Shivananda Khan, OBE (1948-2013)

Shivananda Khan, OBE (1948-2013)

India HIV/AIDS Alliance remembers the life and achievements of Shivananda Khan, one of South Asia’s leading activists who left an indelible mark on the global LGBT rights movement and did so much to expand the HIV response for sexual minorities all over the world. The following remembrance and poem were written by Alliance India staff members who worked closely with Shiv over the years.

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Celebrating Shiv
A remembrance by Shaleen Rakesh

In the summer of 2000, I was invited as a guest speaker at one of India’s first national gay conferences in Hyderabad. The event was organised by a man I had heard much about, Shivananda Khan. Holding a regional conference of this scale was not an easy task in those days. I met several activists there for the first time, people who are leaders of the movement today like Laxmi Narayan Tripathi, Vijay Nair, and Sunil Menon, among many others. Shiv was his usual dramatic self: cracking quips with elan, cigarette in hand, a perfect blend of ice and fire.

Shiv and I bonded from the start. He told me to be bold and chart my own course. Sometimes he would look at me with a long stare and say I was meant to be an activist. He said he never saw me happier than when I put on the activist hat. Shiv was the conduit for funding from the UK Lotteries Commission that supported the programme I headed at the Naz Foundation (India) Trust working with men who have sex with men and transgenders. I used to joke with Shiv that the British put in place Section 377, a colonial law against homosexuality, and now British money was funding efforts to have it revoked!

I will never forget the hours we spent together at Hotel Samrat in New Delhi, where Shiv, the author Jeremy Seabrook, and I would have long conversations on the nature of gay identity in India and alternative pathways to freedom. In Shiv, I had a soulmate with whom I could speak intelligently of repression and its costs.

Shiv’s contributions to the queer movement are too many to count. Though he had a global influence, the focus of his life’s work was always South Asia. In recognition of his efforts, he was awarded the Order of the British Empire in 2005, perhaps an ironic if deserved reward for someone who had worked so hard to achieve freedom for sexual minorities in a post-colonial world.

To a fellow activist and my dear friend, a final goodbye.

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Remembering Shivananda Khan
A poem by Yadavendra Singh

Though the sun was shining bright
The winds were blowing hot
Yet it felt like a cold and silent night
Night of December
‘Coz you were no more amongst us
Us – Lesbians, Gays, Bisexuals, Transgenders, Hijras,
We all want to thank you – yet again
You shall continue to inspire generations to come
With your charisma, your leadership
Your vision, your zeal
None can ever have this cut healed
Today we remember you – with our eyes closed, with our breath silent
We are sad but we won’t shed a tear
As we have a long way to clear
And we all want to thank you – yet again.

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Transgenders Speak Out in Kerala, India: A Blog for International Day Against Homophobia & Transphobia 2013

Due to often violent transphobia in Kerala, the community members who took part in the first-ever consultation with state government on transgender issues have requested anonymity. (Photo by Simran Shaikh, India HIV/AIDS Alliance)

Due to often violent transphobia in Kerala, the community members who took part in the first-ever consultation with state government on transgender issues have requested anonymity. (Photo by Simran Shaikh, India HIV/AIDS Alliance)

Shanno (name changed) is a 35-year-old transgender living in the Ernakulam district of the southern Indian state of Kerala. From childhood, Shanno bent towards feminine behaviour, a habit highly discouraged by her family and unacceptable in Kerala’s highly conservative society.

“I was mocked by neighbours and classmates. It not only made my life miserable but also that of my family,” she says. She dropped out of school and lost several jobs. “I remember locking myself inside my house without seeing sunlight for days. Suicide was the only word that played in my mind.”

Shanno’s case is hardly unique. Though Kerala has witnessed a number of social movements advocating for rights, the state remains visibly transphobic and homophobic. MSM, transgenders and hijras (MTH) are considered criminals, frequently harassed and even murdered.

Already disproportionately vulnerable to HIV and other sexually transmitted infections, community members have limited access to quality health services, and healthcare workers too often treat them with little dignity or respect. Such discrimination undermines health and wellbeing, forcing the community to remain hidden with limited economic prospects. Many turn to sex work or leave Kerala for better opportunities elsewhere. The state has the highest migration rate for transgenders in India.

The Pehchan programme in Kerala is helping to change these norms.  Sangama, Alliance India’s Pehchan partner in Kerala and Karnataka, made history of sorts on April 23, 2013, when it brought 35 transgenders and hijras to meet with Sri. P. Mohanadas, a District Judge who serves as Member Secretary of Kerala State Legal Service Authority (KELSA). The authority works to provide legal aid to the poor and other marginalised sections of society to protect their constitutional and legal rights.

