“In the early 1990s, CRHP and the National AIDS Research Institute partnered to determine the overall prevalence rate of HIV/AIDS among pregnant women in the population served by CRHP, revealing that CRHP’s rural population had a prevalence rate of 0.75% as compared to the urban Maharashtra prevalence rate of 3-5%. CRHP has been able to contain the epidemic within its project villages through the implementation of programs aimed at HIV/AIDS health awareness, prevention and promotion in a non-stigmatizing manner.
It has been at least two decades since the last comprehensive testing was done in the area, despite the many risk factors associated with living in rural India. Stigma-associated silence, heavily trafficked truck-driver crossroads and lack of education threaten low prevalence rates. Currently, CRHP is aware of at least ten villages in the project area that have HIV+ patients, but with so much HIV-related stigma and silence, the rate is undoubtedly higher. The vast majority of villagers will not utilize government hospitals where testing kits are cheaper because of the ill-reputed barriers associated with accessing quality care in a timely and appropriate manner. Furthermore, an individual test kit is outside the affordable range for most villagers.”
In the start of September, I volunteered/was assigned to take on a research project: “HIV Testing, Treatment and Education in CRHP Project Villages” as the study is formally entitled. The project is a result from a grant given to CRHP from UMCOR, focuses on women aged 18-40, and is twofold in design: in phase one, women in CRHP’s project villages will be tested for HIV via Tri Dot, blood test. In phase two, Village Health Workers (VHWs) and members of the Mobile Health Team (MHT) will be trained in Kalapathak – a creative method of educating others about disease by using dramas, integrating the health-related message with other social and health issues to reduce stigma.
I work with a dynamic team: Ratna, a training coordinator and social worker, Pandit Uncle, a social worker and Chandu Mama & Uma, both lab technicians. Each morning, we leave campus around 8:30 and head for one of CRHP’s villages. We set up our work station (a mat, box that contains our syringes and tubes, and register) in a central location, often a temple or pre-school, and with the help of the VHW, begin spreading word that rukta tapasne – blood checks – are being held for women. The women gather and we take their blood, ask them a series of demographic questions, and then ask them if they know what HIV is. If they say ‘no’ we stop the survey. If they say ‘yes’ we inquire further, with the aim of understanding their knowledge and attitude toward HIV:
Can HIV/AIDS be transmitted by sexual intercourse?
Can coughing transmit HIV/AIDS?
Can HIV/AIDS be transmitted by mosquito bite?
Would you invite someone with HIV/AIDS into your house for tea?
Would you share food with someone with HIV/AIDS?
The results of this brief questionnaire have been very eye opening, and the amount of stigma, educated or not, is astounding. So far, we have worked in 8 villages and tested 638 women, chugging along on our way towards our goal of 1,000 women! Even better, we have only had two results that have turned out to be HIV+. The VHW and one of our female social workers, who is HIV+, began counseling immediately and treatment, which is covered by the grant, will begin soon as well.
Uma laughing with village women as she asks questions for our survey
I’ve really enjoyed this project, for a variety of reasons: Working with the MHT is awesome, and I have learned so much about CRHP and the work we do through their telling me stories and answering my unending questions; Uma and Ratna encourage my Marathi-learning by teaching me phrases and putting me on the spot to practice; I am developing an understanding of the process of field research – the good, the bad, and the ugly – and learning how to be flexible when something that should go exactly according to protocol does not, realizing that the 30+ years of experience that Ratna and Pandit surpass the rigid rules of research I learned during Research Methods; my scope of life in a rural village has widened tremendously, and it has been fun to explore and experiment with my camera, which is like a new appendage. Last but certainly not least, this project has allowed me to witness the incredible impact the VHWs have on a community’s health and wellbeing: these incredible women are respected by all as leaders, healers, and educators. Although a white girl is visiting the pre-school seems to draw a hefty dose of curious women, it is the VHWs – concerned, convincing and confident – that truly persuades the women to be tested, and it is she who stays by their side as they wince at the sight of our needle, who omnisciently shares demographic information about each woman, and who will teach her village about HIV.