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South India AIDS Action Programme (SIAAP)
   Last updated: 16.08.02
Its Role, Growth and Development in Meeting the Challenge of HIV/AIDS
Implementers

The South India AIDS Action Programme (SIAAP) was formed in 1991 with the goal of involving existing NGOs in South India in an effort to increase AIDS awareness in the region and to help develop and implement effective education and prevention programmes.

The creation of SIAAP began in 1988, when 30 HIV positive female sex workers in the city of Chennai were jailed. By the time their case went to trial, nearly 900 women were imprisoned in the state of Tamil Nadu. In July 1990, the court ordered all the women released and recommended that no person should be detained on the basis of HIV infection. Shyamala Nataraj, a journalist covering the trial and other AIDS issues in India, discovered there were no support services available for people with HIV/AIDS. Using personal contacts, she established a link with Voluntary Health Services in 1991 to bring existing NGOs together and help them develop strategies for dealing with the epidemic. This led to the founding of SIAAP as an independent NGO.

Background
In the early 1980s India was beginning to see the results of a long struggle to provide better health care for its people. Infant mortality rates were decreasing and average life spans were increasing. Indian citizens in both urban and rural areas had better access to health care in district hospitals and public health centres. When HIV began to emerge as a national health problem in 1986, however, government and health care agencies, like those in most other parts of the world, were unprepared to deal with it. Prejudice and misinformation contributed to a sense of panic.

It was clear that HIV interventions had to include education on safer sex practices including condom use and improved treatment access for sexually transmitted diseases. But it was also important to reduce prejudice and empower people.
Counselling had to be understood as fundamentally different from simply giving out information. In India, counselling and therapy were generally conducted in an official medical setting and considered limited to psychiatry. There was little experience in providing counselling at the community level, especially with issues of sexual behaviour.

Through experience with various projects, it became clear that a primary need in the region was to develop full-time trainers and counsellors outside the established medical system who could deal effectively on a community level with issues of sexual behaviour, empowerment and HIV education.

Objectives and main activities
SIAAP recognised the need for trained non-medical counsellors who could work outside the large institutional frameworks on a community level. The objective of the scaling up was therefore to train full-time counsellors to be placed in government health clinics throughout the region.

Resources and timeframe
SIAAP's first project, funded by the local NGO Madras Christian Council of Social Services (MCCSS), was designing an AIDS education programme in the slums where MCCSS was already working. In 1992, SIAAP launched an education project directed at truckers. They opened a booth at Puzhal, one of the busiest check posts near Chennai, where they distributed information, free condoms and lists of referral centres for the treatment of STDs. These early projects led to the development of a comprehensive three-year action plan that would expand educational programmes, particularly those dealing with truckers and women in prostitution (WIPS). HIVOS and the Ford Foundation funded this proposal.

Having largely succeeded in its attempts to get NGOs and governments to address HIV issues, the SIAAP management began to consider the future direction of their organisation. In the fall of 1996 HIVOS invited the SIAAP director to visit the Gestalt Foundation in the Netherlands where they consulted with Harm Siemans, a trainer and therapist. Siemans visited the region in November 1996 and issued a report supporting SIAAP's proposal for increased counselling services and recommending that SIAAP take primary responsibility during the initiation phase. The Gestalt Institute offered training and supervisory support for the first two years.

Outputs/outcomes
By the end of the project period in 1996, SIAAP had fulfilled many of its objectives. A total of 42 NGOs throughout the region were incorporating AIDS education and prevention into their existing programmes, as well as developing specifically targeted new projects. The NGOs were funded by a variety of agencies including USAID in Tamil Nadu, and HIVOS in Karnataka and Andhra Pradesh. The Department for International Development (DFID) UK supported a7national trucking programme, which absorbed many of the existing interventions in Tamil Nadu.

Despite the problems in scaling up, the results were still positive. By June 1999, forty-five community groups were meeting sporadically and by January 2000 these had stabilised at 18 sangams (those in the villages with whom SIAAP was working). Of these, two have been running intensive HIV intervention programmes for 4 years. In February 2000 a combined community meeting for solidarity brought together 700 people from across the state and culminated in a resolution demanding protection of human rights.

Internal organisational implications
From the beginning of the first training session in April 1997, organisational resources remained minimal and were stretched far too thin. There was no start-up period, no pre-planning and few people available to take responsibility for the details of what was becoming a huge and complex enterprise that had to provide counselling, training and service in the states of Tamil Nadu, Karnataka and Andhra Pradesh.

In April 1998, the Dutch trainer responsible for the Tamil Nadu programme left without warning and was not replaced by the Gestalt Institute. Two Indian trainers stepped in on a part-time basis but the remaining trainer found it difficult to meet all the demands.

The first group of counsellors graduated in September 1998 and a second group followed in June 1999. When the arrangement with the Gestalt Institute came to an end in August 1999, a full time Indian supervisor took over.

Lessons learned
The process of scaling up showed that while SIAAP's technical skills were considerable, its organisational and administrative capacity were inadequate. Staffing, organisational structure, training and supervision needed to improve as well.

Other important lessons:
• Community organisations require a great deal of support.
• Setting up advocacy structures and recruiting adequate personnel needs to be a priority.
• Appropriate peer training and supervision is essential.
• Counsellors recruited from affected communities perform significantly better than those not from these communities, even when they enter the programme with less education or experience.
• Client centred counselling, as a specific process of individual empowerment, is a relatively new discipline in India.
• Community based counselling along with hospital-based counselling provides a good balance.

SIAAP's community counselling programme has been acknowledged and appreciated by the established medical system and embraced by the Indian government. SIAAP has decided to focus on evolving as a training institution and transfer programme implementation and responsibilities to the sangams.

Source: A Question of Scale
This is an extract from A Question of Scale: The challenge of expanding the impact of non-governmental organisations’ HIV/AIDS efforts in developing countries,
by Jocelyn DeJong, published by the Horizons Project of the Population Council with the International HIV/AIDS Alliance in 2001. To view the whole report follow this link.

To download, complete with graphics, in pdf format (which requires Adobe Acrobat software to read it) follow this link (file size 1.43 Mbytes).