It was here that Shanno and others like her told how societal and familial pressure, transphobia and homophobia forced them to leave their families and turn to sex work or begging to survive. The participants demanded equal opportunities in education and employment, equal protection under law, and lives free of harassment from society and the police.

Mr. Mohanadas was convinced that there was an urgent need to address this pattern of marginalization experienced by transgender and hijra Keralites. He expressed his support for the transgender movement in the state, proposed a petition to the state’s High Court and described plans for other state-level action to support Kerala’s transgender and hijra communities. He observed dryly, “It’s strange that, in a country where all are guaranteed rights, trans people have none.”

In Kerala and elsewhere in India, Pehchan is working to confront and address the destructiveness of transphobia and homophobia. Discrimination based on sexual orientation and gender identity has devastating effects on individuals and communities. By creating opportunities for MTH communities to speak openly to decision makers in government about the challenges they face, Pehchan is encouraging advocacy and action and helping India heal the damage done by transphobia and homophobia.

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The author of this post, Simran Shaikh, is Programme Officer: Pehchan.

With support from the Global Fund, Pehchan builds the capacity of 200 community-based organisations (CBOs) for men who have sex with men (MSM), transgenders and hijras in 17 states in India to be more effective partners in the government’s HIV prevention programme. By supporting the development of strong CBOs, Pehchan will address some of the capacity gaps that have often prevented CBOs from receiving government funding for much-needed HIV programming. Named Pehchan which in Hindi means ‘identity’, ‘recognition’ or ‘acknowledgement,’ this programme is implemented by India HIV/AIDS Alliance in consortium with Humsafar Trust, PNRO, SAATHII, Sangama, and SIAAP and will reach 453,750 MSM, transgenders and hijras by 2015. It is the Global Fund’s largest single-country grant to date focused on the HIV response for vulnerable sexual minorities.

Registering for a Healthy Life: Chanura Kol Helps Women Who Inject Drugs

A registration book lies open in front of a woman who has just used a clean syringe provided by a Drop In Centre in Manipur. The needle is being washed and will be discarded in one of the trash cans that can be seen in the background. Photo by Prashant Panjiar for India HIV/AIDS Alliance

A registration book lies open in front of a woman who has just used a clean syringe provided by a Drop In Centre in Manipur. The needle is being washed and will be discarded in one of the trash cans that can be seen in the background. Photo by Prashant Panjiar for India HIV/AIDS Alliance

Chochong was married at the young age of 15. Unable to cope with her husband’s abuse, she was tempted to try drugs. It was an easy way for her to overcome the suffering she endured every day. In 2010, Chochong met a field worker at a hotspot in Imphal who motivated her to register with Alliance India’s Chanura Kol project. “I was hesitant at first and scared thinking, ‘What will they do?’ Their guidance has helped me lead a healthier life.”

Chochong is not alone. Since 2010, 720 women who inject drugs (WWID) have registered with Chanura Kol to avail a range of services provided by the project. Registered WWID have received psychological and social support through counseling services from Chanura Kol. They have also received information about HIV-related services, as their risk of infection is high, because of injecting drug use and sex work, which many depend on as their primary source of income. Services also include free health checkups with the provision of basic healthcare and treatment support for those living with HIV.

In addition, WWID registered with the project receive income generation support from activities like making pickles, selling dry fish, catering and supplying clothes. This new income can play an essential role in preventing relapse into drug use. Chanura Kol aims to ensure that WWID receive essential support and care services which can prevent them from relapsing and protect them from HIV and other blood-borne viruses like Hepatitis C.

“I have a hope that if I continue to avail services of Chanura Kol, I will soon be able to meet my son whom I left back because of this habit,” Chochong says.

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The author this post, Ankita Bhalla, is Communications Associate, India HIV/AIDS Alliance.

India HIV/AIDS Alliance in partnership with SASO, implements the Chanura Kol project in Manipur. Funded by the Elton John AIDS Foundation, Chanura Kol was initiated in 2010 and serves to expand interventions to reduce drug relapse among female injecting drug users. Based on a holistic and sustainable approach, Chanura Kol aims to address the root causes of vulnerability and the primary causes of relapse post-detoxification for women who inject drugs in India’s north-eastern state of Manipur, many of whom are also sex workers. Chanura Kol provides these women with long-term shelter, creates opportunities for income generation outside of sex work, and encourages the rebuilding of family relationships.

