http://www.asianage.com/columnists/there-s-safety-nitty-gritty-762

There’s safety in the nitty-gritty

Patralekha Chatterjee

Eight years ago, while researching a report on awareness about HIV and AIDS in India, I spent an afternoon at the Inland Container Depot at Tughlakabad, on the outskirts of Delhi. A lanky young man working with an NGO was holding “classes” for truck drivers in a shed. He began by asking the young men about their day (and night) on the road. Once rapport had been established, he got into more personal issues, testing his listeners' knowledge of HIV/AIDS. Eventually, the sensitive issue of condom use popped up. He did not merely say, “Have safe sex.” He took out a wooden demonstration penis and showed his students how to slip on a condom and how to take it off, clarifying doubts about the many things that could go wrong in the process. There were questions from the crowd. Some sought one-to-one time with him later. I remember a remark by a 21-year-old truck driver who was standing next to me that afternoon. “Like everyone else who drives trucks on the highway, I have seen posters about AIDS. I know AIDS kills. I also know that I ought to have safe sex. But no one actually told me what to do next, where to go, how you slip on a condom, till today.”


Talking about AIDS and security in the same breath may seem incongruous. But there is a takeaway message in the anecdote relevant to our current discussions about security. “Have safe sex” messages worked when they were followed by nuts-and-bolts information on what exactly to do and not do, where to go for more information, and who to turn to if one was in doubt. Ditto with security.


There has been a lot of talk about security since last Wednesday’s “briefcase” bomb blast in front of Delhi high court’s gate no. 5. We know there are weaknesses in the current security system and we know that it needs to be strengthened. The focus on the larger issues underpinning security is welcome. But we also urgently need to know more about the specific actions that individuals and institutions need to take in the short, medium term and long term to tone up security preparedness in these times of terror. In short, we need to dwell a lot more on the details. Just as AIDS advocacy achieves little if it is confined to “AIDS kills” and “Have safe sex” posters, security advocacy will also achieve little unless statements are translated into action-points — what to do, what not to do, how to make sure one is doing it right, and what to do when something is not working.


The discussion on security technology provides a telling illustration. There is a widespread belief that in view of repeated terror attacks in the country, better security technology and more specialised equipment are urgently needed. Investing heavily in security technology, however, will not automatically lead to better security unless many other things are done.
It is a bit like safety features in cars. Such features are necessary but not sufficient. Equally important is training the driver to use those features, actions of other people on the roads, the training they’ve had, the decisions they make, and the milieu they are operating in. The same is true of security.

Investigators of September 7 blast face a serious handicap because there were no CCTV (closed circuit television) cameras at the gate, though there had been an attack near another gate earlier this year. The high-decibel discussion on CCTVs will ensure that Delhi high court soon has CCTVs everywhere. Many other institutions will follow suit. But installation is only the first step. Without proper operation and maintenance, even state-of-the-art equipment is of little use.


Over and beyond security equipment is the question of security consciousness and that, along with the equipment, needs to be monitored. In nuts-and-bolts language, that means tasking specific persons to do specific jobs and holding them accountable for it.

In this context the Comptroller and Auditor General of India’s latest (2011) report on security management in the Indian Railways is revealing. According to the report, a surprise check to gauge the preparedness and alertness of security staff at 15 railway stations deemed to be at “high risk” revealed the following: Out of 470 CCTV cameras/monitors at these stations, 76 were not working. Two of the 15 stations had no CCTV. Out of 96 door-frame or walk-through metal detectors (DFMDs) in the 15 stations, 32 per cent were found to be non-functional. Baggage scanners had been provided at only five of the 15 stations.


Out of 137 authorised gates, 41 had no DFMDs. And of these 41 gates, only 59 per cent were found to be manned by security personnel. In only three stations out of the 15 did passengers have to go through any checks. Disturbingly, there were 106 unauthorised entry points at these 15 stations. No security personnel were deployed at these entrances except at one station. At one major station, Sealdah in Kolkata, nearly 68 per cent of the DFMDs were out of order. At the Jharsuguda station of South Eastern Railway Station, which falls in Maoist-affected terrain, there were several unauthorised entry points
and no door-frame metal detectors. The two that had been installed had gone for repair.

There were no baggage scanners or CCTVs either at this station.
Railway stations are by no means the only places where necessary security equipment is either lacking or not working. The broad message when security gizmo talk is at its peak is: installation alone is not action.


Patralekha Chatterjee writes on development issues in India and emerging economies
and can be reached at patralekha.chatterjee@gmail.com

World AIDS Day: Rising from the ashes

World AIDS Day: Rising from the ashes

Inpaper Magazine

By Huma Khawar

Shafqat Nisa’s first source of information regarding HIV was Nazeer Masih, President New Light AIDS Control Society, a non governmental organisation working for People Living with HIV. “He told me that he himself was HIV positive and one of the first to have declared his HIV status in Pakistan. Before that I thought my husband was the only one suffering from the infection,” says Nisa, Coordinator of the Rawalpindi branch of the NGO.

