Avahan in Andhra Pradesh: Expanded Access and Increased Impact

ai_avahan_cover_low resAvahan India AIDS Initiative is a focused prevention initiative funded by the Bill & Melinda Gates Foundation that works in six states of India to reduce HIV transmission and the prevalence of sexually transmitted infections (STIs) in vulnerable high-risk populations—female sex workers (FSWs), men who have sex with men (MSM) and transgenders—through prevention education and services. The programme’s main components are condom promotion, STI management, behavior change communication, community mobilisation, and advocacy. Avahan also supports the creation of an enabling environment through individual and organisational capacity building to increase the effectiveness of the HIV response.

India HIV/AIDS Alliance is a state lead partner for Avahan in Andhra Pradesh. Alliance India’s efforts in the state have strengthened the capacity of NGOs and CBOs to implement quality HIV and STI programming in close partnership with the State AIDS Control Society (SACS) and in accordance with the National AIDS Control Programme.

Alliance India’s work with Avahan in Phase I covered 13 districts of the Telangana and Rayalseema regions in Andhra Pradesh and reached nearly 72,000 FSWs and MSM. Now in Phase II, Alliance India is transitioning programme activities to the state government as planned and supporting efforts to further strengthen community mobilisation with beneficiary groups to ensure sustainability of prevention activities under government support.

To learn more about our Avahan work in Andhra Pradesh, please download our brochure here.

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The author this post, Dr. M. Ravikanth, is Documentation & Communication Specialist, India HIV/AIDS Alliance.

The Avahan India AIDS Initiative (2003-2013) is funded by the Bill & Melinda Gates Foundation. The programme aims to reduce HIV transmission and the prevalence of STIs in vulnerable high-risk populations, specifically female sex workers, MSM, and transgenders, through prevention education and services such as condom promotion, STI management, behavior change communication, community mobilization, and advocacy. Avahan works in six states, and Alliance India is a state lead partner in Andhra Pradesh.

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Uniting Against Discrimination: Women form advocacy groups to respond to cases of violence

Building on the sense of community that exists within this peer group, the Chanura Kol has created Advocacy Groups to deal with challenges faced by female injecting drug users. Photographer: Prashant Panjiar

Building on the sense of community that exists within this peer group, Chanura Kol has created advocacy groups to deal with challenges faced by female injecting drug users. Photographer: Prashant Panjiar

Alliance India understands the power of community participation and engagement. In partnership with the Manipur-based local NGO, Social Awareness Service Organisation (SASO), the Chanura Kol project has established four Core Advocacy Groups to help women who inject drugs, many of whom are sex workers.

Each advocacy group, comprised of 10-15 members consisting of female injecting drug users, sex workers or their pimps, serves to address stigma and discrimination faced by women who inject drugs as well the frequently reported cases of violence experienced by them. Group members have received training on advocacy and documentation and, since the establishment of the groups in early 2011, have responded close to 100 cases of violence, harassment and extortion by women who inject drugs.

The reported incidents that these advocacy groups have responded to included domestic violence and harassment by sexual partners and security forces. The latter are notorious for extorting money particularly from female injecting drug users who engage in sex work. Each of the reported incidents was responded to within 48 hours during which time the advocacy groups provided support to those affected and their families.

Group members also held sensitization and advocacy meetings with those involved in perpetrating the violence. Although these advocacy groups were initiated last year, SASO has implemented the creation of support groups since 2007 in keeping with its belief that these groups play an important role in garnering community involvement and family support, facets that are integral to the recovery of vulnerable women who inject drugs.

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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, the project serves to expand interventions to decrease HIV transmission and reduce drug relapse among female injection drug users (FIDUs).

Women Out Loud: New UNAIDS/UNWomen Publication Cites Our Chanura Kol Project

UNAIDS and UN Women recently released Women Out Loud, a new report on women living with HIV and the key role that they play in ending the epidemic. A UNAIDS feature on the document’s release notes the following:

In a new report, entitled Women Out Loud, UNAIDS explores the impact of HIV on women and the instrumental role women living with the virus are playing to end AIDS. It includes the latest data and commentary from some of the leading advocates on women and HIV.

The report includes the voices of some 30 women living with HIV who have given their personal insights into how the epidemic is affecting women and on how women are actively working to reduce the spread and impact of AIDS.

HIV is continuing to have a disproportionate effect on the lives of women. It is still the leading cause of death for women of reproductive age, and gender inequalities and women’s rights violations are persistent in rendering women and girls more vulnerable to HIV and preventing them from accessing essential HIV services…

Marginalised women remain the most impacted by HIV

Sex workers and people who use drugs are particularly vulnerable to HIV. When sex is exchanged for money or drugs, women often exert little influence over a partner’s condom use. Female sex workers are 13.5 times more likely to be living with HIV than other women. Some countries reported an HIV prevalence of more than 20% among female sex workers in capital cities. Studies conducted in nine European Union countries have indicated on average a 50% higher prevalence of HIV among women who inject drugs than in men who inject drugs.

