On an AIDS control mission

P. Krishnamurthy

On an AIDS control mission

Even today HIV/AIDS is a highly misunderstood and stigmatised disease. Imagine what would it have been in 1995 when AIDS Prevention and Control Project (APAC) came into existence to arrest it's spread. Myths about the virus confused the public, doctors shied from treatment and no successful field strategies to control the increasing spread of the disease were available. A mammoth task awaited P. Krishnamurthy, the Joint Director of Tamil Nadu State AIDS Control Society, who was selected as the Project Director of APAC. Nothing short of determination, grit and a very large measure of perseverance would be critical in driving away the myths, raising knowledge levels and creating an environment conducive for treatment. And this is exactly what kept him and his team going to find solutions in an unchartered territory, says Dr. Krishnamurthy.

In the city recently, he spoke to Puja S. Navin about the challenges and achievements.

Describing the origin of the project, he says, "APAC project was formed in 1995 through a tripartite agreement between the Voluntary health Service (VHS) in Chennai, a non-governmental organisation, United States Agency for International Development (USAID) (donor agency) and Government of India with the primary objective of preventing and controlling the spread of HIV/AIDS through sexual mode. This was the first of its kind in the country."

Hence, the tasks awaiting it were mammoth. As he took over, the first challenge was how to implement the project and what mode of communication could be used to communicate messages as sensitive as changing the sexual behaviour.

"Though there were many models of programme implementation from Thailand, South Africa and Cambodia, we had to innovate through trails and researches and develop strategies suited to our environment."

Since a specific population is at a higher risk, a targeted intervention strategy (TSI), i.e. activities and approaches aimed at working closely with such groups were evolved. (These include women in prostitution, industrial workers, truck drivers, urban backward settlements and slums and men who have sex with men.)

"The first challenge we faced was to identify the people at a higher risk. You can imagine the difficulties; who will disclose that they are sex workers or affected by the disease? We moved in the field, worked silently, trained NGOs to build rapport and win the trust of the target population. A snow-balling technique was developed and we identified an entire group through the help of a few members."

The second challenge was developing communication techniques that could bring about a change in behaviour. "How do we communicate that you must have a single partner, you must use condoms. We struggled to find suitable communication packages." They used innovation once again. Mobile vans with folk media and street plays were used for creating awareness.

The third issue, which confronted programme planners, was paucity of reliable field researches.

"So, we undertook a good number of academic studies to understand the behaviour of the high - risk population, estimate the prevalence of sexually-transmitted infections in the community, assess the quality of Indian condoms and understand the behaviour of doctors towards patients. The findings of these research studies have been very useful for the National Aids Control Organisation (NACO)."

For example, the communication needs assessment research helped them understand that a communication strategy that gives repeated messages, builds in an interpersonal communication component that will be more successful than one that is through literature and hoarding and even television programmes.

The results speak for themselves. Many myths and misconceptions about the disease and virus have been dispelled, awareness among the common public has increased, sustained behaviour change among the high-risk populations has taken place as recent surveys show and there has been a reduction in the rate of spread of the disease. The other encouraging trend is the increasing participation of private players in treatment.

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