Working with people living with HIV and AIDS for over a decade, Nisa, 42, sees a remarkable change in people’s attitudes over the years. “When my husband returned to Pakistan after becoming HIV positive, I had no idea about the infection except through some strange television advertisements which made it seem like something terribly bad.”

“At that time when we visited the hospital, people gathered around us as if to see the eighth wonder of the world — including doctors,” she narrates her story of the stigma associated with the infection.

Masih, identifying the potential in Shafqat asked her to look for more HIV positive people, especially women. Although she thought it an ‘impossible task’, deriving support from Masih and his wife, she felt “if this sharing can help me so much I need to help other people out there still in hiding, not being able to find a soul to cry with.”

When her husband died in 2002, she was already working for the organisation.

The global HIV pandemic involves a significant proportion of children, with most paediatric HIV infections acquired through mother-to-child transmission during pregnancy, child-birth or breast-feeding. An increasing number of women and children infected with HIV are being reported in Pakistan. According to the UNAIDS estimates, out of the 96,000 people living with HIV in Pakistan, 27,000 are women of child-bearing age.

Gradually women started contacting Shafqat; even doctors referred patients. Today she has 70 HIV positive people registered. “When an HIV positive woman becomes pregnant, she knows she has to contact us as soon as possible. After a counselling session we take her to the lady doctor at the Treatment Centre at the hospital for further counselling.” Many women today, thanks to the timely referral by Nisa, have been able to give birth to HIV free child.

As I sit talking to Nisa in her office, Jamila, an outreach worker brings me tea and biscuits. Jamila’s husband tested HIV positive while working at a restaurant in London. “It was the hospital people who called my father-in-law and asked him to get me tested. The two tests, Rapid test at Pakistan Institute of Medical Science (PIMS) and Eliza at National Institute of Health, (NIH) Islamabad, both confirmed my HIV positive status. At that time I was seven months pregnant.”

Jamila, now 26, delivered her first baby boy in 2007. “I met the doctor at PIMS who gave me medicines so that my child is HIV negative. When the baby was born, they conducted two tests; both were negative. Alhamdolillah”, she adds.

Soon we are joined by another HIV positive woman Rasheeda, 23, carrying a six-week-old baby, her fifth child. “My husband is an Injecting Drug User and bed ridden for the past one and a half years. I have received ARVs during my last two deliveries and both my children have been tested HIV negative.”

“Initially breast feeding by HIV positive mother was considered a big risk for the baby and the mother was strictly forbidden to breastfeed. But now this has changed.” Nisa shares her concern of how difficult it is to convince these women on the changing global research every day.

“Deprived of mother’s milk the baby suffers from low weight, slow growth and ill health, besides diarrhoea and pneumonia”, explains Dr Shazra Abbas, health officer at UNICEF Pakistan.

According to the WHO Guidelines on HIV and Infant Feeding 2010, ‘Evidence has been reported that antiretroviral (ARV) interventions to either HIV infected mother or HIV exposed infant can significantly reduce the risk of post-natal transmission of HIV through breastfeeding.’ The recommendation, that replacement feeding should not be used unless it is Acceptable Feasible Affordable Sustainable and Safe (AFASS) remains.

Although the official figure of People Living with HIV is around 5,000, we see an increase of around 35 to 40 new patients every month at our Treatment Centres all over the country,” says Dr Naveeda Shabbir, of National AIDS Control Programme, (NACP) Ministry of Health.

“Most of the HIV cases in Pakistani women according to Dr Shabbir, show the infection acquired through the risk behaviours of their husbands. Most women are wives of migrant workers or IDUs. “Our women have ‘one of the highest maternal mortality rates in the world and lowest access to reproductive health services. These factors combined with poverty, illiteracy and lack of decision making make them vulnerable to HIV and AIDS,” adds Dr Shabbir.

(World AIDS Day is observed on December 1)

Creating a sectoral partnership

Women parliamentarians, journalists and civil society members from Pakistan, India and Bangladesh begin to work together on women and HIV-AIDS. TERESA REHMAN describes this coming together of three sectors.

Little did three women meeting for a friendly luncheon at Heritage India at Dupont Circle in Washington DC realize that they would actually propel a novel sisterhood of women all over the world.

The three friends, Leslie Wolfe, Jane Ransom and Yolonda Richardson were powerful women, heads of three international women's organizations based in Washington DC - Centre for Women Policy Studies (CWPS), International Women?s Media Foundation (IWMF) and Centre for Development and Population Activities (CEDPA) respectively.

What came out of the lunch was a resolve to chart a new course of partnership among women's rights organizations. Particularly among three sectors - parliamentarians, journalists and civil society who rarely work together in a 'safe space'.