On page 21 of the report in the chapter on people who use drugs, the following point is made: “Women who use drugs are widely reported to experience disproportionate levels of stigma and discrimination, often compounded during pregnancy, and as mothers.” One of the three references for this observation is In the Shadows, the baseline findings report from our Chanura Kol project.

India HIV/AIDS Alliance is grateful to UNAIDS and UN Women for this citation of our work. Many thanks to the Chanura Kol team and particularly to our implementing partners, SASO and Shalom, for their many contributions to the report and to the project overall. To read more about our baseline findings, click here or on the report cover below.

In the Shadows: Chanura Kol Baseline Report_Alliance India 2011

Chanura Kol is funded by the Elton John AIDS Foundation and serves to expand interventions to decrease HIV transmission and reduce drug relapse among women who inject drugs. Based on a holistic and sustainable approach, the project was initiated in 2010 to address the root causes of vulnerability and the primary causes of relapse post-detoxification for women who inject drugs in India’s northeastern 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 helps them rebuild family relationships.

Chanura Kol is one of a handful of efforts in the region to address the distinct needs of women who inject drugs and reduce their vulnerability to HIV. To learn more, please see a recent slide show about the project:

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Their Voices Count: Stand with PLHIV on Human Rights Day!

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Even after more than two decades of a coordinated national response to HIV/AIDS in India, stigma and discrimination towards people living with HIV (PLHIV) remain commonplace. These forces—and the violence and other rights violations that often accompany them—undermine the efforts of the government, civil society, and donors to mount a truly effective response to the epidemic.

December 10th is Human Rights Day. It is an opportunity to advocate for the full enjoyment of human rights by all people everywhere. This year’s theme is ‘My Voice Counts.’ For those of us working to address HIV/AIDS, it’s a moment to reflect on progress but also on how much more work remains. Just a few days ago, an incident took place in Jodhpur, Rajasthan that illustrates how far we still need to travel.

A couple living with HIV received regular support from a local NGO. A staff member from the NGO made a home visit and, while enquiring about the address of their house, inadvertently revealed that the couple was HIV-positive. Neighbors beat the couple and threw them out of their home. Presently, they are living on the streets. (The Deccan Herald reported on this incident in their November 30th issue.)

HIV was first identified in India in 1986. After more than 26 years of rigorous efforts to raise awareness about HIV/AIDS and increase understanding of the disease, our efforts to reduce stigma and discrimination remain inadequate as the Jodhpur case shows. While there are pockets of progress, the majority of the 2.4 million PLHIV in India still live in fear of being harassed, humiliated, stigmatized, beaten, and disowned.

The despicable treatment of the couple in Jodhpur was covered by the media, but numerous other such situations go unrecorded. What should our leaders do? What steps are needed to truly address the ignorance and fear that drives neighbors to hurt not help? The Supreme Court of India ruled that PLHIV are assured a right to treatment, but why are we so indifferent about protecting the right of PLHIV to lead full and productive lives?

The National AIDS Control Organisation (NACO) recognizes the important role that rights protections play in the AIDS response. NACO has a ‘Know Your Rights’ page on its website, but do PLHIV really know what measures they can take to protect themselves when faced with violations of their basic rights? And if they do, what happens when they stand up for themselves?

In early November, a group of 70 PLHIV walked into Bihar State AIDS Control Society to demand a meeting. The crowd was angry as there had been an interruption in the supply of antiretroviral drugs in the state. Such gaps can significantly undermine the effectiveness of treatment and lead to drug resistance. The group protested in loud voices, and in the process, a couple of flowerpots were broken. The police were called, and Gyan Ranjan Khatri, president of Bihar Network of People Living with HIV, was arrested. Getting him bailed out was difficult, and locals report that a case may be filed against him. The question remains: How can it be a criminal offence to demand the government protect the basic right of PLHIV to health?

If India is to progress towards UNAIDS’ global strategic goal of ‘Getting To Zero,’ then we must recognize that our efforts to achieve ‘Zero Discrimination’ need new energy and focus. Like it or not, HIV still inspires irrational fear. Today, on Human Rights Day, we should ask ourselves what we must to do to protect the rights of PLHIV here in India and all around the world. While there can be many solutions—and many are needed—we must listen to PLHIV. Their voices count.

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

Spanning five countries (China, India, Indonesia, Kenya, and Malaysia), Community Action on Harm Reduction (CAHR) expands harm reduction services to more than 180,000 injecting drug users (IDUs), 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 Alliance India in partnership with SASO, Sharan, and a number of community-based harm reduction organisations and networks. This project 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.

