HIV/AIDS Awareness for Population

of Kalash Valleys

Organization Involved            AWARD (All Women Advancement & Resource Development) established in 1994.AWARD has integrated development and gender right based approach covering Health, Education and Income generation. AWARD has extensive experience and insight in health sector. It is one of the Pioneer organizations working in Reproductive and Sexual Health issues and emerged as resource organization for sexual health issues in NWFP

AWARD Contact Address:       17(40-B) Railway Road, University Town , and Peshawar

                                                Phone# +92-91-84406,844207

                                                Fax #   +92-91-844209

                                                E-mail: award@psh.paknet.com.pk

PROJECT SUMMARY

Project Title : HIV/AIDS AND HEALTH AWARENESS RAISING PROGRAMME FOR THE KALASH VALLEYS

Location:   Kalash Valleys of Chitral, Malakand Division

Implementing Agency: KALASH ENVIRONMENTAL PROTECTION SOCIETY (KEPS) in consultation with
                                    AWARD
Duration : Two Years

This pilot project has been designed to create awareness and educate the communities of the three valley on HIV/AIDS and STD’s, Hepatitis B & C and TB. During the first season, the capacity building of KEPS and Kalash people on the subject will be carried out to ensure the sustainability and documentation of the project.

INTRODUCTION

KEPS has been running a medical programme in the valleys for many years. It started with the Director (a qualified Emergency Medical Technician – trained in NYC) doing hands on medicine in the valley of Birir and teaching health education.

Now the NGO has opened a dispensary in Birir; we bring patients from that valley to the hospitals in Chitral, and patients needing special treatment from all three valleys down to Peshawar . This year, KEPS is opening a dispensary in Rumbur.

Back in the late eighties, after discussions between KEPS Director and Micheli Sectoli – Director of ICD – a TB clinic was opened in Shidi for the Afghan refugees and the people of the valleys. A doctor was trained in TB who later became the top doctor in the Civil Hospital of Chitral. Before he was unfortunately transferred to Dir, this doctor, Dr. Nazir, and the Director of KEPS planned to set up a TB programme in Birir-diagnosing the disease and training the local compounder in dispensing the TB drugs in the valley, thereby avoiding the pitfall of the woman falling short of the required amount of drugs, as all were dependant upon their menfolk collecting it from Chitral.

KEPS carried out a survey of TB patients in Birir and discovered that at that time – 2000 – there were approx one hundred TB patients in Birir. In 1986, there was only one. The Agha Khan Foundation was going to assist KEPS and Dr. Nazir. Though appointments were made on several occasions, the Foundation was unable to make it into the valleys, much to the regret of Dr. Nazir and KEPS.

Now, due to a number of Kalash women being exploited by mushrooming hotels, both in Chitral and Bumburet, there are sex workers in the valleys. KEPS is well aware from previous experience in relation to TB, how once a disease, that is passed through bodily fluids, takes root in the society, it will spread rapidly.  KEPS Director has also been to S.Africa on two occasions and has seen the havoc created there by AIDS.

Tara , raw alcohol mixed with industrial alcohol is being brewed in the villages and sold to outsiders. Besides causing death, it makes for uncontrolled behavior towards women.

A programme to bring awareness on the subject of HIV/AIDS, TSD and Hepatitis A &C and TB to the people of the three Kalash Valleys of Birir, Bumburet and Rumbur in the district of Chitral, NWFP is now regarded as a number one priority.

Health education funded by CIDA was carried out by the director of KEPS in 91/92. The programme was for all three valleys. This health education was carried on in the main part of Birir for a number of years after and ended with a two day workshop on the environment. The group has reassembled and is now a registered society.

BACKGROUND

The valleys are remote in winter, due to inclement weather and inaccessible roads. In summer, however, there are visitors from down country - tourists, both foreign and domestic with the largest number being young students from the Punjab . Refugees from Afghanistan , army personal and government officials also visit the area. The vulnerability of the Kalash to HIV/AIDS and STDs is increased due to lack of information and knowledge about the epidemic. Ever increasing tourism makes women and young people especially vulnerable to these diseases and the chances of exploitation.

