A Time To Reflect

charukesi June 18th, 2005

Tamil Nadu school slams doors on HIV positive orphans, says it’s risky - argues if the children fall on or bump against others, they will pass the infection…

But - the article says - the real worry is about other children leaving. And such occurences of discrimination are common…

So much for communication efforts aimed at creating awareness and removing stigma attached to HIV. And this in Tamilnadu which has some of the better developed tracking and intervention systems in the country (Tamilnadu incidentally also has the highest prevalence of AIDS in the country - but this might just be a function of better monitoring and the patients’ willingness to disclose - and Dindugul is one of the HIV hot-beds of India).

Recent efforts in Tamilnadu include the ‘condom on wheels’ project, an attempt to make retailers overcome inhibitions about selling condoms (imagine the magnitude of the task at hand - breaking inhibitions not just on the part of the buyer / user but the seller as well) and the information dissemination through barbers idea. Many Indian men are too embarrassed to buy condoms at a drugstore or to talk freely about sex with health counselors and family members. There’s one place where they let down their hair: the barbershop. So, the state of Tamil Nadu is training barbers to be frontline soldiers in the fight against AIDS, says this report in WSJ.

However it seems like such efforts have not managed to even chip at the stigma - or myth - barrier… If this continues, will we start seeing a sharp decline in reported cases of HIV in Tamilnadu also?

Update : This post by Kalpana Sharma on india together is about HIV and gender - if a woman who has been infected by her husband passes on the virus to her child, she is stigmatised and blamed. And if the infant happens to be a boy, then the woman is considered even more of a villain. And as the article says, this is when the woman may have (in all likelihood) contracted the infection through her husband - either unknowingly - or worse, in a situation where she is aware but without a choice or a voice to abstain from sexual relations or insist on protection…

• Society & Development , - Public health
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charukesi May 26th, 2005

The annual AIDS survey has thrown up this happy but surprising finding that the growth of the disease has been controlled in the country. Only 28,000 new infections were reported in 2004, compared to 6 lakh in 2003.

Surprising since there is no accompanying explanation in the entire article for this remarkable decrease in the growth rate. If this finding is indeed true (and “the methodology used in India is internationally recognised and used all over the world,’’ said Salim Habayeb, WHO representative in India), then a biggish pat on the back of public health systems in India is due. If this finding is true….

For estimates of the spread of this disease in India have always sounded ominous - in a recent interview, the head of the Bill and Melinda Gates Foundation in India said - In a country of a billion people, about 4.6 million are HIV positive. If the problem is left unchecked, that number could reach 20 million to 25 million by the decade’s end. A single country could have an HIV-positive population larger than the total populations of London, New York, and Tokyo combined. At the very least, the number of AIDS patients in India was expected to quadruple by 2010.

Noone had anticipated such a check in the spread of the AIDS virus. There have been some attempts at more efficient and relevant communication including this attempt to enlist barbers in the war on AIDS.

I have a hypothesis here - does this finding mean that reported cases of AIDS are on the decline - and at a worrying rate. Awareness creation programs and appaling stigma seem to co-exist, the former seeming to make little impact. In this situation, is it that people carrying the virus (or the full blown disease) have merely decided not to reveal it.

If this hypothesis is false, as I am hoping it is, then the government is doing something very right - except that noone has heard of any communication / treatment effort that could have such a dramatic impact. In such a case, the Indian government (and all participating agencies) can present a case study for the rest of the (third) world where the disease is surging ahead at an uncontrollable rate.

Also puzzling is the fact that close to 70% of Indians affected by HIV/AIDS live in the six states of Tamil Nadu, Maharashtra, Karnataka, Andhra Pradesh, Manipur and Nagaland. Four of these states (excluding the North Eastern ones and to a lesser extent AP) are high on most development indices - then what is going wrong?

As opposed to this , some states including Bihar have recorded zero cases and officially, Uttar Pradesh, India’s most populated state, has only 0.25 per cent of its people affected by the virus - if that does not sound counter-intuitive, then what does? This is where my hypothesis was born…

(Some earlier thoughts on my favourite AIDS crusader Balbir Pasha here and here)

• Society & Development , - Public health
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charukesi April 7th, 2005

Patrix writes about the AIDS tsunami…

Here’s an interview with the head of the Bill and Melinda Gates Foundation in India - from the mckinsey quarterly on battling AIDS in India (you need registration but it is worth the effort)

In a country of a billion people, about 4.6 million are HIV positive. If the problem is left unchecked, that number could reach 20 million to 25 million by the decade’s end. A single country could have an HIV-positive population larger than the total populations of London, New York, and Tokyo combined.

• Society & Development , - Public health
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charukesi December 1st, 2004

If you are wondering why all this hoopla about AIDS (as I was till just now), today is World AIDS day.
Following Balbir Pasha’a return to the scene, I found this piece of information very interesting - India Enlists Barbers in the War on AIDS. Rediff had carried a similar story recently : Want to learn about safe sex? Visit the barber.

