HIV 5

SOCIAL ISSUES:

1. DISCRIMINATION:
Discimination is an unfair treatment of a person or group on the basis of prejudice.
 discrimination against people with HIV/AIDS is still pervasive in most parts of the country;
 discrimination touches every aspect of the lives of people with HIV/AIDS;
 discrimination is becoming more subtle and hard to redress;
 discrimination has a significant impact on the health and well-being of people with HIV/AIDS and of populations affected by HIV/AIDS.
2. STIGMA:
"Stigma remains the single most important barrier to public action. It is a main reason why too many people are afraid to see a doctor to determine whether they have the disease, or to seek treatment if so. It helps make AIDS the silent killer, because people fear the social disgrace of speaking about it, or taking easily available precautions. Stigma is a chief reason why the AIDS epidemic continues to devastate societies around the world."
From early in the AIDS epidemic a series of powerful images were used that reinforced and legitimised stigmatisation.
• HIV/AIDS as punishment (e.g. for immoral behaviour)
• HIV/AIDS as a crime (e.g. in relation to innocent and guilty victims)
• HIV/AIDS as war (e.g. in relation to a virus which must be fought)
• HIV/AIDS as horror (e.g. in which infected people are demonised and feared)
• HIV/AIDS as otherness (in which the disease is an affliction of those set apart)
3. WORK PLACE ISOLATION:
Persons living with HIV/AIDS often face enormous resistance from employers: "Every study of AIDS-related discrimination to date has found that the largest category of complaints concerns employment. Sometimes employers refuse to hire or retain HIV-infected workers because of ignorance and fear about how HIV is transmitted. Sometimes employers act out of fear regarding increased health insurance costs. And sometimes employers are simply responding to the fear and ignorance of the individual's co workers. Whatever the cause, the result is an unwarranted limitation on work place opportunity: the person with HIV disease is fired from a job, or not
hired for a job, or not promoted, or not given a raise, even though the person is qualified to work and able to keep working."
4. DENIAL OF EDUCATION:
A large segment of people affected by HIV is in the age group of 15-24 years. Many of them being students have had their problems further compounded by the denial of educational facilities in some form or the other. Such student have sometimes been singled out through placement in separate class rooms.They were discriminated to such an extend that some instances of isolation inside glass booths placed in a corner of the class were also reported.
5. FAMILY DISINTEGRATION:
At the family level ,an adult with HIV will severely compromise house hold resources as the functional capacity to work is reduced ,medical expenditures increases and income of both the infected individual and those who care for that person is lost. Reduced income in turn threatens food supply, the ability to pay for the education or health of surviving family members. And there are also cases in which the affected individual is forsaken by the members for certain reasons.

ETHICAL ISSUES:

1. CONFIDENTIALITY:
Because of the sensitivity of HIV-related information, many countries have adopted laws that provide additional protection to HIV-related medical records. except to public health authorities.


2. INFORMED CONSENT FOR HIV TESTING:
HIV testing was recognized as different from other blood tests because it presented serious psychosocial risks, such as rejection by family; discrimination in employment; and/or restricted or no access to health care, insurance, and housing. In recognition of these circumstances and to encourage testing, special procedures were adopted for obtaining consent for an HIV test, such as pretest counseling and specific informed consent.
3. PRENATAL HIV TESTING:
The primary strategy to prevent perinatal HIV transmission is to maximize prenatal HIV testing of pregnant women. Hence under mandatory newborn HIV testing, newborns are tested for HIV, with or without the mother's consent, if the mother's HIV status is unknown at delivery.
4. PARTNER NOTIFICATION:
It allows the doctors to discuss with the HIV infected patients about their active partners. (those whom they may have exposed to HIV infection through sex or needle sharing.) The Health Department or physicians can then notify people who are at risk about where to get counseling, testing, and treatment if they are infected.

LEGAL ISSUES:
1) Liberty, autonomy, security of the person and freedom of movement:
• People with HIV or AIDS have the same rights to liberty and autonomy, security of the person and to freedom of movement as the rest of the population.
• No restrictions should be placed on the free movement of HIV-infected people, and they may not be segregated, isolated or quarantined in prisons, schools, hospitals or elsewhere merely because of their HIV-positive status.

