a group of about 130 women in white and sky-blue sarees step out and walk towards one of the platforms. The onlookers gawk at this brigade of young, middle-aged and old healthcare workers holding banners that read: ‘We pledge to eradicate HIV and AIDS.’ The platform is filled with a few stalls displaying artificial male genitals and packets of condoms.
A group of women stop by a stall where a volunteer doctor demonstrates the ‘proper’ technique of wearing a condom. “Don’t let the air stay inside the condom,” he says, “It is the presence of air that causes the rupture leading to infection.”
Anita Devi, an Accredited Social Health Activist (ASHA), watches the presentation along with other healthcare workers. Taking notes in quick intervals and nodding her head thoughtfully, Anita knows the knowledge learnt will be important when she goes back to her village to support similar HIV and AIDS prevention exercises in her community.
The doctor finishes the presentation and the women head towards the Red Ribbon Express (RRE)—a colorful eight-coach train—which has just arrived in Bihar after it took off from Indian capital city of New Delhi in January. Patna is its 105th stop.
The Red Ribbon Express (RRE) started its first journey in 2007 reaching out to more than six million people. Every year it travels across the country to promote awareness and reduce discrimination against people living with HIV and AIDS, particularly in rural India. This time, the train will cover 25,000 kilometers, including 23 states and 162 health stations.
India has the third largest population of people living with HIV and AIDS worldwide with close to two million people affected. The disease was first reported in Tamil Nadu in 1986 and by 1996 it had reached eastern Indian state of Bihar.
At present, there are 120,000 people living with HIV AIDS, and 4,897 children living with HIV AIDS in Bihar.
UNICEF partnered with National AIDS Control Organisation (NACO), National Rural Health Mission (NRHM) and other key stakeholders for the RRE project, supporting the initiative with planning, design and technical expertise.
In the coaches of RRE, HIV tests are conducted; workshops are carried out and various visual representations—advertisements, short films and photo exhibitions—are hosted. The train is embellished with a series of punch lines like ‘Zindagi Zindabad!’ (Long Live Life) and ‘Uniting India against AIDS’.
Anita walks through a dimly lit coach and halts at the spinning wheel marked with messages –‘unprotected sex, infected blood transfusion, infected syringes and needles’- that suggest the ways of HIV transmission. She glances around the coach at the other installations. “I think I will never forget these visuals,” Anita says, pointing at the spinning wheel, “Everything here is so simple to understand.”
For a health worker like her, who has never participated in a mega awareness campaign, coming to the RRE is like a reward for her work. “Earlier, when I worked on my own, I lacked the courage to talk about AIDS. I was very apologetic about my job and no one took me seriously. But after the awareness during the review meetings and through the audio-visual shows in the community, Anita feels much more empowered. “A lot has changed. Now people listen to me and I also have a lot to tell,” Anita says.
At the village level, ASHAs like Anita are the first point of contact for any mother or children in need of healthcare. They track pregnant women in villages and encourage them to get their ante-natal check-ups done. Sometimes they accompany them to the concerned Auxiliary Nurse Midwife (ANM), who immediately motivates them to go for HIV and AIDS screening tests.
ASHAs also keep track of migrant labourers visiting their homes and through the ANMs provide condoms to their wives. “We tell them to convince their husbands to use condoms when they return,” says Shashi Kala, an ANM from ChakhFaiz village in central Bihar.
“It’s very hard to make them understand. They often ask us: why would my man come back with a disease? What makes you think that he will be cheating on me? Sometimes it gets intense and we have no idea what to do,” adds Kala.
Thanks to her visit to the Red Ribbon Express, Kala feels she is in a better position to answer most of the questions she faces in the field.
“It is important to dispel fear and advice people what to do. HIV and AIDS is no longer a deadly disease. AIDS has become a chronic disease like diabetes, blood pressure. There is no cure for HIV but you can control it with drugs. If you tell this to people, they will not fear, feel traumatised or ashamed about it and will seek treatment,” says Kala.
“Frontline rural healthcare workers like Kala have now become important cogs to tackle HIV and AIDS in the country and are helping the Government to increase the demand for HIV screening,” states Aradhana Kumari, Assistant Director, Documentation and Publication at Bihar State AIDS Control Society (BSACS). “They have a deep reach in the villages. Without them it is very difficult to track and refer pregnant women for HIV testing.”
UNICEF is working closely with BSACS to strengthen focus on preventing Parent to Child transmission. The first step for this is to ensure HIV screening of every pregnant woman during routine ante-natal check-ups (ANC). “UNICEF’s advocacy with BSACS has led to mainstreaming this in Vaishali district with encouraging results. “As of August 2012, out of 3934 pregnant women, 3288 were referred by the front line workers and 1979 pregnant women have undergone HIV screening,” shares Yameen Mazumder, UNICEF Bihar Chief.
An increasing focus is on involving elected representatives in the village – mukhiya and ward-members and adolescents in spreading HIV-AIDS awareness. Around 4,000 adolescent girls of school-based forums (Meena manch) in Vaishali district have also participated in workshop to learn about ways of transmission and prevention.
Before the Red Ribbon Express chugged away from Patna Railway Junction, 543 people were tested for HIV and AIDS. Three were diagnosed as positive.