2. Project description (background and justification)
In India, the trends in drug abuse have shifted from the traditional abuse of opium and cannabis to heroin (primarily adulterated heroin or "smack") and, more recently, to synthetic opiates, other pharmaceutical preparations, volatile substances and designer drugs. New drugs, together with increasing injecting drug use, are posing new challenges for service providers and policy planners. Approximately 5% of HIV sero-positives are injecting drug users (IDUs). In a country where the total population is over one billion, the spread of the problem requires effective measures for drug abuse prevention.
Drug and alcohol abuse results in problems impacting not just the individual user, but also the family and community. Relationships suffer, financial sources get depleted, health costs increase. There are greater employment problems and increased emotional stress. Common family responses include depression, stress and resentment. The non-drug using partner may also take to drugs or alcohol for solace. The consequences of drug abuse are often more pronounced for families in precarious or poverty-stricken circumstances. Sexual relationships can become adversely affected. There is a serious risk of transmission of HIV and other blood borne viruses to partners of infected drug users, and of contracting sexually transmitted diseases. Drug use is often associated with domestic violence, which in turn aggravates the physical and emotional distress of the family. Drug abuse makes its deepest impression on those most vulnerable. Women, who traditionally appeared to have some kind of immunity to drug abuse, at least in terms of 'social inoculation' are now recognized the world over as increasingly being susceptible to drug use and burdened by its related problems.
The social, economic and health burden of substance use by the male impacts the lives of at least 5 members in his family. Of this, in India, at least half are female. Substance-use-related physical and emotional violence on women has been reported by at least 24-60% of women family members in a recent study commissioned by UNODC ROSA and the Ministry of Social Justice and Empowerment. Vulnerability to HIV/AIDS and STD risks among women partners was found to be very high. Multi-partner sex by male substance users was very high.
India also has an estimated 5.1 million people
(IMPORTANT: footnote on revision of estimates in July 2007) infected with HIV, an overall HIV adult prevalence rate of 0.9%. Thus, 10% of the world's population of people with HIV is Indian. The overwhelming majority of these (90%) are in the age group of 15-44 years. In the year 2000, HIV prevalence was over 1% among antenatal attendees in seven states.
Mizoram, one of the states where the project intends to work has over 5% HIV prevalence in high-risk populations. Women constitute 21.4% of known AIDS cases in the country. India's HIV epidemic is marked by heterogeneity - not a single epidemic but made up of a number of distinct epidemics, often co-existing in the same state. Driven primarily by heterosexual transmission, HIV infection is moving steadily beyond its initial focus among commercial sex workers and their clients, STD patients and Injecting Drug Users (IDUs), into the wider population. There is a noted shift towards women and young people with an accompanying increase in vertical transmission and pediatric HIV.
Girls and women are more vulnerable for a number of social, cultural and economic reasons. According to official figures, women comprise approximately one-third of reported HIV/AIDS cases. Ante Natal Clinic attendee rates in 7 states have shown a prevalence rate of over 1% signifying a generalized epidemic. The National and State Governments have concentrated on working with priority 'high risk' groups. Governments are now addressing the epidemic among the general population but given the size and diversity of India, it is an extremely challenging task.
Women in the project sites have scanty understanding of their reproductive health system and have low access to information and medical care. Cultural beliefs, practices and values control women's access to knowledge about their own bodies, particularly matter of sexual health. Female literacy rate is 54 %, close to 189 million women still lack the basic capability to read and write.
Gross enrolment rate in school is 65% for boys and 49% for girls, ages 11-14, with dropout rates of 60% for girls, 54% for boys.
3. Project description
CHARCA is a joint UN system project in partnership with the National AIDS Control Organization (NACO) of India. It aims to reduce the vulnerability of young women (aged 13-25 years) in the general population to the risk of HIV infection. It is being implemented in six localities in India. One of these is Aizawl in the state of Mizoram.
[1]
Mizoram's geographical location makes it a conduit for drugs (heroin) entering from Myanmar. Pharmaceutical drugs like spasmoproxyvon produced elsewhere in India are also illicitly consumed in the state. The drug issue has become a major public health problem in recent years and has added to the risk of spreading HIV.