2) HIV Testing
(a) When may a person be tested for HIV
• No person may be tested for HIV infection without his or her free and informed consent (except in the case of anonymous epidemiological screening programmes undertaken by authorised agencies such as the national, provincial or local health authorities.)
• In all other cases – such as HIV testing for research purposes or when a person’s blood will be screened because he or she is a blood donor – the informed consent of the individual is legally required.
• Where an existing blood sample is available, and an emergency situation necessitates testing the source patient’s blood (e.g. when a health care worker has been put at risk because of an accident such as a needlestick injury), HIV testing may be undertaken without informed consent - but only after informing the source patient that the test will be performed and after assuring him or her that privacy and absolute confidentiality will be maintained.
• If an existing blood sample is not available for testing in an emergency situation, the patient must give his or her informed consent for blood to be drawn for the HIV test to be done.
• Routine testing of a person for HIV infection for the perceived purpose of protecting a health care professional from infection is impermissible - regardless of consent.
• Proxy consent for an HIV test may be given where an individual is unable to give consent. Proxy consent is consent by a person legally entitled to grant consent on the behalf of another individual. For example, a parent or guardian of a child below the age of consent to medical treatment may give proxy consent to HIV testing of the child.



(b) Informed consent, pre- and post-HIV test counselling
• Informed consent, which includes pre-HIV test counselling, is compulsory before HIV testing may be carried out.
• Informed consent means that the person has been made aware of, and understands, the implications of the test.
• The person should be free to make his or her own decision about whether to be tested or not, and may in no way be coerced or forced into being tested.
• Pre-test counselling should occur before an HIV test is undertaken. It should take the form of a confidential dialogue between the client and a suitable, qualified person where relevant information is given and consent obtained.
• Post-test HIV counselling should take place as part of the process of informing an individual of an HIV test result.
• Anonymous and confidential HIV antibody testing with pre- and post-HIV test counselling should be available to all. Persons who test HIV positive should have access to continuing support and health services.
3. Confidentiality and privacy
• People with HIV infection and AIDS have the right to confidentiality and privacy about their health and HIV status.
• Health care professionals are ethically and legally required to keep all information about clients or patients confidential.
• Information about a person’s HIV status may not be disclosed to anybody without that person’s fully informed consent.
• After death, the HIV status of the deceased person may not be disclosed to anybody without the consent of his or her family or partner – except when required by law.
4. Health and support services, public benefits, medical schemes and insurance
• Because people with HIV or AIDS in South Africa have the right to equal access to public benefits and opportunities, HIV testing should not be required as a precondition for eligibility to such advantages.
• People with HIV/AIDS have the same rights to housing, food, social security, medical assistance and welfare as all other members of our society.
• Public measures should be adopted to protect people with HIV or AIDS from discrimination in employment, housing, education, child care and custody and the provision of medical, social and welfare services.
• Medical schemes may not discriminate unfairly- directly or indirectly – against any person on the basis of his or her state of health.
• People with HIV infection or AIDS (and those suspected of being at risk of having HIV or AIDS), should be protected from arbitrary discrimination in insurance. Insurance companies may not unfairly refuse to provide an insurance policy to any person solely on the basis of HIV/AIDS status.

