Falling Through the Net No More: Community Advocacy Expands Sexual & Reproductive Health Services for PLHIV

Alliance India’s Koshish programme supports advocacy to improve sexual & reproductive health services for PLHIV and other key populations at government facilities. (Photo © 2012 Peter Caton for India HIV/AIDS Alliance)

Alliance India’s Koshish programme supports advocacy to improve sexual & reproductive health services for PLHIV and other key populations at government facilities. (Photo © 2012 Peter Caton for India HIV/AIDS Alliance)

Sexual & reproductive health (SRH) services must become responsive to the specific needs of people living with HIV (PLHIV). Unfortunately, this is typically not the case in India. PLHIV face barriers in accessing basic SRH services or they have needs that go beyond mainstream services. These challenges are compounded because HIV services do not target the holistic needs of PLHIV and these patients are not encouraged to demand expanded access to suitable SRH services. As a result, PLHIV frequently ‘fall through the net’ of HIV and SRH services.

Facing these difficulties, what has Alliance India’s Koshish programme done to improve the SRH of PLHIV and fulfill their basic human rights claims such as the right to health? With funding from the European Commission, Koshish has supported the formation and growth of four state-level advocacy coalitions in Andhra Pradesh, Gujarat, Maharashtra, and Tamil Nadu. These coalitions are organised by PLHIV and comprise of stakeholders representing key population networks, media, mainstream development organisations and civil society. In each state, the coalition identified SRH and rights needs of PLHIV and charted out advocacy strategies targeting these unfulfilled needs.

A state-level meeting organised by the coalition in Andhra Pradesh highlighted the urgent need for the government health system to ensure the availability and accessibility of testing and treatment for cervical cancer among women living with HIV. A similar initiative was undertaken in Tamil Nadu and Maharashtra. The effort in Maharashtra also advocated for initiating Pap smear tests at government hospitals for eligible women living with HIV. To achieve these goals, the advocacy event began by recognising and appreciating the work of healthcare providers in providing care for PLHIV and then sensitising them about the value of the Pap smear test for women living with HIV and requesting their support.

Press conferences in Maharashtra and Andhra Pradesh helped get coverage of the unmet SRH needs of PLHIV in the popular media. A workshop in Gujarat in December 2012 also trained 77 print and electronic media representatives. Workshop participants learned about Koshish and actively interacted with PLHIV community members, discussing their SRH needs, service availability, and the frequency of rights violations.

Community advocacy supported by Koshish has helped draw state and national level attention to the SRH and rights needs of PLHIV. And this is just the beginning. PLHIV are essential partners is India’s response to AIDS. By empowering PLHIV with advocacy tools, Koshish and our state partners continue to promote policies and strategies to improve the lives of PLHIV in India and build them as the natural leaders of these efforts.


The author of this post, Kumkum Pal, is Programme Officer for Alliance India’s Koshish programme.

 Alliance India works closely with PLHIV in India through its Koshish programme which aims to strengthen civil society organisations and networks that represent and work with PLHIV and other marginalised groups, such as MSM, transgenders, sex workers and IDUs, to effectively advocate for policies to improve the sexual & reproductive health and rights (SRHR) 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.


Changing a Habit of Addiction in the Land of the Gods

Severe punishments doled out to drug offenders in Uttarakhand have motivated users to shift from heroin and brown sugar to injecting pharmaceutical cocktails. (Photo by G. Charanjit Sharma for India HIV/AIDS Alliance)

Severe punishments doled out to drug offenders in Uttarakhand have motivated users to shift from heroin and brown sugar to injecting pharmaceutical cocktails. (Photo by G. Charanjit Sharma for India HIV/AIDS Alliance)

Uttarakhand’s natural beauty has captivated tourists and residents alike for centuries. Wildlife and nature enthusiasts, pilgrims, and even those wanting an escape from city life have turned to the serenity of Uttarakhand’s lush green mountains, fresh air, and the sacred Ganges river that runs through this North Indian state, often called ‘the Land of the Gods.’

Beyond its scenic beauty, Uttarakhand is also well-known for the cannabis that naturally grows all over the state. Cannabis has traditionally been associated with the holy men of this region but recently has seen an increase in consumption by the local population and tourists. Over the years, however, drug consumption has shifted towards heroin and brown sugar. Severe punishments given to drug offenders by the government for using these substance have motivated users to shift to injecting pharmaceutical cocktails, sold not by pharmacies but by local residents who bring them from outside the state.

New options for drug use have also led to an increase in number of people who inject drugs (PWID) and growing numbers who are infected with HIV, Hepatitis C and TB from sharing of syringes. Prolonged drug use impacts individual productivity. Most PWID are unable to keep steady jobs; they have limited financial resources, little family support or no meaningful access to drug treatment facilities. Social stigma and exclusion are constant features of daily life for PWID in Uttarakhand. Marginalized, they are routinely treated with disrespect and denied access to services they need, including healthcare.

Mindful of the current state of drug use in Uttarakhand, Alliance India’s Hridaya programme is working with seven organisations to offer harm reduction services in four districts, including the holy town of Haridwar and the state capital of Dehradun. Aiming to cover all PWID in these areas over the next two years, the programme will focus on the unmet needs of this vulnerable populations and complement activities in the state under India’s National AIDS Control Programme.

