The Outcasts

Malik Aftab Ahmed Awan, Pakistan

“He was already an addict and a shame for family. Now he has contracted AIDS as well. He has brought us nothing but sorrow, shame and disgrace. We shall never allow him to get back into this house.”

According to the reports of Pakistan Narcotics Control Division and UNODC, Pakistan is home to around five hundred thousand drug addicts who abuse different substances in one form or other. A significant percentage of them are injecting drug users. The injecting drug users commonly referred to as IDUs are a group marginalized and stigmatized by the society which shows little concern for the factors leading or driving them to drug abuse. The increasing prevalence of HIV among them has worsened their condition and added to their woes. Harassed by law enforcement agencies, stigmatized and ill-treated by health practitioners and shunned by their own families, they are the true outcasts of the society. You find them huddled together under the bridges, curled up in the dark corners of ill lit streets and sometimes sharing syringes and needles in deserted and desolate parks but prefer to ignore them pretending that they don’t exist. But by ignoring it we can make the problem go away. If we think the problem will automatically solve itself one day, we are badly mistaken. Drug use is an issue which we have been facing for many decades and by the looks of it, it is here to stay for a long time. Its repercussion and implications for development process in particular and for society in general are far reaching and manifold. It needs special attention from all of us and especially from those who matter like policy makers.

Though all the drug users face stigma and discrimination but the injecting drug users among them face it in much severe form due to many reasons and factors. Sharing of syringes and needles is a common practice among the group of injecting drug users. Injecting drug use is associated with many local and systemic complications for the individual and also is associated with the transmission and spread of infectious diseases including HIV via needle sharing and sexual activity. In recent years the prevalence of HIV epidemic has risen dramatically among injecting drug users and this rise has driven Pakistan in the second stage of HIV epidemic. According to internationally agreed definitions every epidemic passes through three stages. If the prevalence of epidemic is less than 0.1 % among general population, the country is termed as low prevalence. If the prevalence is more than 5 % in any sub group of the population, it is called concentrated epidemic and it is the second stage of epidemic. The epidemic is called generalized epidemic if 1 % of all pregnant women are positive. Pakistan today has reached the concentrated epidemic stage of HIV as more than 15%  of all the injecting drug users are HIV positive. In some cities of Pakistan the prevalence of HIV among injecting drug users is as high as 50%. To say that it is an alarming state is an understatement. There is every probability that in coming years we will be faced with a generalized HIV epidemic.

The spread of HIV among IDUs highlights many development issues as well as the issues of human rights. Risk behaviours leading to HIV transmission through shared needles and syringes are closely linked to development problems such as poverty and lack of sustainable livelihoods, exploitation, inadequate education and political repression. It is notable that some of the countries and communities most at risk from HIV and injecting drug use are often some of the least developed and Pakistan is no different. Even among these least developed countries drug use and HIV affect the most vulnerable and marginalized groups within communities. So they are the disadvantaged of the disadvantaged. The social and moral rejection and criminalization of drug use add to the plight of the drug users and drive further into isolation.

We must remember that problems associated to drug use and injecting drug use never remain confined to the group of injecting drug uses. Rather these affect the whole fabric of society in one form or another. Injecting drug use destroys social cohesion and erodes social capital. Through the cumulative loss of potentially important contributors to society, ultimately, injecting drug use undermines sustainable human development. Experience in many countries has shown that human development index suffers a severe setback. Add to this the spread of HIV and the gravity of the situation increases manifold. It is not uncommon for the HIV epidemic to travel to general population from IDUs through bridge populations. The wives (52% of all IDUs are married), children, families, clients and other people in direct contact with IDUs are called bridge population. Some of the IDUs are involved in selling and buying sex as well. Almost all the sexual encounters, which the IDUs have whether within the marriage or out side the marriage, are unsafe and unprotected. So it is not very far fetched to predict that in Pakistan too the epidemic is soon going to travel to general population through the bridge populations.

