Taking it to the Village: Reducing stigma through Traditional Street Theater

WE CARE SOCIAL SERVICE SOCIETYTAMIL NADU, INDIA

Promotion of Community Discussion and Debate

Background

• HIV prevalence is less than 1% in Kancheepuram district, Tamil Nadu

• WE CARE provides Counseling, Psychosocial Support, Employment, Nutrition and Treatment services to PLHIV through community outreach, Community Care Center etc.

• PLHIV experience and fear S&D. Common forms included: – Rejection– Isolation– Blame– Shame

• Stigma and discrimination faced by PLHIV is a large barrier to our services such as • PLHIV refuse to accept home based services• Afraid to get welfare services from the government• Afraid to visit Community Care Center to access care services• Travel to far off distances to access services avoiding locally available

facilities

Therukoothu – Street Drama : Why?

Attracts a diverse audience: Men, women and children Able to maintain the absolute attention of the audience. Allows weaving in HIV and S & D issues Non-threatening way to broach sensitive topics in socially

acceptable way with a mixed age and gender audience

Program Design

Identification of problemWhat are the stigma related

issues among PLHIV?

Identification of places10 villages with

more than 5 PLHIV

Development of scripts Weaving the S&D and HIV

issues with the script

Formation of Village Committee for organizing performances

(Village leaders, women self help groups and youth groups)

Program Evaluation(20 FGD, 64 Key informant interviews)

Formation & Training of troupe(5 PLHIV + 3 Non PLHIV performers + 7 Traditional

Koothu performers

Pre-performance interactionsPerformances &

Post performance interactions(Team resides in the village and performed in 3 nights)

Key Issues Addressed in Play

• PLHIV, including children, face S&D• S&D takes many forms • S&D has harmful consequences

• HIV is NOT transmitted casually: no need to fear PLHIV

• PLHIV can live long, healthy, productive lives

• Importance of family & community in supporting PLHIV

Critical Elements of Play

• Generating discussion and debate among the audience– Stopping play at key intervals to ask and respond to questions– Prizes awarded for participation

• Clarification by facilitator of myths and misconceptions raised during audience interaction

• Sharing of testimonies of positive persons, both positive actors and others

• Post performance discussions:– Troupe resides in village for all 4 days

Results: Villages• Around 7000 audience members in 10 villages

• Village leaders engaged to support follow-on activities & knowledge increased on: – Challenges faced by PLHIV in their villages– Need to organize services & address S&D

• Increased awareness & understanding in villages leading to: – Reduction in fear of casual transmission

“just living with a person with HIV does not lead to infection,”

– Willingness to interact with and support PLHIV “definitely behavior towards PLHIV will change because we no longer are afraid of them. My own behavior will definitely change as I am not longer afraid.”

– Awareness of availability of services: ICTC, PMTCT, ART“That it is possible for PLHIV to get married to each other, and to live positively. That we should not feel bad about HIV.”

Results: Villages

Reduced fear of S&D among

PLHIV, if their status becomes

revealed

“Before I had much self stigma, I was afraid the

general community people would stigmatize me if they

got to know my status. Now, because of the play, I am less afraid of what might

happen if they get to know my status…

Results: PLHIV(Troupe Members)

• New skills– Theatre– Life and social skills

• Built self-esteem and confidence

• Meaningful activity: being able to share own life and educate others

• Provided income to contribute to the household– Improving status and reducing stigma at home

• Provided impetus & support to reduce drug use.– When I am providing the information (in the play), it makes me feel

stronger as I am telling people they can live long with HIV if they take medicine, and so that reinforces me and encourages me to do that.

Key Lessons• Power of Theatre to reduce S&D

• Non-threatening and socially acceptable way to address sensitive and taboo topics

• Allows message to be heard by a diverse audience

• Involvement of community Leaders is critical• Contact strategies Key for success:

• Stop-start drama to allow for interaction & address specific audience issues

• Presence of team in village for 3 days• Knowing the audience & crafting

messages• Sharing of life experiences

by PLHIV

Key Lessons

• Careful crafting of script to: – Be flexible– Ensure sensitive issues and facts

presented in an acceptable manner – Strike the balance between entertainment

to hold the audience’s attention, and delivering messages

• Change takes time and requires ongoing support.

• Stigma reduction should be integrated in all HIV Prevention and Care programs.

• Need to scale up community support for replicating similar Programs.

• Need to address S&D in Health Care setting

Next . . . .

THANK YOU

WE CARE4/98, Nethaji Street, Singaperumal Koil,Kancheepuram District - 603 204Tamil Nadu, IndiaPhone: 044 – 2746 4037Mob : 93 4000 1000Email : wecareindia@gmail.com