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CULTURE, COMMUNITY NETWORKS, AND HIV/AIDS OUTREACH
OPPORTUNITIES IN A SOUTH INDIAN SIDDHA ORGANIZATION
Kaylan Baban, Scott Ikeda, Deeangelee Pooran, Nils Hennig MD/PhD, Debbie Indyk PhD, George Carter, Henry Sacks MD/PhD
Thomas C. Chalmers Clinical Trials Unit, Mount Sinai School of Medicine, New York, NY 10029
Foundation for Integrative AIDS Research, New York, NY 11217 & Gandeepam Siddha Hospital and Research Center, Tamil Nadu, India.
Methods
Background
 The gap that keeps HIV/AIDS treatment discrete from education and
prevention is a global phenomenon, acknowledged as a major challenge to
controlling the spread of HIV/AIDS.
 This study focuses on the work of Gandeepam, a non-governmental
organization (NGO) in the poor rural region of the south Indian state of
Tamil Nadu. Gandeepam practices an affordable traditional healing system
known as Siddha medicine. The priority of their three clinics is the curative
treatment of HIV/AIDS. In a country with one of the most rapidly increasing
rates of HIV infection, the small state of Tamil Nadu contains close to 50%
of India’s cases.
 Gandeepam is a strong and well-recognized presence in the community.
A large portion of Gandeepam’s time and staff are dedicated to education
and empowerment programs. Gandeepam’s non-medical efforts have five
primary foci, organized into the following Community-Based Organizations:
Child Labor Project, Farmers’ Group, Kitchen Herbal Garden Project,
Sanjeevini Women’s Group (originally a Gandeepam project; now an
autonomous, federated NGO), and Youth Club. (See table.)
 Villages in the region establish local chapters of these groups, with help
from Gandeepam. Some villages have chapters of all five groups, while
some have only one, according to the needs and interest of the villagers.
 In addition, Gandeepam heads a network of 60 Tamil Nadu NGOs, known
as the Gandeepam Global Foundation (GGF). Thus, Gandeepam has farranging influence not just in the immediate community, but in the larger
state as well.
Location in India
of Tamil Nadu
Purpose
 Part of a planning grant to assess Gandeepam’s capability to conduct
future clinical trials of their herbal HIV treatment. See also: posters by Scott
Ikeda and Deeangelee Pooran.
 This assessment is meant to establish the extent of Gandeepam and the
GGF’s influence on their communities, and to determine whether maximum
use is made of the opportunities thus provided to promote HIV awareness,
prevention, and treatment.
Reprint Requests or Correspondence should be directed to:
Kaylan Baban, BA, Mount Sinai School of Medicine
600 Columbus Ave, Apt 10J, NY, NY 10024
[email protected]
 Three weeks were spent with Gandeepam staff and patients, assessing Gandeepam’s
community programs and regional influence, as well as approach to HIV/AIDS education,
treatment, and prevention.
 Site visits were made to the headquarters of two Gandeepam partners, members of the
GGF, for purposes of better understanding the extent of the GGF’s influence, and making
comparison to Gandeepam’s approach to HIV/AIDS in the community.
 A qualitative survey on the subject of beliefs and attitudes towards HIV/AIDS education,
treatment, and transmission prevention was administered to representatives of 39 GGF
NGOs during a quarterly conference in July 2004.
Extent of Gandeepam’s Reach
Chapters do operate independently, but a hierarchical network from Gandeepam’s
Director to local field staff in the villages serves to ensure that they do not become too
isolated from one another, or from Gandeepam.
Through specific goals and target populations, these community-based organizations
provide a forum for virtually every member of the village, and can form a net to
strengthen the self-reliance of a village as a whole.
Community-Based
Organization
(CBO)
Description and Membership
Child Labor Project
Intended to benefit working children, provides evening classroom instruction
in 15 villages for approximately 1575 children ages 6 to 17, some working and
others not. Groups meet at least twice per month.
Farmers’ Group
For men, centered around Gandeepam trainings in plant cultivation. One of
the less well defined CBOs, the reach and extent of members’ participation is
unclear.
Kitchen Herbal
Gardens
Meant to enable households to treat minor illnesses, low-cost plants with
medicinal and nutritional value are marketed to approximately 60,000
households in 654 villages. Additional homes are reached by GGF partners.
Sanjeevini (now
autonomous)
For women. Local chapters work to keep teachers in regular attendance at
school, educate other parents against child labor, and draw government
attention to village problems as necessary. Office located at Gandeepam
headquarters in Kilavayal.
Youth Club
Predominantly young men over the age of 17. Members keep schools clean
and maintain village libraries where possible. Role and membership seems
less defined than that of other CBOs.
HIV/AIDS Outreach Practices
HIV/AIDS education is conducted almost entirely separately from Gandeepam’s
established community groups, and appears to fall solely to clinic personnel.
Gandeepam’s official prevention and treatment messages discourage the use of both
condoms and allopathic medicines, and promote their herbal treatment as a cure.
According to Siddha tradition, sexual intercourse decreases the body’s ability to fight
infection; therefore, patients are encouraged to practice abstinence, for therapeutic
purposes, while undergoing treatment.
Since adherent patients should be abstinent during treatment and cured after treatment,
Gandeepam clinic staff do not counsel on ways to avoid transmission of HIV to others.
An herbal oil to prevent HIV transmission has been made at Gandeepam, but is not in
use.
The survey of Gandeepam’s partner organizations (members of the GGF) yielded widely
varied approaches to HIV/AIDS education and prevention, and no discernible
coordination with treatment.
Like Gandeepam, most GGF NGOs neither provide, promote, nor believe in condoms
to prevent HIV transmission.
Most GGF NGOs are reluctant to discuss sexual health issues with men or single
women. Thus, those that do promote condoms usually target married women.
A small minority of GGF organizations does provide condoms to sex workers.
Conclusions & Looking Forward
Based on time spent with Gandeepam staff, patients, and partner organizations, it
appears that Gandeepam has created a very large and influential education and
empowerment network in its region. However—although fighting the spread of HIV is one
of Gandeepam’s top priorities—neither HIV education, nor treatment, nor prevention is
among the goals of its CBOs. Issues concerning HIV/AIDS are dealt with separately by
clinic staff treating infected patients and, since patients are considered abstinent during
treatment and treatment is considered curative, clinic counseling does not involve
discussions of how to prevent HIV transmission. The clinical trial this grant lays the
groundwork for could assist Gandeepam in assessing these outreach messages.
Though in a unique position to raise awareness and combat the spread of HIV, it appears
that Gandeepam and its partners are missing opportunities to do so, in part due to lack of
integration of HIV education into other programs. As indicated in conversation and in
survey responses, this approach seems at least partly informed by local belief systems
and cultural norms.
In recognition of the different beliefs held by the parties at Gandeepam and Mount Sinai
School of Medicine, these small, realistically attainable goals are proposed:
Build upon Gandeepam’s strength—their extensive access to and influence in the
community—to reduce local stigma against HIV patients. Proactive education in the
villages, conducted as a matter of course and independent of specific individuals, could
make life much easier for known HIV positive villagers.
Open a dialogue with Gandeepam to ascertain the nature of their dislike of condoms,
which is in part rooted in Siddha’s Hindu tradition. It is not expected that Gandeepam will
begin to promote their use, but perhaps they may not continue to discourage it in all
circumstances.