HIV epidemic though concentrated only in the certain sub groups of population is already costing us millions of dollars in loans and grants. If it travels into general population, the resources required to control it are definitely going to be out of our reach. Today we deny HIV positive IDUs the provision of ARVs (Anti Retroviral Drugs for treatment not cure of HIV) completely violating of their basic human rights of access to treatment and services. Will we be able to do the same to out general population if the HIV epidemic reaches the generalized epidemic levels? Do we know that 40% of the IDUs are less than 30 years of age, which is considered the prime working age? By letting the problem grow unattended we are essentially exposing our entire young generation and thus our future to risk of a full fledged HIV epidemic.

Unfortunately, like most of the developing countries Pakistan has not yet been able to devise a comprehensive strategy to address the issue of injecting drug use in general and of spread of HIV epidemic among IDUs in particular. Though a few NGOs like Nai Zindgi are doing remarkable work, yet the coverage of the entire group remains a big issue. The problems include:

• The current policy environment, making it difficult for community-based programs to prevent HIV among injecting drug users

• Lack of policy dialogue between sectors of government responsible for responses to HIV and drug use

• Economic, social and political dislocation, leading to increases in drug injecting, needle sharing and, consequently, HIV

• Low community capacity, in terms of skills, resources and experience to respond to HIV among IDUs

• Injecting drug users, being demonized for their drug use, rather than supported, placing them at particular risk of both human rights abuses and HIV infection

Lack of reliable data regarding the actual number of IDUs in Pakistan is another great impediment. According to the Mid Term Review report commissioned by Government of Pakistan and National AIDS Control Program in 2006-7, there are around five hundred thousand persons who use drugs in one form or the other in Pakistan. Out of these 150,000 are injecting drug users. Whereas according to the report of HIV and AIDS Surveillance Project which was also commissioned by National AIDS Control Program, the number of injecting drug users in 12 major cities of Pakistan is around 30,000 which when extrapolated to all urban areas comes to approximately 49,000. Yet another report by Narcotics Control Board says that out of 500,000 drug users in Pakistan 15% are injecting drug users i.e. 75,000. With different government departments providing different figures about the numbers of the same group, it is extremely difficult for any one to devise an effective strategy to address the numerous issues related to injecting drug users.

The above mentioned challenges do not mean that it is impossible to address the issue. The goal is not only control the spread of HIV among IDUs but also to provide them another chance of living healthy positive lives. In many countries community-based harm reduction programs including needle and syringe exchange programs, primary health care, peer education and counseling along with rehabilitation and re-integration have been very successful and they have been able to control the spread of HIV among the group. There is no reason why it can’t be done in Pakistan as well if we have the will to do so. (2008)

Malik Aftab Ahmed Awan is a dedicated and passionate development professional, working as the National Manager of Society for Sustainable Development and resident of Islamabad, Pakistan

Where Measles dare

Sugata M

When I entered the village, I felt something unusual. I could not find the children flocking and chasing me. There were few of them here and there but not keen to show the kind of attention generally showered on me in the villagers as a stranger.

The village looked surprisingly calm, hardly anyone seen outside their cottages. I could hardly hear the cries of the toddlers from their nests. The women were equally keeping quiet as if they forgot to take charge of their unruly children. I could mostly hear the chirping of some birds as if they were celebrating the silence of the villagers.

I choose the third cottage to trigger off my usual monitoring business. I checked the house marking and date first and then entered the small courtyard in front of the original cottage. An old man sat on the edge of the cottage veranda. He gave me rather ignoring look and even didn’t try to know why I sneaked into his place.

I told him politely the purpose of my visit and asked him if the children below five years of his cottage had been given polio drops in recent days by our house to house moving vaccinators. The old man gave me a blank look and did not make any reply. I asked him again but he remained dumb.

