AVERT - India & Russia

It was the aim of AVERT's overseas program to help in countries where there was a particularly high rate, or rapidly increasing rate of HIV infection. Inevitable this meant the focus was mainly on Southern Africa. But there were some occassions when we had projects in other countries. One was a project with the NGO Sangram in India. Another occassion was when we partnered with the Privolzhsky Okrug AIDS Control and Prevention Centre at Nizhny Novgorod in Russia.

Sangram

AVERT's partnership with the Indian NGO Sangram started in 2003 when the first met Meena Seshu, the general secretary of SANGRAM, at a meeting in London. SANGRAM had a medical clinic for truckers, rural women and sex workers that was about to be closed because of a lack of money. AVERT was asked, and agreed, to provide the funding to keep it operating.

Truck Driver's project

The doctor at one of the clinic points alongside a truck stop

The doctor at one of the clinic points alongside a truck stop

Fear of stigma and discrimination against those who are HIV positive was, and probably in many instances still is, very strong in India. So much so that it stops people who are HIV positive accessing treatment or counselling. To overcome this SANGRAM had started a mobile clinic with a doctor and counsellor. This made treatment for STDs and for HIV related Opportunistic Infections, available directly at truck stops. Also, as antiretroviral drugs began to be available, they helped people to get them from the local hospital. Local sex workers also acted as educators, and SANGRAM's worked was very linked in with that of VAMP.

VAMP

SANGRAM had begun its work in the Sangli district of South Maharashtra in 1992. Since the early 1990s women in prostitution had brone the brunt of the HIV epidemic in India. However, many HIV intervention programmes had further stigmatized women in prostitution by labelling them as transmitters of infection. Rather than continuing to label these women as victims, SANGRAM started a peer based condom intervention program with women in prostitution.

In 1996 peer educators supported by SANGRAM formed a collective called VAMP that became separately registered as an organistaion with its own board of directors drawn from peer educators and other women in prostitution. Some of these women were devadasis, meaning that their families had dedicated them to the service of a goddess.

By 2002 SANGRAM had become an internationally respected organisation, but the persistent harassment by the local police of the members of VAMP interupted work that had previously resulted in the distribution of 350,000 condoms a month. A local political leader claimed that:

"under the garb of HIV/AIDS prevention programmes, these women are promoting prostitution"

The difficulties that SANGRAM and VAMP faced with some of their HIV/AIDS work was to continue for some year, including during the time that we made a memorable visit to Sangli.

Visiting SANGRAM & VAMP

Members of VAMP with Meena Seshu (in green) together with the son of one of the sex workers

Members of VAMP with Meena Seshu (in green) together with the son of one of the sex workers

We visited SANGRAM and VAMP in December 2005. We wanted to understand more about the context of their work, as well as discussing a possible extension of their funding. During this visit we were able to see the AVERT funded project in action. We visited the truck stops and we saw the women talking to the truck drivers and demonstrating condom use. We also attended a meeting of some of the women members of VAMP where we were asked whether we would like to visit a nearby brothel. Always keen to understand more about the culture in other countries, Pete and I went along with the son of one of the peer educators.

Annabel attending a meeting with members of VAMP

Annabel attending a meeting with members of VAMP

We walked up and down the rows of houses amazed by the scale of the red light district, where there were apparently some 400 women. In one of the houses we went upstairs and there in the bottom of the shower cubicle there was a big pile of wet condoms. What are they doing? we asked. The answer was that the condoms were being washed so that they could be reused!! Not exactly what the health educators recommended.

Then as we walked back towards our car we were suddenly completely surrounded by a large group of young men who brought us to a complete halt. What are you doing here, they demanded to know. It was one of the few times on an AVERT visit that I was worried about my physical safety, and I was really quite afraid.

The background to this was that earlier in the year, in May 2005, the brothel had been raided by the police encouraged by an American organisation called Restore. We had thought that all these problems were over, not realising until we were on our way to the brothel that the American had entered the red light area again in October. This time without police support. We were the first westerners to have visited since then. So the young men, many of them relatives of the sex workers, wanted to know if our visit was the prelude to another raid.There had been:

"a frenzied moral climate of raids and rescues"

We hurriedly explained that we were visiting by invitation. We had only come in order to understand more about the issues thay faced. Such was the reputation of the Americans that we had to emphasize our Britishness. It seemed that what we said was reassuring, because the group of young men suddenly dispersed and we could go on our way.

