Ratan Singh Ng.Chairperson

GIPA Alliancee-mail:gipa.alliance@gmail.com

“GIPA in the Resource Poor Setting

& Conflict Situation ”

Manipur – a northeastern state of India bordering Myanmar (354km long stretch) known as flower in the lofty heights but now as HIV/AIDS epicenter. Population – 23,88,634 Total area – 22,327 sq. km. – 90% constitutes hills 29 tribes (having different dialect) Birth rate – 42.4/1000 child mortality <5yrs 61.7/1000 Per capita – Rs. 12,198 ($271), Lit. rate 66% BPL – 29%

Some salient features of the epidemic:Some salient features of the epidemic:

Porous border, instable govt., chaotic law & order situation, Porous border, instable govt., chaotic law & order situation, poverty, insurgency, etc. fuels the epidemic.poverty, insurgency, etc. fuels the epidemic.

Close proximity to Golden Triangle – Many have addicted to Close proximity to Golden Triangle – Many have addicted to Heroin Heroin

Estimated no. of IDUS : 30,000 - 40,000 apptly(80% are young).Estimated no. of IDUS : 30,000 - 40,000 apptly(80% are young). 23,288 ve+ (MSACS) upto June 2006 UNAIDS presumption is 3 23,288 ve+ (MSACS) upto June 2006 UNAIDS presumption is 3

times.times. 52.36% constitutes IDUs, 0.87% = antenatal mothers, 2.46% = 52.36% constitutes IDUs, 0.87% = antenatal mothers, 2.46% =

perinatal transmissionperinatal transmission A paradigm shift of HIV transmission-from IDUs to spouses – A paradigm shift of HIV transmission-from IDUs to spouses –

further to childrenfurther to children Seropositivity among antenatal mothers = 3.04%Seropositivity among antenatal mothers = 3.04%

0

10

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30

40

50

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90

1994 1996 1998 2000 2002 2004

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0.5

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1.5

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94 97 2000 2003

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Sentinel Surveillance conducted by Manipur State AIDS Control Society

Injecting Drug Users Pregnant mothers

PLWHAs in General Present State

Still underground/cocooned Majority are IDUs; male; married & unmarried

are equal. Many have formed self help/support groups

which play vital role in minimizing the impact. MNP+ takes a pivotal role while advocating &

minimizing Stigma & Discrimination.

Socio-economic State

Majority are poor and lack proper education.Majority are poor and lack proper education. Fall below poverty line.Fall below poverty line. Majority are daily wage earners.Majority are daily wage earners. Constant health break downs drastically Constant health break downs drastically

affects their income.affects their income.

Access to TreatmentAccess to Treatment

Access to care & treatment still a major Access to care & treatment still a major hurdle.hurdle.

4000-5000 would be needing ART4000-5000 would be needing ART Total no. of on ART 2003 (806-RIMS; 1062-JN; Total no. of on ART 2003 (806-RIMS; 1062-JN;

82-CCpur; 53-Ukhrul & others-350)82-CCpur; 53-Ukhrul & others-350) 1500 – 2000 have been estimated on 1500 – 2000 have been estimated on

prophylactic treatment. treatment.

Access to Treatment ………

Co-infection with Hep C among IDUs is extremely high. (98% - CCPr; 92% - Imphal, Panda 2000)

Treatment for Hepatitis is beyond the reach for majority of PLWHAs.

Hep-C is the major cause of death for those on ART as they cannot afford either the anti HCV or the alternative ARV such as EFV

Access to Treatment ………

Children have the least priority while accessing the ART moreover pediatric ARVs are extremely limited.

IDU constitutes atleast 60% those accessing ART out of which 5 – 10 % constitutes active/current IDUs.

Linkage between the patients and ART Centers is poor. No follow ups.

Adherence on treatment – another important area where many have fail to keep up with.

Stigma & Discrimination

S & D is comparatively better than rest of the country.

Much has been reduced as many can now access the treatment.

Except for the 2 main hospitals (JN & RIMS) rest of the district hospitals usually avoid treating HIV positives.