5.Education on HIV and AIDS
• All people have the right to proper education and full information about HIV and AIDS, as well as the right to full access to and information about prevention methods.
• Public education with the specific objective of eliminating discrimination against persons with HIV or AIDS should also be provided.
6.The responsibilities of the media
• Persons with HIV infection or AIDS have the right to fair treatment by the media and to observance of their rights to privacy and confidentiality.
• The public has the right to informed and balanced coverage of, and the presentation of, information and education on HIV and AIDS.
7.The right to safer sex
• All persons have the right to insist that they or their sexual partners take appropriate precautionary measures to prevent the transmission of HIV.
• The especially vulnerable position of women in this regard should be recognised and addressed - as should the especially vulnerable position of youth and children.
• People have a moral and legal obligation to tell their sex partners if they are HIV positive. They must also ensure that their sex practices are as safe as possible (e.g. by using condoms). Disclosing HIV infection to sex partners is a part of one’s duty to protect others from potential exposure to the virus.
8.The rights of prisoners
• Prisoners with HIV infection or AIDS should enjoy the same standards of care and treatment as other prisoners.
• Prisoners with HIV/AIDS should have access to the kind of special care that is equivalent to that enjoyed by other prisoners with other serious illnesses.
• Prisoners should have the same access to education, information and preventive measures (condoms) as the general population.
9. Duties of persons with HIV or AIDS
• Persons with HIV or AIDS have the duty to respect the rights, health and physical integrity of others, and to take appropriate steps to ensure this when necessary.










NATIONAL AIDS CONTROL PROGRAMMES (NACP):

EVOLUTION AND STRUCTURE:
• National AIDS Control Organization (NACO) established in 1992 with $ 84 million loan from the World Bank.
• In 1999, phase II of the National AIDS Control Program (NACP-II) initiated with another loan from the World Bank for $ 191 million. The National AIDS control policy adopted in 2002
• NACO has established State AIDS Control Societies (SACS) in most states to administer prevention and care activities
• Within the ministry of health and family welfare, the National AIDS Control Program is implemented as a vertical, stand alone program
• 64% of the budget allocated for prevention; 15% to care and support programs (excludes ARV drugs); 15% for technical capacity; and 6% for inter-sectoral collaboration
OBJECTIVES OF THE PROGRAM AND POLICY:
• In the second phase, the program aims to achieve 90% awareness levels and 90% condom use among “high risk” categories, and keep HIV prevalence below 5% in high prevalence states
• The project aims to train 600-100 NGO in conducting interventions among high-risk groups defined as sex workers, truck drivers, injecting drug users, migrant laborers and men having sex with men.
The main project components are
1. targeted interventions for the "high-risk" populations
2. preventive interventions for the "general" population
3. low cost care for HIV positive persons
PROGRAM AND POLICY PRIORITY:
• Emphasis on awareness in design of IEC, VCT, school based education
• National policy aims to reinforce "traditional Indian moral values" among youth
• STI control based on strengthening of STI clinics at the tertiary levels where drugs, reagents, training and other laboratory facilities provided
• Condom programming – decline in free distribution and increase in social marketing approaches
• Vulnerability of women articulated in terms of gender inequality and poverty, but no specific strategies identified
• Recent plans to introduce MTCT programs in all district hospitals
• Program document says that government will review and reform criminal laws in context of HIV, strengthen anti-discrimination laws and support services to educate HIV affected people about their rights
SIX KEY COMPONENTS:
1. Targeted interventions and “risk group” approach
2. Condom programming
3. STI control
4. IEC and Family health awareness campaign
5. HIV testing and counseling (VCT)
6. Mother to child transmission (MTCT)

SOCIAL SUPPORT SYSTEMS FOR PLHIV:

Social workers are one of the strongest sources of social support associated with high levels of medication compliance in patients with HIV/AIDS.
Today, social workers help clients cope with HIV/AIDS in a wide variety of settings, including home health agencies, hospitals, infectious disease clinics, and AIDS service organizations. While the doctor’s relationship with the patient seldom extends beyond the clinic or hospital doors, the social worker’s concern reaches into every area of the client’s daily life, confronting the challenges the client faces every day. One of the greatest challenges is remaining compliant with complicated treatment regimens.
The family and the environment remain the social support system to the client.
SUPPORT GROUPS:
The very AIDS Support Group mention of AIDSprovokes a picture of a person ridden with feelings of guilt and shame. There are many people who cannot bear with the idea of getting a HIV infection. They are scared to talk to anyone about it and also terrified how it will affect their family. Persons with HIV infection get terminated from their jobs and has no access to social services.
A support group helps one to deal and survive with the truth, horror, pain and deep sorrow. A community which shares and cares together. Help comes from all directions. Your experiences will also give another person hope!