By that time two more men were seen coming from the backyard. They stopped after meeting me. I told them what I previously told the old man. “You must have heard about the door-to-door polio campaign that is on its way now. The Indian government wants to end polio for ever. That’s why every two months we conduct this campaign to give polio drops to all the children below five years. I have come to see if the small children of your village have received polio drops. If any one is left I will give them the polio drops.” I showed them the vaccine carrier that I was carrying.

“Yesterday the local polio-man visited our village. He gave drops to some of the children. But quite a few children were missed” I got the reply from one of the men.

“Why?” I exclaimed.

“They all died. You see this old man sitting here? His 11 year old boy died two days back. Since then he has become absolutely speechless.”

“But how did those children die?” I got a shock of my life.

“Khasra’ (measles) took their lives away. For last one month many of us in the village caught the disease including big and small children.”

“But didn’t you inform the district hospital?”

“Who will do it Babu (Sir)? We don’t know anybody in the hospital. Who will listen to us?”

The two men helped me to make the round of the whole village. I never experienced something worse than this before. There were still several children, big and small, struggling with measles. Some of them already developed complications like severe chest infection, unstoppable diarrhea and ugly infections all over their skin. Few were gasping in front of their helpless parents. When I asked about the number of deaths I could not find the exact figure from any one. It ranged from fifteen to twenty five.

“Is there any doctor treating the children?”

“The ‘jholachhaps’ (unqualified rural practitioners) generally treat us. We are poor people. We can’t afford to visit the big doctors of the town.”

“But these children are very serious. They should be taken to the district hospital immediately” I tried to explain to them.

“What is the use Babu? There is no medicine in the hospital. There is no bed. Patients are lying on the floor. The doctors are hardly seen. They will keep our children in the hospital to die. The ‘jholachhaps’ are at least available in the village. They come to our places whenever we call them to treat our children” A villager reverted back  with a cynical despair and frustration.”

Being a physician myself, I never felt so helpless and hopeless in my entire life.

When we are putting our best efforts to drive polio away, measles is taking away the lives of our children. Most surprisingly, nobody in the district came to know about this horrific crisis in a village which is just 5 km away from the district head quarter.

I rushed to the popular practicing quack in the next village. The man was a sincere informer. When I asked him about the measles mishap, he replied with a gesture of astonishment, “I know about the measles problem from the beginning. I also treated some of those ailing children. You told me to report only the cases of flaccid paralysis suspected to be polio. But you have never told me to report the cases of measles. So I didn’t bother to inform you about it”.

The proud Surveillance Medical Officer of the distinguished National Polio Surveillance Project of India received the biggest jolt of his life.

 I engaged the unqualified rural practitioners in the reporting network because they serve the poor villagers at their door steps and have the potential to report suspected polio cases during their very first contact. But the same system failed  to alert me on another deadly disease named measles because I never thought to equally sensitize my informers to report measles along with polio.

When I was leaving the measles-struck village, an old woman stopped me on the way and asked, “You guys come to our place to deliver polio drops. Why don’t you also give 'chhuiyans' (injections) to our children?”

Somewhere in her illiterate mind there was a strong belief that giving injections are critical to keep their children safe.

She was so true to figure out our massive failure to deliver routine vaccines to their small, innocent and highly vulnerable children.

(Based on a monitoring trip report of pulse polio program in Bihar in 2004)

CHILDREN OF LESSER GOD



It has become a common scene in Delhi these days.

When your car stops at the red light signal, a group of children, young boys and girls in their early teens rush to the vehicle with a handful of books, magazine and peep through your window pan with a sheer appeal in their face and eyes. They try to get the products sold to you. Some of them even show acrobatics on the road while the bigger ones beating drugs and sing popular Hindi film songs to entertain, most of time in vain, the moving people in the cars.

I had the similar experience while traveling by an auto on 25^th Dec. But the difference is, the mobile street vendors, this time were not even five years old. That means they can be still targeted for the pulse polio drive.

