«Published Annually Vol. 6, No. 1 ISBN 978-0-979-7593-3-8 CONFERENCE PROCEEDINGS Sawyer School of Business, Suffolk University, Boston, Massachusetts ...»
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India’s growing economy with a rate of 7.45% and investment of 4-5% of GDP in infrastructure has resulted in a huge deficit in infrastructure, both physical and social. (India GDP Growth Rate, 2011) Pertaining to the social infrastructure of health, AIDs is a problem which India can’t fight shy off. Currently 2.4 million people are estimated to be infected and only 428,638 people undergoing antiretroviral treatment (ART), which is just 5.6%. (NACO, 2011) Though government hospitals, internet, ART centers are available, infected people face difficulties in approaching these services as the disease is associated with social stigma in India. In such a situation, new breed of telephonic helplines attempt to clear the confusion and better connect the people with the available infrastructure. Telephonic counseling can help callers with information and behavior modification, while giving the comfort of veiled faces. The paper discusses the case study of such a telephonic helpline Samvad of Muktaa Charitable Foundation in Pune. It discusses the effectiveness of the helpline by giving details about the number of calls attended, age and education of callers, types of questions answered, and problems that the helpline solves effectively, future aims of Samvad, challenges, and operational functioning.
Key words: HIV AIDS, telephonic counseling, helpline, health, Samvad.
Indian economy has been growing at an average rate of 7.45% from 2000 until 2011, reaching a historical high of 11.80% in December 2003 and a record low of 1.60% in December 2002. (India GDP Growth Rate, 2011) The rapidly growing economy fuelled with low investment in the infrastructure (4-5% of the GDP) has compounded the problem of infrastructure deficit.
(India GDP Growth Rate, 2011) Many researchers and practitioners have defined infrastructure of two types – physical and social. Physical infrastructure consists of transportation, power and communications that facilitate business growth through backward and forward linkages. Social infrastructure consists of facilities for water supply, education and health; these enable the population to avail the benefits of the growth process (Figure – 1). (Businessworld, 2011) This paper studies the deficit in infrastructure for fighting AIDS in India and explores one way of reducing this deficit; that is telephonic counseling.
Conference papers © Knowledge Globalization Institute, Pune, India, 2012 One report, published in a medical journal in January 1986, stated: “Unlike developed countries, India lacks the scientific laboratories, research facilities, equipment, and medical personnel to deal with an AIDS epidemic. In addition, factors such as cultural taboos against discussion of sexual practices, poor coordination between local health authorities and their communities, widespread poverty and malnutrition, and a lack of capacity to test and store blood would severely hinder the ability of the Government to control AIDS if the disease did become widespread.” (T.K., 1984 (1)) As per Census of India, the current population of India is 1.21 billion. (Kumar, 2011) It is estimated that people living with HIV is around 2.4 million people. (Joint United Nations Programme on HIV/AIDS (UNAIDS), 2010).
Of the total people living with AIDS, 428,638 are receiving antiretroviral treatment (ART). (NACO, 2011) This is 5.6% of the total.
Based on HIV Sentinel Surveillance 2008-09, it is estimated that India has an adult prevalence of 0.31%. Out of the total infected people living with HIV, 39% are female and 3.5% are children. (NACO, 2011) The high risk groups (HRGs) identified are Female Sex Workers (FSW), Injecting Drug Users (IDU), and Men who have Sex with Men (MSM). Their risk of infection of AIDS is about 20 times higher than the general population. (NACO, 2011) The overall HIV prevalence among different population groups in 2008-09 (Figure - 2) prevalence among HRGs – IDU (9.19%), MSM (7.3%), FSW (4.94%) and Sexually Transmitted infections (STI) clinic attendees (2.46%), and low prevalence among Antenatal Clinics (ANC) attendees (0.48%). (NACO, 2011)
Infrastructure available in India is at governmental level and non-governmental level.
National AIDS Control Organization, established in 1992, is a division of the Ministry of Health and Family Welfare that provides leadership to HIV/AIDS control program in India through 35 HIV/AIDS Prevention and Control Societies. NACO implements one plan at the national level. (NACO, 2007) State AIDS Prevention and Control Societies (SACS) implement NACO program at state level, but have functional independence to upscale and innovate.
There are many non-governmental organizations (NGOs) also fighting AIDS.
The current infrastructure aims to serve at the community level as well as the individual level. Community-level programs include awareness campaigns about HIV prevention and care, while individual-level programs include facilities such as lab testing, medical care for HIV, prevention of HIV, face-to-face counseling. There is a new breed of infrastructure that works at individual level, but not face-to-face. This is the telephonic AIDS helplines. These helplines are Sadhan in Mumbai, Tarshi in Delhi, and Samvad in Maharashtra and Bihar.
Why telephonic helpline?
People suffering from HIV and AIDS do not want to face the counselor. They fear that the family and / or the society will outcast them if they admit this. Discrimination is meted out against people related directly or indirectly to the patients. (Gupta,
1994) Pragmatic efforts to confront the issue of AIDS often falls victim to prudishness, misplaced priorities, or evasion. AIDS workers and organizations face unwillingness in many quarters to even recognize that the problem exists. (Salvi, 1995) This adds to the stress of these patients in India.
Conference papers © Knowledge Globalization Institute, Pune, India, 2012
The knowledge about HIV and AIDS among Indian people is limited. The AIDS awareness efforts haven’t been very successful.
One research points out that effect of several covariates such as education and mass media, on awareness in Indian women is different from their effect on quality of knowledge. (Aggarwal & Rous, 2006) Hence, Indian people need to have scientific information about the disease and want to know the cure. Due to the nature of the society, Indian people are comfortable venting out their feelings and fear or admitting their guilt to an unknown, friendly, caring voice of an expert counselor.