Leading by Example: People from Drug-using Backgrounds Strengthen Harm Reduction Interventions in India

Amit Bali, who works as a Hridaya peer counsellor, started using drugs at the age of 16.  He has been drug-free now for three years. (Photo by Francis Joseph for India HIV/AIDS Alliance)

Amit Bali, who works as a Hridaya peer counsellor, started using drugs at the age of 16. He has been drug-free now for three years. (Photo by Francis Joseph for India HIV/AIDS Alliance)

Effective harm reduction programming requires the involvement of people who inject drugs (PWID). This approach helps ensure the accessibility and responsiveness of harm reduction services. With this in mind, Alliance India’s Hridaya programme has engaged former PWIDs as peer counsellors.

Hridaya empowers drug users by identifying and building PWIDs as leaders in their communities. The programme works in the states of Bihar, Haryana, and Uttarakhand to strengthen harm reduction interventions at state and district levels and establish a resource pool of trainers to support capacity building in organisations working with PWIDs.

People from a drug-using background often better understand the lives of PWIDs and are familiar with the isolation and rejection they often experience from family, friends, and society at large. Building rapport with PWIDs and gaining their trust are essential steps in harm reduction programming, and Hridaya’s approach is designed to demonstrate the value of harm reduction as a strategy to address HIV in PWID communities in India.

Take the example of 33-year-old Amit Bali. He began abusing prescription drugs at the age of 16 and even used his school fees to support his addiction. When caught, he ran to Mumbai but lost all his belongings and had to return to Dehradun, his hometown. Once there, he felt isolated which further encouraged his drug use.

Amit used every drug he could lay his hands on. You name it, and he has done it. But in 2002, a friend introduced him to a new drug — brown sugar (street name: pudia). From that day on, he was hooked. It was an expensive habit in a city like Dehradun, so he moved to a cheaper alternative and started injecting drugs. Soon Amit was injecting 10 to 15 times a day and started selling drugs on the street. Before long, he was caught by the police.

While battling for his dignity in police custody, Amit regained his lust for life. After release, he checked into a rehabilitation centre though he relapsed within a few days. Later he got in touch with the Herbertpur Christian Hospital Targeted Intervention Programme (HCH TI) near where he lived in Dehradun and sought help to get out of the vicious cycle of drug dependency. He again was admitted to a rehab centre and started to attend Narcotics Anonymous (NA) support group meetings. NA is a worldwide fellowship of people recovering from drug dependence who want to stay clean and help others do the same. Now more than three years later, Amit’s life has changed completely.

Amit now works as a peer counsellor with Hridaya. Passionate about his new life, he observes, “The value of an addict helping another addict is without parallel. My only aim is to help my peers as much as possible so that their quality of life improves. I want to give them the support I longed for when I was in their place.”

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The author of this blog, Francis Joseph, is Programme Officer for Alliance India’s Drug Use & Harm Reduction programmes and is based in New Delhi.

Spanning five countries (India, China, Indonesia, Kenya, and Malaysia), Community Action on Harm Reduction (CAHR) expands harm reduction services to more than 180,000 people who inject drugs (PWIDs), their partners and children. The programme protects and promotes the rights of these groups by fostering an enabling environment for HIV and harm reduction programming in these five countries. CAHR is supported by the Ministry of Foreign Affairs, Government of Netherlands.

In India, CAHR is called ‘Hridaya’ and is implemented by India HIV/AIDS Alliance in partnership with SASO, Sharan, and a number of community-based harm reduction organisations and networks. This programme helps build the capacity of service providers, makes harm reduction programmes more gender-responsive, improves access to services and advocates for the rights of PWIDs. In addition to providing services, Hridaya has a strong capacity building component to support advocacy, knowledge management and improved services for PWIDs.

New Advocacy to Address Cervical Cancer in Women Living with HIV

Early detection of cervical cancer can help WLHIV live longer and more productive lives. (Photo by Prashant Panjiar for India HIV/AIDS Alliance)

Early detection of cervical cancer can help WLHIV live longer and more productive lives. (Photo by Prashant Panjiar for India HIV/AIDS Alliance)

Alliance India’s Koshish programme advocates for policies and strategies on sexual and reproductive health (SRH) and rights for people living with HIV (PLHIV) in India. The programme is implemented in Maharashtra, Tamil Nadu, Andhra Pradesh and Gujarat.

