"There is high awareness of ICTs and many applications have been developed. But that does not mean it is enough or enough has been done, says Maxine Olson, in an interview with Manish Kumar of OneWorld South Asia.
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Maxine Olson
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The South Asian region has about six million people living with HIV/AIDS. Data from UNAIDS indicate that (excluding Bhutan) there has been an increase of over 25 per cent in the PLWHAs during 2001-03. What could be the possible reasons?
Well, the possible reasons have to do with, of course, how it spreads, as it is highly infectious under certain circumstances. It has proved to be extremely difficult to be able to address effectively because of the close interrelationship between the values that people hold and their behaviour. People are embarrassed to talk about it. And also the initial population that have been the most vulnerable to the infection have been the one where many people do not associate in their mind that they are equally vulnerable like any other person. Of course there are sex workers and intravenous drug users. Now since people say, I do not do that, they do not see that it is something they are also vulnerable too.
But, the reality is that they may visit the commercial sex workers and once it is into the general population then of course everybody is vulnerable.Thats how it spreads.
Does this mean that HIV/AIDS spread has got social dimension?
It has got social component to it. It is so closely linked to personal behaviour and it is very hard to be able to address it unless one is able to break into the personal space of the individuals. Now if you look at the challenges that are there, the first challenge is awareness. The people must understand what HIV/AIDS is about, who is infected and how they themselves are vulnerable to it. Information, knowledge about it is the second thing. But the real goal that makes a difference is behaviour. And the link between awareness, information, and behaviour is not necessarily a smooth one.
Not a linear one
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Its not a linear one. People can know all about it, but intellectually even they know that they are vulnerable whether they will change the behaviour or not does not follow automatically. So this is a great challenge.
Adult men account for 2/3rds of the recorded increase in PLWHAs in India. What impact does it have on the livelihoods of the people?
Tremendous impact. Work is going on to look at, specifically, what is called the burden of the disease, what is the economic impact. This work has no specific conclusions yet. Some estimates are around. But we can see the examples of African countries where the Gross Domestic Product itself is projected to be much lower because of the existing rate of HIV infection. India is not immune to that level of infection either.
However, its very difficult to assess the impact in India because there is a tendency among people to deny it and to think that this does not happen in India. Its similar to the African situation where 10 years back people used to say, its not us, it does not happen that way, our population is different, etc.
How does it impact women and children?
Its moving to rural areas and it will infect more and more women and children each year. We do have a programme for women called CHARCA which is focused on young women in six districts of the country. We are working with them in terms of discussing their vulnerability and what they can do to reduce their own vulnerability.
One of the most startling statements that I have heard in the times I have been in India is that the most interesting thing a women can do to contract HIV/AIDS is to get married. Because the male population is much more active sexually than the female population and given the resistance to testing, I think HIV/AIDS tests should be normal part of the preparations for marriage.
NACO has undertaken a massive HIV/AIDS awareness campaign in India. How effectively can the national media channels deliver the desired result in this awareness campaign?
First of all NACO is looking at a number of ways to do this. Surely, Doordarshan will be one of them. They are also running four different trains from different parts of the country to increase the awareness in the country about HIV/AIDS. I am sure they will use different ways to get the awareness up and there will be a number of organizations that will be happy to work with NACO in terms of developing appropriate messages. This is extremely important. There is no doubt about that. Information is one thing but really understanding that one is vulnerable is important.
The NACO director has raised his concerns time and again about the limited budget of 90 million Indian rupees, at their disposal for this entire campaign. How can they overcome this constraint?
First they will be looking to mobilize additional resources. They will put out an appeal. But of course that is the beauty of ICT tools. They are not necessarily so expensive. You can spread the message very effectively.
Do you think ICTs can make HIV/AIDS efforts cost effective by extending the outreach of health programmes?
I think it is a tremendous tool. Also it is interactive. Even though it is not face to face but e-mail to e-mail, there can be exchange among people. There are a number of UNDP initiatives, which are also working at that level. We have supported a regional website called youandaids. It provides information, counselling as well as chat rooms in a number of ways to people to share experiences, to get information, and to be able to interact in what many people would, perhaps, feel as safe environment. It can be anonymous. People normally do not share their HIV status for fear of social stigma.