Looks to me the government has finally feebly abandoned its ostrich stance and is ready to face the problem as it is: Some statistics - India with 5.1 million people living with STD / AIDS (and this number is expect to quadruple by 2010) is very close to the world’s laregst AIDS affected country, South Africa.

And one major step in disseminating information (and dispelling misinformation) about the disease is the
identification of that most important element in the communication flow : the right medium, or channel.

Wonder if the government got a tip from The Tipping Point where Malcom Gladwell has described a similar situation where a nurse began a campaign to increase knowledge and awareness about diabetes and breast cancer of San Diego. Aiming to create a grassroots movement towards prevention, she used black churches around the city as communication points. A strategy which failed since church attendance was feeble and people did not seem interested in the message. She needed a place where women were relaxed, receptive to new ideas, and had the time and opportunity to hear something new.

And she moved the campaign from churches to beauty salons.

And she had a captive audience (in more ways than one. You tell me, would you argue with your hair-stylist / barber who is weilding a pair of scissors dangerously close to your ears?)

Reminds me of something I read long ago : three things matter in a piece of communication : who says it, how it is said and what is said - of these, the last matters the least! Think about it, till you get steps one and two right, whatever you say will fall on indifferent ears…..

• Indiawatch , - Public health
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charukesi December 1st, 2004

Its time now for Bombayites to wonder Balbir Pasha ki biwi aur bacchon ko bhi AIDS aayega ? Yes, Balbir Pasha is back (with a bang, may I say? pun intended or otherwise) and once again looms large from hoardings all over Bombay…

I had written long ago about the emerging soober-star of Madras, Pulli Raja - Pasha’s Tamil half brother…. who just sat pretty and shook people out of their complacence and the ‘it cannot happen to me’ belief…

This ad (eduvertisement? to coin a new phrase?) is such a cool example of how social communication can be spread…

Must say am glad to see Balbir Pasha back in ‘action’!

• Advertising , - Public health
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charukesi October 6th, 2003

Move over, Rajinikanth….. Pulli Raja is here…

The newest Soober Star to hit Chennai is Pulli Raja…. Whose face stares out of every other cut-out*, a quintessential feature of the Chennai skyscape…. Whose presence is felt on every main road, every nook and crossing…..

Pulli Raja is the Tamil brother of Balbir Pasha, a character created by Population Services International in its fight against AIDS in India. Pasha is the ‘common man’ of the AIDS scene in India, the group representing the greatest challenge to the combat against AIDS; of the arrogant, it cannot happen to me stance….

The PSI, through its mass Pasha / Pulli Raja campaign, seeks to reach vulnerable and high-risk groups. Part of Operation Lighthouse, this campaign is targeted at men between 18 and 40 years from lower socio-economic groups

The series of ads seek to address different issues (which emerged out of preliminary research) associated with AIDS :

1. The Alcohol Connection : I often use condoms, but when I get drunk, I
sometimes forget to use them.
2. Regular Partner Issue : I only have sex with this one person (sex
worker or casual partner) and hence I am safe
3. Asymptomatic Carrier Issue : If a person looks healthy he/she must be
safe from HIV/AIDS

In my opinion, this campaign is a huge success evaluated against its objectives :

* Create awareness about AIDS and the HIV virus
* Dispel myths about AIDS (the most challenging as I mentioned earlier, it cannot happen to me)
* Change behaviour (which I suppose is the ultimate objective of any marketing communication)

I see two reasons for the impact of this campaign :

The message : the campaign started with a teaser ad : Will Pulli Raja / Balbir Pasha get AIDS ? I suspect many people thought this was the latest quiz on some Tamil soap….. Whatever, but it did arouse curiousity…. love it or hate it, this campaign is impossible to ignore….. step one to creating the desired impact.

The medium : To complement the daring messages, these ads are splashed across town on huge hoardings, ensuring thsat there is no way anybody can miss seeing the ads. No coy television spots alone for Pulli Raja.

Not surprisingly, this campaign has come in for severe criticism. In Mumbai, the ads have has been called sexist and vulgar and there have been protests to have the campaign stopped. Conservative Chennai too has heard many rumblings…. Protests against obscene hoardings carrying embarrassing questions….

Yeah right….

Ramba in a micro mini exposing her fat thighs twined around Prabhu Deva’s hips is not obscene (man, that sounds straight out of the Kamasutra…. But I did see this very hoarding in Madras, okay?). Pulli Raja is….

This is the first time that any social organization in India has taken a direct, on your face approach to such an issue. These ads do not moralize or criticize….. on the contrary, they create an interest and generate discussion around an otherwise hmmm-errr kind of topic….

The Indian Express says, Hats off To Balbir Pasha….. I say so tooo….

* A cut-out is a Tamil word, the equivalent of a hoarding / bill-board, except that figures are actually cut out from the board. The taller the cut-out, the higher the social / political standing of the cuttee.

• Advertising , - Public health
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