Renewing Our Commitment to the Global Response to HIV/AIDS

Image 1Globally, the incidence of new HIV infections and the number of AIDS-related deaths are decreasing. According to a recent report by UNAIDS, the annual number of deaths fell from 2.3 million in 2005 to 1.6 million last year. In 2001, there were more than half a million new HIV infections in children; in 2012, there were just over a quarter of a million.

Much of this progress is due to significantly expanded access to antiretroviral drugs particularly in low- and middle-income countries. Investment in antiretroviral drugs increased from $3.8 billion in 2002 to $18.9 billion last year. Significant results have also been achieved in reducing the number of deaths among those co-infected with TB and HIV, which have declined by 36% since 2004.

Despite flattening donor funding for HIV, which remains around 2008 levels, domestic spending on HIV has increased, accounting for 53% of global HIV resources in 2012. Nonetheless, the total global resources available for HIV in 2012 were estimated to be roughly US$ 3-5 billion short of the US$ 22-24 billion estimated to be needed annually by 2015.

The UNAIDS report also reviews progress on ten specific targets which were set by United Nations member states in the 2011 Political Declaration on HIV and AIDS. Progress has been slow in protecting human rights, securing access to HIV services for people most at risk of HIV infection, and in preventing violence against women and girls––all key factors in reducing vulnerability to HIV. Gender inequality, punitive laws and discriminatory actions continue to hamper national responses to HIV, and concerted efforts are needed to address these persistent obstacles to the scale up of HIV services for people most in need.

With support from donors like the Global Fund, PEPFAR, and the Bill & Melinda Gates Foundation, India HIV/AIDS Alliance in collaboration with hundreds of organisations across the country supports sustained and effective community-based responses to HIV. We focus our efforts on populations most affected by the epidemic, including men who have sex with men, transgenders, hijras, people who inject drugs and sex workers, as well as people living with HIV from all walks of life, including women and children.

Watch for our social media series, ‘The Six Strides’. Over the coming week, we will highlight the progress that we have made with our partners in six of the ten HIV/AIDS targets defined by the UN in the 2011 Political Declaration.

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My Trans Reality: An Interview with Tista Das, Founder, SRS Solutions

(Photo courtesy of Tista Das)

(Photo courtesy of Tista Das)

An important step in the process of self-affirmation for many transgender people is to adapt their physical appearance to align with their gender identity. Many transgenders face significant challenges in accessing transition-related services in India. Government hospitals seldom offer services like Sex Reassignment Surgery (SRS) and the private ones are too costly for many community members to afford. Without other options, many turn to quacks and other unlicensed practitioners for help.

SRS Solutions is a community-led and self-funded initiative that provides SRS-related information, counselling, and referral services to trans people in Kolkata. It was founded by Tista Das, a self-identified trans woman. In an interview with Alliance India’s Ankita Bhalla, Tista opened up on the tough times she has faced as a trans woman and what motivated her to found SRS Solutions.

Q: When did you acknowledge your gender identity? What was the response from friends and family?

Tista Das (TD): My parents always insisted that I was a boy, but I always felt like a girl. All my childhood playmates were girls. I used to behave and dress like them. I felt discomfort among the boys, and I was always forced to use the boy’s toilet. When one of my closest schoolmates was undergoing menstrual changes, I had an inner desire to be able to do so too. I missed the same changes in my body.

I came face to face with my trans reality when I saw a photo of female genitals when I was in Class 8th. I was perplexed. The question ‘why was I different from girls?’ kept playing in my mind. I was desperately searching for a way out of this anatomical cage. I wanted to align my body with my psyche. Then I came upon an article of postoperative trans women in a leading Bengali fashion magazine. I jumped in joy, but my entire family and most of my friends were strongly against my desire. In my first medical intervention, I was taken to a psycho-therapy clinic. The clinician there was understanding, and she requested my parents to let me live my way. My parents were against this and searched for a new psychiatrist, who gave me six electric shocks to cure my ‘disorder.’

I was lucky to have some supportive friends. Every day I changed from male to female at my friend Nupur’s house. My friends never refused me, even after they became subject to ridicule by neighbors because of me. Most people only consider two genders in life: male and female. They are seldom think beyond this conventional gender frame.

Q: What prompted you to start SRS Solutions?

TD: While my peers were going to college and checking out career options, I was denied admission to university because of my gender identity. While my friends where enjoying gully cricket, I dealt with insults from neighbors who took it upon themselves to make my family’s life and mine miserable. I was scared, upset and totally at a loss.

There was a strong urge in me for surgical intervention, but I had no money. I was introduced to the eminent author and professor Nabanita Debsen who told me about an executive opening at a sister concern of Indian Oil Corporation for a trans woman. I successfully made it through. Now I had a job and an income, but no place to undergo my physical transformation. Government hospitals were just playing with my emotions and wasting my time. Private care was not what I could afford. I underwent the same agony each day.

I underwent psychometric testing—a primary diagnostic procedure to conform whether a person is really suffering from gender dysphoria and is eligible for SRS—and was recommended for hormone replacement therapy. But again my resources were limited. I approached government hospitals in vain for genital reconstruction. I lost all hope. Then my parents came to my support. My mom sold her jewelry and my father took some loans. I got donations from school teachers. Still it was not enough. Finally, a miracle happened. I got an opportunity to act in an English short film as a protagonist girl. This income helped my desire come true.