The boy and girl were shivering in the cold with barely anything on them. They were running between the vehicles to sell some ‘made in China’ products. I purchased one such thing from the girl. When the boy discovered me to take the item from the girl, he put his torso inside the auto to cling my feet and cried profusely to take at least one of his products.

It is not a novel thing. Small children are being constantly engaged into this in the busy streets of Delhi.

Who are the people behind this act? They do not bother to push the hungry, shelter less and careless children into a risky and inhuman business without caring damn of its implications.

We are supposed to have some acts in our legal system in the name of ‘Child Labor Protection Act’. We also have our ‘Human Rights Commission’ strongly positioned in our system. There are long list of NGOs and voluntary organizations being constantly vigil to detect the slightest violation of human rights. But there is nobody to protect these poor children in the streets of the capital city.

Sometimes, I feel we are not residing in a civilized society.

How can we say this society civilized where children are continuously getting deprived of their basic rights and undergoing treatments that simply stain humanity?

Sugata

CHALLENGES FACED BY PEOPLE LIVING WITH HIV/ AIDS IN SENEGAL.

By Uchenna Anozie, Nigeria

CHALLENGES

·         CO-INFECTIONS

·         MALNUTRITION

·         ARV SIDE EFFECTS

·         STIGMATISATION

·         ECONOMY

·         CO INFECTIONS

TB, KAPOSI, DIAHORREA, DRY COUGH, RASHES AND SKIN INFECTIONS

Patients living with HIV/AIDS have low immune system, often times patients think their ARV drugs are enough to protect them and some patients stop taking drugs when they feel healthy, some do not keep to medical appointments and only visit the hospital when they are critically ill. Some take herbal treatment along side with ARV drugs, good hygiene practice remains a thing of concern among people living with HIV/AIDS in Senegal.

·         MALNUTRITION

Poor state of the economy, neglect and lack of support from family members and the community, lack of appetite due to state of health and even drug reactions all contribute to the high occurrence of malnutrition in people living with HIV.

·         ARV DRUGS SIDE EFFECTS

ARV drugs are known for some side effects ranging from Lack of appetite, diahorrea, cough, hormonal problems and lactic acid imbalance in the body system, loss of weight, vomiting, nausea, and liver problems.

·         STIGMATIZATION

Stigmatization arises from fear, ignorance and socio-cultural factors. Up till date the societies, culture and religions have not learnt to accept people living with HIV and show love care and support to them, we have immigration laws and policies restraining the movement of people living with HIV/AIDS.

·         ECONOMY

It is no hard fact that economic situation in Senegal does not support people living with HIV; irrespective of the fact that they receive free ARV, they are not given free medical assistance or treatment for co-infections except TB. The employment sector openly oppresses people living with HIV/AIDS.

PUBLIC HEALTH APPROACH TO TACKLE THESE CHALLENGES:

·         HEALTH PROMOTION AND EDUCATION: people living with HIV/AIDS should receive proper counselling on how to take their medications, consequences of not taking their drugs, they should be taught how to practice proper hygiene practice and protect themselves from malaria and other diseases.

·         PROPER COUSELLING AND SOCIAL GROUP SUPPORT FOR PEOPLE LIVING WITH HIV BY GOVT.  NGOS AND CBOS: people living with HIV/AIDS should be encouraged to enrol with social groups to receive proper information on living positively, share experiences and also receive entitlements meant for them.

·         CHANGING THE THERAPY IF THE PATIENT HAS SEVERE ARV DRUG SIDE EFFECTS: patients who suffer from extreme side effects of ARV drugs should be given alternative ARV drugs to reduce suffering.

·         EMPOWERING PEOPLE LIVING WITH HIV WITH JOBS: micro credit facilities should be made available for people living with HIV/AIDS and if possible jobs should be created for them.

·          POLICY MAKING AND DEVELOPMENT: policies that protect people living with HIV/AIDS in places of employment, schools and immigration laws should be developed.

·         NUTRITION GUIDENCE: due to lack of appetite, people living with HIV/AIDS should be encouraged to eat as much as possible, eat small but frequently and drink lots of water also food supplements should be administered to them free of charge.

