IMCARES, India
IMCARES (Inter-Mission Care And Rehabilitation Society)
is a Christian NGO working with local churches in the poorest
communities in Mumbai, India. There are an estimated
2.5 million people living with HIV in India.8
Mumbai is the economic capital of India, but more
than 60% of its 20 million population live in the
slums or on the streets. Mumbai is the capital of
Maharashtra state, where HIV prevalence is amongst
the highest in India. HIV prevalence for female sex
workers in Maharashtra is reported to exceed 20%.9
Stigma remains high and those living with HIV are
often abandoned by family and unable to access
treatment in hospitals.
Since 1992, IMCARES has been running the IMPACT
(Inter-Mission Prevention of AIDS Through Care and
Training) project, responding to HIV in the slums
of Mumbai. IMCARES aims to raise awareness and
transform community attitudes towards people
living with HIV, from stigma to acceptance. It is
working to advocate for access to treatment and
to enable the local church to help provide care
for people living with or affected by HIV. Through
Reaching
marginalised
communities and
networking for
impact
working with local churches IMCARES is reaching
hidden and marginalised populations such as slum
communities, sex workers and eunuchs.
A distinctive feature of the church-based response
to HIV in Mumbai is the way that local churches and
Christian NGOs in the city have networked together
and cooperate with each other to share learning,
expertise and support, and ensure a more effective
response to the HIV epidemic.
Budget (2007): US $186,000
Achievements
■ IMCARES staff and volunteers work with more
8 Avert (2006)
www.avert.org
9 Ibid
than 1,200 children and adults every day, and
reach around 15,000 indirect beneficiaries.
■ Clinics in slum communities provide primary
health care for 6,500 patients.
■ Advocacy to uphold the rights of people living
with HIV and combat discrimination to ensure
access to treatment.
■ Awareness-raising about HIV, reaching more
than 100,000 people every year through media
and other campaigns.
■ IMCARES facilitates the CORINTH network in
Mumbai (Christian Organisations’ Response in
Networking to HIV/ AIDS).
IMCARES works among marginalised
communities in Dharavi slum in Mumbai, India.
T R ANSF ORMING LIV ES: C HU RC H- BASED R ESPONSES TO HI V
Empowering local communities – This women’s group meets in the Resurrection of Jesus Church in Dharavi slum. Here they are using a
community mapping tool from Tearfund’s PILLARS Guide: Mobilising the community (www.tearfund.org/tilz) to identify needs and resources
within their community.
PROGRAMME
Working with the church
IMCARES is committed to working with local
churches, particularly the small churches of the
slums. IMCARES begins by meeting with the local
pastors. If the pastors are interested, they must
write a letter requesting IMCARES to come and
work with their church. This activity ensures that the
church committee has discussed and agreed to work
with IMCARES, so that the church takes ownership
of the work.
IMCARES provides training and advice to pastors
and church volunteers, to enable them to respond
more effectively to HIV. The response is therefore
led by people who live in the community, who know
and understand the local needs. One young mother
who was receiving support did not want IMCARES
staff to visit her home in case it raised community
suspicion over her HIV status, but volunteers from
the church were able to visit, because they were
neighbours. Usually local church leaders already
have an established and trusted voice among their
community, and people will often come to the local
church for help with problems. The churches can help
to provide information and to link their communities
with local NGO services.
IMCARES runs a one-year full-time Community
Training Course (CTC) for church volunteers, to
sensitise and equip the church to respond to HIV. The
volunteers spend two months learning theory and
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attending training about HIV work and ten months
gaining practical experience on the streets. Many
of the staff of IMCARES and other local NGOs are
former CTC students.
Many of those who were initially receiving care, such
as those living on the streets, people living with HIV,
or orphans and vulnerable children who have grown
up in the IMCARES Agape Family homes are now
actively involved and taking up leadership positions
within local churches.
To help with monitoring and evaluation, IMCARES
has adopted a diary system, where volunteers and
staff keep a diary, briefly recording key events and
learning from each day. The diaries help with writing
reports and are kept to form a reference library of
IMCARES’ work.