PLWHAs often magnifies the level of S & D then what it actually is

The Evolution of GIPA Alliance

PD & NGOs

With the Women SSGs

Formation

The Evolution of GIPA Alliance

GIPA – started happening after almost 10 GIPA – started happening after almost 10 years.years.

After the announcement - 6 NGOs & 40 After the announcement - 6 NGOs & 40 SSGs (PLHA) established the GA (GIPA SSGs (PLHA) established the GA (GIPA Alliance).Alliance).

GA encompasses altogether 1247 PLHA.GA encompasses altogether 1247 PLHA. Has a core committee that consist of 6 Has a core committee that consist of 6

entities (MNP+, NEIHRN, LLF, SASO, KF & entities (MNP+, NEIHRN, LLF, SASO, KF & CF.)CF.)

VISIONVISION

An enabling and supportive environment in response to the impact of the epidemic through GIPA for integrated community

development.

Bringing quality life to people living with or affected by HIV/AIDS.

Endorsing GIPA at all level for ensuring ownership & effective implementation of policy/program on HIV/AIDS through advocacy.

Motivation and skills development to empower PLHAs for a sustained enabling environment through capacity building.

Strengthening and expanding the Alliance at the regional level through networking and linkages amongst various agencies.

MISSION MISSION

Achievements

State Level Establishing Workshop – Hotel State Level Establishing Workshop – Hotel ExcellencyExcellency

Regional Level Consultancy Meeting – State Regional Level Consultancy Meeting – State Guest HouseGuest House

Series of advocacy meetings with RIMS, JN Series of advocacy meetings with RIMS, JN Hospital & MACS – resulted to – MOUHospital & MACS – resulted to – MOU

Placement of 4 GA Volunteers at ART Placement of 4 GA Volunteers at ART Center, RIMS. The same was placed at ART Center, RIMS. The same was placed at ART Center, JN Hospital. Center, JN Hospital.

3 Treatment Counselling Centres in 3 Treatment Counselling Centres in collaboration with ART Centres manned collaboration with ART Centres manned by GA membersby GA members

GA employs a State Coordinator GA is included in the State Advisory

Committee on ART programState Steering Committee for GFATMState Steering Committee for GFATM

Achievements…………..

Representation at the Executive Representation at the Executive Committee of State AIDS Control SocietyCommittee of State AIDS Control Society

Gave us a room to share our experience in Gave us a room to share our experience in the Project Implementation Plan for the Project Implementation Plan for National AIDS Control Program-IIINational AIDS Control Program-III

Representation of members in the Joint Representation of members in the Joint Appraisal TeamAppraisal Team

Initiated a Media Committee on HIV/AIDSInitiated a Media Committee on HIV/AIDSFree Legal Aid Cell for PLHAFree Legal Aid Cell for PLHA

Memorandum of Understanding signed

with Regional Institute of Medical Science (RIMS) & Manipur State AIDS Control Society (MSACS)

GA Chairman has been included in State Advisory Committee on ART

Also in the State Steering Committee on Global Fund for AIDS, Malaria & TB

Volunteers placed at RIMS ART Center RIMS

ART Center JN Hospital

Exploring Effective Advocacy Strategies

NGO/CBO/FBO - 1SHGs; Religious Groups

PLWHA

HOME & COMMUNITYFamily; Friends; Relatives

ARV/OI Med SUPPLYART Center; Chemist;Stockist; Pharma Compy.

HEALTH CARE PROVIDERHospitals: State; Districts; Med. College;Pvt. Hospitals; Clinics; Practitioners;

MONITORINGDIAGNOSTICSVCCTC; Microbiology;Pvt. Diag. Centers

REFERRAL &NETWORKING

GIPA Alliance

CONTINUUM OF CARE Area Specific

Distribution of Drugs

Free Health Camp

Peer Support/counseling Fund Raising

Org 4

Org 1

Org 2

Org 3

GIPA ALLIANCE

STATE HEALTH SECTORSPrimary, Secondary & Tertiary

MONITORING & ADVOCACY

STATE WIDE CONTINUUM

District A

District D

District C

District B

TOGETHER WE CAN MAKE A DIFFERENCETOGETHER WE CAN MAKE A DIFFERENCE

GIPA Alliance

THANK YOU!

AIDSDENIALI

SM

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