In addition to providing PWID with Hepatitis C education and overdose management, Hridaya will also encourage Hepatitis C testing, work with families of PWID to strengthen community mobilization, establish legal support and crisis response teams, and offer counselling on sexual and reproductive health, along with service referrals. To improve implementation and impact, the programme will also conduct drug pattern assessments to understand the dynamics of drug use in the state to respond more effectively to the needs of PWID.

In January 2013, the Hridaya team trained 30 newly recruited staff in Uttarakhand, including project officers, outreach workers, peer educators and peer counsellors from six CBOs. In these sessions, special effort has also been made to increase capacity overall and specifically train women in these roles to respond more effectively to the needs of female PWID. Similar staff trainings were held in Hridaya’s two other focus states, Haryana and Bihar.

Hridaya’s three-day training on harm reduction uses an intensive participatory workshop model featuring various techniques such as interactive presentations, group discussions, demonstrations, and feedback. Topics covered include: an overview of Hridaya; drug basics; drug-related harms; principles of harm reduction; outreach and peer education; Targeted Intervention (TI) prevention interventions under the national programme; needle and syringe exchange; operational aspects of interventions such as demand calculation, waste management and disposal; post-exposure prophylaxis for needle stick injury; sexually-transmitted infections; safer sex; drop-in-centres; service referrals; and networking.

As a guiding principle, Hridaya affirms the essential humanity and worth of PWID. This core value informs both the programme’s goals and its implementation. Building rapport with PWID and gaining their trust are essential steps in harm reduction programming, and Hridaya’s approach is designed to support the expansion of service offerings and demonstrate the importance of harm reduction as a key strategy to address HIV in PWID communities in India.


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 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. 

CAHR in India 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.

From Inequality to Inclusion: Recognizing the Vulnerabilities of Sexual Minorities in the Response to the Delhi Gang-Rape

The Justice J.S. Verma Commission stresses that the word ‘sex’ in the Constitution of India should be understood to include sexual orientation. (Photo © 2012 Peter Caton for India HIV/AIDS Alliance)

The Justice J.S. Verma Commission stresses that the word ‘sex’ in the Constitution of India should be understood to include sexual orientation. (Photo © 2012 Peter Caton for India HIV/AIDS Alliance)

Convened in the aftermath of the horrific gang-rape and murder of a 23-year-old woman in New Delhi this past December, a special commission headed by former Chief Justice J.S. Verma was tasked to suggest amendments to criminal laws to improve the security of women in India and ensure speedier justice.

In its 657-page report released in January 2013, the Commission has provided an initial set of recommendations, but it has also gone a step beyond its mandate. Unexpectedly and to its great credit, the report has made special mention of India’s sexual minorities, who are too often also victims of social stigma, discrimination and violence.

Even in the first chapter of the report, the Commission stresses the need to acknowledge differences in sexual orientation as ‘a human reality’ and recognizes the range of sexual and gender identities.  It also makes clear that the use of the word ‘sex’ in the Constitution of India should be understood to include sexual orientation. The full passage is a remarkable testament to social progress in India:

We must also recognize that our society has the need to recognize different sexual orientations a human reality. In addition to homosexuality, bisexuality, and lesbianism, there also exists the transgender community. In view of the lack of scientific understanding of the different variations of orientation, even advanced societies have had to first declassify ‘homosexuality’ from being a mental disorder and now it is understood as a triangular development occasioned by evolution, partial conditioning and neurological underpinnings owing to genetic reasons. Further, we are clear that Article 15(c) of the constitution of India uses the word “sex” as including sexual orientation.”

The report also powerfully justifies the inclusion of sexual minorities as indisputably entitled to their human and legal rights and fully embraced as equal citizens:

“Thus, if human rights of freedom mean anything, India cannot deny the citizens the right to be different. The state must not use oppressive and repressive labeling of despised sexuality. Thus the right to sexual orientation is a human right guaranteed by the fundamental principles of equality. We must also add that transgender communities are also entitled to affirmation of gender autonomy. Our cultural prejudices must yield to constitutional principles of equality, empathy and respect.”

The report proposes qualitative indicators measuring the perception of safety and security for women and other vulnerable groups as a tool to improve police performance and accountability. It also makes case for ‘community policing,’ a strategy to involve local populations and increase confidence in the safety of the citizenry. The report places emphasis of building capacities of the police on both gender-based violence and discrimination.

These suggestions and the arguments used to justify them are not only indicative of dynamic social change in India but also offer an unprecedented opportunity for civil society—including those of us working to improve the health and wellbeing of marginalized communities—to build and sustain collaboration with law enforcement agencies and the judiciary.

Through this engagement, we can begin to address some of the structural forces that increase vulnerability to HIV and hamper efforts to create an enabling environment for women, sexual minorities and other groups who continue to live in constant fear for their safety and security.

Read our January 3rd blog, The Other Epidemic: Gender-based Violence in India.

Read the complete report here.


The author of this post, Yadavendra Singh, is Senior Programme Officer: Capacity Building for Alliance India’s Pehchan Programme.

With support from the Global FundPehchan 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.