In December 2010 the Mercury Phoenix Trust made a very generous grant of £10,000 in support of the third year of Christian Aid’s four year project ‘Preventing Parent to Child Transmission (PPTCT) work in Tamil Nadu’. The project aims to improve the access to and quality of PPTCT services and information for vulnerable people in this high prevalence state. The following report will provide information about the activities undertaken, the results to date and challenges encountered.

 

There are many key achievements stated throughout this document which highlight the fantastic work which has been achieved in tackling the area of PPTCT. Previously hospitals would not work with women living with HIV due to the stigma attached. Thanks to the support from Mercury Phoenix women have had the chance to lobby their rights to state officials, and now most government and many private hospitals care for positive pregnant women. Couple’s counselling has been hugely encouraged throughout this project so husbands do not stigmatise their wives. In the first year this proved difficult with only 16% of husbands attending. This has now increased dramatically to 82% of husbands attending couples counselling with their positive pregnant wives.

 

 

Activities carried out:

§ Outreach to HIV positive women. In each district the trained volunteers identified pregnant women and then through counselling them they were encouraged to go for a HIV test.

§ The women who are tested positive (PPW – positive pregnant women) are then referred to various medical services including pre-natal classes and support and network groups.

§ Outreach to PPW’s partners and couples counselling. By partaking in couples counselling women are less likely to receive discrimination from their partners.

§ The mother and child after the delivery receive regular check-ups for 18 months. HIV testing of the child and any other children in the family is done; anti-retroviral treatment is used if required.

§ Case studies were collected from several women regarding the discrimination they faced from the health services. This provided evidence to advocate for change.

 

Results:

§ In the third year of this project the number of couple’s being counselled increased dramatically from just 16% in the first year to 82% in the third year. All couples being counselled were concordant.

§ Out of the 82% of husbands that have been/are being counselled 28% are taking anti-retroviral treatment (ART)

§ From all the contacts referred from the volunteers 97% of them attended follow up sessions after the birth of their babies, with 96% of mothers and children receiving Nevirapine prophylaxis .

§ Out of all PPW who carried out follow up treatment for 18 months after the birth 98% of the babies tested negative.

§ Around 5,000 people are attending meetings put on by the service providers including medical and emotional support.

§ There are 12,239 people who have been trained on issues of PPTCT by the volunteers.

§ There were many positive case studies from women and husbands who received couples counselling – this was used to encourage other PPW to receive couples counselling.

 

Challenges:

§ There was difficulty shown because many women did not want their status to be disclosed so therefore did not want anyone to visit and give them health check-ups, so they had to find other places where they could meet the health workers. This added on to the challenges of having couples counselling as many women were too fearful to tell their husbands their status. It proved safer to implement the rule that women who had tested positive are not allowed to receive the results unless they are with their husband as then they can receive counselling and are more likely to accept the status of their wife.

§ According to WHO, the most common reason for new born deaths in South East Asia are infections including tetanus, asphyxia and low birth weight. As it is not possible to test very new born babies for HIV we have to take the common causes as the reason for death.

§ Within the last 3-5 months seven still births and 15 baby deaths have been reported because of unknown cases with a low CD4 count of the mothers.

 

 

Activities:

§ Further development and re-cap training for volunteers and outreach workers. They were trained fully in the first year so only needed a continuation of updates throughout the year with new relevant information. District coordinators were continuously strengthening the volunteer’s knowledge by providing them with monthly training workshops.

§ Building networks with other NGOs and development organisations. The District coordinators over the past three years have built strong relationships with other supporting organisations and NGOs. Many NGOs have been supporting this projects work with PPW and volunteers.

§ Assessments of the volunteer’s knowledge and attitudes towards PPTCT were carried out first, second and in the third year PPW were also assessed to see how their knowledge had improved.

§ The volunteers helped in setting nutritional support for PPW. In general the practice of the volunteers has improved and they were involved in the community more assertively.

§ There is no general awareness around for women or men on HIV so the volunteers have to form lasting relationships with the women to encourage them to go for testing.

