SIAAP AND ITS PROGRAMMES
Organisation and Staffing
By early 1992, there were seven staff working with SIAAP. (See Exhibit 1.) SIAAP was soon to lose Nandini, who would be getting married and following her husband to Bombay. A second member, Roma, was also scheduled to leave Madras in 1993, to join her husband at his new military posting. Recognising that they needed to make more formal arrangements for the accounts, the SIAAP team had begun the search for a part-time accountant to help them maintain their financial records and produce their financial reports. The volume of correspondence and documentation passing through the office was also forcing them to think of getting computer-literate secretarial help.
The single-room office had become far too cramped and the team was looking for larger office space and a sponsor to pay the rent. In May 1992, SIAAP was to become a registered voluntary organisation, with the right to maintain its own funds, rather than having them channelled through an intermediary such as VHS or PANOS. The original project funding was to end in October 1992.
The NGO Support Programme
The District workshops revealed that NGOs would need considerable help to implement HIV/AIDS intervention programmes. Although the NGOs had agreed that sexually-transmitted diseases (STDs) were a common problem in their communities, they said they were unable either to talk about them or to provide or link up with any kind of diagnostic and clinical services. Condom promotion was rare, with most NGOs focusing on types of family planning methods for which women take responsibility. Few NGOs had any experience in collecting and analysing information to help assess programme needs. Many had difficulty in identifying possible intervention strategies for STD/HIV prevention, tending to stick to approaches with which they were already familiar. Programme monitoring and evaluation were almost non-existent. Most importantly, in relation to HIV/AIDS, the staff was unaccustomed to talking to their clients about sex and sexuality and needed help in developing communication skills in this area.
SIAAP was given its first opportunity to provide follow-up support to an NGO when in April 1991 the Madras Christian Council of Social Services (MCCSS) asked for help in setting up an AIDS education programme in the slums where it was working. Shyamla helped MCCSS to design and conduct a survey to assess the needs of the slum communities, to develop an appropriate intervention strategy and programme, and to recruit and train programme staff. It soon became clear that in order to effectively integrate the AIDS programme into the work of the organisation, all the MCCSS staff needed information and training on HIV/AIDS. Shyamla also worked with staff to help them overcome their reluctance to talk about sex and to encourage non-judgemental attitudes. As Shyamla said, "the MCCSS staff changed from a group that did not use the word 'sex' if a substitute could be found, to a situation where condom jokes were heard freely around the office". This work with MCCSS was very valuable for Shyamla, giving her the chance to actually experience what SIAAP was asking other NGOs to do. It also confirmed for Shyamla that SIAAP had an important role to play as a resource for other NGOs and convinced her that SIAAP should continue to be involved in programme implementation if they were to be able to help other NGOs to do the same.
Other SIAAP Programmes
By keeping the project workshop costs to a minimum, by volunteering their time wherever possible, and by seeking local sponsorship, the SIAAP team managed to stretch the project funds over a number of other activities. These activities were in line with SIAAP's intention to develop model HIV/AIDS interventions that could provide examples to, and be replicated by, other NGOs.
The lorry drivers' health education programme was started by Kumar in October, 1991. His previous experience had shown that simply giving out STD information and condoms had little effect on behaviour, so this programme started with a survey of 200 lorry drivers at a check post some 30 kms. outside of Madras. The results of the survey showed that almost 90% of the drivers had visited commercial sex workers, more than 90% had had some form of STD, but less than 30% regularly used condoms. The drivers said that they would welcome somewhere to relax at the checkpoint as well as information about STDs and AIDS. In response, Kumar set up a health education booth at the check point where the drivers could relax and get entertaining STD/AIDS information, including details of where to go for treatment, and obtain condoms of different makes. By April 1992, there were indications that the programme had had some impact. The lorry drivers were asking more questions about STDs, were requesting more condoms, and had asked for STD services to be provided at the checkpoint. In addition, a number pf other NGOs, who had learned about the programme at the State workshop, had asked SIAAP to help them replicate it at other check points.
Nandini's previous experience had led to the design and implementation of a training programme for volunteers in Madras. The programme, run jointly with Kate, trained individuals to become peer educators for HIV prevention in their communities. Training in telephone counselling was to be included in the programme in the near future. With the help of these volunteers, SIAAP had already mounted puppet shows and street theatre, using traditional folk media, to help communicate the HIV/AIDS prevention messages to the urban slum communities with whom MCCSS was working.
Roma's training and experience helped her to conduct a study of the Madras slum dwellers' access to services for sexually transmitted diseases (STDs). It was estimated that one out of every 20 people in India suffered from an STD, and there were many reports from the slum women of infertility, frequent miscarriage and leucorrhoea (all indications of potential STDs). The study showed that whilst men were well aware of the dangers of STDs and sought medical attention (and penicillin shots) after "risky" sex, women would seek treatment only if they had an obvious problem. Women also tended to use private practitioners. Use of Government services by women was low, largely due to the lack of female specialists, the lack of STD services in the nearby clinics, the absence of adequate privacy, the judgemental attitudes of the doctors, and the costs of travelling to the hospital. NGOs working in the slum areas tended to focus on basic MCH services and referred any STD problems to the general hospital. The report indicated an urgent need for STD services to be provided in the slums, preferably a mobile clinic that could cover a larger catchment area. Roma found out that the Ministry of Health already had a van equipped to provide STD services, but lacked a female STD specialist or gynaecologist to run it. Over the next year, Roma planned to focus on finding ways to meet some of the STD needs identified by the survey.
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