Recently, a few women who had been exploited by certain individuals have been entrapped or attracted to commercial sex. Since the majority of the people are living in relative poverty, becoming a sex worker has been as a means of escaping from this unfortunate state. Sometimes these women are taken into Chitral or even Peshawar and seduced into prostitution. Unscrupulous government officials, police officers, local administrative officials and hotel owners are all culpable. Due to this and the sensitive nature of the subject, great care has to be taken to safeguard people’s reputation, both the sex workers and their clients and those propagating the trade to ensure safety of the sex workers and the survival of this ethnic minority group.

The Kalasha have been marginalized with low level of education, although that is now improving, low employment, lack of income generation, social exclusion due to beliefs, gender inequality and lack of control over one’s health. All these factors, compounded by the behaviour of a few high risk women, has increased the vulnerability of these people.

In such a scenario, where there is desperate economic pressure on the households to provide even the most basic necessities of life, issue such as family planning or safe sex (use of condoms) becomes secondary of less important. The prevention of sexually transmitted diseases (STDs), the consequences of which may be little understood, may not have a high priority in the face of a great many other social and economic risks.

About fifty percent of the inhabitants belong to the small indigenous ethnic group – the Kalasha. Most of the other have converted to Islam during the last forty years. The majority of the people are illiterate although now there are both Muslim schools and special schools for the Kalasha people.

The very existence of this ethnic minority group is at stake. If the HIV/AIDS epidemic finds its way into this community, their lack of knowledge will put them and their society in jeopardy.

Immediate measures need to be taken because:

JUSTIFICATION:

l.          In the valleys, there are now known sex workers.

2          There are a number of outsiders visiting the valleys. There are tourists, both foreign and domestic, refugees, army personal, male students from down-country, government officials, plus there are certain individuals enticing Kalasha women to go into Chitral for sexual activities.

3.         The majority of the people are illiterate.

4.         There is desperate economic pressure on households to provide even the basic necessities of life, Issues such as family planning and safe sex (use of condoms) becomes secondary or of less importance. Such things are not taken seriously and are little understood.

5.         Male visitors often take alcohol or hashish.

6.         Some Kalash and Muslims seek employment outside the valleys, as far away as Karachi .

7.         Lack of overall good healthcare facilities.

8.         Unscreened blood transfusions.

9.         Segregation of women during menstrual cycle and giving birth in unhygienic surroundings.

10.       Most people have no knowledge of sexually transmitted diseases, let alone HIV/AIDS. There is still a lack of real hygiene in most of the villages. Hepatitis is again not understood. (TB, which has almost reached epidemic proportions, is now being understood by some of the people due to health education, but there is a need for a greater involvement of the govt. on this issue.)

ll.          Family planning is rare. Condoms are very seldom used. Except in the rare cases of a few women take birth control pills, abstinence is the only method of birth control.

GOALS

1.         To bring education on this subject to both adult men and women

2.         To bring the same education to the schools

3.         To target the Bashali Houses, which are visited by all sexually active women who go there for their menstrual cycle and to give birth. The TBAs can be utilized to create awareness among the women.  

4.         To have the known sex workers screened for HIV/AIDS

5.         To prevent the spread of Hepatitis and STDs and TB.

6.         To make the people aware of the danger of Hepatitis, STDs, HIV/AIDS and how they can prevent these diseases.

7.         To carry out a survey for TB and Hepatitis along with AIDS research.

EXPECTED RESULTS

1.         That the people will become more sophisticated about the transmission of sexually transmitted diseases and Hepatitis, and TB.

2.         That they will become aware of the existence of HIV/AIDS, its dangers and how it is transmitted.

3.         That the project will save lives and prevent the decimation of a small ethnic minority group.

4.         That the people will adopt safe sex methods.

5.         That there will be diagnostic centres in the valleys for TB and Hepatitis and that medicine will be dispensed within the valleys.

