For a people's movement

The key to APAC's success lies in its community-based approach to prevention.

APAC believes strongly in involving the whole community in the implementation of targeted intervention programmes. People's commitment, it says, is necessary to convert its efforts into a people's movement.

APAC involves local non-governmental organisations; voluntary peer educators who represent various areas and languages; volunteers who are part of cultural teams that organise street plays and programmes in the intervention areas; and community-based organisations such as self-help groups, youth associations and film fan associations. It trains private doctors to provide quality treatment and care for sexually transmitted diseases, ensuring their support on a permanent basis so that they provide non-stigmatised treatment to those in need.

APAC considers peer educators central to reaching out to the people. The reason: "Peer education is an important way of imparting non-professional education at a small cost in short periods by which culturally sensitive messages are delivered successfully for the benefit of specific groups."

Peer educators disseminate basic facts on STDs/HIV/AIDS, and provide care and support to those infected; educate high-risk groups on safe sex practices, condom use, and condom negotiation with sexual partners; help in the free distribution of condoms to specific groups on the basis of their need and popularise social marketing of condoms; identify those afflicted with STDs and motivate them to take early and complete treatment along with their partners; identify cases of repeated STD infections and /or treatment failure and refer them to appropriate health centres; and participate in APAC activities such as preparation of IEC (Information Education Communication) materials, monitoring, training, and so on.

Peer educators play a crucial role in linking the condom outlets and service providers; generating demand for counselling and voluntary testing; disseminating information to bring about behavioural changes; and identifying HIV-positive persons and helping them get medical intervention and support services.

APAC has a number of programmes to train, equip and build the capacity of peer educators.

According to peer educator M. Padma of the Community Health Education Society (CHES), an NGO that works with women in prostitution in 10 areas in Chennai, peer educators play a crucial role in breaking the barriers to discuss sensitive matters without fear and in confidence, which initiates and leads to sustainable behaviour change.

Says Devika Thilakaraj, a project coordinator with the Bro-Siga Social Service Guild (an NGO that works in 19 slums in Chennai): "Peer education is the most effective and informal way of giving the right message to target groups in a short time." According to her, a peer educator reaches out to some 25 people at a time. When he/she manage to effect any behavioural change in that population - usually within six months - he/she graduates to a super peer educator and starts training peer educators. In the past six years, over 90,000 people have been reached and some 1,000 peer educators trained by Bro-Siga.

Says CHES counsellor V. Kumaresan: "The training, awareness and information provided by APAC have empowered us to do our work efficiently. APAC's IEC material is extremely useful to reach out to people." According to him, the communication skills and technical training imparted by APAC are so strong that CHES has trained hundreds of peer educators.

The situation of children orphaned by AIDS is pathetic. They are generally ostracised by the community because they lost their parents to AIDS. CHES runs a home and provides education to such children.

According to peer educator M. Vijaya of the Indian Community Welfare Organisation (ICWO), a Chennai-based NGO working with women in prostitution, APAC has trained them not only to reach out to the high-risk group, but has helped set up the Indra Peer Educators Collective with 634 members who try to bring together all commercial sex workers in the State. Says Vijaya: "Myths and ignorance about STDs/HIV still exist. A lot of hard work has to be done to reach out to all those people. APAC is doing a wonderful job in this. We are happy to be part of this movement."

Says ICWO project coordinator K.P. Ravichandran: "APAC's capacity-building in imparting basic knowledge, counselling, social marketing of condoms, developing of supervisory skill, providing care and support to the needy, and documentation, has gone a long way in bringing about behavioural change." For instance, while a few years ago hardly seven shops stored condoms in Mahabalipuram, the seaside temple town near Chennai, today 37 of the 42 shops store condoms in a prominent way.

APAC has also taken initiatives to strengthen the networking of peer educators by forming district- and State-level peer educators associations. To strengthen the network, APAC organises district-, cluster- and State-level conventions on such themes as women in prostitution and long-distance truck drivers every year. The conventions, usually attended by 70-150 peer educators carefully selected by NGOs, are held once in six months to discuss the problems they encounter and find solutions.

According to V. Ilango, a peer educator with the Villupuram-based Association of Rural Mass India (ARMI), an NGO working with long-distance truckers, APAC's Demonstration Centres at Nagercoil, Tiruchi and Villupuram play a significant role in giving refresher training to new staff from affiliated NGOs all through the year. Ilango, who also owns a kiosk in Villupuram, has convinced 15 kiosks along the national highway to store condoms prominently. He conducts regular meetings for truck drivers and women in prostitution along the highway to educate them about STDs and refer them to doctors trained by APAC for medical help. All this, according to Ilango, has been made possible by the training provided by APAC.

