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India

Dr. Adey Niyamathi in India

Dr. Adey Nyamathi, who has spent a great deal of time in recent years doing collaborative research on HIV/AIDS in India, was visiting several years ago when she became intrigued by a discussion Indian scientists were having about a new strategy for promoting health in rural villages.

In 2005, as part of its National Rural Health Mission, the Indian government began using ASHAs (Accredited Social Health Activists). The concept involves training lay village women who reside in rural communities to be health advocates who can address the needs of marginalized community members and serve as liaisons to primary care providers - specifically, community nurse midwives, clinic nurses and physicians. At the time, the ASHA effort was focused on reproductive health. But Nyamathi saw potential benefits in training ASHAs in the area of HIV/AIDS. With encouragement from the then-Minister of State, Nyamathi applied for and was funded by the National Institutes of Health to examine the feasibility of such an approach.

An estimated 2.5 million people are infected with HIV in India, of whom roughly half are women. Access to antiretroviral therapy is expanding for people living with AIDS, but most of the treatment centers are located in urban areas - making the lifesaving therapy difficult to obtain for the nearly half of the HIV-infected population living in rural areas. "The hospital is typically hours away from where they live," explains Nyamathi. Even for those who obtain the therapy, she adds, there is a great need for support to help rural women adhere to the complex medication regimen. What's more, many of these women are illiterate and have little decision-making power; rarely are they employed.

Nyamathi's group is pilot-testing the effectiveness of a culturally appropriate, community-based HIV health promotion intervention program, ASHA-LIFE (Life Improvement For the Empowered), in improving outcomes related to physical health, mental health, adherence with therapy and HIV/AIDS knowledge among rural women with AIDS. Women in the ASHA-LIFE group are also being taught "life skills" to assist them in earning a livelihood.

The study, now in its third year, is already yielding dramatic results. After six months, adherence to antiretroviral therapy was significantly improved for the intervention group vs. the control group, and the stigma associated with HIV/AIDS had been reduced. "We have seen tremendous improvements among the women receiving the ASHA-LIFE intervention," Nyamathi says. The research could lead to a new national model - the Indian Council for Medical Research has expressed an interest in expanding the intervention across India's rural areas if the pilot study proves successful.

"It's very exciting for India, but this is also an approach that could be effective in many impoverished areas where access to care is poor," says Nyamathi, whose work in the world's second-most populous country is yet one more significant piece in the school's growing overseas presence.

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