By Abhishek Jha for Youth Ki Awaaz:
“Nadda ji goes to the U.N. and pledges support for making an AIDS-free world by 2030. Can we have an AIDS-free world when you are not releasing funds properly?” Amit Kumar, National Programme Coordinator of All India Network of Sex Workers, said to me. He was arguing why their organisation thinks that the government will not be able to meet the target. This is because, he said, the government has reduced the participation of the community that gets affected by AIDS in its National AIDS Control Programme (NACP), which is in the final year of its fourth phase.
The NACP is run by the National AIDS Control Organisation (NACO). It is implemented in each state by a State AIDS Control Society (SACS). Since the second phase of the NACP, which began in late 1999, preventing new infections through Targeted Intervention (TI) in communities of high-risk groups (HRGs)- such as female sex workers and their clients, MSMs, transgender people, and intravenous drug users (IVDU)- has been an important aspect of the programme. This is because TIs are managed at the community level by partner NGOs and CBOs (Community Based Organisations), whose outreach workers (ORWs) and peer educators are often from the HRGs. They can, therefore, reach out to the remotest person affected by HIV.
“When the staff don’t get salary on time and peers don’t get their honorarium on time, it lowers their motivation and affects the work. We don’t get the results as expected,” Dr. Umakant Sharma, who is the Programme Manager at Indian Society for Applied Research and Development, which collaborates with the Delhi State AIDS Control Society (DSACS) told me.
Dr. Sharma was narrating a problem that has been hurting collaborators of the DSACS for one and a half to two years. Five different collaborators that I spoke to said that they have not received the funds for either five or six months from the financial year 2014-2015 and 2015-2016. Although they have received funds for the months of April to September 2016 recently, the arrears are a cause of concern. Some narrated the problems they are facing only on the condition of anonymity.
Peers, I was told by different organisations, are the worst affected by the delay in funds. “They are doing such great work, getting their friends out of risk. Then (when they don’t get paid) they feel that the programme is a sham,” Amitabh*, who works as a Programme Director at A*, told me.
Chhaya*, who works as an ORW at C*, told me that as some of these peers have either been forced out of their homes or left their families, they don’t have an alternate support system. When they don’t get paid, she said, some peers “are forced to do sex-work even when unwilling” to do so. And there, Amitabh explained, as customers pay only around Rs. 100 to 200, sometimes they are forced to consider them even when they don’t want to use a condom.
“This whole process (of disillusionment with DSACS to AIDS-vulnerability) is interlinked,” Amitabh told me, arguing how the fund crunch has created vulnerabilities afresh. They take the risk because there are daily expenses like that of food, shelter, and conveyance to be paid for.
Moreover, he added, when the DSACS does not tell them exactly when the funds will arrive, he is unable to give concrete assurances to the peers and staff. This creates disillusionment among them and affects their relationship with the organisation. Some eventually leave. Chhaya told me that in the past two years, some 16 to 17 peer educators out of 20 and about 3 to 4 out of 6 outreach workers had left their organisation.
The organisation suffers too. Beena*, who works as a programme manager at B*, told me that they used to conduct an annual get-together meeting, which was also a way to promote safe-sex practices and other information related to HIV/AIDS. The expenses for the same were met through the funds provided by DSACS. Due to the delays, they could not conduct the meeting last year. This, she told me, was in addition to the problems they were facing in conducting their regular meetings.
“The fund (from DSACS), on the other hand, is awarded on the basis of the performance indicator, and we are asked why our performance is down,” Dr. Sharma told me.
The NGO/CBO operational guidelines of the NACO state that two or more poor performances in an year can lead to termination of grants offered to the organisation. 62 TI NGOs in Haryana have reportedly had to shut down since December 2015 because the Haryana SACS stopped funding them. The reason cited was that they were ‘not performing’.
The delays in payment to these collaborators started around 2014 when the process of disbursement of funds from the National AIDS Control Organisation (NACO) was altered. It was then decided that funds for the centrally funded National AIDS Control Programme (NACP) will be first transferred to the state treasuries and then by the state to the state societies.
Documents accessed by a Reuters reporter in 2015 under the RTI Act had shown that several states were holding back funds from the state societies, using them instead for their own schemes. Before this the health ministry in 2013 had failed to sign a grant renewal worth US$ 187 million from the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) for 18 months, triggering drug shortages.
