India HIV/AIDS Resource Centre
National AIDS Control Organisation
Ministry of Health & Family Welfare, Government of India
HIV is not merely a health issue. The epidemic is driven by a number of socio-economic factors. Therefore, health interventions alone are not sufficient to address cause sand consequences of the epidemic. Addressing the various factors involved requires a multi-faceted and multi-sectorial response and central to this logic is Mainstreaming and Partnerships. Mainstreaming approaches to HIV have increasingly gained ground with the realization that the non-health sector can play an important and meaningful role in reducing vulnerability to HIV and mitigating its impact on those infected and affected. The importance of mainstreaming and partnerships becomes all the more relevant in a country like India which has low prevalence and low visibility, thus creation of HIV specific health infrastructure all across the country is not appropriate. The resources available under health infrastructure with any constituency, whether urban or rural, public or private, need to be optimally utilized to contribute to the National programme. It is important to note that mainstreaming does not replace the need for traditional approaches of prevention, care, support and treatment for People Living with HIV, it may instead complement and strengthen the same.

 

The operational definition of mainstreaming  is “Integrated, inclusive and multi-sectoral  approach that transfers the ownership of HIV/AIDS issues – including its direct and indirect causes, impact and response to various stakeholders, including the government, the corporate sector and civil society organizations” The main purpose of mainstreaming is to ensure that all stake holders and agencies, state and non-state, adapt their programmes and policies accordingly to addresses direct and indirect aspects of HIV and AIDS within the context of the normal functions of an organization. It requires exceptional responses that demonstrate timeliness, scale, inclusiveness, partnerships, innovation and responsiveness. Mainstreaming HIV and AIDS is collective and iterative process of learning, engagement, action, experimentation and reflection. For the national AIDS response Mainstreaming and Social Protection continue to be key strategies for risk reduction, integration and impact mitigation.

 

In a country like India, with low prevalence and low visibility of HIV, creation of HIV specific health infrastructure all across the country is not deemed fit. For optimal utilisation of resources under the health infrastructure, there is a need to address the challenge of varying capacities of health systems to sustain access to quality HIV/AIDS services without stigma and discrimination. Access to social protection schemes for people infected and affected with HIV/ AIDS through mainstreaming of HIV/AIDS with health and non-health departments must be ensured.

However it must be clearly understood that mainstreaming mainly complements the need for traditional approaches of treatment, care and support for People Living with HIV. Learn More:

 

I Sailent Features

 

The goal of Mainstreaming is to create a harmonized and coordinated multi-sectoral national response to achieve NACP –IV goal of accelerating reversal and integrating response.

Its objectives under NACP are to:

·         Create an enabling environment through policies, programme and communication.

·         Provide support to mainstream HIV and risk reduction activities to other ministries

·         Facilitate integration of STI/HIV/AIDS related services into the health services of other ministries.

·         Modify policy, programmes and schemes as appropriate to support needs of PLHIV and HRG.

·         Promote positive prevention strategies through PLHIV Networks

·         Synergise and co-ordinate efforts across different players to optimize resource utilization and maximize impact.

 

II  Objectives and Outcomes 

1.       Objectives: To achieve the stated objectives mainstreaming is done with the following key constituencies:

·    Government – Which includes Ministries and Departments (Central, State, District, Block levels, including convergence with other departments within Health Ministry) Public Sector Undertakings, Panchayati Raj Institutions, Urban Local Bodies, Armed forces, Police &  Paramilitary forces, Railway                 Protection Force, Judiciary, Parliament/legislature, Statutory authorities/regulatory bodies, Central and State owned universities, labs and special bodies ( such as ICMR, CSIR, DRDO).an enabling environment through policies, programme and communication.

·    Civil Society – Not-for-profit organisations, community based organisations and Faith Based Organizations, positive networks. Local self-governance units at the grassroots level in rural and urban setting

·    Corporate - Private sector (large), Small and Medium Enterprises (SMEs), CSR Foundations

·    Development Partners - Such as World bank, GFTAM, DFID, UNAIDS, UNDP, UNICEF, ILO, UNFPA, UNWOMEN, BMGF

 

2.       Outcomes: Expected Outcomes of the mainstreaming process include:

·       Creation of enabling environment where the legal, policy and living environments are conducive for the PLHIV and MARP groups to access services.Reduction/ elimination of stigma and discrimination faced by PLHIV and MARPS at family, community and services level.

·        

Provision of appropriate social protection schemes, by largely modifying existing schemes to make them more PLHIV and MARP friendly.

·        

Expansion of health services- There is vast health infrastructure and resources available with other ministries, which can be utilized to contribute to NACP-IV.

·    Enhanced reach and coverage of MARPs and people more vulnerable to HIV- It is important to work with certain risk groups and profiles who are more at risk e.g. migrant workers and their female partners, sea farers, hotel workers tribals etc. Mainstreaming & Partnership is the most cost effective way to reach them since they are difficult to reach due to a variety of reasons – their mobility, migration, remote location etc.

 

III Strategies 

Based on the need to achieve the objectives, outcomes and the potential role of the various constituencies the strategies outlined below will be used to create optimal Mainstreaming Partnerships:

Build capacities of key institutions at various levels which can affect lives of PLHIVs and MARPs:  Capacity building and technical support are two key roles of NACO, SACS and developmental partners facilitating mainstreaming programmes. To this end, capacity building modules will be developed and made available. In addition, need based technical support to various partners will be provided in ensuring that the mainstreaming activities are rolled out successfully. Here the support and partnership with capacity building organizations and PLHIV and HRG groups are critical.

Promoting partnership with Government and other institution for expansion of STI/HIV/ AIDS related prevention, care, treatment services into the existing infrastructure. : HIV and AIDS can push people and households into poverty, in part the existing health care facilities of public and private sector organizations having health infrastructure for delivering HIV/AIDS treatment and care services by reducing household labour capacity and by increasing medical expenses. In some cases, HIV-related stigma and discrimination marginalizes people living with HIV (PLHIV) and households affected by the disease and exclude them from essential services. Therefore, partnership with Ministries will be promoted for mitigating the impact as provision of social and legal protection to communities infected and affected by HIV. There are several factors increasing the vulnerability of young, uniformed personnel, migrant labourers etc to HIV.  There is a need to reach all of them with information on services and also leverage for which partnerships will be built with concerned ministries.

Modification of policies, programmes and social protection schemes as appropriate to support needs of PLHIV and HRGs: There are two types of social protection schemes – those which are exclusive for PLHIV/HRG and other general social protection schemes which need to be modified to benefit PLHIV and HRG. Here the efforts will be more to review and propose amendments in the existing schemes for inclusion of PLHIV and HRG. 

Creation of an enabled environment through policies, programme and communication: Under this strategy, all policies and laws that affect PLHIV and HRG will be mapped, reviewed and issues identified that affect their rights or access to services. To this end much has been done; but a more systematic effort will be launched to give a boost to this activity. Actions under this strategy will also include support in policy analysis, advocating with various departments on changes required, supporting departments in making the changes and implementation support. The mapping and analysis will be carried out with support of PLHIV and HRG and consensus built on actions required.

 

 

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