THRIKKUNNAPPUZHA GRAMA PANCHAYATH: REPLICABLE RESPONSE OF A LOCAL SELF GOVERNMENT FOR THE CARE AND SUPPORT OF THE HIV INFECTED

[BEST PRACTICE DOCUMENTATION UNIT OF KSACS]

Thrikkunnappuzha, a rural village of Alappuzha District in Kerala
State has now become a replicable model for other Gramapanchayaths
(Rural Self Government Agencies) in the State for providing care and
support to the HIV infected without hurting their privacy or secrecy.

Providing welfare opportunity to all citizens, without any stigma or
discrimination is the constitutional obligation of all local self
governments in India. Hence HIV infected persons are also equally
eligible to become part and parcel of all welfare initiatives of Local
Self Governments (LSGs). They are also entitled to receive special
attention from LSGs as in the same kind as other weaker sections of
the Society benefit. However many instances of repudiation or
deliberate evasion of the HIV infected have been reported from many
corners of the State. Though there are several reasons for these
repudiations, wrong moralistic perspective of society towards sex and
sexuality play behind denial of such welfare services to the HIV
infected.

Albeit there has been a major change of mindset of society to the HIV
infected, self-stigma still exists in many of the infected persons. A
majority of the infected persons hide their HIV status due to the fear
of disgrace and abasement. It is estimated that there are a total of
55167 HIV infected persons in Kerala. However, three-fourth of them is
still invisible to the public health-care system. Political leadership
of many Gramapanchayaths in Kerala has shown willingness to support
their HIV infected people as a result of coordinated mainstreaming
efforts by the Kerala State AIDS Control Society. Some
Gramapanchayaths sanctioned projects for nutrition support, education
support, etc. Many such initiatives have failed, as the real
beneficiaries are unwilling to reveal their status before the
implementing officials owing to shame, fear of disgrace to the family
and possible stigma and discrimination from the neighborhood.

Realizing the situation, Thrikkunnappuzha Gramapanchayath authority
has taken necessary measures to ensure confidentiality while
implementing a nutrition support programme to its HIV infected
persons. The Gramapanchayath has been supporting their HIV infected
inhabitants since 2007 as an impact of the ‘Thejaswini’ Programme
implemented by KSACS to highlight the sufferings of HIV infected
persons to the community. This year the Gramapanchayath is spending
`35000 for providing nutritious food for all the eight HIV positive
cases among its inhabitants. Of course, the project amount is very
small but its unique implementation process ensures accessibility to
all the infected without revealing their identity to anyone in the
Panchayath.

The implementing officer of the ‘Nutrition Support Project for HIV
Infected’ is the Medical Officer of Thrikkunnappuzha Government Homeo
Hospital. The Project implementation procedure allows none of the
elected Panchayath members or other officials except the implementing
officer to meet or interact with the beneficiaries of the project.
The Medical officer of the Hospital normally hails from other areas of
the State and hence, technically none in the Panchayath are aware
about the beneficiaries of the Project. It encourages the real
beneficiaries to come forward and receive the benefit of the Project
without the fear of revealing their identity and possible stigma and
discrimination from the community.

With the support of ‘Prathyasa Kendram’, the Drop in centre for PLHIV
implemented by KSACS and managed by the ADNP+ (Alappuzha District
Network of People Living with HIV/AIDS), the implementing officer
distributes the nutrition kits to the beneficiaries every month. For
convenience, the Gramapanchayath authority transferred the sanctioned
project amount to the separate bank account opened by the ADNP+. Every
month, ADNP+ submits the expenditure statement to the Panchayath. They
never quote the name and address of the beneficiaries in any of their
communication or reports to the Panchayath. Instead, they quote the
ART Registration Number of the person in all its documents. The
Implementing Officer verifies these registration numbers. Distributing
the nutrition support outside the Gramapanchayath, and using ART
registration number for documentation and communication, ensures
supreme confidentiality to the beneficiaries of the programme.

If all Local Self Governments in Kerala replicate the procedure
adopted by Thrikkunnappuzha Panchayath to extend care and support to
their civilians, more people will come forward and receive such
supports. Gradually it will pave the way for reducing both self-stigma
of the HIV infected, and the stigma and discrimination of the
community towards them. Such a situation will certainly reduce the
invisibility of the infected from the Public Health care system. All
of them will definitely come forward and register at the ART Centre
for further health care. It also will contribute to the ‘halt and
reverse the epidemic efforts’ of National AIDS Control Organization
and its National AIDS Control Programme.