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Why India’s free online condom store is succeeding when the government’s distribution system is not

Repeated condom stock outs and faulty distribution make it difficult for people to get condoms through the public health system.

When the international non-profit organisation AIDS Healthcare Foundation started a free online condom store in India this April, they were surprised by the response that it got. In less than three months, the store’s stock of nearly 10 lakh condoms was shipped out to customers.

The foundation had expected its initial stocks to last till the end of the year but has now ordered another 20 lakh condoms that are expected to arrive this month.

The foundation started the free online condom store to fill gaps in the National Aids Control Organisation’s condom distribution programme. Promoting the use of condoms is one of the cornerstones of the HIV prevention and control programme. NACO distributes condoms to groups of people at high risk of contracting HIV like sex workers, transgender people and gay men. NACO workers also distribute condoms at antiretroviral treatment centres at government hospitals. Besides, NACO also gives condoms to non-traditional outlets such as kirana shops and barber shops, where condoms are either given away for free or sold at a low prices. NACO has installed condom vending machines in major cities and towns so that people can pick up condoms discreetly.

Despite all these measures, the number of condoms that NACO has been able to distribute among people at a high risk of contracting HIV has fallen drastically in recent years. In its mid-term appraisal report published in August 2016, NACO said that while it has distributed 88 crore condoms in 2014-’15, it managed to distribute only 20.90 crore condoms in 2015-’16.

“The fall in the condom distribution was a very glaring gap,’ said Dr V Sam Prasad, the AIDS Healthcare Foundation’s India programme director. “We hear of stock outs every now and then.”

Akhila Sivadas, executive director at the Centre for Advocacy and Research that works with people living with HIV, said that NACO’s supply of condoms has been particularly erratic in the past year, because of stock outs. Outreach workers with the Centre for Advocacy and Research in Ajmer had to get condom supplies from the government’s Family Planning Programme in Jaipur to make up for the shortfall of condoms from NACO.

Dr S Venkatesh, the deputy director general of NACO, did not reply to Scroll.in’s queries about gaps in supply.

NACO and the Family Planning programme are the two public health channels through which condoms are distributed. The Family Planning programme distributes condoms at government health centres and directly to people through Accredited Social Health Workers or ASHAs.The National Family Health Survey shows that the use of condoms among married women has increased only marginally from 5.2% in 2005-’06 to 5.6% in 2015-’16.

Poonam Muttreja, executive director of the Population Foundation of India, believes that asking ASHAs to distribute condoms is a flaw in the programme’s delivery.

“How can ASHA convince a man to use condoms?” she asked. “People are shy to go to the village ASHA for condoms. She lives in the same community. This is a management failure and a distribution failure.”

Bypassing stigma

Given that in India there is still a lot of secretiveness about sex and stigma around contraception, the AIDS Healthcare Foundation wants to give more people access to condoms discreetly and a free online store seemed to be the best idea.

“The objective is to showcase how condoms can be distributed online,” said Prasad. “The stigma is so high. There is a lot of discomfort when a person goes to buy condoms. Having a free condom store ensures that the person’s identity is confidential.”

In their campaign about the online store, the foundation asked people to call on a toll free number or write and email to them asking for condoms. The store sends boxes of 144 condoms each to people calling and writing in. The store also checks that the person ordering condoms will use the condoms and not sell them.

It is uncertain whether this early success of the online condom store is filling the gaps in NACO’s and the Family Planning programme’s condom distribution. Most of queries for condoms have come from men in urban areas, said Prasad. This shows that people in villages who health workers find it difficult to reach are not using the online store yet. However, the foundation hopes that word of the store will spread enough for queries to come from rural areas too.

Some organisations that distribute condoms are also using the online store to bolster their supply. For example, a targeted intervention programme in Tamil Nadu associated with NACO asked for a lakh condoms.

In all, the foundation sent 2,820 consignments of condoms to individual clients, while about 18 larger consignments were sent to non-profit organisations.

