Empowering communities in North India
by Sanjana Das

"My husband is a God-fearing man. He loves our children and me. He goes out to earn for himself and the family for months together. I have no idea as to whether he goes to any other women for fulfilling his sexual urge. I can never even question him, even though I have my own doubts. Now I know that the best way of keeping myself protected is to practice safe sex. But how can I even talk of condoms since I have already got myself operated. Moreover, we have never discussed about condoms nor do we talk about sex. In a situation like this, how can I protect myself from HIV/AIDS?"

A woman raised this question during a women's fellowship training workshop sponsored by the Church of North India. This group of women hailed from very interior rural areas of the state of Orissa. It was a tribal group with little access to information and communication. They had known only one means of birth control – tubectomy. Most had between five and nine children. Their husbands worked mostly as labourers, migrating out to the neighbouring states or to other parts of Orissa.

The Church of North India, through the Synodical Board of Health Services (SBHS), is focused on HIV/AIDS prevention by supporting awareness programs and working to bring about attitudinal changes. Training workshops are organized for youth and women's fellowships of all 26 dioceses. Participants become core trainers who train others from their parishes and communities.

The spread of HIV/AIDS in India

In India, HIV/AIDS is spreading like a wildfire throughout the length and breadth of the country. Over the next decade, the HIV virus is likely to be the highest cause of death among India's adult population.

Eighty-nine percent of the reported cases are in the sexually active and economically productive age group of 18—40 years. Over 50 percent of all new infections take place among young adults under 25. Twenty-one percent of new infections are among women – a majority of whom do not have any risk factor other than being married to their husbands. This adds to mother-to-child HIV transmission.

Persons in traditionally high-risk groups, including women in prostitution, injecting drug users, and men who have sex with men, have been shown to have alarmingly high rates of infection. In several states of India, such as Maharashtra and Tamil Nadu, the epidemic has spread to the general population.

There are various factors contributing to the spread of HIV/AIDS in India. These include poverty and low economic status, a high prevalence of sexually transmitted diseases which mostly go untreated, gender disparity, double standards of morality and gender norms, population mobility, migration and rapid urbanization, injecting drug use, lack of information and failure to observe mandatory Universal Precautions and screening of blood.

As is known, infection by the virus is preventable, and the spread of the epidemic can be stemmed if prevention strategies are put into action on a large scale. There are strong links between incidence of infection and the economic and sociological vulnerability of specific groups, and there is ample evidence that those who have information and choices can protect themselves from exposure to the virus.

The HIV/AIDS epidemic is not just a health issue but also a development challenge. It impacts the social, economic, cultural, political and legal parameters of society. Therefore, it is important to empower communities not only in the context of HIV/AIDS prevention, but also in the wider context of socio-economic development and basic human rights.

Breaking the silence

My work takes me to different parts of the country and I meet with adolescents, youth, women and men. As I work with these different groups I sense the urgent need for people to "break the silence" and to talk. It's not just talking about HIV/AIDS, but talking about a whole range of issues.

The adolescents need to cope with peer pressure and to understand sex and sexuality. This group is highly vulnerable to sexual abuse and exploitation. They need an environment of trust and openness and to be able to talk without being judged or condemned.

The women I come across during my field visits have made me understand women as a disadvantaged group socially, economically and biologically. Their vulnerability is a major concern in our society since this is a major factor influencing the spread of the epidemic. Trafficked women and girls represent the most vulnerable category as far as sexual violence is concerned. There is an integral connection between HIV/AIDS, gender and trafficking through the nexus of vulnerability and sexual violence.

Women face greater risks of rejection, ostracism and neglect if they get infected, making them even more vulnerable. Indeed, the shame, blame, fear, distrust and dangers that surround these issues, and the difficulty of discussing them in present-day cultures, are major problems. The stigma surrounding the AIDS pandemic is in fact helping to fuel the spread of the virus.

Church initiatives

Community mobilization and empowerment are critical to HIV/AIDS prevention and care. Thus, the effort of the SBHS is geared toward trying to create spaces for facilitating greater community action. Its activities include workshops for pastors and lay leaders, prayer vigils, a Teen Peer Educators Program, college seminars, and mass awareness programs.

The SBHS has an ongoing project in the states of Assam, Orissa, West Bengal, Madhya Pradesh and Chattisgarh. This project is primarily being supported by DANIDA, the Danish Embassy. Its objective is to empower communities to deal with the HIV/AIDS pandemic in a more comprehensive, systematic and humane way. The project aims at increasing awareness, motivating people to take preventive measures, providing testing and counseling facilities for those affected, and persuading communities to support affected individuals and their families.

In Madhya Pradesh, we are beginning to work with a tribal community called Banchra. Among the Banchras, prostitution is openly practiced, promoted and protected, not withstanding the law and international convention against it. This community migrated from Rajasthan centuries ago and has engaged their daughters in prostitution, making them the principal breadwinners of their families. The men mainly solicit clients for their daughters and sisters. They live in 35 villages with a population of more than 6,000 people. Official estimates say that over 600 women are engaged in prostitution in this belt. The Church of North India through its AIDS wing of the SBHS has started working in this area. The main objectives are to increase the level of awareness, bring about change in behaviour of women in prostitution, bring about change in community attitudes, empower women in prostitution to make decisions about themselves, their profession and their health with an open mind and without pressures, provide alternative sources of income through self-help groups and networking with governmental and non-governmental organizations, work with truckers on the highway who are their major clients, build hospices and provide care and support to people living with HIV/AIDS.

In Assam, the Assam State AIDS Control Organization (ASACS), which is operating under the National AIDS Control Organization of the Government of India, has given us their School AIDS Education Programme for one district covering 30 schools. A targeted intervention project for the truckers on the National Highway of Assam has been submitted to ASACS and is in the process of being sanctioned.

We have networked with the government, with UN bodies and NGOs as well as with various other churches. On June 4, 2002, a National Consultation of Church Leaders in response to the HIV/AIDS crisis in India was jointly organized by SBHS, the Church of North India and the Lutheran Church. UNAIDS has assured this network of its support. We are working with different denominations even at the grassroots level, such as the Baptist, Roman Catholic, Lutheran and Methodist churches and the Church of South India.

An epidemic is an extraordinary situation. It demands extraordinary efforts. I am reminded of what Dr. S. Radhakrishnan, the first Vice-President and second President of Independent India, once said: "Christians are very ordinary people claiming to do extraordinary work." The entire team of AIDS Wing, SBHS, Church of North India asks for your support in prayer as we take small steps in fulfilling this great mission.