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Reaching the Unreached : Expanding Access to HIV/AIDS Services

This document discusses the changing face of the HIV epidemic, from high-risk groups to the general population, and from urban to rural areas. It addresses the challenges of reaching the unreached, including lack of access to information and services, stigma and discrimination, and community unawareness. The document outlines major policy decisions taken to expand access to HIV/AIDS services, including training of healthcare workers, universal HIV screening for pregnant women, and strengthening access to quality blood transfusion services and condoms. It also provides a companion guide for field-level workers, offering information on HIV/AIDS prevention, testing, treatment, and care, as well as strategies for fighting stigma and discrimination and addressing gender dimensions of the epidemic.

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Reaching the Unreached : Expanding Access to HIV/AIDS Services

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  1. Reaching the Unreached :Expanding Access to HIV/AIDS Services Bhopal July 4, 2010

  2. Changing Face of HIV Epidemic Movement from … High risk groups to general population Urban to rural areas High prevalence states to all states Feminization High vulnerability of youth/ migrants

  3. Background > 10 lac HIV positive people are yet to be reached, scattered in general population, underground Lack of access to information & services Inability to negotiate for safe practices Widespread stigma & discrimination in society Community unaware about its role in prevention & management of epidemic

  4. Towards NACP & NRHM Convergence Major policy decisions taken: Train ASHA, ASHA facilitators, ANM & LHVs on module “Shaping Our Lives” Universal HIV screening of pregnant women through rapid blood test at VHNDs, HIV status disclosure only at ICTCs All 24x7 facilities to provide ICTC & PPTCT services Counselors under NACP program to also counsel non HIV pregnant women on nutrition, STIs, birth spacing Incentive to service providers conducting institutional deliveries for WLHIV & support to C/ pregnant WLHIV for additional visit to health facility under JSY/ un-tide funds for VHSC Assured access to STI services & cross referrals with HIV/TB programmes Strengthening access to quality blood transfusion services/ condoms

  5. Shaping Our Lives -Companion for Field Level Workers For - ASHA, ANM, LHV, AWW & SHGs - Providing information on how to prevent HIV infection - Informing about ICTC for couples willing to take HIV test at nearest PHC/CHC - Motivating family of PLHA to take ART treatment at nearest ART center in government hospital - Counsel family on need for special diet & nutrition for PLHA - Mobilize community leader on care & support for PLHA - Informing adolescents & elders migrating for work on safe behavior

  6. Contents 1. Learning about HIV/ AIDS and field workers role: - Modes of HIV transmission, symptoms & stages of HIV/AIDS - STIs and its management - Prevention of HIV AIDS, Men’s role & responsibility in protection & prevention 2. Counselling and Testing, Treatment and child care: - Pre & Post test counseling, integrated with maternal health & institutional delivery promotion for optimal benefits - Helping the client with outcome results - What is CD4 count test? - PPTCT & its prevention, role in PPTCT

  7. contd… - Difference in treatment of infants, children & adults - Community care centers role ART: - ART not required for all HIV positive persons - ART if discontinued, leads to resistance - Prevention of HIV/ AIDS - ART treatment is free in all ART centers - Start treatment only after medical advice - CD4 test is only test to tell when to start treatment

  8. contd… 3. Gender Dimensions of HIV/AIDS: - HIV & women empowerment issues - HIV vulnerability of girls & women, how to address it - Impact of trafficking & migration on women - Vulnerability of even married women - Rights of HIV positive person - Interaction with community with role plays & story 4. Fighting stigma & discrimination: - Addressing stigmas & discrimination in village - Disclosing positive status with spouse/partner - Working with others to protect rights of W/CHIV, community mobilization

  9. contd… 5. Nutrition for PLHIV: - Importance of good nutrition - Nutritious diet - Nutritional care for PLHIV: asymptomatic, pregnant women, infants & children, persons on ART, loss of appetite, diarrhea, mouth sore and oral thrush 6. Fighting myths & misconceptions: - HIV spreads through shaking hands, eating/ drinking together, working, sharing house/cloths, mosquito bites - Blood donation may lead to HIV - Safe for PLHA to have unprotected sex with another PLHA - Caring for HIV/AIDs is risky - Women should not ask for condoms, Sex with virgins may cure STI & HIV

  10. Some Areas for Strengthening - Providing platforms to practice skills: VHNDs, community sensitization sessions, VHSC meetings - Counseling universal HIV screening for pregnant women, people with STIs. - Visit to STI clinics, ICTCs, PPTCT centers, CCCs, ART centers & DICs to have a experience on activities and approach to PLHIV - A chapter on HIV and Males, and role of PRIs to address livelihood support, gender, stigma & discrimination, human right issues of women & children living with HIV. - Provision for feedback from health facilities to ASHA on referrals made by her - Reporting & monitoring system

  11. Outcome - All pregnant women line listed for birth plan & counselled on nutrition, STI & HIV testing. - All pregnant women screened for HIV, if positive, have access to ICT & PPTCT services - All women have access to quality maternal care, STI services, safe blood transfusion services - W/CLHIV supported for additional visits to health facilities - Increased awareness on HIV/ AIDS prevention , care & support in unreached population - Community taking lead to address lack of - knowledge, livelihood, stigma & discrimination issues of women in general & PLHIV in particular

  12. Thank You

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