The Long Road Ahead

_MG_5246On 11 December 2013, the streets outside the Supreme Court of India thronged with a dazed crowd, hugging, sobbing and not quite sure what had happened. Inside the hushed courtroom, the judges had just passed a devastating ruling. Lesbians, gays, bisexual and transgender (LGBT) people in India had once again been labelled criminals. Section 377, the 152-year-old colonial law that banned gay sex, had been upheld by the Highest Court of Law of India saying that amending or repealing Section 377 should be a matter left to Parliament, not the judiciary.

For gay and lesbian Indians, the Supreme Court verdict means that they become vulnerable to harassment all over again. In India, domestic partnership and adoption—things that straight people take for granted—cannot even be discussed by activists because Section 377 makes it illegal to engage in gay sex. Under the colonial law, men could be jailed for 10 years for having sex with men, an act which was classed as an ‘unnatural offence’ along with paedophilia and bestiality. How can one talk about rights when the legal framework makes you a criminal?

In 2001, on behalf of the Naz Foundation (India) Trust and with the help of the NGO Lawyers Collective, I began to put together the public interest litigation against Section 377. Apart from just coming out and shouting from the rooftops about our human rights, trying to change the law was the only thing we could do. The everyday harassment of gay men by police and thugs also strengthened my resolve to fight for this cause. Although gay men are rarely prosecuted under Section 377, they are often intimidated or exploited because of it.

Once, while I was coordinating the Naz Foundation’s programme for men who have sex with men’ (MSM), a whole group of our clients were badly beaten up. They were walking home from a support meeting when they were attacked by some street boys with iron bars and hockey sticks. Many of them got their heads smashed that night and had to be taken to the hospital. We knew who did it. I wanted to make a police complaint but we could not because of the law. The police had a history of raiding groups who worked with gay men and of rounding up and arresting outreach workers. We were afraid. The men who were beaten up were also afraid to speak out. They were not ready to own up to being gay publicly; they thought they would be criminalised. In the end we made no complaint.

I had begun my journey to becoming a gay rights activist when, as an 11-year-old schoolboy in Delhi, I realised I was attracted to men. I grew up surrounded by a ‘conspiracy of silence’, in which nobody even spoke of the possibility of homosexuality. I would have been happy to hear something I could latch onto or fight with, but there was just silence—a mind-numbing and suffocating silence. There was this hypocrisy—it’s okay to do what you want to do in the bedroom but you do not talk about it in the living room. I found this appalling.

I got into gay activism in my early twenties. I realized that voicing my feelings openly began to heal the years of silence and oppression that I had faced as a gay boy growing up. But before I could go public, I had to tell my mother. After having kept my sexuality secret from family and friends for a decade I came out to my mum, whose matter of fact reply was such a delightful relief for me. She said simply, “So what?”

Most gay Indians do not have the privilege of being born to such liberal parents. After confiding in my family, I began working with gay organisations, starting with the Humsafar Trust in Mumbai and then Naz in Delhi. I became an open gay rights activist. I wrote a magazine column. I did training workshops and seminars. I was vociferous in the media. I organised protests and did work with the National Human Rights Commission on the psychiatric mistreatment of homosexual patients by the medical fraternity.

Gay men are more than fifteen times more likely to contract HIV than the average Indian, and many groups lobbied for Section 377 to be overturned on the grounds that it pushes gay men underground, increasing vulnerability to HIV. The National AIDS Control Organisation (NACO), the governmental leading the response to the epidemic in India, came out against Section 377 in 2006, arguing that the law made HIV prevention more difficult. The then Health Minister of India Shri Anbumani Ramadoss and many AIDS organisations, including the India HIV/AIDS Alliance where I now work as a Director, also called for the law to be abolished in order to protect public health. Our consistent efforts did lead to a sweet victory (now turned sour) when Section 377’s criminalisation of consensual sex between adults was declared unconstitutional by the Delhi High Court in July 2009. Constitutional morality had prevailed upon public morality, but this victory was short-lived.

The 2009 ruling had a huge impact, opening the floodgates of demand for social acceptance by LGBT people. Cities including Delhi and Mumbai have held gay pride marches; young gay people and their families are being interviewed by journalists on primetime television; Bollywood films now have gay characters. Bombay Dost, a gay magazine, has been re-launched and is no longer sold furtively wrapped in brown paper. This cultural shift gave us some degree of comfort to believe that the general population was ready for real social change. But there was plenty of opposition too. Religious groups, leaders of the BJP (the Hindu nationalist party), and hundreds of millions of ordinary Indians, especially those in rural areas, still find homosexuality unacceptable.