Wolfe explains, "We wanted to create an environment of sisterhood and trust which, to be honest, would resemble our own trusting and sisterly relationship. It was especially important to us that our three NGOs were not competitors in any way, as we had different constituencies, different convening strategies, and different sets of expertise."

Therefore, the trio resolved to do something different. They decided to complement rather than compete with each other in order to have a multiplier effect on the way the toughest women's human rights issues could be address through women's policy leadership -- as policy makers, policy advocates, and policy reporters.

Their idea bore fruit and with grants from Ford Foundation, their first programme titled "Advancing Women's Leadership in Global HIV-AIDS policymaking" to foster new global partnerships to promote woman-centered HIV/AIDS policy in their countries. Two women each from the three sectors - parliamentarians, journalists and women living with HIV-AIDS and NGO leaders representatives from three different countries India, Kenya and Mexico came together to attend a series of high-level meetings at the US Congress, Washington DC and the UN Headquarters, New York in June 2008.

The participants resolved to go back to work in their own milieu but also continue this partnership and try to expand it to other sectors as well. The main concern was the similarity in their problems inspite of being from diverse countries, the escalating feminization of the epidemic and the alarming rise in HIV positive cases in married women in monogamous relationships. These revelations broke new ground - on how the very definition of HIV-AIDS is skewed and how it perpetuated stigma and discrimination. And how the stigma is killing more people than the virus itself. The meeting inspired the initiation of a listserv called Red Ribbon Media where women from these three sectors share news and information relating to HIV-AIDS.

In 2009 again, the resolve moved from 'global to regional', the focus this time was on South Asia in order to see some specific regional follow-up plans that two participants each from the three sectors in three different countries -- India, Bangladesh and Pakistan would develop and commit to implementing during 2010. During the South Asia Initiative held in Washington DC in December 2009, the participants resolved to work together on various issues like property rights, sex education for adolescents and access to information on HIV/AIDS. The idea was to bring the women together in new ways that might not reflect their Governments' traditional and current relationships.

The women discussed various issues and how its time to stop focusing on specific "risk groups" of women and instead consider that all women face some level of risk of HIV infection, some level of stigma and discrimination, some level of sexual violence and economic dependency. Once again it dawned on everyone that women and their issues were similar, only the circumstances varied.

"Of greatest importance is the fact that women's self-defined needs are not yet at the absolute center of HIV-AIDS policy and programming. At long last, during the past decade, women have gotten onto the agenda at a higher level, but unless we move to the top of the policy agenda, I fear we will still be having these conversations again in 20 years -- and that would be a tragedy for the world," adds Wolfe.

The first step in bringing the three sectors together to achieve a shared mission had been accomplished. Yasmeen Rehman, Member of Parliament from Pakistan feels it's a "brilliant" idea. "In Pakistan taboo and stigma is a big problem. Some people bracket HIV-AIDS with bad sex behaviour. Moreover, there is no clear-cut policy on stigma and allocation of funds. The silence is killing and we have to come out of this state of denial." She has some ideas like mainstreaming of HIV-AIDs with other health services, educating adolescents and motivating religious leaders to talk about it in the sessions after the prayers called the 'Khutba'. As a representative of the people, she feels that if she goes out and meet HIV positive people, she will succeed in breaking the stigma to a great extent.

Member of Parliament from India, Prabha Thakur who is also on the Parliamentary Forum on HIV-AIDS feels that these three sectors are anyway interlinked though not formally. "I am looking forward to this formal interlinking through ngos, public representatives and media monitors. The ngos give information to the public to create awareness, the MPs can talk on policy making and take it up with the health ministry and media can create awareness through education and knowledge," she says.

Bangladesh already has a vibrant civil society. Mufaweza Khan, Executive Director, Concerned Women for Family Development, an NGO of Bangladesh feels that it is important to take forward the existing policies and programmes rather than creating something new. She feels that care and treatment of HIV positive women is a real issue. "The reporters will write, the civil society will keep them informed and act as a pressure group on the parliamentarians to implement the policies," she says.

The journalists from these three countries have always been working with the civil society but are enthused by the involvement of the Parliamentarians. Journalist from Bangladesh, Zannatul Bakiya working with Channel I, the first satellite channel of the country feels that these linkages will have to created step by step. Yasmin Reema, working with 'Daily News', Bangaldesh feels that for 16 long years, she has been working on the issues of HIV-AIDS but in isolation. She looks forward to working in collaboration with these three sectors now.

The Pakistani journalists are buoyant about working together too. Sumera Khan, from Express news channel feels all the three sectors will have to do continuous follow-ups and work for the cause. Her colleague, Huma Khawar, a development journalist says, "The meeting broke the ice between us. We will be on better terms once we go back to our countries. We develop a bond in such forums to take it forward. I am very positive about it." Hopefully one luncheon will lead to a chain reaction -- of many more luncheons all over the world and usher in positive changes in women affected and vulnerable to HIV-AIDS.

(The writer is a journalist based in India and has been part of this programme. She can be reached at www.teresarehman.net).