1. Statement of needs
Tibetan refugees in India, approximately 83,000, should be categorized as a high risk group for HIV infection, due tohigh mobility, poverty, and lack of access to healthcare facilites. About 65% of the Tibetan refugee workforce travel in India seasonally as street venders; most of them travel to urban areas alone and are separated from their family for several months out of the year. Although no formal study has been conducted to determine the risk factors among Tibetan male refugees, it is highly speculated that they are at risk of exposure to HIV due to engaging in unprotected sex with commercial sex workers. According to the WHO, HIV prevalence among commercial sex workers is significantly high in India; for example, in Bombay, 60 % of sex workers are HIV positive. India has the third highest number of HIV infections in the world, and 85.6 % of cases are sexually transmitted.
The above data on HIV/AIDS in South-East Asia should be considered a warning to the community. The prevelence rate of HIV infection among Tibetan community is not offically announced but one data showed that 2 out of 45 Tibetan youth tested were HIV positive, as a result of a random sample test conducted in 2006. It leads to a conclusion that a dedicated program of education intervention and treatment is needed in the Tibetan refugee community.
Despite the urgent needs to tackle with HIV issues in the community, there are few awareness and prevention programmes visible within the communities. CHOICE takes an initiative to scale up prevention intervention and design and implement comprehensive HIV programs. Our challenges include: promoting behavior change among people through a broad communication of information on HIV, developing women's negotiation skills through gender workshops; and reducing stigma and discrimination against people living with HIV/AIDS (PLHA).
CHOICE plays a facilitators role in community mobilization and sensitization. We recognize that every phase of our programs should be people-centered and respond to people's need. Therefore, involvement of every stakeholder, including Tibetan Government in Exile (TGiE), NGOs, local community and People living with HIV/AIDS (PLHA) in designing and implementing programs is crucial to the success of our project. This strategy would bring a sense of ownership among the project beneficiaries and would help for sustainability of the project. (*1) Migration for work, seasonal labor and professions such as truck-driving can separate men from their spouses or regular partners for long periods, increasing the likelihood of entering into casual, unprotected sex, including relationships with sex workersh (UNAIDS. 2006, HIV/AIDS and Gender: Facts sheets).
2. Organaizational history
“Being mobile in and of itself is not a risk factor for HIV infection. It is the situations encountered and the behaviors possibly engaged in during mobility or migration that increase vulnerability and risk regarding HIV/AIDS.” - UNAIDS
Seeing that Tibetan refugees were in need of effective HIV/AIDS preventative intervention early on, the Director of the Lung-ta project (Japanese NGO), Ms. Akemi Takahashi first supported the training on HIV/AIDS and related issues for a group of Tibetan professionals.
The group consisted of two doctors from the Tibetan Medical and Astrological Institute (TMAI), a senior nurse from the only Tibetan-run Hospital (Delek Hospital), the Director and staff from the Dharamshala based Kunphen Centre for Substance Use and Drug Abuse, and a member of the Tibetan Youth Congress. These members underwent a three week intensive course on HIV/AIDS and its related issues at the SAHARA Centre for Residential Care and Rehabilitation (www.saharahouse.org), New Delhi, in order to take action to: scale up prevention intervention and design and implement comprehensive HIV programs. Our challenges include: promoting behavior change among men and women through a broad communication of information on HIV prevention such as promoting condom use, developing women's negotiation skills through empowerment workshops; and reducing stigma and discrimination against people living with HIV/AIDS (PLHA).
1. Mr. Dawa Tsering, MP Tibetan Parliament
2. Mr. Karma Yeshi Nazee, Editor Voice of Tibet
3. Dr. Tenzin Namdul, Tibetan Medical & Astrological Institute of H.H. the Dalai Lama Institute of H.H. the Dalai Lama (TMAI)
4. Dr. Yangzom Dolkar, Delek Hospital
5. Nurse Tsering Paldon, Delek Hospital
6. Mr. Lobsang Yeshi, Researcher
7. Mr. Sonam Topden, PGT, TCV Gopalpur
8. Mr. Tashi Dhondup, Health Worker, Sherabling
9. Mr. Phuntsok Chomphel, Project Officer - CHOICE
Ms. Akemi Takahashi / Co-founder
Dr. Rigzin Sangmo, TMAI
Ms. Dolma Choephel
Mr. Tenzin Lekphel