The hardships I had faced seeded within me the idea of an organization where people in gender distress can get proper solutions. My desire was made stronger by the suicide of one of my transgender classmates. I finally established the SRS Solutions in Kolkata in 2012.

Q: How do you feel post transformation?

TD: I have chosen to be a woman neither to get any socio-legal and political advantages nor to get a sex partner. It was unbearable for me to live in an unwanted body, and every day I desperately hunted for a way out. I always loved to see myself as a girl physically in front of the mirror. I always felt trapped in a male body. I felt incomplete and wanted to align my body with my psyche. I only wanted to be a beautiful, decent girl, nothing else.

Q: What are the common problems faced by trans people in India related to SRS?

TD: Trans people in India who want SRS face problems in arranging the finances needed, identifying qualified facilities for surgeries, and gaining social acceptance for their transformation. A large number of us are oppressed because of the alarmingly low level of awareness at all levels of society. Few doctors are skilled in SRS, and most don’t understand gender identity issues. The pressure of having to fight society at every step, along with our own discomfort of being stuck in bodies we wish to change, is highly traumatic.

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Readers can learn more about the challenges faced by transgenders and hijras in accessing gender transition services in India in our recent publication,Transforming Identity, which presents findings of our recent research on this topic.

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

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,  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.

Going Global: An Indian Transgender at Prague Pride 2013

Abhina leads 25,000 LBGT community members and their supporters at Prague Pride 2013. (Photo: Courtesy of Prague Pride)

Abhina leads 25,000 LBGT community members and their supporters at Prague Pride 2013. (Photo: Courtesy of Prague Pride)

Big things often come unexpectedly. Last year, I met Lukas Rossalie, a gay photographer and activist from Prague, and shared with him the work we have been doing to support HIV prevention for men who have sex with men, transgender and hijra (MTH) communities in India under our Pehchan programme. Since then, we had been in constant touch, exchanging messages and discussing developments on MTH issues across the world. Then one day with little fanfare, he invited me to this year’s Prague Pride.

Prague Pride is the biggest lesbian, gay, bisexual and transgender (LGBT) event in central Europe. I had the honour to be the first hijra activist from India to lead the Prague Pride Walk. I was awestruck to walk with more than 25,000 LGBT Czechs through their monumental city for more than two hours, celebrating their lives and affirming their rights.

My four-day stay in Prague was full of excitement and adventure. Some people just wanted to stare at me; others wanted pictures. I was interviewed by several reporters who were keen to learn more about the MTH community back in India. I met with a feminist writer, then a psychiatrist who counsels on sexual reassignment surgery, and even a small group protesting against Prague Pride. Each interaction made me richer, and I gained new insights into the issues that transgenders face in Europe.

The week-long annual Prague Pride includes a programme called ‘Transgender Me’, which this year included an inter-cultural exchange that brought together transgenders from around the world to share their insights on gender identity globally. The event allowed me to showcase the work we’re doing under Pehchan. I described the progressive steps taken by the National AIDS Control Organisation in developing transgender- and hijra-specific HIV prevention interventions, and I took great pride in sharing stories of the remarkable transgender and hijra leaders who are inspiring so much social change in India.

The audience was fascinated to hear of the progress we have made. One of the best parts of the session was meeting India’s Ambassador in Prague, V Ashok. He listened intently to the entire discussion on LGBT life in India and developments since the Delhi High Court’s historic Section 377 judgment that decriminalized homosexuality. Afterwards we spoke, and he noted how impressed he was with the work the Indian LGBT community has done so far.

My few days in Prague had a fair share of proud moments, but there was one that was truly unforgettable. While sitting outside the meeting hall with the Indian ambassador, I was approached by a women with her young kid. I looked at her and exchanged greetings thinking she must be curious to ask questions or click a photo.

I looked at the kid lovingly and asked his name. “He is Denis [name changed]. He so wanted to meet you,” replied his mother while the boy kept looking at the floor. She continued, “Denis is a special child. He feels he is a girl and loves to dress like one.”

I was numb for a moment. My own childhood memory of being dressed in a saree flashed in my eyes. I gathered my courage and asked, “Honey, can we be friends? I have come all the way from India to meet you.” Denis came and sat on my lap, silently holding my arm and playing with my ring. I felt a shiver and exchanged a gaze with his mother. She was in tears. We spent ten minutes without saying anything.

Then his mother continued, “He does not make too many friends. At times other children laugh at him. He gets confused about which washroom to use. Other parents ask me to beat him so that he can be cured.” It was not just the child who needed support; his mother was also trying to cope. Fortunately, she had the wisdom to want him to be comfortable in his skin.

I shared my own story, another journey guided with a mother’s love and support. Denis opened up and soon we were friends. He had watched my dance performance and drew a picture of me. I was so touched when he gave it to me. Though it was soon time to go home, my memories of Prague and of Denis will stay with me always.

Denis’ drawing of Abhina (Prague, 2013)

Denis’ drawing of Abhina (Prague, 2013)

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The author of this blog Abhina Aher is Manager of the Pehchan programme at India HIV/AIDS Alliance.

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, 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.