The research question I set out with was “Can counseling over telephonic helpline help fight against HIV and AIDS?” Questionnaires were sent out to respondents and their response to the reliability of telephonic counseling was found out.
Three HIV-AIDS helplines in India were identified based on the expert (Dr. Shirisha Sathe - B. A. M. S. M. A. Clinical Psychology) opinion of a practicing psychologist and a psychotherapist in Pune and a professor at Flame School of Liberal & Management Education. Experimental research in the form of mock calls was conducted to find out the effectiveness of the three helplines.
Based on the effectiveness, one helpline was chosen. The selected helpline was chosen as a case to study. Detailed study was done to find out the number of calls attended, the demographic details of the callers, questions of the callers, future aims of the helpline, challenges faced, and operational functioning. This study was done to find out whether telephonic counseling is and/or will be effective method to deal with the problem of HIV – AIDS.
As per 74 responses to the online questionnaire, 43% (9% + 34%) of the respondents had a favorable opinion about telephonic helpline. This questionnaire was distributed online in the Foundation of Liberal & Management Education (FLAME) community and outside amongst faculty, staff, and students. Hence, the respondents include either graduate, post graduates, and undergraduate students.
Experiment: Mock calls were conducted to the three identified helplines – Samvad, Tarshi, and Sadhan in India.
Objective: To find out the effectiveness of the helpline Question: Can HIV AIDS spread through oral sex?
1) Experiment – 1: Mock call to Tarshi helpline in New Delhi – 011-26472229 There was taped message only and no personal counseling. I chose the option of English language and selected the nearest question: “How does HIV get spread?” I got the taped answer. It was not better than reading information from the internet.
2) Experiment – 2: Mock call to Samvad helpline in Pune – 020-26381234 A lady picked up the call. There was no taped message.
Conference papers © Knowledge Globalization Institute, Pune, India, 2012 I could ask my question – “Can HIV AIDS spread through oral sex?” She gave me detailed answer of the question. She started with the basic information that HIV can spread through vaginal, anal, and oral intercourse. Oral methods of licking the vagina, licking the penis, friction of penis in the mouth, and swallowing the semen can be very risky. She said sexual liquids (semen and vaginal liquid), blood, breast milk contains high percentage of the HIV virus. So even if the penis is taken in the mouth and semen is not swallowed, the virus can come out of the penis opening and penetrate through a tiny bruise in the mouth (the bruise in the oral cavity may be so tiny that it may get unnoticed by the person having it) due to friction of the penis in the mouth.
In such a case a person needs to get tested. She suggested that the person may go for a HIV antibody test. It has a window period of three months. Our body requires three months to produce antibodies against the virus after it enters the body. The test is inexpensive and can be done in any private pathology laboratories or government laboratories. She said that the private laboratories may recommend expensive and complicated tests; however, these tests are not required. The antibody test is reliable. The government laboratories do only the antibody test.
She further asked why I was asking the question. She asked if I knew someone with whom such an incident had occurred or I was asking for information purpose. I said I was asking for information purpose.
She further said that if such an incidence has occurred with any person and if that person is married, then he/she will have to take care in personal life as well so that the partner does not get infected. Also, if such a person is planning to start a family, due care needs to be taken so that the child is not infected.
She said that even if the test is negative, it does not make one risk-free for life; but necessary precautions have to be taken if one has to indulge in high-risk situations.
She not only answered my question but also gave me explicit details surrounding the question. There was a certain sensitivity and firm tone to the counselor’s voice. I thought I was speaking to my friend and guide. I was completely satisfied with the counseling. Also, I had no problem of disclosing my identity as in face-to-face counseling.
Experiment 3 - Sadhan Helpline in Mumbai - 022-24114000 The lady counselor spoke to me and gave a detailed answer to all my questions, similar to Samvad helpline. However, she lacked the warmth of the counselor at Samvad.
I found that I did not know the details of HIV – AIDS even though being a well-educated person. The counselor was able to give me information and able to do behavioral counseling also. She asked me what precautions I would take to protect against HIV and AIDS.
I chose to do the case study of Samvad helpline as it turned out to be the most effective.
In addition, Tarshi doesn’t have software support and the number of counselors is limited. Hence, the service can’t reach out to large numbers.
‘Samvad’ means conversation in local Indian language.
A visit was conducted to the helpline. Interviews were conducted with different founders and also the counselors. Also, information was collected from the website.
Samvad HIV Helpline:
Samvad HIV Helpline is an initiative from Muktaa Charitable Foundation (MCF), registered trust founded by socially conscious citizens. MUKTAA stands for Making U Know and Talk About AIDS. Founders of the Trust are volunteers who have come together to manage the Trust and its projects. Its project is Samvad HIV helpline for Maharashtra, and Bihar. The trust has been founded by 9 like-minded individuals based in Pune who come from various walks of life – doctors, businessmen, housewives Conference papers © Knowledge Globalization Institute, Pune, India, 2012 and others, with a vision to make a visible impact on the epidemic of HIV and AIDS in India. Samvad does counseling not only for HIV and AIDS but also for sexually transmitted diseases (STD), and questions related to sexuality (such as masturbation).
Effectiveness of Samvad:
Samvad has a database of the clinics or services available in India for testing or treating AIDS. When an individual calls up the helpline, he/she is very nervous and afraid. The counselors give him/her mental support. This helps in alleviating the caller’s fear. The expert counselors diagnose the kind of problem of the caller and suggest a remedy. The remedy can consist of scientific information about AIDS, contact information and guidance about laboratory tests, nutritional support, address of shelter homes for the infected, short-distance palliative care centers, contacts of legal entities (to handle legal issues), antiretroviral treatment (ART) centers, side effects of ART, etc.