NACP set for designing fourth phase

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IMPHAL, June 9, 2011: The National AIDS Control Programme is in the process of designing the fourth phase of the programme, which is expected to be launched in April 2012. In response to this, 500 civil society organizations and community groups from across the country have decided to come together and conduct five regional consultations to shape a blue print and design for the programme.
In order to facilitate participation consultations will be held in different regions over the coming week. The first consultations which began in Guwahati today for the North East region will be followed by consultations in Delhi for North India, Pune for West India, Kolkata for East India and Bangalore for South India. The Guwahati consultation was attended by 110 participants from eight states including Manipur, Nagaland, Mizoram, Arunachal Pradesh, Sikkim, Meghalaya, Tripura and Assam. The regional consultations will feed into the NACP IV design, especially areas that communities and civil society want incorporated and made integral to the programme.
Commenting on this unique and unprecedented response, Dr. Sundarraman, a social activist involved for the last 30 years on the issue said, “We are not here just to dot the “I’s” and “T’s” of a programme document outlined by officials of NACO.”  Therefore, participants, many of whom have the vast experience of the community and hitherto difficult-to-reach populations, will deliberate on, “what worked for them in the present programme and why and what did not work” and how did we go about fixing it”.
During today’s deliberation, there was general discontentment about the lack of sharing by NACO of the planning process and proposed design of NACP IV. Many of the participants felt that their key role in the present phase of the programme has been completely ignored and their participation sidelined. The common demand of 100 delegates from civil society at the Guwahati consultation was let the fourth phase of the National AIDS Control Programme be a “people’s programme”.
Tomorrow, June 10,  over 95 participants from various line departments such as the Women and Child, health, law, education, DIPR, RNTCP and the AIDS Control Program such SACS, DPACU from the state level government agencies, from across eights North East states, are expected to make their recommendations for the design of the fourth phase program. Five members of the civil society will participate in the regional consultation and provide recommendations emerging from the ongoing community interactions.
 In light of this, the civil society consultation has emerged as a vibrant forum and an opportunity for the communities and civil society to put forward its experiences and expectations from the NACP IV. In one voice the message from all the participants is that a sense of urgency must be made a part of the planning and that the spirit of partnership witnessed in phase 3 must be strengthened to ensure that as the fourth phase program rolls out.
Dr. S.I. Ahmed, Director, AIDS Prevention Society, stated, “We need to ensure that the State AIDS Control Societies, health departments are made more accountable. Inter- sectorial collaborations are important but without ownership at the district level it’s a distant reality. More importantly, we are not seeing any systematic efforts to strengthen community ownership”.  
Bulee, a peer educator with the NGO Lamjingshai, Meghalaya, spoke of how, “Community mobilization is difficult particularly in Meghalaya, which has a matrilineal social setup because stigma and discrimination is high. The larger community, unlike in other states , is yet to acknowledge the existence of the community. Mental health has not been addressed at all. Most of the community members take to drugs due to frustration (lack of recognition). Let’s address mental health issues be addressed before we talk about behavioral change” she added.
Jahir Ulla Ali, Team Leader, Bhorakha Group, Guwahati, pointed out that, “ICTCs do not have MSM counselors who clearly understand the psycho-social issues of the community. Guwahati has only one MSM DIC. Stigma and discrimination is also preventing community members from accessing treatment in general hospitals and other clinics. Mobilization is also difficult due to a lack of MSM specific services.
Mary, a FSW from Manipur opined that, “NACP-IV should go beyond providing basic STI treatment and take into consideration the treatment of other related complications. A number of FSWs are homeless, having been driven out of their homes by their families and are taking shelter in bus stops, market sheds and other public space which is making them even more vulnerable”. Earlier, while speaking on behalf of community groups of the seven states in the North East, Raj Kumar Raju opined that, “If the rich experience of the community is not taken seriously and a comprehensive programmes are not worked out for an array of drug users, including under-served groups like female drug users, during the next phase of programme it would be difficult to halt the epidemic let along reverse it.”  
Taking this forward, Luke Samson, from the NGO Sharan, emphasized that the time has come for community groups most affected by HIV to go beyond providing advice and recommendations and start shaping the operational scope of the programme. He made it clear that while some interventions such as the Needle Syringe Exchange Programme (NSEP) have to be consistently implemented for regular drug users; other more complex interventions such as Opioid Substitution Therapy (OST) required a tremendous amount of designing and planning, especially in the programmes run in community settings.  He added that, “Without a human rights framework any health intervention that is seeking to address such marginal communities cannot work.”
Shashi, SASO, Manipur spoke of how, “IDUs, PLHAs and other communities are suffering in the North East. However, the NACO’s planning process did not even invite a large organization like SASO which is working with the community to the working group consultations”.
A key recommendation that emerged from the civil society representatives was that the fourth phase must be more accommodating and flexible to the ground level situations.
Bazo, Director, Kekhrie Foundation, Nagaland, felt that, “The key focus should be on women and children. We need a response to the stigma and discrimination that people are facing on the ground. PLHAS must be involved as a distinct entity rather than as part of the program delivery.”
Pratishta Chettri, Drishti, Sikkim, West District, narrated the difficulties of implementing programmes for vulnerable populations like FSWs in Sikkim and how it was difficult to overcome the stigma faced by the populations. “They are not able to come out. How do we reach out to them and give services?” She also felt that strategies like the PPP model could not be adopted in the context of Sikkim since very few private providers were willing to come forward.
Bhiku Brahmanand, Secretary, Arunachal Pali Vidya Peet, Lohit, Chowkham spoke of the necessity of ensuring that the skill building process reached out to the more isolated areas of North East.

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