Networking
A distinctive feature of the church-based response
to HIV in Mumbai is the cohesive, networked nature
of the response. Rather than just isolated churches
with an individual vision, or NGOs implementing
separate projects, churches and NGOs are working
together. The CORINTH (Christian Organisations’
Response in Networking to HIV/AIDS) network,
focusing on HIV work, is part of the wider Mumbai
Transformational Network which links together
churches and Christian organisations across Mumbai
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IMCARES, India
CASE STUDY
Working together
Kalpana was 11 years old when she was sold into
child prostitution by her brothers. As a result, she
is now living with HIV. Oasis (a member of the
CORINTH network) found her during their work
in the red light district. Another network member,
International Justice Mission, fought and won a
legal case on her behalf. Later Oasis sponsored
Kalpana to attend the IMCARES CTC course, and
she now works with IMCARES as a volunteer
teacher at the Charkop Day Care Centre.
cases the directors of NGOs are themselves leaders
of local churches, and most of the volunteers
and staff are members of local churches so the
relationships are personal, not simply professional,
and based on shared values.
Local churches can raise awareness about HIV and encourage people to
access voluntary counselling and testing, which is vital to help prevent
mother-to-child transmission.
focused on addressing poverty in the city. IMCARES
is one of the founding members and currently
coordinates the CORINTH network.
The network is largely informal and is made up
of individuals, small local churches and larger
organisations all working to respond to HIV.
Members meet four times each year to share
concerns, resources, learning. They update each
other on their work and pray together. In many
Raising awareness IMCARES raises awareness around HIV through
various means. These clocks, which feature the message ‘HIV? Do
not fear, I am with you’ and contact details for IMCARES, were
distributed to police stations and prisons.
Other strategies include sending SMS messages to local pastors,
writing articles in a local weekly paper, and producing popular music
videos with HIV messages. These Bollywood-style films are made
in consultation with people living with HIV, and shown at churches,
schools, street showings and broadcast on cable TV.
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T R ANSF ORMING LIV ES: C HU RC H- BASED R ESPONSES TO HI V
Groups are formed within the network to coordinate
joint activities such as media events or awarenessraising programmes. At one meeting, IMCARES
facilitated a mapping exercise of the city, to identify
where the local churches are and what work they
are doing. This has helped reduce duplication
and encouraged a more strategic, cooperative
Local churches
are providing care
and education for
vulnerable children
growing up in
slum communities
in Mumbai.
response rather than isolated interventions.
Sharing learning, expertise and opportunities,
and providing mutual help and support through
this network ensures a more effective and
comprehensive response to HIV in Mumbai.
Reaching the marginalised
IMCARES’ ‘Pavement Ministry’ involves volunteers
spending regular time with people living on the
streets. They sit with and talk to them in order to get
to know them individually. The volunteers document
each ‘contact’ and go back to visit regularly, providing
food such as soup, cleaning and dressing wounds, or
taking people to hospital where necessary.
It is the personal care that has most impact, as one
contact said: ‘Our own family don’t do this. You are
so loving to us, you have become like family to us.’
Stigma and discrimination mean that people living
with HIV may be rejected by family and friends. In
India, this isolation is often increased by the caste
system, which designates some of the poorest
people as ‘untouchable’. So when IMCARES’ staff
and volunteers tend to the people they meet on
the streets, and care for them with their own hands,
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it can help restore people’s sense of worth, and
transform community attitudes by example.
IMCARES’ focus is on the quality of personal care
rather than maximising beneficiary numbers. Building
relationships gives the volunteers the opportunity
to talk about sensitive issues such as HIV. Often
they will accompany a contact to the VCT clinic. A
government doctor may only have limited time for
counselling, but the volunteers can spend time with
‘The church is
part of the community
– it is impossible to work
with the church without
involving the community, and
it is impossible to work with the
community without involving
the church.’
Timothy Gaikwad
Director, IMCARES
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IMCARES, India
people after the test, to answer their questions and
provide emotional support.
Through its work with local churches, IMCARES is
able to access marginalised communities within
the slums who are rarely reached by government
services. IMCARES also works with sex workers and
a number of hijra (eunuch) communities in Mumbai.
