The Hindu Business Line : Let's talk about it...

Every morning, in Andhra Pradesh, a group of men and women are making change, and history. They set out to do something that most people normally shy away from — talking about sex, sexuality and HIV/AIDS.

Every day, V. Samson and S.K. Sultana Begum are among 48 peer counsellors who head towards schools, railway colonies, health units, railways hospitals, training centres, junior colleges and mahila samitis (women's groups) — all known as `entry points' and affiliated with the Indian Railways. The Railway Women's Empowerment and AIDS Prevention Society (REAPS), an NGO based in Vijayawada, is implementing a project called `Equalising Gender Relationships in the Context of HIV/AIDS Epidemic'.

At the heart of the project are the peer counsellors. It's break time at the railways' school and the boys and girls run towards Samson on seeing him. "Three days a week, I work with the children of classes VIII and IX. In the beginning, I gave information on HIV. They called me the AIDS bhai! Then I provided health information, general information about the body, and linked it to HIV and, finally, gender. It's been a struggle," says Samson, 24.

Delhi's Lady Irwin College developed a module containing information, games, stories and techniques relating to HIV/AIDS. The module was incorporated into the curriculum in consultation with parents and teachers.

It's 10 a.m. and Sultana Begum begins her rounds of the Railway Colony in Eluru, 90 minutes from Vijayawada. "I am 40 years old, and have three children aged between 4 and 18 years. I trained as Auxiliary Nurse Midwife (ANM). But my in-laws said I couldn't go out and work. Eventually my husband, who works as a cabin master, and was involved in a field action group, said I should work outside the home," says Sultana.

She enters the homes, encouraging the women to attend a Mahila Samiti meeting. The women are still completing their morning chores. The children are at school and the men at work. It takes a while, but eventually about 50 women gather. Some small children and pets also join in. The peer counsellors offer information not only about HIV/AIDS, but also health issues, good recipes, hints for child rearing and income generation schemes.

The REAPS project is a partnership between the Ministry of Railways and UN Fund for Development of Women (UNIFEM). The Indian Railways is the second largest employer in the world (behind the Chinese army), and the largest public sector undertaking in India. An estimated 16 lakh employees and 70,000 railway stations service 1.45 crore people every day.

In 1994, UNDP sponsored a study on HIV/AIDS in the Indian Railways, as it had a large mobile population that was highly vulnerable. The Railways was equally concerned. It chose Vijayawada for the pilot project, because of high prevalence rates. "The strength of the Railways are its hospitals, staff that is open to the project, and the railway colonies," says Dr D.K. Das, Director-General, Railway Health Services.

The Vijayawada Division in the South Central Zone spans 1,327 km, has 30,000 employees (15 lakh population), 15 health units, and a divisional headquarter hospital. It is estimated that 51 lakh Indians are infected with HIV. Andhra Pradesh has the second highest number of HIV infections in India, with about 4.7 lakh reported cases. It is also active in awareness and prevention of HIV/AIDS.

The REAPS project aims to strengthen the Indian Railways' capacity in offering gender-sensitive counselling services. And to highlight the fundamental link between gender and HIV/AIDS, as a strategy to prevent the spread of HIV/AIDS in India.

"For UNIFEM, gender means working with men, and mainstreaming issues into their agenda. It is wonderful but hard work," says Chandni Joshi, Regional Director, UNIFEM.

The project began in 2002. What has been its experience so far?

"The biggest challenge was opening up channels of communication throughout the community through peer counsellors and various entry points. Interacting with absolute strangers and getting them to confide, was part of this challenge," says Dr Girija Shankar, Director, Industrial Health, Railway Board, New Delhi.

Peer counsellors entered the scene after community-based studies showed that most people were comfortable having people from their community talking to them about HIV/AIDS. Men and women, aged 22-65, in and outside the Railway community were enlisted as peer counsellors, who work in twos and threes. They were trained in counselling and gender perspectives at the Christian Medical Centre, Vellore, and Asmita Women's Resource Centre, Hyderabad.

The other `entry points' are the Railway health units where peer counsellors meet patients, and work closely with the doctors and nurses. The Voluntary Testing and Counselling Centre (VTCC) at the Vijayawada Railway hospital routinely refers clients to peer counsellors, and vice versa. Trade unions (16 lakh members) and the `running rooms' where engine drivers rest between shifts are the other entry points.

Workers now say they are more comfortable asking questions about sex, homosexuality, condoms and HIV/AIDS. Engine drivers have asked for condom boxes in running rooms and for information on HIV/AIDS to read on their trips.

The target population comprises employees who are either illiterate or have studied up to secondary or high school. Typically, the job requires physical strength and skill, and the men are prone to alcohol consumption, aggression, violence and sexual recklessness — casual sex with multiple partners or paid sex. At the same time, they head a household and support a family.

Despite greater awareness of HIV/AIDS and the key modes of transmission, there aren't enough prevention measures. The communication challenge lay in breaking strong sexual stereotypes and, through this, providing women a space in which they can negotiate. The posters, slogans and other written material focus on addressing and involving men in the process of empowering the women.

Besides the work at the entry points, a major concern related to the people living with HIV/AIDS (PLWA) and their families. Many of them were deep in debt; a few families owed more than Rs 1 lakh each. A revolving fund was created, based at the South Central Railways Women's Welfare Organisation (RWWO), Vijayawada. Women living with HIV/AIDS, and other affected women in the Railway community in the eight project districts are eligible for aid.

The project work largely centres on communication at the individual, family and community level. The peer counsellors focus on gender-sensitive messages on prevention, care and treatment.

"We need to focus on the condom, not as a symbol of promiscuity or for prevention of STIs (sexually transmitted infections), but as `a sexual health promoting gadget' between man and man, and woman and man. In the family planning programme, the primary function of the condom was child spacing. Now we want to promote the dual function of the condom — lead a happy sexual life, without infection, and with child spacing," says Dr Prasad of the Andhra Pradesh State Control Aids Society (APSACS).

The REAPS project has a chance of real success. The zeal of the Indian Railways, the strategic interventions by UNIFEM, a small and dedicated team, and committed peer counsellors are a start. On World AIDS Day in 2004, K. Damayanti, project director, APSACS, announced that it was mandatory for liquor shops to hand out a free condom with every bottle of alcohol sold from December 1. Neighbourhood hair salons will also be involved in the awareness drive, and nearly 25,000 barbers have been trained. In January 2005, Andhra Pradesh Chief Minister Y.S. Rajashekhar Reddy recruited religious leaders to join forces against AIDS.

Women's Feature Service

Article E-Mail :: Comment :: Syndication :: Printer Friendly Page

Stories in this Section
Let's talk about it...

Two good!

The new-age Marco Polo

Tintin and the designer wear

Young and calling the shots

A vegetarian in Hong Kong

Shopping and some more...

The early birds...