India’s Red Ribbon Express Connects Citizens to HIV Information

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India’s Red Ribbon Express Connects Citizens to HIV Information

Deepali Gaur Singh

A colorful new train will travel throughout India to bring HIV information -- in accessible, multimedia format -- to Indians countrywide.

On July 24 a specially
designed train with seven cheery yellow coaches chugged in to the Bangalore railway station, carrying in it a motley group of cultural
troupes, educational materials and giant models, one of which is of a
pregnant mother with an automated voice of a child that regularly reminds
her of precautionary measures during the pregnancy. With a salute to
life and the inspiring slogan ‘Zindagi Zindabad’ (literally meaning
‘Long Live Life’), the Red Ribbon Express (RRE) started its year-long
journey along the length and breadth of India carrying the critical
messages associated with HIV/AIDS. That the Indian railways should be
made the vehicle of this campaign is apt since it is the one government-run
machinery that single-handedly connects and reaches out to the largest
numbers in the country.

In partnership
with various international, national, state and local organizations,
the Indian Railways employed the colourful coaches of the train to convey,
through innovative and interactive educational material, information on HIV
specifically dealing with primary prevention services and enhancing
people’s knowledge about such preventive measures, health habits,
lifestyle and safe behavioral practices and developing a more unprejudiced
understanding of the virus and consequently removing the associated
stigma and discrimination against positive persons and their families.

In the constant
effort to reach as many people in as little time as possible, the battle
against HIV, at times, has been difficult, especially in a country where
outreach to the remotest of areas continues to be plagued by numerous
obstacles, poverty and illiteracy being at the core of all these issues.
And it is keeping this in mind that this campaign seeks to prioritise
those far-flung villages that already suffer a minimal or the complete
lack of media or government interventions.

After over seven
months on the tracks the train made its pit-stop in the southern state
of Karnataka, where during its halt here, it is expected
to reach out to at least 5,000 people a day. Flagged off from New Delhi
on December 1, 2007, the train aims to mainstream the issue of HIV in the context of overall socio-economic
development, a concern that had thus far remained in the realms of a
medical and/or public health issue. Envisioning a multi-sectoral approach
based on the combined use of the multimedia and mass mobilization, the
project aims at a holistic and comprehensive campaign in 180 halt stations,
across approximately 43,000 villages of 24 states and union territories
to mobilize a people’s movement against AIDS.

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Of the seven coaches
of the RRE three coaches carry educational material primarily on the
virus but linked to other programs as well supported by multimedia
tools like interactive touch screens and 3-D models. One of the coaches
is the auditorium-cum-conference arena for film screenings and orientation
and sensitization sessions for selected groups of community stakeholders.
One coach is specifically dedicated to counseling and medical services
with doctors available for syndromic treatment for STI and RTI cases.
While there is no onboard HIV testing facility there are provisions
for referral services to the nearby ICTC and other care and support
services on HIV/AIDS. The remaining two coaches are dedicated to the
food and accommodation arrangements for the traveling team.

Besides, the in-train
activities that include exhibitions, audio-visuals, films, training,
counseling and medical services at every station that the train docks
there are also on-platform activities that include an exhibition and
cultural performances on the platforms till the departure of the train.
And during these days the outreach activities in to villages revolve
around cycle and bus caravans. While the latter (bus caravan) travels
to the peripheries of each district as per the route map taking with them knowledge on the virus
and the associated risks, the former includes the use of the performing
arts (specific to the local, regional and cultural context) to disseminate
the HIV prevention messages. The performers disperse to the selected
villages in the districts on cycles singing songs, telling stories,
enacting incidents, staging plays with one common thread – all
with HIV related issues woven in to them.

Using traditional
techniques of a more rustic brand of infotainment through folk theatre
and songs these traveling artistes not only disseminate information
but simultaneously break myths and misconceptions that have continuously
besieged every affirmative action to combat HIV. While maps on board
the train give a clearer perspective on the extent of the threat of
HIV/AIDS in various states, the giant blood bags and syringes are to
bring greater clarity to the modes of transmission of the virus. Age-
and gender- customized interactive animated films, games and quizzes
testing the HIV/AIDS IQ of visitors as well as condom vending machines,
(with condoms at Rs 5) are the other activities and facilities that make
up this grand HIV-centric traveling carnival. From the importance of
using single-use disposable syringes – a concern area since many infections
have been located to IDUs – to using HIV safe blood from a licensed
blood bank; from how the transmission of HIV to the child during pregnancy
can be prevented with right medication to the options for HIV positive
pregnant women, the train is literally a hub of information on the virus
and associated concerns. With groups travelling to various villages
everyday the RRE is also covering this distance for a greater sensitization
towards positive persons and their families, an issue which has manifested
itself in various degrees and forms of ostracization and isolation and
continues to dog all efforts at basic human rights and dignity for positive

An important component
is what is seen as environment building at the program villages which
will use traditional, popular techniques of information dissemination
in literacy–poor, rural areas like loud-speaker campaigns, besides the
more common methods of wall-writing, hand outs and pamphlets. Additionally,
the interactive sessions would involve crucial stakeholders of the village
with a deliberate focus on youth groups, women’s self-help groups (SHGs),
Anganwadi Workers (AWWs), adolescents/student community from schools
and colleges or non-student youth, particularly in these rural areas.
One of the important government assignments of the AWWs has been their
outreach campaign for pregnant and lactating mothers, which is what
also makes them crucial access links to this group with regard to HIV
testing as well as preventive measures for pregnant positive mothers.
Similarly, youth and women groups or SHGs already have established
contacts within the villages and hence enjoy a greater level of comfort
and trust within the community thus allowing for such community-based
interventions to be more successful.

From Karnataka
the train now heads to Goa and is already on its return journey as it
goes through the west to the extreme north of the country and eventually
returns back to Delhi on November 28, 2008. Even as the RRE continues
to break ground by tackling issues in the interiors of the country which
would be otherwise considered taboo, on the basis of its interactions
and interventions it also fixes the role and responsibility of various
sections of the government with regard to creating awareness and controlling
new infections is concerned.

Quite ironically
a train that, during the course of its journey, will cut across all
those states that blocked the sex education curriculum for adolescents
is drawing school children in hordes. So even as sex education remains
a contentious issue this train with HIV/AIDS at the centre of its theme
(and evident from the response it has garnered) exposes the obvious
disjunction in many policies and programmes that distance themselves
from crucial issues on the basis of arguments rooted in traditions and
culture. Not surprisingly many politicians continue to reduce the entire
issue of combating HIV to that of "abstinence-only" and "the importance
of upholding values" even as the response to the RRE reveals the average
Indian’s willingness to utilise information and services as long as
it reaches them in a manner and language that is comprehensible to them
and located within their specific local context.