This social discrimination will be much harder to change now that the law again upholds it instead of denigrating it. In small towns of India, it is still not easy for people to reveal their sexual orientation to their family. Even in Delhi, young gay men need guidance and support to come out. Gay men succumb to the social pressure around them and keep their sexuality secret. When I was in my late teens I asked a man I met at a cruising spot whether he would ever get married (to a woman). “I already am,” he replied, “Isn’t everyone?”

But despite these challenges, things can improve if we choose to believe in ourselves. When I chose to come out and start working as a gay rights activist, I used the very stigma which tried to oppress gay men as a weapon to create my own life of freedom and help others along the way. Today I am not only a political activist working on sexuality issues but also a writer on the subject. My sexuality, a source of anxiety in my early years, has defined, quite successfully, who I am and what I have chosen to do with my life.

And even as I write this, the Government of India has appealed to the apex court seeking a review of its judgment on Section 377, saying that ruling falls foul of the principles of equality and liberty. Let us hope that all our rights will once again be preserved.


The author of this post, Shaleen Rakesh, serves as Director of Technical Support at India HIV/AIDS Alliance. He initiated the fight against Section 377 of Indian Penal Code while on staff at the Naz Foundation (India) Trust in 2001. A collection of his poems,The Lion and The Antler, was recently published.

A version of this blog was published on Citizen News Service and Asian Tribune in December 2013. 

‘Has anything changed?’ A Decade of International Day to End Violence Against Sex Workers

Community mobilisation and peer support can make a significant difference in the lives of female sex workers, helping to reduce the impact of criminalisation, social stigma and vulnerability to HIV. (Photo: Peter Caton for India HIV/AIDS Alliance)

Community mobilisation and peer support can make a significant difference in the lives of female sex workers, helping to reduce the impact of criminalisation, social stigma and vulnerability to HIV. (Photo: Peter Caton for India HIV/AIDS Alliance)

The International Day to End Violence Against Sex Workers was created to call attention to violence and other hate crimes committed against sex workers all over the world. Conceptualised by Dr. Annie Sprinkle, the first annual day was observed in 2003 by the Sex Workers Outreach Project USA (SWOP-USA) as a memorial and vigil for the victims of the Green River Killer in Seattle, Washington. On that day sex workers gathered to honour women and sex workers murdered by the serial killer Gary Ridgeway. In the killer’s own words: “I also picked prostitutes as victims because they were easy to pick up without being noticed. I knew they would not be reported missing right away and might never be reported missing. I picked prostitutes because I thought I could kill as many of them as I wanted without getting caught.”

Today, ten years from that first annual observation we should to pause and take stock. Has anything changed substantively in the last decade?

“Sex workers are subject to violence from the general community, who do not view us as deserving of protection. Sex workers are often rejected by family and peers, and for transgender and HIV-positive sex workers, the stigma can be even more intense.” (Friends Frangipani, Papua new Guinea, Asia-Pacific Regional Dialogue, 16–17 February 2011, quoted in Global Commission on HIV and the Law (GCHL) report “Risks, Rights & Health”)

In a public letter, Sprinkle states: “Violent crimes against sex workers go underreported, unaddressed and unpunished. There really are people who don’t care when prostitutes are victims of hate crimes, beaten, raped, and murdered. No matter what you think about sex workers and the politics surrounding them, sex workers are a part of our neighborhoods, communities and families.”

The GCHL report published in July 2012 highlights that more than 100 countries globally criminalise some aspect of sex work. Some countries, such as most of the United States, Cuba, People’s Republic of China, Iran, Vietnam and South Africa, outlaw sex work entirely. Some in Western Europe, Canada, Latin America, and South Asia prosecute activities related to sex work such as brothel-keeping or transporting sex workers, communicating for the purposes of prostitution, street soliciting and living off its profits. Norway and Sweden do not criminalise workers themselves, but paradoxically criminalise buying sex and arrest clients of sex workers.

Most countries use other laws against civil and administrative offences such as “loitering without purpose”, “public nuisance”, and “public morality” to penalise sex workers. Often anti-human trafficking laws are targeted against adults involved in consensual sex work rather than ensuring that the enforcement of those laws identify and punish those who use force, dishonesty or coercion to procure people into commercial sex, or who abuse migrant sex workers through debt bondage, violence or by deprivation of liberty.