§ During outreach activities the volunteers make sure that all PPW have a delivery plan and are aware of their CD4 count and general medical advice. Volunteers also visit frequently before the birth, are there during the birth to help as a health assistant, and after. Volunteers also offer advice to general pregnant women.

§ Many volunteers disclose their own HIV status. They were trained to tackle village and service discrimination, identifying issues for advocacy and solutions.

§ Assessments were done around the support for PPTCT from public and private maternity centres. Assessing the quality of service and discriminatory practice.

§ All projects are monitored with monthly review meetings done at partner level with all district coordinators attending. In this they review discrimination or other problems and also identify future issues that may crop up and work out solutions.

 

Results:

§ District coordinators over the years have developed relationships with other supporting NGOs and organisations. Good rapport has developed over the years with over 30 organisations. Activities have been enhanced greatly due to the support received. For example more women are coming forward for HIV testing due to the stigma being tackled.

§ 71% of volunteers were widows which traditionally would be seen as very taboo for them to work but through volunteering they have been empowered, with 80% of volunteers revealing their status and 60-70% able to go on and get a job within government support.

§ 68% of all identified pregnant women were referred for HIV tests.

§ In the first year many private hospitals were not willing to have PPW as patients due to the stigma attached to this. By the third year most provided ANC (Anti-Natal Care) for PPW. There are also a few in the city who conduct positive delivery.

§ 239 nurses and doctors have had training on PPTCT from 78 hospitals, with 15 private hospitals conducting 22 deliveries so far.

§ The community teams have managed to reach out to almost 20,000 women.

 

Challenges:

§ Some volunteers had to leave the program due to illness so new volunteers were recruited meaning relationships needed to be rebuilt between PPW and volunteers.

§ It is still proving a challenge to encourage private hospitals to partake in positive delivery procedures, however this is slowly being tackled but is a long process.

 

 

Activities:

§ Positive speakers are currently partaking in advocacy work in the districts and are being trained as positive activists.

§ District coordinators review the services and inform the authorities of any gaps in services.

§ When new services are introduced to the community the volunteers give plans to all local officials so the movement is strengthened and as many people as possible are aware of different projects going on.

 

Results:

§ Representatives from the committees were invited to share their findings and recommendations at district official meetings.

§ The project and staff report that awareness and interest at state and district level keeps rising and pressure toward private hospitals to support PPW is increasing.

 

Challenges:

§ The main challenge still remaining in this area is the issue of private hospitals not allowing births of PPW, and although advocacy is having a positive impact the process is still very slow.

 

 

Activities:

§ A network group was started for just women, where they could meet and have their needs heard as a number one priority.

§ Training a core group of women as community peer educators.

§ Training an administrator and financial manager for positive women’s network groups.

§ Support group meetings to support positive women started up in the third year of the project by positive speakers. This is a chance for all positive women to come together to collate information to feed back to other NGOs and official organisations.

§ Solidarity meetings have been set up to link PPW with other PLHIV connected with other networks.

§ Case studies of PPW are collected over the first three years and will then be used at a state level public hearing.

§ District level advocacy meetings have been conducted throughout the year discussing many issues for example delivery services, supplementary nutrition and anti natal care.

 

Results:

§ When the project first started there were very few networks just for women to speak openly about living with HIV, now there are network groups exclusively for women to join, their needs and demands will now be heard.

§ In the first two years the coordination and cooperation between many officials and network groups was weak in getting their attention to solve issues. This has now been addressed and improved with many issues such as lack of services being increased and discrimination being tackled.

§ It has been tackled at national level and private hospitals are being encouraged to not deny positive women delivery services.

§ There are now over 24,000 members in the HIV women’s network groups.

 

Challenges:

§ Some women have joined the positive women’s network group but are not very active because of fear of disclosure.

§ Although coordination has vastly improved between different network groups there is still concern for some groups who do not receive as much funding from the state.

 

 

 

Thank you again for your support

 

If you would like any further information about this project please contact

Laura Cooke, Trust Officer, Christian Aid on

+44 207 523 2474 or lcooke@christian-aid.org