6.         That the speed of infectious diseases will be curtailed.

7.         That the hospitals in the area will use only screened blood.

8          An information centre set up for the help or guidance of anyone who wishes for an HIV/AIDS test.

9.         Resource persons identified.

10.       Communities identified which are particularly vulnerable.

ACTIVITIES

1          To identify suitable teacher/trainers among the inhabitants. Those women known already to be sex workers would be asked to be teachers themselves. They are intelligent women, could be of great use in the programme. This will also, hopefully, ensure that they do not feet stigmatized or resentful about the implementation of the programme.

2          To engage the services of specialists in the field (AWARD) to preside over the initial workshop and a follow-up workshop - a 5-day workshop in each of the three valleys. The men would be separated from the women so as to lesson any chance for embarrassment. The subject is sensitive and in Kalash society, women are regarded as ‘impure’. These workshops to be held at the beginning of the programme and the beginning and end of the second year. The workshops would be small – directed at possible teacher/trainers identified by KEPS and the women’s societies.

3          Mini workshops in each of the three valleys directed by the trainer/supervisor with the help of the already identified resource persons. The teaching would be conducted stressing the WHYs of everything. Too often teaching, whether the three R’s or in health education, is taught and learnt parrot fashion which is not sustainable.

4          KEPS would do one-day monthly instruction in the schools and for the community organizations

5         To setup centres (perhaps at the dispensaries) where women can go for advice on where to go for HIV/AIDS testing.

METHOD OF MONITORING

No. 4 of the above would be followed by large one-day workshops in each of the valleys after the first eight months – a question and answer programme in which AWARD could assess the success of the programme. This would be followed by a further two-day workshop at the end of the eight months.  To this we could invite the donors to assess for themselves the benefit of the programme  

SUSTAINABLILITY

1        At the beginning of the nineties, KEPS director set up small health education groups in each of the three valleys for the Kalash women. In Birir this was extended as a women’s’ society, meeting each week. At the beginning, the women had approximately one-minute attention span. After several years, the attention span extended to a two-day workshop.

Now this group has become a registered society with AKRSP. Women’s societies have been formed in the other valleys as well containing the original women from the health education groups. These women are the most aware of the local women to follow through on the teaching at their weekly sessions.

2          Award is building capacity of KEPS for teaching the programme. KEPS has been involved in several teaching programmes, including general health education, sanitation cleanliness, guide training.

3          KEPS can also identify women among the Muslim society to work with the Muslim women in their community and their village organizations.

4          The mosques and schools can help sustain the programme by mentioning the teaching to the pupils on a weekly basis and the mullahs at Friday Prayers. Some of these religious leaders have already been approached and are keen to assist.

5          People involved in sex related activities shall be taken into confidence so that they could be used as a medium and source to minimize the chance for spreading the diseases. Meetings with Kalash students studying down in Peshawar our Muslim medical project worker from Birir, have shown that these educated youth are aware of the danger facing them and that they wish for a programme to be carried out in the valleys. Educated people can help the community in understanding the issue because they and the ones who are related to books and literature and can transfer, what they learn from different informative resources. They are also keen to assist when they return for vacations to the valleys. Most of them belong to a local organization that they have formed which now includes some female students. A number of these have been trained as local health workers or TBA’s and are receiving salary. These women will play an important role in educating the local community, especially young females. Both the LHWs and students are willing to assist by giving their time to the project without any additional salary.

ARRANGEMENTS FOR IMPLEMENTATION

KEPS and AWARD, in consultation, will develop working methodology and detailed work plan, which includes monitoring of the project’s activities and monitoring indicators. Monitoring will be on integrated part of the implementation mechanism, but a third party evaluation by the doctor is welcomed.

Cost Estimate for the HIV/AIDS Awareness for the Population of Kalash Valley

Duration                                                                    two year   Knowledge Awareness Practice Study                      Total duration-60days

  Three Workshops (Training and evaluation) each 5 days will be conducted in the beginning and at the end of the Project period.        

Direct Programme Cost

Organization’s Share