Press Clippings: World AIDS Day All-India Run & Cultural Event Media Coverage (December 2012)

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Motivated to raise awareness about HIV, more than a thousand people participated in India HIV/AIDS Alliance‘s World AIDS Day All-India Run & Cultural Event on Sunday, December 2, 2012. The run was followed by music and drama performances celebrating life and diversity in the face of the epidemic. The event was enthusiastically received by participants and attracted considerable interest from the media. The following is a selection of the coverage.

In English:

English-language newspapers that covered the World AIDS Day All-India Run & Cultural Event include: The Hindustan Times, Deccan Herald, Millennium Post, The Hindu, The Pioneer, Business Line, The Indian Express, Political and Business Daily , The Tribune, The Asian Age, The English Daily, and The Sikh Times. (Click on images of the clippings to enlarge.)

In Hindi:

Hindi newspapers that covered the World AIDS Day All-India Run & Cultural Event include: Dainik Bhaskar, Amar Ujjala, Rashtriya Sahara, Aaj Samaj, Mahamedha, Voice of Politics, Dainik Bharati, Dainik Nav Jyoti, Qaumipatrika, Amrit India and Adhikar. (Click on images of the clippings to enlarge.)

For more photos, please click here to see our album on Facebook.

World AIDS Day Op-Ed: New Optimism, Old Challenges: Prioritizing High-Risk Groups at the Frontline of AIDS

In a new opinion piece published on OneWorld South Asia, Alliance India’s James Robertson argues that while India’s admirable progress in achieving a greater than 50 percent reduction in new HIV infections deserves accolades and emulation, it should not be mistaken for victory over the epidemic. Click here to read more.

World AIDS Day Op-Ed: Cross Out HIV Stigma

In her column in the Asian Age newspaper, Patralekha Chatterjee admires India’s progress and wonders about the future of the AIDS response in the country. Alliance India’s James Robertson is quoted. Click here to read more. The column was also picked up by the Deccan Chronicle.

Thanks to everyone who took part and helped make our World AIDS Day activities such a success. Many thanks again to our co-sponsors: Population Council; CitibankUNDPCentre for Advocacy & Research (CFAR)Delhi Frontrunners; and Blind Relief Association. Special appreciation also to National AIDS Control Organisation, Delhi State AIDS Control Society and the Delhi Police for their support in mounting this event. 

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India HIV/AIDS Alliance (Alliance India) is a diverse partnership that brings together committed organisations and communities to support a sustained response to HIV in India. Complementing the national programme in India, it works through capacity building, knowledge sharing, technical support and advocacy. Through our network of partners, Alliance India supports the delivery of effective, innovative, communitybased HIV programmes to key groups affected by the epidemic.

New Optimism, Old Challenges: Prioritizing High-Risk Groups at the Frontline of AIDS

WAD_2012In a new opinion piece published December 1st on OneWorld South Asia to commemorate World AIDS Day, Alliance India’s James Robertson argues that while India’s admirable progress in achieving a greater than 50 percent reduction in new HIV infections deserves accolades and emulation, it should not be mistaken for victory over the epidemic:

2012 has been a year of heightened public optimism about the future of HIV/AIDS. From UNAIDS audacious “Getting to Zero” campaign to US Secretary of State Hillary Clinton’s aspiration for an “AIDS-Free Generation,” everywhere it seems that the end of AIDS is finally on the horizon.

New strategies and new tools have injected new hope into the global response. Last summer’s International AIDS Conference was abuzz with the potential that antiretroviral treatment has to prevent HIV transmission by reducing a treated person’s infectivity. Our investments in treatment can now be understood to contribute to limiting the epidemic’s spread: a virtuous cycle of responsible public health. 

Yet this optimism has emerged as governments and donors are questioning the scope and scale of their HIV funding. Excitement notwithstanding, who will fund treatment as prevention when we still struggle to fund treatment as treatment? In low and middle income countries, we’re a long way from relying on drug regimens to control this epidemic. Barely a quarter of the 34 million HIV-positive people around the world are currently being treated, and the quality of care remains variable at best.

Political will to scale up treatment has not yet coalesced, and even if it does, it will not suffice. Pharmaceuticals and other tools remain only part of what is needed for us to master this epidemic. Expansion of treatment must be coupled with more and better-focused prevention. We need to significantly increase our efforts to address HIV among those most at-risk, even if they are not politically popular or socially accepted. And we must address larger structural factors that continue to impede our progress the world over.

To read the complete article, please click here.

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James Robertson is Country Director of India HIV/AIDS Alliance in New Delhi.