Says S. Sekar, a young driver who has become an out-reach worker with APAC: "It takes three months to break the barrier with lorry drivers and refer them to doctors for medical help. But behaviour change is definitely noticeable among them." According to him, thousands of lorry drivers have benefited from APAC's intervention programme.

According to ARMI out-reach worker N. Sivakumar, 15 lorry booking offices along the national highway at Villupuram, are covered by ARMI. It has started a counselling centre at the regional transport office to generate awareness among lorry drivers. STD/HIV awareness messages are printed on the licence application forms. ARMI has helped in setting up 235 condom retail outlets between Villupuram and Udumalpet and trained 45 private doctors as referrals. "All this would not have been possible without APAC's help," says Sivakumar.

According to C. Kabilan, president, Tamil Nadu PATH (prevention along the highway) Peer Educator Association, 11 NGOs and 250 peer educators work in APAC's PATH project. "APAC's IEC material, which is comprehensive, detailed and tailored to specific needs, play an important role in disseminating information to people at large," he says.

Graduate students Johanna, Armelle and Elise have come all the way from France as part of their course work to get trained in HIV/AIDS prevention communication. Affiliated to ICWO in an APAC-funded project, they are based in Mahabalipuram and primarily help in creating awareness about HIV prevention among foreign tourists who come in large numbers to the temple town.

To overcome message fatigue, APAC has developed game and puzzle-based materials, such as carrom boards and snakes-and-ladder boards with prevention and care messages; and jigsaw puzzles and Rubik cubes to teach the right way to use a condom. These games have been replicated by HIV/AIDS societies all over India.

APAC has innovated the concept of a mobile exhibition booth, which has become an ideal material for intervention programmes all over India.

A ration-card cover with prevention and care messages, developed by APAC, addresses adults and youth in slums. Basic information on the disease is provided and people are encouraged to seek additional data from NGOs. A driver's kit along with prevention messages and methods of condom usage has been designed. APAC also develops television advertisement spots with messages from celebrities from the film world.

It has also developed materials including posters, stickers, handouts, and advertisement spots involving R. Meenakshi, a person living with HIV and an active member of Positive Mothers Network, Coimbatore. This material has helped in reducing the stigma attached to HIV/AIDS patients and their social discrimination.

APAC has also developed target-specific IEC materials for PATH, TWIP (tourist and women in prostitution), WIP (women in prostitution), SIP (slum intervention programme), CLIP (clinical intervention programme), MSM (men having sex with men), C&S (college and school students) and migrants.

Identifying the needs of people living with HIV/AIDS, APAC has prepared a handbook, Pudhiya Nambikkai ("renewed confidence"), which provides comprehensive information to give patients courage and hope. This booklet also provides information on their rights as also the services available to them. According to Meenakshi, the book provides a lot of courage to HIV-positive mothers and drives home the point that they can lead a normal, healthy life. "The success of the book is primarily because APAC consulted us on the material used in almost every page of the book," she says.

Apart from providing courage to HIV-positive mothers, APAC has also helped them form a network; provided them training in home care and counselling; and encouraged them to start cottage units such as card-making. According to Meenakshi, without APAC's encouragement the network would have remained a non-starter.

Giving training a central role, APAC has identified three Resource and Training (R&T) Centres (in Tiruchi, Madurai and Nagercoil) to develop trainer of trainers (TOTs) in street plays and traditional media. The TOTs, in turn, train others and form cultural teams to organise cultural programmes. According to Nagercoil-based R&T coordinator A. Palaniapillai, 124 NGOs, 50 of them APAC-affiliated, and 255 TOTs have been trained by these R&T centres. From the trained NGOs, 1,372 people have formed 127 cultural troupes and performed 7,857 shows all over Tamil Nadu. According to Palaniapillai, over 2.5 lakh people have watched these cultural shows. These programmes aim at providing comprehensive information to the general population and encouraging the target community to approach local NGOs for assistance.

According to Kabilan, APAC's ultimate aim is to make STD/HIV/AIDS prevention a people's movement, by reaching out to all sections throughout the State, so that the fight against the scourge continues regardless of the availability of funds.