One of the UNDP projects with NIIT in India called Project Outreach focuses on the awareness aspect. Please tell us about it?
It targets on the awareness component and also provides information. Since it uses peer educators it has more of a chance to get into the behavioural aspect. Because as soon as you have one person talking to another you have a far more powerful intervention. When a person shares something of his or her life with another person, that person is more likely to take it seriously, understand the impact that it has and there is a higher chance of behaviour change.
So ICTs do play a very important role when it comes to awareness and information. But how far ICT can push personal interaction into behaviour change is an important question.
So your experience with the Outreach project is quite positive.
Yes, quite positive.
Do you think it can be scaled up?
I do think it can be scaled up. And we are very happy with how well it has been taken by NIIT in terms of spreading it throughout the country in all the training centers. It is tremendous to be able to do it.
Is it not a good idea to involve all the educational institutions in this initiative, whether they work with NIIT or not?
One initiative is not the answer, even if that initiative has the capacity to reach over 100,000 people. Of course it reaches a key population that is young, the youth and youth are the priority in the work we do on awareness. So thats excellent. But there are number of ways to use ICTs to address the issues. One of the things we also know is that the role models and the people in authority are powerful exponents of information, awareness and helping people to understand the seriousness of the issue.
One of the programmes that we are now developing is with the leaders of Panchayati Raj Institutions. We will be working to develop a web-based application that increases their awareness and information on the issue. And at those places where Internet is not available, it will be disseminated through CDs. Its like a tutorial you can provide to increase peoples understanding of HIV/AIDS and how it can affect them.
While there have been several concerns raised on the prevention aspects aimed at the migrant labour population in the
destination areas of migration, we are yet to see significant interventions in the source areas. Does UNDP have any initiative in this context?
I am not familiar with such programme at the Indo-Nepal border but I have heard about it from the Nepal side in terms of attempting to maintain contact between the migrant labourers and their family, so that they do not forget that they have a family for whom they are responsible.
There is also a regional programme called REACH which works with potential migrants from Orissa who are planning to go to Gujarat. Its a programme that provides information related to working opportunities at the work destination. An ICT enabled kiosk is provided in a Orissa village so that people are in a position to find what kind of jobs are available, what is the salary and at the same time providing information about HIV/AIDS and safe behaviour.
We know that migrants are among the vulnerable population and 200 million Indians move every year. Its a huge number, almost 20 per cent of the total population.
What purpose can a MIS on migrants serve?
Actually you can track down the transmission of HIV along the major transportation routes, primarily for the migrants.
Is there a need for research studies on the impact of HIV/AIDS on livelihoods?
There is need for such studies. There is already ongoing work but we need to make them better known. In UNDP we have a study currently in progress.
Do we have enough knowledge about the health benefits from growth in equity of information and knowledge access and interaction through the new technologies?
I think the potential of ICTs is better understood in India than in most countries. There is high awareness of ICTs and many applications have been developed. But that does not mean it is enough or enough has been done. I think much more can be done, for example working with elected Panchyati Raj leaders and youths. We also had a discussion with the Ministry of Youth and Sports in India. They have youth centers around the country, which do have ICT equipments through which tutorial programmes can be provided to raise their awareness about HIV/AIDS. A lot more can still be done.
Does India have a strategic thinking and action that seeks to harness the overall new technology trends e.g. Internet cafes and mobile phones - for health action?
Its a good point. You are right about the need to be strategic in using ICTs and look for ways that infrastructure is set up to produce and use different health messages. This way economy of scale is possible.
What role do you see for the private sector?
I think the more people work together, the better it is. The role of private sector is essential. Of course the employer has a particular responsibility for the welfare of the staff. Its important to have a policy in place, which encourages people to open up about their HIV status, without the fear of loosing their jobs and also provides a mechanism for creating better awareness.
What would you like to suggest to all the people involved in fighting HIV/AIDS?
My aspiration is that people would work toghether. We all have our roles to play and if we can understand other peoples role and encourage them, it will indeed be great.
About Maxine Olson: She is the UNDP Resident Representative and UN Resident Coordinator in India.
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