COMMUNITY HEALTH PROGRAMMES:
It focuses on the health, development and wellbeing of individuals and their families; and through them the community at large. The program has been envisaged to address key issues affecting life at various stages.
It includes:
• Making Pregnancy Safe (MPS)
• Child Health and Development (CHD)
• Adolescent Health and Development (AHD)
• Nutrition for Health and Development (NHD)
• Reproductive Health and Research (RHR)
• Strengthening Public Health

POSITIVE WOMEN’S NETWORK:
Positive Women Network (PWN+) is an All-India network of HIV positive women, focused on improving the quality of life of women and children living with HIV/AIDS. We support one another, fight for our rights, and sensitize society about our needs.
Activities include…
• Organizing self-help and support groups
• Counselling
• Providing access to information and medicines
• Developing models for generating income and creating livelihoods among Women Living with HIV/AIDS (WLHA)
• Organising national consultations, public hearings, projects and workshops
• Forming regional networks of WLHA
• Carrying out research on key issues affecting women and children
The five core strategies of PWN+ are:
• Strengthen community outreach systems to identify and enhance the greater involvement and participation of women living with HIV/AIDS (WLHA)
• Scale up advocacy initiatives based on the experiences of WLHA, and the innovative strategies and interventions undertaken by the Positive Women Network and each of the state chapters
• Network with like-minded, supportive and influential institutions, stakeholders and groups that can address the concerns of WLHA
• Improve delivery mechanisms and modalities of all types of services for women vulnerable to, and living with HIV/AIDS
• Expand capacity building programmes and to work through WLHA wherever possible
{HIV/AIDS brings with it a fear of rejection, stigma, discrimination and harassment. Women living with the virus have described a sense of fatalism that sets in and a darkness that descends on their lives.
Living Positive is a means of converting a life filled with fear and fatalism into one of hope and meaning. It involves knowing that something can be done to make your life better, and that there are people who can walk with you on your journey.
Know your Rights
First, you have to know your entitlements. As a woman living with HIV/AIDS, you have a right to:
• Live free from violence
• Choose when to get married
• Choose who you marry
• Own your share of property
• Learn the skills you need for employment
• Get employment opportunities
• Guarantee your child a secure future
• Receive proper healthcare
• Get necessary information
• Get proper counseling
• Have reproductive choices
• Confidentiality regarding your HIV status
• Access drug rehabilitation services
Get help
Get access to information, medicines and advice
• Visit our Drop-In centres, which are open from 9:30 am - 5:30 pm on weekdays. You can get information on various issues (eg: legal matters, health advice etc.), help with medicines and/or doctor’s appointments, or just come to chat and relax.
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• Talk to us about anything you need to. If something is worrying you, tell us and we will help. We can talk to you over the phone, visit you at hospital, or you can even come in to meet us face to face. We guarantee to maintain confidentiality. No one will learn about your HIV+ status.
Get emotional support
Join one of our support groups, and gain strength from the ‘togetherness’. Experience has shown us that there is a lot to be gained from sharing your problems and supporting other women in your situation.
Find a means of earning your own income
• Start a business of your own: Thirteen women living with HIV/AIDS decided to create a means of earning their own livelihood. Starting out with no business knowledge and almost no money they worked towards starting an enterprise. With our help, The New Modern Garments Store, is now a flourishing enterprise.
• Join an existing venture:Social Light Communications is a design and print company that helps organizations develop communication material, and in doing so provides an income for women living with HIV/AIDS.
• Make and market products: The WE Shop provides marketing support for products made by women living with HIV/AIDS who are deprived of basic rights.
Find Inspiration
What does it take to survive the challenges of HIV/AIDS? Where do you find the energy to fight for what you need? How do you keep going when your world is falling apart? Can life ever really be normal again?
Across India, women living with HIV/AIDS find reasons to live and paths to happiness. Hear their stories. Learn what pulled them through…
Join the community
There are thousands of women Living Positive. They are all going through what you are. Why walk alone? Join our network and benefit from their experience, support and guidance. }