The ART Centre at Sangli Hospital

Plaque on the wall of the ARV centre funded by AVERT

Plaque on the wall of the ARV centre funded by AVERT

ARV centre at Sangli civil hospital funded by AVERT

ARV centre at Sangli civil hospital funded by AVERT

During our time in Sangli, Meena took us to visit the Civil hospital where the poorest people in Sangli received their health care. This was also where the Indian Government rollout of antiretrovirals was starting to take place. The basement had recently flooded and was permanently out of use. This had resulted in particularly bad overcrowding. The drugs were being given out in one small room by a row of workers. All of them were wearing facemasks. We were told the facemasks were because of the number of HIV positive people who had drug resistant TB.

There were plans but no money for an extension to the hospital. AVERT eventually after much further discussion provided funding of £3,000 for this. Unfortunately we never got the chance to visit the new AVERT clinic as our partnership with SANGRAM ended in 2008. By that time, with less money available, the AVERT trustees had decided to concentrate their efforts on countries with a particularly high rate of HIV infection. This was instead of also including those with a rapidly increasing rate of infection. It was in any case being increasingly claimed by the Indian authorities that the levels of HIV infection in India were lower than previously thought.

AVERT's Overseas Program - Russia

At about the same time that we were working with SANGRAM in India, we were also doing some work in Russia. In 2002 the Department for International Development (DFID) funded and operated a Health & Social Care Partnership (HSCP) scheme which partnered UK organisations with organisations in Russia, Ukraine, belarus and Moldova.

DFID asked us if we would partner with the Privolzhky Okrug AIDS Control & Prevention Centre in Nizhny Novgorod in the Russian Federation. The Centre was a federal AIDS centre whose main goal was to stop the spread of HIV infection in the Volga region, an area with a population of over 32 million. The centre was in charge of "supervising [all the] HIV combating activities", and they specifically wanted to improve the HIV/AIDS and drugs education in their schools. The setting up of the project was sufficiently complex and difficult that Pete and I went on an initial visit to Nizhny Novgorod (previously called Gorky) in the summer of 2002 in order to complete all the preparatory work.

Teaching the teachers

The first part of the project focused on training for some of the teachers in Nizhny Novgorod. The training sessions included information on the relevant issues and new teaching methods. There were also written activities for school children. This part of the project was necessary because of thieir lack of understanding of the issues. Their ways of working were also very different to how we provided education for young people in the UK.

HIV teacher training in Russia

HIV teacher training in Russia

In Nizhny Novgorod at that time much of the teaching was based on the young people sitting at their desks in row, and copying down facts written on a blackboard. We wanted to introduce the teachers to some of the ideas we had developed through the "Working with Young People" project, of young people being actively involved in discussion and activities. The education would have at its starting point the issues and concerns of young people themselves. Our project partners were keen to learn about such idea as the use of "role play" or drama, which they referred to as Forum Theatre methods.

The "Working with Young People" materials had been so successful internationally, that they had been translated into a number of different languages. So we were able to provide our Russian partners with a copy of them in Russian. There was also a very good World Health Organisation publication on School Based Education. However, after extensive discussion with a number fo people and organisations, it was disappointingly established that the Russian edition of these materials had been lost by WHO/UNESCO. So it was agreed that the most important parts of this publication would be retranslated.

Some visits

As part of the project our Russian partners made a visit to England in 2003. One of the visitors was Nikolai Nossov, the head of the centre. We understood that he regularly met with people from other federal HIV/AIDS centres, of which there were only about eight throughout the Russian Federation. So when the group asked if during their stay they could visit some other organisations beyond the specific ones required for the project. this seemed important. It was a possible way of influencing services in the Russian Federation beyond what was specifically being done as part of the DfiD project.

Annabel & Pete, with interpreters, talking to a prison guard about HIV in Russian prisons

Annabel & Pete, with interpreters, talking to a prison guard about HIV in Russian prisons

So we arranged for our visitors to stay on for a few extra days at AVERT's expense. During this time they visited the Public Health Lobaoratory Service (PHLS) to discuss the public health aspects of the HIV/AIDS epidemic. They also met Professor Gerry Stimson to talk about policies regarding HIV/AIDS epidemics among drug users. This included talking about harm reduction, and we also arranged for them to visit a methadone treatment centre.

