Presentation on theme: "CULTURE, COMMUNITY NETWORKS, AND HIV/AIDS OUTREACH OPPORTUNITIES IN A SOUTH INDIAN SIDDHA ORGANIZATION Kaylan Baban, Scott Ikeda, Deeangelee Pooran, Nils."— Presentation transcript:
CULTURE, COMMUNITY NETWORKS, AND HIV/AIDS OUTREACH OPPORTUNITIES IN A SOUTH INDIAN SIDDHA ORGANIZATION Kaylan Baban, Scott Ikeda, Deeangelee Pooran, Nils Hennig MD/PhD, Debbie Indyk PhD, George Carter, Henry Sacks MD/PhD Thomas C. Chalmers Clinical Trials Unit, Mount Sinai School of Medicine, New York, NY 10029 Foundation for Integrative AIDS Research, New York, NY 11217 & Gandeepam Siddha Hospital and Research Center, Tamil Nadu, India. Background Methods Extent of Gandeepams Reach HIV/AIDS Outreach Practices Conclusions & Looking Forward Based on time spent with Gandeepam staff, patients, and partner organizations, it appears that Gandeepam has created a very large and influential education and empowerment network in its region. Howeveralthough fighting the spread of HIV is one of Gandeepams top prioritiesneither HIV education, nor treatment, nor prevention is among the goals of its CBOs. Issues concerning HIV/AIDS are dealt with separately by clinic staff treating infected patients and, since patients are considered abstinent during treatment and treatment is considered curative, clinic counseling does not involve discussions of how to prevent HIV transmission. The clinical trial this grant lays the groundwork for could assist Gandeepam in assessing these outreach messages. Though in a unique position to raise awareness and combat the spread of HIV, it appears that Gandeepam and its partners are missing opportunities to do so, in part due to lack of integration of HIV education into other programs. As indicated in conversation and in survey responses, this approach seems at least partly informed by local belief systems and cultural norms. In recognition of the different beliefs held by the parties at Gandeepam and Mount Sinai School of Medicine, these small, realistically attainable goals are proposed: Build upon Gandeepams strengththeir extensive access to and influence in the communityto reduce local stigma against HIV patients. Proactive education in the villages, conducted as a matter of course and independent of specific individuals, could make life much easier for known HIV positive villagers. Open a dialogue with Gandeepam to ascertain the nature of their dislike of condoms, which is in part rooted in Siddhas Hindu tradition. It is not expected that Gandeepam will begin to promote their use, but perhaps they may not continue to discourage it in all circumstances. Chapters do operate independently, but a hierarchical network from Gandeepams Director to local field staff in the villages serves to ensure that they do not become too isolated from one another, or from Gandeepam. Through specific goals and target populations, these community-based organizations provide a forum for virtually every member of the village, and can form a net to strengthen the self-reliance of a village as a whole. Three weeks were spent with Gandeepam staff and patients, assessing Gandeepams community programs and regional influence, as well as approach to HIV/AIDS education, treatment, and prevention. Site visits were made to the headquarters of two Gandeepam partners, members of the GGF, for purposes of better understanding the extent of the GGFs influence, and making comparison to Gandeepams approach to HIV/AIDS in the community. A qualitative survey on the subject of beliefs and attitudes towards HIV/AIDS education, treatment, and transmission prevention was administered to representatives of 39 GGF NGOs during a quarterly conference in July 2004. Community-Based Organization (CBO) Description and Membership Child Labor Project Intended to benefit working children, provides evening classroom instruction in 15 villages for approximately 1575 children ages 6 to 17, some working and others not. Groups meet at least twice per month. Farmers Group For men, centered around Gandeepam trainings in plant cultivation. One of the less well defined CBOs, the reach and extent of members participation is unclear. Kitchen Herbal Gardens Meant to enable households to treat minor illnesses, low-cost plants with medicinal and nutritional value are marketed to approximately 60,000 households in 654 villages. Additional homes are reached by GGF partners. Sanjeevini (now autonomous) For women. Local chapters work to keep teachers in regular attendance at school, educate other parents against child labor, and draw government attention to village problems as necessary. Office located at Gandeepam headquarters in Kilavayal. Youth Club Predominantly young men over the age of 17. Members keep schools clean and maintain village libraries where possible. Role and membership seems less defined than that of other CBOs. Reprint Requests or Correspondence should be directed to: Kaylan Baban, BA, Mount Sinai School of Medicine 600 Columbus Ave, Apt 10J, NY, NY 10024 Kaylan.Baban@mssm.edu The gap that keeps HIV/AIDS treatment discrete from education and prevention is a global phenomenon, acknowledged as a major challenge to controlling the spread of HIV/AIDS. This study focuses on the work of Gandeepam, a non-governmental organization (NGO) in the poor rural region of the south Indian state of Tamil Nadu. Gandeepam practices an affordable traditional healing system known as Siddha medicine. The priority of their three clinics is the curative treatment of HIV/AIDS. In a country with one of the most rapidly increasing rates of HIV infection, the small state of Tamil Nadu contains close to 50% of Indias cases. Gandeepam is a strong and well-recognized presence in the community. A large portion of Gandeepams time and staff are dedicated to education and empowerment programs. Gandeepams non-medical efforts have five primary foci, organized into the following Community-Based Organizations: Child Labor Project, Farmers Group, Kitchen Herbal Garden Project, Sanjeevini Womens Group (originally a Gandeepam project; now an autonomous, federated NGO), and Youth Club. (See table.) Villages in the region establish local chapters of these groups, with help from Gandeepam. Some villages have chapters of all five groups, while some have only one, according to the needs and interest of the villagers. In addition, Gandeepam heads a network of 60 Tamil Nadu NGOs, known as the Gandeepam Global Foundation (GGF). Thus, Gandeepam has far- ranging influence not just in the immediate community, but in the larger state as well. HIV/AIDS education is conducted almost entirely separately from Gandeepams established community groups, and appears to fall solely to clinic personnel. Gandeepams official prevention and treatment messages discourage the use of both condoms and allopathic medicines, and promote their herbal treatment as a cure. According to Siddha tradition, sexual intercourse decreases the bodys ability to fight infection; therefore, patients are encouraged to practice abstinence, for therapeutic purposes, while undergoing treatment. Since adherent patients should be abstinent during treatment and cured after treatment, Gandeepam clinic staff do not counsel on ways to avoid transmission of HIV to others. An herbal oil to prevent HIV transmission has been made at Gandeepam, but is not in use. The survey of Gandeepams partner organizations (members of the GGF) yielded widely varied approaches to HIV/AIDS education and prevention, and no discernible coordination with treatment. Like Gandeepam, most GGF NGOs neither provide, promote, nor believe in condoms to prevent HIV transmission. Most GGF NGOs are reluctant to discuss sexual health issues with men or single women. Thus, those that do promote condoms usually target married women. A small minority of GGF organizations does provide condoms to sex workers. Purpose Part of a planning grant to assess Gandeepams capability to conduct future clinical trials of their herbal HIV treatment. See also: posters by Scott Ikeda and Deeangelee Pooran. This assessment is meant to establish the extent of Gandeepam and the GGFs influence on their communities, and to determine whether maximum use is made of the opportunities thus provided to promote HIV awareness, prevention, and treatment. Location in India of Tamil Nadu
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