Intervention In Sexual Health

Part of Deepak Foundation's Annual Report, 2001-2002

DCT's intervention in this field is now more than three years old. Our interventions in STI/HIV/AIDS prevention have not limited their focus to promoting condom usage and STI treatment as the main components for behavior change communication. A very important part of our intervention is to address the concerns of men related to non-contact sexual concerns i.e. semen loss, masturbation and nocturnal emission. DCT's field research over the past three years has proven that any intervention strategy that does not take into consideration these concerns of men is more than likely to fall short. DCT's intervention in sexual health is funded by the DFID and funds are routed through the Gujarat State AIDS Control Society (GSACS).

In the past year, the condom distribution network has been strengthened and today comprises of DCT's Outreach Workers, Village level Health Workers (both men and women) & Anganwadi Workers; Barber shops and `Paan' shops and Peer Educators. The total number of condoms distributed was: 1,62,818 and number of beneficiaries were 13,996.

STI Identification is an important element of the project. In the year 2001 a total number of 3,763 cases were identified of which 481 cases were new. Rigorous follow-up was done and efforts were made to ensure that the individuals undergo treatment. Two STI clinics for women, one in Nandesari and one in Angadh village, are held every Wednesday, which are handled by gynecologists from Baroda. A STI clinic for men is also held every Wednesday at the DMF hospital. However we suspect that many men shy away from attending this clinic because if they do so ,the fact that they suffer from STIs would become known. We are now encouraging men to come to visit the DMF hospital anytime for treatment of STIs and not just on Wednesday afternoon in order to avoid the `stigma' of attending the STI clinic , since the doctor in-charge is our resident medical officer and is available on all days.

(photo no.4)

DCT was able to reach out to a total of 21,474 individuals for Behaviour Change Communication (BCC) through the various counseling activities of the project (condom counseling; one to one counseling; post STI counseling; STI treatment taken etc).

From illicit liquor to milk....

Ashaben (name changed) was married at the age of 14. She has four children. When her children were young, her husband died leaving her with no source of income. One of her husband's friends encouraged her to start brewing illicit liquor and helped her to start. She soon developed a relationship with him. He used to bring his friends to her house to drink - she had physical relations with these men and had to have two abortions. When DCT staff visited her and gave information about STI/HIV/AIDS, she insisted that her partners start using condoms. She interacted a lot with the DCT staff. During counseling sessions, she revealed that she was unhappy with her life. With regular counseling she reduced multi-partner sex and even joined a Self Help Group. She availed of a loan from the group and bought a buffalo. She has reduced the quantity of liquor that she brews. She is able to earn a livelihood from the sale of milk to the women's dairy co-operative in her village. Not only this, she is even a member of the Managing Committee of the Dairy Co-operative in her village. She acknowledges that there is a big change in her life. She no longer has multi-partner relationships and insists on condoms being used. Today she is an inspiration to other widows in the village who face trying circumstances in their lives

The DCT team also identified individuals displaying High Risk Behaviour (HRB). A total number of 1,347 individual displaying HRB were identified. The DCT team has worked intensively with these people at BCC. We have been successful in forming Self Help Groups of some of these individuals. Three Self Help Groups were formed of HRB widows. It is hoped that these women can save money and create assets. There have been instances in the past when this has happened. Adolescent girls and boys displaying HRB were encouraged to join skill-enhancing classes under the UNFPA funded Adolescent program. Behaviour change was observed to be faster in those who joined the classes. We have also had success in our interactions with the community leaders and parents regarding widow remarriages. Widow remarriage is a big taboo in this predominantly `darbar' (rajput) community. Parents have now started discussing remarriage of their widowed daughters - this is a very progressive step - something we have been trying to initiate ever since we started work in Nandesari.

Nandesari being an industrial estate, there are a lot of factories located here. Thus workplace interventions have been an important part of our overall strategy to create awareness about prevention of STI/HIV/AIDS. In the past year workers of 8 industries were covered. Condom depots are set up in these factories. That this intervention in the various factories is successful is revealed by the fact that a large number of patients attending the STI clinic at the DMF hospital are from these factories. This is a big achievement for us.

The story of a PE...

For as long as Rajeshbhai (name changed) could remember, he was stubborn and did whatever he felt like. By the age of 14 he had multi-partner relations. A few years later, in order to earn money, he started having sex with men. He used to solicit clients not only in his village but also in nearby villages and in Baroda. In January 2000, DCT initiated the Sexual Health Program in his village. He was referred to the DCT staff by other village people as one showing High Risk Behaviour. The DCT staff member developed a rapport with him and won his confidence. He was interviewed at length and his detailed case history noted. He was counseled and given information about the risks of HRB and STI/HIV/AIDS. In one of the clinics run by DCT he was identified as suffering from a STI. He was explained the importance of the treatment and complied with it. After a lot of interaction with the DCT staff he decided that he wanted to join the project as a Peer Educator. Since then he has changed his behaviour and no longer has sex with men. He now uses condoms regularly. As per his colleagues, he is a very good Peer Educator and works devotedly.

One of the reasons for the headway that we have been able to make with the community is DCT's competently trained team. There is a very strong element of training in the program. Members of the community work as Peer Educators (PEs) and work closely with the community. The total number of PEs is 40. The Peer Educators (PE) and Village level Health workers (VLHW) are trained intensively on different issues. This rigorous training plays an important part in the success of this intervention.

What gives us great hope for this program in the future is the validation that we have received from the community. Without the co-operation of the community, such interventions are near impossible to implement. A study was carried out by a student of IIHMR (on placement at DCT) at the end of 2001 wherein he surveyed village leaders (`Sarpanches') and informal community leaders of 24 villages regarding their feedback about DCT's intervention in Sexual Health. All the leaders overwhelmingly responded positively. They felt there was a great need for this kind of intervention and were very positive about it. Thus it has been a real morale booster for us to know that we have the backing of the community.