HIV prevalence among hijras is high, and they are
surrounded by stigma. For marginalised groups like
this, and particularly for those who are dying of
AIDS-related illnesses, there is no support network.
Because of widespread stigma and conservative social
attitudes around sex, politicians and policy makers
in India are often reluctant to engage with these
‘hidden’ populations. In working with commercial
sex workers and hijras, IMCARES and the churches it
works with are breaking down barriers and enabling
marginalised communities to access services.
Medical care
IMCARES medical clinics operate from the IMCARES
Agape Community Care Centres within Mahim,
Dharavi, Bandra, Kandivali and Charkop slums. They
provide voluntary HIV testing, pre- and post-test
counselling, bereavement counselling and medicines.
They charge a small fee for the medicine, as they
have found that this means that people will value
it and complete the course of treatment. Since
the government has begun to provide affordable
VCT, and ARVs are now available, IMCARES now
focuses on advocacy and helping patients to access
these government medical facilities. However, for
many people in the slums, transport to government
hospitals remains a problem, especially when they
are sick, so these local clinics enable them to access
medical help.
IMCARES provides home-based care and nutritious
food where needed to people living with HIV. There
Providing medical
services and care
to marginalised
communities:
the clinic in
Charkop slum.
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T R ANSF ORMING LIV ES: C HU RC H- BASED R ESPONSES TO HI V
‘Christians
helped me,
they cared for me.
Now I want to start
helping.’
Himanshu Shah
CASE STUDY
Meeting local needs
Himanshu Shah (right) regularly attends Charkop clinic.
are also support groups for people living with HIV
that meet at the clinic. If they wish, clients at the
clinic are linked into local churches to help provide
long-term support, but there is no requirement to
join a church.
The clinic in Charkop slum was begun in 1992 as
a local church initiative, supported by IMCARES,
to provide medical care and advice to the local
community, many of whom have no means to travel
from this area to the hospitals in the city centre.
‘When I am
ill, I can’t go to
hospital, because it is
too far, but I can come
here. In an emergency I
know they will help.’
Himanshu Shah
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Himanshu Shah (seated on the right) attends
the clinic in Charkop regularly. He has been
living with HIV for 20 years, and is open about
his diagnosis and raising awareness. He has
valued the medical support offered at the
clinic, as he says, ‘When I am ill, I can’t go to
hospital, because it is too far, but I can come
here. In an emergency I know they will help.’
Himanshu particularly appreciates the personal
and spiritual support he has received here.
He attends a monthly support group at the
clinic for people living with HIV, and receives
ongoing counselling from Raju, a local pastor
from IMCARES who works as a counsellor at
the clinic. Himanshu explains, ‘Pastor Raju lives
locally, he stays here and he loves the people.
He visits us at home, he gives counselling as well
as medical and nutritional support. Christians
helped me, they cared for me. Now I want to
start helping.’ Himanshu now volunteers to help
other patients, for example by accompanying
them into government hospitals to help them to
access services.
The clinic offers basic health care, medicines, and
testing and counselling for HIV. A local doctor holds
free clinics on four afternoons each week. He also
trains volunteers from local churches as counsellors
and health educators. As well as volunteering at the
clinic, they raise awareness about HIV and sexual
health issues in the community where they live, in
their church groups and among those they work
with. Around 60 people living with HIV regularly
attend the clinic. If someone misses a number of
appointments, then a volunteer will visit their home
to check they are well.
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IMCARES, India
CHALLENGES
Addressing stigma
Much of IMCARES’ HIV work has focused on
addressing stigma and discrimination against
those living with HIV, particularly around access to
treatment. Many hospitals were initially reluctant
to admit patients with HIV. They would keep
them in isolation and refuse to dress their wounds.
Sometimes hospitals would even discharge patients
with HIV, particularly those brought in from the
streets or slum communities, who have no family to
support them. Now, church leaders and IMCARES
staff often accompany patients into the hospital, to
ensure they are admitted and cared for.