Muttreja said that online delivery of condoms was a fabulous idea. “We should try do everything to promote condoms, which is the only contraceptive with no side effects,” she said. “Even one unwanted pregnancy is one too many.”

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Changing the conversation around mental health in rural India

Insights that emerged from discussions around mental health at a village this World Mental Health Day.

Questioning is the art of learning. For an illness as debilitating as depression, asking the right questions is an important step in social acceptance and understanding. How do I open-up about my depression to my parents? Can meditation be counted as a treatment for depression? Should heartbreak be considered as a trigger for deep depression? These were some of the questions addressed by a panel consisting of the trustees and the founder of The Live Love Lough Foundation (TLLLF), a platform that seeks to champion the cause of mental health. The panel discussion was a part of an event organised by TLLLF to commemorate World Mental Health Day.

According to a National Mental Health Survey of India 2015-16, conducted by the National Institute of Mental Health and Neurosciences (NIMHANS), common mental disorders including depression, anxiety disorders and substance use disorders affect nearly 10% of the population, with 1 in 20 people in India suffering from depression. The survey reported a huge treatment gap, a problem that is spread far and wide across urban and rural parts of the country.

On 10th of October, trustees of the foundation, Anna Chandy, Dr. Shyam Bhat and Nina Nair, along with its founder, Deepika Padukone, made a visit to a community health project centre in Devangere, Karnataka. The project, started by The Association of People with Disability (APD) in 2010, got a much-needed boost after partnering with TLLLF 2 years ago, helping them reach 819 people suffering from mental illnesses and spreading its program to 6 Taluks, making a difference at a larger scale.

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During the visit, the TLLLF team met patients and their families to gain insights into the program’s effectiveness and impact. Basavaraja, a beneficiary of the program, spoke about the issues he faced because of his illness. He shared how people used to call him mad and would threaten to beat him up. Other patients expressed their difficulty in getting access to medical aid for which they had to travel to the next biggest city, Shivmoga which is about 2 hours away from Davangere. A marked difference from when TLLLF joined the project two years ago was the level of openness and awareness present amongst the villagers. Individuals and families were more expressive about their issues and challenges leading to a more evolved and helpful conversation.

The process of de-stigmatizing mental illnesses in a community and providing treatment to those who are suffering requires a strong nexus of partners to make progress in a holistic manner. Initially, getting different stakeholders together was difficult because of the lack of awareness and resources in the field of mental healthcare. But the project found its footing once it established a network of support from NIMHANS doctors who treated the patients at health camps, Primary Healthcare Centre doctors and the ASHA workers. On their visit, the TLLLF team along with APD and the project partners discussed the impact that was made by the program. Were beneficiaries able to access the free psychiatric drugs? Did the program help in reducing the distance patients had to travel to get treatment? During these discussions, the TLLLF team observed that even amongst the partners, there was an increased sense of support and responsiveness towards mental health aid.

The next leg of the visit took the TLLLF team to the village of Bilichodu where they met a support group that included 15 patients and caregivers. Ujjala Padukone, Deepika Padukone’s mother, being a caregiver herself, was also present in the discussion to share her experiences with the group and encouraged others to share their stories and concerns about their family members. While the discussion revolved around the importance of opening up and seeking help, the team brought about a forward-looking attitude within the group by discussing future possibilities in employment and livelihood options available for the patients.

As the TLLLF team honoured World Mental Health day, 2017 by visiting families, engaging with support groups and reviewing the successes and the challenges in rural mental healthcare, they noticed how the conversation, that was once difficult to start, now had characteristics of support, openness and a positive outlook towards the future. To continue this momentum, the organisation charted out the next steps that will further enrich the dialogue surrounding mental health, in both urban and rural areas. The steps include increasing research on mental health, enhancing the role of social media to drive awareness and decrease stigma and expanding their current programs. To know more, see here.

This article was produced by the Scroll marketing team on behalf of The Live Love Laugh Foundation and not by the Scroll editorial team.