CONCLUSION

I have outlined some challenges amongst many others that people living with HIV/AIDS face in Senegal, we hope that government institutions, NGOs, CBOs, religious and cultural organisations will all fight against stigmatization and administer more support, love and care to that people living with HIV/AIDS. This also applies to many developing countries in the world; I want to use this medium to urge all public health workers to do more in ameliorating the situation of people living with HIV/AIDS in our immediate communities.

We can start today and our efforts can create a difference in our society.

The Hero of Manabpur (Story)

Manabpur is a thickly populated industrial township located at the Western corner of India. The place is inhabited by huge number of migrant workers who generally hail from poverty-stricken states of Bihar, Uttar Pradesh and Madhya Pradesh for livelihood. The place is also occupied by a large section of female sex workers and transgender with flourishing flesh trade.

Tuberculosis is a common problem of the poor local residents because mainly of their unhealthy living condition and gross lack of awareness. Most of the TB cases visit the flock of private doctors of Manabpur and spend their hard-earned money for the treatment. They are clueless about the fact that Govt. of India has a National TB Control Program where all TB patients are entitled to receive treatment free of cost.

The threat of HIV transmission is also looming large over Manabpur. The number of cases suffering from Sexually Transmitted Infections is rising. They are highly stigmatized mass, often visit unqualified local quacks for treatment and finally land into more trouble with incomplete and faulty treatment.  The sex workers and transgender depend mostly on the quacks for their health problems including frequent genital infections. They hardly go for HIV testing. They don’t know their HIV status. And they care a damn for condom if the clients offer more compensation.

Vinod came to know quite a lot about Manabpur from his friend Sudha who was working as a nurse of the local district hospital. Sudha told him that the district hospital receives off and on TB patients and some of them are also infected by HIV. She suspected the situation is really bad and something has to be done before it sneaks into the stage of ‘no return’.

Vinod just completed his Masters in Social Work and in search of a job. Sudha suggested him to apply for the contractual position of TB Health Visitor of Manabpur in the National TB Control Program. Vinod carried long cherished desire to be associated with disease control program the one like TB, so he immediately submitted his application. He had previous experiences of pulse polio and Mother & Child Health program. He got the job and his happiness knew no bounds.

The National TB Control Program of India hires one TBHV for the population of 1 lakh. The position is based in the urban set ups. The TBHV is responsible for field activities like visiting potential high risk groups of TB in the town/city, creating TB awareness and referring the TB suspects to the demarcated cough collection centres of the TB program. A person having cough for more than 2 weeks is a potential TB suspect.

Vinod came to know from Sudha that many of the TB cases belonging to Manabpur and adjacent areas visit private practitioners for treatment. Unfortunately, those practitioners are mostly unqualified and not trained at all on the management of TB. But they are strongly influential in the area both politically and at the medical business circuit. Nobody actually wants to disturb the equilibrium with them.

Vinod made them his first targets. He kept on visiting those practitioners on regular basis. His supportive behaviour and friendly nature won the hearts of those practitioners within a short span of time. He was able to convince them to refer the poor TB suspects visiting their chambers to the district hospital of Manabpur for free check-up and treatment. He even converted some of them into DOT (Directly Observed Treatment) provider to offer the medicines to their TB patients under direct observation on behalf of the National TB Program with an incentive from the program. Many of those private practitioners also participated in the training program organized by the district hospital and Vinod ensured that they would receive a certificate of attendance of the training that is duly signed by the District Administrator and District Tuberculosis Officer. The certificates were true motivator of the practitioners which made their engagement stronger with the National Program.

But Vinod didn’t draw full stop there. He still had miles to go.

He met with the coordinator of the newly formed District AIDS Society and fed him with the current HIV situation in the township of Manabpur. He gathered most of that information from Sudha and the private practitioners who used to treat a large number of Sexually Transmitted Infections as well in their clinics.

