WHARF volunteers from R.A. Podar College led discussions with students about WHARF ’s goals and accomplishments.

Community-based efforts address HIV/AIDS epidemic in India

On December 1, 2005, health care providers and activists around the world once again observed World AIDS Day. Annually people come together on this day and the days following for a series of events to focus attention on HIV/AIDS. The events of World AIDS Day help to highlight scientific research related to HIV/AIDS, promote fundraising efforts, commemorate victims of this epidemic, and provide education to aid with prevention and treatment. With the most recent observance of this day just behind us, this seems a natural time to review the efforts of HMI and its partners to address HIV/AIDS.

Dr. Harvey Makadon

WHARF provides education to frontline caregivers
In India, HMI continues to deliver free education programs under the auspices of WHARF (Wockhardt-Harvard Medical International HIV/AIDS Education and Research Foundation), an NGO formed by HMI and Wockhardt Hospitals, Ltd. in 2002. WHARF was spearheaded by Harvey Makadon, MD, HMI vice president of health systems, in collaboration with faculty and physicians in India. Utilizing a train-the-trainer approach, WHARF seeks to build the capacity of frontline health care providers confronting the HIV/AIDS epidemic, and is the catalyst for collaborations between providers all over India.

Dr. Rakhi Nair, a founding member of the WHARF faculty, reports that since its inception, 36 basic WHARF programs have provided training for over 1,200 people. These trainees, as a condition of admission into the program, have each pledged to train five more caregivers. It is estimated that as of this writing, more than 3,000 more caregivers have been trained.

“The program participants are not only clinicians or students who are in medical school, but also counselors, social workers, and paramedical students,” said Nair.

WHARF’s programs address the full spectrum of HIV/AIDS-related issues, exploring the epidemiological impact at both the global and country level, as well as presenting the latest knowledge in the clinical areas, including the principles of antiretroviral therapy, prevention and management of opportunistic infections, prevention of mother-to-child transmission, and HIV virology and its pathogenesis. The programs also cover HIV care from a primary care perspective, and emphasize prevention. The WHARF faculty includes clinicians from both Harvard Medical School and India. WHARF’s programs are funded in part by a grant from the Horace Goldsmith Foundation.

WHARF has also established an advanced program for providers who have completed the basic program or been in practice for at least four years. To date, six advanced programs have been held, and they are expected to continue. “The basic program participants are usually very enthusiastic to attend the advanced program,” said Nair.

World AIDS Day programs reach out to young people
WHARF faculty organized a series of educational events in Mumbai to mark World AIDS Day, including three programs for 540 college students, a community-based program in Dharavi that was attended by 75 boys, and a basic WHARF training program at Prince Aly Khan Hospital for 54 health care professionals.

Dharavi program uncovers lack of knowledge about HIV/AIDS
Last summer, Nair led a program in Dharavi, the largest slum area in Mumbai. The goal of this program was to provide training and education to local providers, and assess knowledge about HIV/AIDS in the community.

Lakshmi Nambiar (in blue, at center) participated in a WHARF program held in Dharavi.

Lakshmi Nambiar, a student at Massachusetts Institute of Technology (MIT) in Boston, participated in this program as part of MIT’s Douglas Traveling Fellowship for Juniors. Her task was to conduct a survey of local residents to find out what they knew and understood about HIV/AIDS. She went door-to-door throughout Dharavi and spoke to approximately 200 women. “I found that doctor-patient interactions in the community failed to address many of the concerns of the women,” said Nambiar. “Many of the women surveyed had first-hand experience with HIV/AIDS as close relatives, including spouses, had died due to the disease. However, despite their visits with doctors, they had received no counseling and many remained unaware of the routes of transmission.”

Addressing needs in rural settings
In July 2004, the predominantly tribal district of Jhabua was the site of an education program aimed at providing nurses, midwives, teachers, and community leaders with the tools and knowledge to address the HIV/AIDS problem in the region. The two-day program attracted a diverse group of 170 participants.

WHARF became involved in this program because of Dr. Fabian Toegel, who was then a student at Ludwig Maximilians University, an HMI partner institution located in Munich, Germany. Toegel works with the Association of Partners of India (API), a Germany-based NGO involved in several health-related projects in Jhabua. Makadon connected Toegel with WHARF faculty members Dr. Deepak Batura and Dr. Rakhi Nair.

Toegel reports that API has continued to work with WHARF to conduct voluntary counseling and testing centers for HIV/AIDS patients in four key towns across Jhabua, and collect epidemiological data from local patients.

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