During community consultations with PLHIV in these four states, the Koshish team noticed that women living with HIV (WLHIV) had low awareness of cervical cancer and seldom go for testing. HIV-infected women with advanced immunosuppression (CD4 count < 200 cells/µL) are particularly vulnerable to infection with human papillomavirus (HPV) that leads to cervical cancer.

As the availability of ART has increased, it has given greater hope to WLHIV to live healthier and longer lives. With improved survival, it has become even more imperative to address cervical cancer risk as a priority. Early detection of cervical cancer is possible through a Pap smear test. While not available at primary health centres, the test should be available at every government district hospital’s gynecological departments. Unfortunately, access is limited due to non-availability of kits or lack of trained lab technicians. Typically WLHIV are referred for the test only if doctors think the woman is vulnerable, basing their decision on certain symptoms.

HIV programming needs to integrate Pap smear testing into routine care. Koshish has been actively pushing for regular Pap smear test for WLHIV at civil hospitals. Our partners in Maharashtra, Mamta and the Maharashtra Network of People Living with HIV/AIDS (NMP+) have been successful in motivating Pap smear testing in five implementing districts, Nagpur, Amravati, Kolhapur, Ahmed Nagar and Thane.

In Ahmed Nagar, the team organises a health camp on the first and third Saturday of every month. In these camps, 25 women are screened for cervical cancer. In Thane, the civil surgeon has arranged for a monthly camp for 30 women. The camps in Kolhapur have begun and are being organised on Tuesday and Saturday, while in Nagpur the camps are being successfully held with support from the Indian Cancer Society. In Amravati district, the civil surgeon has issued a circular instructing routine Pap smear testing for WLHIV. Of the WHLIV tested for cervical cancer so far, nearly 10% have tested positive.

The risk of cervical cancer remains high in developing countries due to a lack of prevention and screening programmes. Under Koshish, partners have already started advocacy with decision-makers at State AIDS Control Societies to make annual Pap smear testing a mandatory part of the care for every WLHIV over 30 years of age who is on ART. Data collected from each state will support national level advocacy with decisional-makers at India’s National Health Mission and the National AIDS Control Organisation to ensure that prevention of cervical cancer among WLHIV is a priority. Koshish is committed to empowering PLHIV in India with advocacy tools to promote policies and strategies to improve their lives and build them as the natural leaders of these efforts.

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India HIV/AIDS Alliance works closely with PLHIV in India through its Koshish Project which strengthens civil society organizations and networks that represent and work with PLHIV and other marginalized groups, such as MSM, transgenders, sex workers and IDUs, to effectively advocate for policies to improve the sexual and reproductive health and rights of PLHIV in India. This project is funded by the European Commission and is implemented in partnership with MAMTA, PWDS, VMM and CHETNA, along with state-level networks for PLHIV in Maharashtra, Tamil Nadu, Andhra Pradesh and Gujarat.

Detox and a New Life: Supporting Options for Women Who Inject Drugs in Manipur

Post detoxification, women are encouraged to learn new vocations. In this photograph, a woman at the Chanura Kol short stay home learns to make frankincense sticks. (Photo by Prashant Panjiar for India HIV/AIDS Alliance)

Post detoxification, women are encouraged to learn new vocations. In this photograph, a woman at the Chanura Kol short stay home learns to make frankincense sticks. (Photo by Prashant Panjiar for India HIV/AIDS Alliance)

Alliance India’s Chanura Kol project offers a range of harm reduction services for women who inject drugs to help them lead a better life. Detoxification is the most important option in this strategy.Since the inception of the project in 2010, 113 women have completed detoxification to wean themselves off drugs.

Detoxification reduces withdrawal symptoms and helps an addicted person adjust to living without the effects of opiates or other drugs. Alliance India’s partner in the project, Social Awareness Service Organisation (SASO), provides this option either at the homes of female injecting drug users in situations where they have supportive family members or in a clinical setting when drug users lack family support.

Once detox is completed, the process of rehabilitation begins. Chanura Kol encourages the rebuilding of strained family relationships during the reintegration period. As a key part of rehabilitation, these women are helped to learn new vocations to earn a living. They often receive loans from self-help groups established by their peers to support these efforts to start small businesses.