One day, a team from the District and State AIDS Societies came down to Manabpur and conducted the primary assessment survey. They met and interacted with the sex workers, pimps, transgender and the private practitioners and tried to capture as much information possible to have a clear stock of the situation. They also met the doctors of the district hospital. Vinod was their constant companion from the beginning till end of the survey.

Soon after, the State AIDS society appointed a local NGO to design a HIV project for the sex workers and transgender of Manabpur and submit a project proposal for the same. Vinod was specially requested by the District AIDS Society to guide the NGO in developing the proposal.

The proposal for the HIV project was approved by the state society and the NGO started their activities to enhance safe sex and health seeking practices among the sex workers. Vinod found it to be a good opportunity to initiate collaboration between the TB and HIV programs of Manabpur.

He started creating TB awareness among the female sex workers and transgender under the banner of the HIV project and triggered off TB suspect referral to the district hospital from these groups. Initially the sex workers were very reluctant to visit the hospital. They suspected once their identity gets disclosed they would have been grossly discriminated and ill-treated over there. But Vinod, with his sheer determination and exemplary managerial skill, overcame that challenge. He invited her nurse friend Sudha and other staff of the hospital including 2-3 doctors to have a round of discussion with the sex workers. A number of issues and doubts raised by the sex workers regarding their health seeking at the district hospital got clarified by the hospital staff. Gradually, the sex workers started moving to the hospital and utilizing the TB, STI and HIV counselling and testing services of the place. They could not find discriminatory behaviour from the hospital staff.

The TB program of the district does not have counselling services as per the norm of the National TB Program. Vinod fully utilized services of the counsellor who was hired for the HIV project of the sex workers. He brought his TB patients to the counsellor for motivating and mobilizing them for HIV counselling and testing in the district hospital.

The work load of the hospital increased many folds after Vinod joined the TB program of Manabpur.

His strategic move and hard work to improve the TB and subsequently HIV/AIDS situation in Manabpur have received high praise and accolade by the District Administration and Health authorities.

Vinod has recently been nominated for the award of the best health worker of the state for the year.

Sugata M

HIV/AIDS PEER EDUCATION AMONGST FEMALE SEX WORKERS IN ANAMBRA STATE, NIGERIA. EXPERIENCES, CHALLENGES AND WAY FORWARD

Anozie Uchenna

By This paper provides good information to planners and all stakeholders (National agency for the control of AIDS, National AIDS and STDs control programme, ministry of health, Nongovernmental and community based organisations) involved in HIV/AIDS peer education amongst female sex workers, this work was conducted in Anambra state, Nigeria, on the 23^rd October 2010 to 24^th January 2011 with the support from family health international and society for women and AIDS in Africa, Nigeria, to ascertain the need assessment for peer education amongst female sex workers in Anambra state Nigeria.

Training of FSWs Peer educators in a brothel, Ekwulobia, Anambra state, Nigeria.

According to the 2008 National HIV Sero-prevalence, Nigeria has a HIV prevalence of 4.6% and the female sex workers fall under the vulnerable groups. There is no recent data on the HIV prevalence rate of FSW in the country but the figures from the national AIDS and STDs control programme (Federal ministry of Health 1997) shows a prevalence rate of 36%.

 So far, these are various intervention methods put in place to protect the FSWs from getting infected; health education and free HIV counselling, screening and treatment. Peer education and IEC materials are widely used. The National Agency for the Control of AIDS (NACA), NGOs such as; Family Health international, PEPFAR, and society for women and AIDS in Africa and society for family health have been carrying out these intervention activities.

In carrying out this project we encountered difficulties ranging from the fact that; there were no clear criteria for choosing the female sex workers to participate in the peer education exercise, the low literacy level of the female sex workers was challenging, technical resources and funding of the project was not adequate, the time allotted for the project was small and project sustainability was difficult because of financial resource and lack of continuous supervision.