It has been important to raise awareness and address
fears and misconceptions within communities in
order to ensure the rights of those living with HIV,
such as access to communal water supplies. Widows
often lose their homes to their husband’s family
when he dies of AIDS-related illness. CORINTH
network members include lawyers, so collectively
there is the capacity to respond to legal issues such
as those related to inheritance rights.
Attitudes within the church
Attitudes within the church have also needed to
be transformed. Many church leaders were initially
judgemental and reluctant to engage in the response
to HIV. Although this has improved over time, and
through increased awareness, there is often still a
reluctance to speak about issues of sexual health
and comprehensive prevention strategies including
condom use. Tearfund is working with partners such
as IMCARES to challenge and engage local churches
on these issues.
Lack of resources
In many slum communities, levels of poverty and
lack of access make an effective response to HIV
difficult. Even when medicines are available, if people
are sick and cannot work, then there is no money
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T R ANSF ORMING LIV ES: C HU RC H- BASED R ESPONSES TO HI V
Local churches are working in marginalised communities in
Mumbai to provide care, support and hope, for those living
with or affected by HIV.
for food. It is important that people who are taking
ARVs have adequate nutrition. The communities are
isolated and so it is often difficult to access NGO or
government health facilities, particularly for the sick.
However, IMCARES’ work has demonstrated that
small churches in poor communities have the
capacity to offer support to those living with or
affected by HIV. In one slum community there was
a widow who was living with HIV who attended the
church clinic. The church leader took her to hospital
and she was admitted, but she later died. Donations
from church members helped pay for the funeral.
Her daughters (aged 13 and 15) wanted to stay in
their own home, so the local church is now providing
some money and food each week to enable them to
stay. A woman from the church has moved in to live
with them. She helps to cook food and pays some
rent to help support the family.
KEY LEARNING
Sustainability
Providing community
IMCARES works in partnership with local churches
to ensure sustainability and local ownership of the
work. The aim is to eventually hand over all of the
work to the local church, so it always has a higher
profile than IMCARES during the project life. In fact,
a recent external evaluation of IMCARES’ community
work found that people in the community had not
heard of IMCARES – they only knew of the church
related to the project.
A distinctive benefit that local churches can provide
is the sense of belonging to a community. This can
restore hope and self-worth for people living with
HIV, who may have experienced rejection from
family and friends.
Wherever possible, those identified through the
clinics or Pavement Ministry are linked into local
churches so that long-term support is available, but
there is no requirement to join the church.
Reaching communities
IMCARES can respond more effectively to HIV in
the community because it works through the local
church, which is already an integral and long-term
part of the community. This is particularly important
for reaching marginalised communities, such as those
who live on the streets or in the slums of Mumbai,
who have little access to government services.
Changing attitudes
The church has the power to shape values and
attitudes. Lack of awareness and judgmental
attitudes within the church have often meant that
people living with or affected by HIV have suffered
discrimination and rejection. However, when the
church welcomes and cares for people living with
HIV among the congregation, it can dramatically
influence local attitudes and combat stigma. In one
slum community, the whole church came to the
funeral of someone who had died from an AIDSrelated illness. This public show of support helped to
transform local attitudes.
Personal care
The local church responses in Mumbai are
characterised by the personal care provided. In
India, this is highlighted by the realities of the caste
system, which designate some of the poorest and
most vulnerable as ‘untouchable’, but across the
world, stigma and discrimination mean that people
living with HIV are often rejected and uncared
for. In this context, when church volunteers reach
out and with their own hands care for the dying
or the destitute, it can help transform community
attitudes, as well as restoring dignity and identity to
those they care for. IMCARES’ clinics and Pavement
Ministry emphasise giving quality time to each
person, and building relationships, even if that
means taking on fewer cases.
Networking
The church-based response to HIV in Mumbai is
made more effective by the way local churches and
Christian NGOs in the city cooperate in a network
to share learning and expertise, to avoid duplicating
work and to support each other.
Contact details
Timothy Gaikwad (Director)
IMCARES
‘Elim’, JWES Compound
19th August Kranti Marg
Mumbai 400 007, India
Email: agape@imcares.org
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