The key activities of CHARCA are: (1) awareness creation, (2) capacity building, (3) strengthening services, (4) creating an enabling environment, (5) building support structures. As a general population intervention, CHARCA works with young women as well as a range of groups that influence the lives of young women, including groups of young men, groups of older women and positive people's networks.
CHARCA aims to equip women to protect themselves against HIV/STIs and realize their rights and thereby reduce the vulnerabilities of young women by providing information, improving their skills and access to quality services. It also aims to build leadership, support networks and the necessary enabling environment.
4. Project objectives and strategy
The five major areas the project will focus on to realize its objectives are elaborated below:
Awareness: The project aims to provide information on reproductive health and rights, increase their awareness on Reproductive Tract Infections, Sexually Transmitted Infections and AIDS so that they are able to exercise their right to a healthy life.
Building skills: The project aims to build the skills of women on various fronts (for example, education, life skills, vocational skills etc.) so that they have more control over their general welfare and are able to negotiate and exercise their right to a fulfilling life within the family and community.
Improving services: One objective of the project is to improve access and quality of services by reorienting public services to provide gender sensitive and women centered services. It will also attempt to work with service providers to lay emphasis and bring reproductive health services into the forefront of health services in the community.
Building support structure: The project will endeavor to support existing community organizations and collectives and such other groups towards addressing women's needs and problems. Where such groups do not exist, the project will facilitate the formation of such organization. It will render support to such organizations by way of capacity building and improving their skills to function more effectively.
Creating enabling environment: To harness the support of those people and agencies which form a part of the immediate environment of women, the project aims to improve the skills, raise awareness and sensitize them to create a conducive, enabling environment for the women to address their needs with respect and dignity. The project will endeavour to work with influential family members, community leaders, law enforcement agencies and the media to build a positive environment for women.
5. Immediate objective, outputs and activities
Objective
Where UNODC ROSA will play the role of UN lead agency in Aizawl District in Mizoram, a North Eastern state of India:
- to reduce STI/HIV/AIDS risks and vulnerabilities including those specifically related to substance abuse and IDU and increase capacities of young women to better protect themselves.
Where UNODC ROSA, as a thematic agency, provides technical inputs and fosters competencies related to reducing substance abuse driven HIV/STI risks and vulnerabilities in the six CHARCA districts:
- to reduce substance-abuse-related vulnerabilities and risks to STIs and HIV/AIDS among women in the six CHARCA districts in India.
Outputs and activities:
Sub-component A: Where UNODC ROSA will play the role of UN lead agency in Aizawl district in Mizoram.
First year:
- Institutional mechanisms to operationalise the project in Aizawl District are in place.
- Key stakeholders from the line departments and ministries sensitized on gender dimension of HIV related vulnerabilities and the CHARCA strategy.
- Baseline survey of the impact parameters, KAP and communication planning for the project conducted.
- IEC plan for CHARCA activities in Aizawl district are in place
- Peer driven life skills education programme for young people initiated
- Improving skills of young women to protect them selves at the pilot demonstration area initiated Activities.
Second - Third year:
Sub-component B: Where UNODC ROSA, as a thematic agency, provides technical inputs and fosters competencies related to reducing substance abuse driven HIV/STI risks and vulnerabilities in the six CHARCA districts
First, second and third year:
-
A toolkit for strengthening drug demand reduction capacities of young women and service providers dealing with young womens' vulnerabilities is in place.
- An IEC package for building awareness among key stakeholders on reducing substance abuse related HIV risks and vulnerabilities among young people is in place.
-
Technical capacities of a core group of Trainers from the 6 CHARCA districts for building capacities of service providers for better responding to substance abuse related vulnerabilities among young women are strengthened.
- Baseline survey of young women's vulnerabilities and risks of contracting STI/HIV/AIDS in the 6 CHARCA districts related to substance use, abuse and substance induced violence conducted.
-
An IEC/Advocacy strategy for mainstreaming substance abuse related concerns and issues in ongoing programmes and responses and initiating new responses for reducing STI/HIV vulnerabilities and risks in young women in the 6 CHARCA districts evolves and is operational in the pilot demonstration area.
Substance abuse risk reduction is integrated in the comprehensive risk reduction plan of the 6 CHARCA districts for the next scale up phase. |