Pete and I again visited Nizhny Novgorod in 2003 and we saw some of the teacher training taking place. Nikolai knew about the previous work AVERT had done regarding prisoners and HIV/AIDS, and so he asked us to meet with their local prison department. We discovered that along with having an HIV infection level of 8% among incoming prisoners, they also had in excess of 150 prisoners with drug resistant TB.

Teaching the Young People

Young people in Russia learning about HIV through drama

Young people in Russia learning about HIV through drama

The teachers started using their new skills in providing HIV/AIDS education for the young people, and Pete and I were able to see this in action during our last visit in 2004. The schools had a choice regarding the activities that took place and whilst some had undertaken formal class education, others had devloped some more "active learning" class activity.

It had been clear from the start of the project that the most sensitive issue was going to be the discussion of sex and this was indeed the case However, some useful discussions took place about this particularly in relation to a student survey the Russian team had carried our and which asked about the students' sexual behaviour. To the surprise of the teachers the survey showed that young people were having sexual intercourse at a much younger age than had previously been believed. This was much the same result that we had found way back in 1988 when we had carried out our survey of young people in Canterbury!

Disseminating the results

At the end of the project the Russians held a very successful conference to disseminated the results of the project. They also published the teacher's manual that they had devloped and they wrote eleven articles for publication.

The Bishop's AIDS Hardship Fund

The Rapahel Centre, which we had been funding since 2002 was certainly in an extremely high prevalence area in the Eastern Cape province of South Africa. They had informal inks with the Anglican church and particularly with the Diocese of Grahamstown whose office was located just a short walk from the centre. AVERT is not a "faith based" organisation, but works with organisations and people of all faiths, and indeed none, as and when the opportunity arises.

The Children of Ilinge

On our visit to Grahamstown in 2004 the bishop mentioned a trip had had recently made to Ilinge. Ilinge is a village not recorded on most South African maps. In the apartheid era people were sent on internal exile to Ilinge when they were released from Robin Island. As many people in the area did, the people of Ilinge had turned to the church for help, as a last resort, when they were unable to provide even bread for the 300 children in the town that had been orphaned by AIDS.

The bishop, Thabo Makgoba, had immediately gone to visit them when he heard the news. We learnt that a small amount of money had been sent to help the children. However, on our return to the UK we learnt that this money was only sufficient to feed the children for about a month.

Setting up the Hardship Fund

We asked some further questions not only about the cost of helping the children at Ilinge, but also what other emergency needs there were in the diocess in relation to HIV/AIDS. The diocese was a very large area covering the middle third of the Eastern Cape. Thabo was to describe the situation in the diocese in the following way:

"People are dying like flies, to put it crudely"

and

"Priests are spending time at funerals, setting up home based care for parishoners, spending time helping child-led families because parents have died"

Trustees meeting at AVERT 2004

Trustees meeting at AVERT 2004

As a result the trustees of AVERT (the people often referred to as "we" in this history) decided to set up an "AIDS Hardship Fund" which could be spent entirely as the discretion of the bishop. By this time, at the end of 2004 we were starting to plan the setting up of the Sisonke project, which was going to have a particular focus on assisting small organisations and groups. So it was agreed that the Hardship Fund would focus on individuals.

`Bishop Thabo Makgoba with some beneficiaries of the hardship fund

Bishop Thabo Makgoba with some beneficiaries of the hardship fund

The Hardship Fund operated very successfully for several years. Amongst other emergency needs it gave help for the cost of funerals for people who had died of AIDS.

"We used R1,000 for the funeral parlour and an extra R2,000 on the funeral expenses and related things. It was very sad to see Monica die and the family has now broken apart"

Some families were in such a desperate state when several family members had died, that they were leaving a body at the side of a road in the hope that it would be collected by the municipal authorities before the wild animals came and ate it. Another example from one of the reports we received is:

"This sixteen year old was raped and is in a wheelchair and is HIV positive"

The hardship fund continued until in 2008 Thabo Makgoba left Grahamstown. He became the Anglican Archbishop of Cape Town and Metropolitan of the Anglican Church of Southern Africa.

Where next?

You might like to read about AVERT's work in South Africa

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This page was last updated in April 2020

Author Annabel Kanabus

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