World AIDS Day 2009-10 : Missing the target?
- Part 1 -

By Deben Sharma *

This year world AIDS day was observed under the theme, "Universal Access and Human Rights". It is interesting that the global concerns for PLHIV around the world had to seek Human Rights framework to remind states, in developing and underdeveloped countries, their obligations for providing health care, treatment and support service access to PLHIV.

It is indeed a sad fact that 'access' continue to be an issues for PLHIV even after more than a decade of HIV and AIDS programming around the world and even when we are just a year short of hitting the deadline of Millennium Development Goal in 2010.

What is even more disturbing is the lack of clarity on what is/are our local specific issues that is commonly affecting the PLHIV community and also the general population!

State government of Manipur, however, put up a huge function to observe the World AIDS Day 2010 with select people and law enforcement community amidst tight security in safety enclosure of 1st MR without telling much what concrete action plans are in place to improve existing service delivery systems.

The day should have encouraged PLHIV community and their network more to actively discuss and assess the issues of access to care, treatment and support services for different marginalized sections of people in the community and unpacked specific action plans to improve access before the end of MDG decade next year.

Our PLHIV network could also have actively discussed concrete advocacy action plans for improving access and how best they could monitor the government's service delivery systems, quality of services as it is their local responsibilities in collaboration with legal activist networks.

The day seem to have gone by again as 'one of'/ 'stand alone' another routine annual ritual activity without any follow up action plan, as usual. Two main factors motivating the event could be 1) some budget to be spent and/or 2) moral obligations/ a duty.

Behind the state function at 1st MR is also disappointed PLHIV network of the state whose requests for financial assistance for observing the World AIDS Day were turned down due of lack of fund at MACS. Perhaps! MACS had just the budget to organize the huge state level function at 1st MR on their own.

But ask whose issue is 'access' anyway and whose rights are being affected by access or no access? State can always organize functions with concern and goodwill for HIV and AIDS infected and affected people as it should always but what has our state government to offer to the PLHIV community to improve the access within the existing service facilities besides the few mobile ICTCs?

What plans did the honorable Chief Minister and Health Minister who attended the function had to offer to check points of pilferage, loosen bureaucratic bottlenecks and clean up corrupted practices, ensure financial disciplines and good governance in the systems and plans for empowering the PLHIV in terms of decision making? Quite surely 'access' is certainly not Govt's or MACS's issue.

On the theme 'Universal Access and Human rights' we thought PLHIV network and NGOs working with them will take center stage. But it did not happen.

Why? We leave this question for PLHIV network. As for the state it is an obligation and bounden duty to ensure access to health facilities to all its citizens in all corners. State AIDS Control Society is supposed to play a facilitating, empowering and supporting role to PLHIV community/ Network under NACP-III (2006-2011).

On the other hand in the PLHIV community and NGOs involved in HIV and AIDS, and Drug issues also separately observed the day at least 3 different places in the capital city. As if it was unsafe, none of these organizations took out any rally, jointly.

MACS only organized one and some NGOs joined bandwagon! The question here is why a common issue like "access and human rights" could not bring all these organizations or at least the PLHIV networks in the state together on a common platform under a single roof to share their concerns and discuss issues on this annual day and come up with joint strategies of advocacy?

Independent studies have revealed that around 80% of infected people belong to poor families with low literacy and many of whom are innocent young men, women and children who live in remote areas. Majority of them cannot afford private hospital bills and so have to rely on Govt health facilities.

How much of their concerns in terms of access were considered on this day? We need a leader and a hero who despite his better off economic standard consciously decides to seek medical care only from Govt hospitals with a mission to access the facilities to all the poor infected people especially women and children in the state.

While MACS was observing the World AIDS Day at a state level with public rally and meeting small group of concerned members of USER Manipur and senior members of Parenting Forum Manipur had a serious discussion and reflection on the issues of HIV and AIDS in the state under the theme, "Universal Access and Human Rights".

The discussions was participated by 15 youth and elderly persons belonging to different field of work such as legal activist, educationist, teaching, health, culture and social work and Media including 3 PLHIV. Quite surprisingly, the whole of the discussion which began on the theme of "Universal Access and Human Rights" went out of the way so much on the need for Awareness and Prevention in the state.

Obvious reason for this diversion could be that it was not exclusive PLHIV gathering. People who gathered expressed more concerns about the existing level ignorance, lack of awareness, lingering stigma and discrimination and also the alarming rise in prevalence in the state as reported by MACS. The issue of 'Access' never appeared in the entire discussion!

This is not to suggest that access is not a serious issue in Manipur but the question is who should be more involved, promoted and concerned; Health Department/MACS, PLHIV Network/community or Families and communities where PLHIV live.

Secondly, this is to suggest that the HIV/AIDS project focus should go beyond the confines of PLHIV community to involve the general community in greater ways. People today live with PLHIV. They need to be more aware, involved and supportive to PLHIV at homes and community.

The theme of the year 'Universal access and human rights' considered only for PLHIV community miss the general community which are now seriously affected by HIV and AIDS in the state. We must remember that almost all of those 7500+ women who are infected by HIV are respectable daughter-in-laws, and mothers of over 2000+ children who suffered stigma and discrimination in their own families and homes are innocent.

They need to be rehabilitated in their respective families, homes and communities with all the human dignity to lead a normal life. It must also be realized that no responsible parents, husbands, head of Sageis/ clans, elders of Leikai, tribes or community want to have their members infected by HIV and threaten continuation of their members/ population.

Official statistics have shown significant reduction (18% MACS Epidem, 2009) in prevalence among risky behavior groups (IDUs) and alarming rate of prevalence (2000 infected every year on an average/MACS/The Sangai Express/ 6 Nov 2009) among the general population why HIV and AIDS programming should continue to discriminate the general population; the affected people in community, and families and clans from their active participation in ensuring protection, prevention and continuity of their population.

In fact, it may not be wrong to say that the interests of getting ride one's family and community off HIV and AIDS are of greater priority concerns for the affected families and communities.

(To be concluded)