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India HIV/AIDS Alliance in partnership with SASO, implements the Chanura Kol project in Manipur. Funded by the Elton John AIDS Foundation, Chanura Kol was initiated in 2010 and serves to expand interventions to reduce drug relapse among female injecting drug users. Based on a holistic and sustainable approach, Chanura Kol aims to address the root causes of vulnerability and the primary causes of relapse post-detoxification for women who inject drugs in India’s north-eastern state of Manipur, many of whom are also sex workers. Chanura Kol provides these women with long-term shelter, creates opportunities for income generation outside of sex work, and encourages the rebuilding of family relationships.

Confronting Quackery, Demanding Care: India’s Hijras Seek Access to Sex Reassignment Surgery Services

Friendly attitudes and responsive services by hospitals can help transgender patients be comfortable and speak about their health concerns. (Photo by Peter Caton for India HIV/AIDS Alliance)

Friendly attitudes and responsive services by hospitals can help transgender patients be comfortable and speak about their health concerns. (Photo by Peter Caton for India HIV/AIDS Alliance)

Malika (her name changed) remembers feeling helpless when a government hospital refused to treat her for a painful and dangerous infection that had resulted from her sex reassignment surgery (SRS). Malika is a hijra and her story is not unique. Many others in her community sadly face similar problems.

In India, hijras have a long and remarkable history, spanning 4,500 years. They are mentioned in ancient religious texts as symbols of dignity and courage. Yet modern Indian society fails to offer them respect or treat them with even basic human dignity. With limited livelihood options, most hijras turn to sex work, begging or other professions that offer them a meagre salary.

With limited resources, many hijras turn to quacks for SRS services since most of them are unable to afford the high rates charged by private clinics. Without national standards for SRS, most of these surgeries are legally ambiguous and performed in miserable conditions by ill-trained surgeons. In Malika’s case, the ‘clinic’ turned out to be a house without proper lighting, surgical facilities or even a recovery bed. If Malika had known and understood the risks, she would not have travelled some 600 kilometres from her hometown Kolkata in West Bengal to the state of Bihar for the operation.

Whether hijras are operated on by quacks or in more expensive private clinics, they tend to experience the same lack of physical and psychological care that is essential after SRS. Happy to accept fees for the surgery itself, doctors fail to provide their patients with appropriate pre- and post-operative counselling or checkups following surgery.

When Malika felt the intense pain that racked her body and realised that she was suffering from a severe urological infection caused by the surgery, she sought help at a government hospital. Both transgender and HIV-positive status, she was refused a hospital bed and any of the care she urgently needed.

On hearing about Malika’s situation, team members from the Global Fund-supported Pehchan programme organised meetings with the project director of the West Bengal State AIDS Programme & Control Society (WBSACS) and with doctors at two hospitals, including the one that had turned Malika away. They also met with members of the press to raise awareness about Malika’s story. The WBSACS project director wrote Malika a support letter, as did the West Bengal health minister. Armed with these letters, Malika underwent treatment at the hospital that had initially turned her away.

After two months recuperating, Malika was discharged from the hospital. Seeing Malika’s resilience and the bold way she handled her situation, the Gokhale Road Bandhan, a community-based organisation that is a sub-sub-recipient partner of Pehchan, offered Malika a job as an outreach worker. “The job has not only helped me deal with my financial instability but has also instilled a sense of self-confidence and self-esteem especially since many of my peers abandoned me because of my HIV-positive status,” says Malika.

Malika’s story reveals the mistreatment that our country’s hijra community experiences at the hands of doctors and the health system. Progress is slow and often only as a result of significant advocacy by community organisations. While we have our own health priorities such as SRS, India’s hijras and transgenders have the same right to health as any other citizen, and the government must act to protect our lives, provide access to care, and ensure the fulfilment of our full rights. Our community cannot be silent!

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The author of this post, Simran Shaikh, is Programme Officer: Pehchan.

With support from the Global Fund, Pehchan builds the capacity of 200 community-based organisations (CBOs) for men who have sex with men (MSM), transgenders and hijras in 17 states in India to be more effective partners in the government’s HIV prevention programme. By supporting the development of strong CBOs, Pehchan will address some of the capacity gaps that have often prevented CBOs from receiving government funding for much-needed HIV programming. Named Pehchan which in Hindi means ‘identity’, ‘recognition’ or ‘acknowledgement,’ this programme is implemented by India HIV/AIDS Alliance in consortium with Humsafar Trust, SAATHII, Sangama, and SIAAP and will reach 453,750 MSM, transgenders and hijras by 2015. It is the Global Fund’s largest single-country grant to date focused on the HIV response for vulnerable sexual minorities.