The NACO Director General Navpreet Kang, in a meeting with sex-workers in July, acknowledged that there has been “an issue with payments” for the past two years. However, he reportedly said that sorting the issue would require six more months as they have gone back to the old method of disbursement.
Fingers have also been pointed towards the attitude of the government, which has been slow and conservative in addressing HIV/AIDS after gradual reduction in participation of foreign donors when NACP’s fourth phase began in 2012. Stock-outs of essential drugs, shortage of condoms, delays in distribution of condoms to TI organisations have surfaced regularly. In the last fiscal year, funds for the NACP were also cut down by around 22 percent (from 1785 crore to 1397 crore) before being restored to 1700 crore this year.
Meena Seshu, General Secretary of Sangram, a collaborator with the Maharashtra SACS told me in an e-mail that that the NACP has not been able to revert back ever since the Gates Foundation left. The MSACS funding, she said, was disturbed in the past two years and “they don’t have the money to spend on anything”.
The delay in disbursement, whether the problem be with NACO or the SACS, is already having repercussions. Condom distribution among high risk groups is another activity performed by TIs. Meena Seshu told me that while MSACS has condoms in stock, there was a problem with distribution. Her work in Sangli and Satara districts gets affected as the postal mechanism of distributing condoms alphabetically means that there are delays in delivering condoms to the two districts.
Beena, who works at B in Delhi, told me that in the months of April and May this year- when there were reports of nationwide shortage of condoms, they had no condoms at all. They distributed some 1300 condoms from their stock for the month of March.
C did not have any condoms, Chhaya told me, for 2 to 3 months until they received a stock of around 15 to 16 thousand condoms in June when their monthly demand of condoms is around 52,000. In the June stock, Chhaya said, there also had been complaints from community members regarding the quality of the condoms. Their stock for July was already finished when I visited them late in the month.
The weekly stock status of free condoms at SAC TIs uploaded by NACO too said that Delhi did not have sufficient stock of condoms for even a month’s period at SACSs and TIs level as on 18th June 2016. But when contacted, Dr. J. K. Mishra, Joint Director, Delhi SACS (TI), first said that there is a national shortage of condoms before saying that the stock was sufficient for then and that they are managing.
Chotu Ram, Maintenance and Evaluation Officer at Shaktivahini, whom I met at the Indian Medicine Development Trust offices at Lahori Gate in Delhi, told me that since their organisation works at a place with a large FSW (Female Sex Workers) population, they are supplied condoms on time and they do not experience any shortages. Shaktivahini’s President Ravi Kant, however, did tell me that they too had not received funds for several months and had recently received funds for six months.
In a recent interview to Scroll.in, the Joint Commissioner of the NACO, said in the case of shortage of drugs, the State AIDS Control Societies can purchase medicines from any available funds and so can the ART (anti retroviral therapy) centres. Amitabh told me that they are also told to ask the NGO partnering with the SACS for funds when they complain about non-payment of salaries.
Dr. Sharma told me that their organisation does support them through loans, which they reimburse when funds from DSACS arrives. However, he said that such donations and loans are only able to accommodate the field activities. He added that they cannot create this provision with the help of the parent NGO every time.
“One TI has the budget of around Rs. 20 to 22 lakhs. If we do not receive funds for 10-11 months, which NGO has the corporate funds to spend 18-20 lakhs in an year?” Amitabh told me. Beena’s organisation too had been running their programmes with the help of such loans but unable to pay their rent, they had to lock their offices in June. They reopened when the funds for April to September came in.
Dr. Sharma though told me that he has heard that the payment on the arrears of 3 months from financial year 2014-2015 will be made by the end of July and for the 2 months in financial year 2015-2016 later. Other people were not as hopeful.
Amit from the All India Network of Sex Workers says that mistakes of NACP-IV can be addressed only when consultation with communities of high risk groups is done and their recommendations considered before formulating NACP-V. He said that although their President is part of the mid-term appraisal of the NACP-IV going on and due process is being followed, they feel that community members and their representatives are not adequately represented.
Chhaya, therefore, is not hopeful even when I tell her that the NACO Director General has assured that the delays will end in 6 months. As Amitabh put it, the response has always been in the same refrain: “Aa raha hai ji, aa raha hai ji, ab aa jayega“.
*Names of representatives of NGOs/CBOs and their organisations changed on request.
Featured image credit: DIBYANGSHU SARKAR/AFP/Getty Images