This study is necessary to evaluate peer education amongst female sex workers, to ascertain the knowledge and skills of female sex workers on safe sex practices and STI/HIV protection and to see possible ways of sustaining peer education amongst female sex workers.

Those that participated in the peer education programme were all commercial sex workers: 37 peer educators and 111 female sex workers and results showed that, the knowledge and skills of FSWs in Nigeria is poor and needs to be reinforced. We were able to ascertain certain facts through the use of questionnaires; FSWs that did not know their current HIV status was 80%, FSWs that had never gone for HIV screening was 50%, FSWs that use alcohol and hard drugs 90%, FSWs that lacked basic knowledge of STI and HIV was 30% and FSWs that had STIs previously was 70% (treated and untreated).

Training of FSWs Peer educators at Army Barracks, Onitsha, Anambra state, Nigeria.

Clear criteria for selection of peer educators should be developed by organisers of such programmes. This will help to assess the peer educators talents and knowledge.

More time should be allotted for such a programme to promote a long lasting behavioural changes and more learning and training time should be allotted to the peer educators                            

Peer education training required more intensified commitment because of low educational status of the peer educators; also this programme requires adequate funding and meaningful incentives for peer educators considering the natures of their work and how they value time

An organised evaluation research should be carried out to assess the effectiveness of the peer education programme amongst the female sex workers.

This study defines in detail, peer education and theories. Literatures were reviewed as regard the intervention for FSW to reduce the incidence of HIV amongst them. It also shows the experiences, limitations and recommendations for effective implementation of HIV/AIDS/STI peer education programmes amongst female sex workers.

 Anozie Uchenna training the FSWs in Army barracks Onitsha, Anambra state Nigeria.

Anozie Uchenna from Nigeria.
I am an intern (young professional internship programme) with the West African health organisation, Burkina Faso and I currently serve in Centre for ambulatory treatment for people living with HIV/AIDS Hospital FAAN Dakar, Senegal.
I have worked as a field supervisor and as a project officer for society for women and AIDS in Africa, Nigeria.  I have also worked as a volunteer counselling and HIV testing officer for family health international Nigeria. I hold a bachelor's degree in microbiology (Nnamdi Azikiwe university awka, Nigeria, class of 2004)I speak English, French and other native languages in Nigeria.I have a distinguished and extraordinary ability in community health promotions and health campaigns.  I am an innovator capable of creating new ideas and solutions to meet complex needs and challenges in the public health sector.

                  

                

TB-HIV Services Collaboration – List of Activities

From NTP side

1.     Referral of TB cases to VCT/ICTC for HIV counseling and testing

2.     Infection control in DMCs

3.     Providing CPT to HIV-infected TB cases

4.     Referral o HIV infected TB cases to the ART centres

5.     Capacity building of PLHIV networks on TB

6.     Capacity building  of the staff of NTP on HIV/AIDS

7.     Provision of ATT to PLHIV on ART

8.     Promotion of TB/HIV NGO-schemes

9.     Orientation/sensitization of the private practitioners on TB/HIV

From NACP side

1.     Referral of TB suspects from VCT/ICTC to DMCs

2.     Intensified TB case finding among the attendees of ART centres

3.     Infection control in ART centre and VCT/ICTC

4.     Intensified TB case finding among the PLHIV in home based care program

5.     IPT

6.     Provision of ART to those on ATT

7.     Intensified TB case finding in HIV high risk groups in TI projects, STI clinics and referral of TB suspects to DMCs

8.     Awareness generation on TB/HIV in the community

9.     Orientation/sensitization of the private practitioners on TB/HIV

10.                        Capacity building of staff of NACP on TB

11.                         HIV sentinel surveillance of the TB cases

Both the programs

1.     Constitution of TB/HIV Technical Working Group – National and State level

2.     Constitution of TB/HIV Coordination Committee – National/State/District

3.     Development/adoption of policy, guideline, training modules, tools, M/E framework

·         The same colour activity may be implemented jointly by both the programs