The report goes on to say that for sex workers, the threat of violence – from both police and other actors – is a daily reality. Criminalisation, in collusion with social stigma makes sex workers’ lives more unstable, less safe and far riskier in terms of HIV. There is no legal protection from discrimination and abuse when sex work is criminalised. These kinds of laws invite police harassment and violence and push sex work underground, where it is harder to negotiate safer conditions and consistent condom use. Some sex workers fear carrying condoms, which are used as evidence against them, sometimes as an explicit provision of law. Police violence prevents sex workers from seeking their assistance, which ingrains a culture of more client and police violence.

Stigmatised, criminalised sex workers are unable to access programmes of HIV prevention and care. Police, criminals and clients deploy the threat of criminal sanctions to control and exploit sex workers. Rape and assault are difficult to report when the sex worker fears that she will be arrested, and sexual violence heightens exposure to HIV. Working in the informal sector reduces sex workers’ access to education and housing, thus increasing their dependence on others, including pimps.

Today, to make the observation of the International Day to End Violence Against Sex Workers meaningful, we must join the demands of sex workers, and their friends and allies to address the structural factors that continues to perpetrate, condone, and justify persistent violence against sex workers world-wide. Given this unsupportive legal environment around the world and the stigma against sex work, sex workers, and their clients, the critical first step towards ending violence against female, male, or transgender sex workers would be to repeal laws that prohibit consenting adults to buy or sell sex, as well as laws that otherwise prohibit commercial sex, such as laws against “immoral” earnings, “living off the earnings” of prostitution and brothel-keeping. Moreover, sex workers must have access to justice to ensure safe working conditions and security against violence from state and non-state actors.


The author of this blog, Nandinee Bandyopadhyay, is an independent consultant. She has been working on issues of class, gender, and sexuality for over thirty years. She has worked extensively with sex workers’ movements in India and internationally. 

A Transgender’s Story: International Day to End Violence against Sex Workers 2013

Asia has one of the worst records of violence against transwomen, especially sex workers. India is no better. (Photo: India HIV/AIDS Alliance)

Asia has one of the worst records of violence against transwomen, especially sex workers. India is no better. (Photo: India HIV/AIDS Alliance)

Sheela (name changed) is in her late twenties. A transgender, she recounts feeling like a women from a very young age. “I soon gave up my boyish lifestyle and started living like a female,” she says. “This did not go well with my family, schoolmates or neighbours. My father took only a few seconds to disown me. A bunch of young men in my neighbourhood even sexually assaulted me,” Sheela adds as tears roll down her face.

Broken yet determined, Sheela changed cities. From Patna in Bihar to the busy streets of Mumbai, she was now struggling to make a living. Here an older transwoman gave her shelter, but without education or connections she was unable to get a job. Being ‘trans’ made the situation more difficult. No one wanted to employ her, even as a waitress, shop assistant or hostess. She was barred from nightclubs and discos. “I wasn’t into sex work. I never wanted to do it. But I had no option,” she recounts.

Sheela’s story is not unique. Thousands of transwomen across India turn to sex work, not as the most attractive job option but as the only option for survival. Doubly stigmatised as transgenders and as sex workers, they are the most common victims of abuse and violence.

“But it’s not easy out there. Competition on the streets is tough,” she says with a momentary smile. “There are too many trans sex workers, younger and more attractive than me, and too few customers,” Sheela adds. “There have even been fights. Customers often refuse to pay, claiming they didn’t know I’m trans. I have been beaten several times.” 

According to reports, Asia has one of the worst records of violence against transwomen, especially sex workers. India is no better. Conservative attitudes and religious beliefs fuel intolerance and allow discrimination, abuse and violence against transgender people, particularly transwomen. Partner violence against transwomen is also high and unreported. Many transwomen drift into abusive and violent relationships because of low self-esteem.

Sheela has had her share of harassment at the hand of legal authorities. “Police have often harassed and arrested me. Once they found a condom in my bag and charged me with prostitution,” she recalls. “I do not carry condoms anymore and often have unprotected sex.” Recently Sheela found out that she’s HIV-positive. While HIV prevalence is 0.27 percent in the general population, it is estimated to be 8.8% among transgenders and hijras, and stigma often keeps them from accessing treatment and care services.

A recent trans health conference in Philadelphia extensively discussed sex work and violence. A document on violence and criminalisation, endorsed in the final plenary session, declared a set of basic rights relevant to all transpeople, but often denied to them – especially to those in sex work.

The statement demanded the recognition and condemnation of all cases of trans violence as human rights violations. It went on to call for efforts to investigate such cases of violence; to provide fully funded trauma counselling and care for survivors of trans-related violence; to enact laws providing protection against such violence; to provide free and equal access to the justice system for transpeople; and to provide administrative, security and legal personnel with sensitivity training on trans issues, as well as on human rights standards on trans-related issues.

In India, we’re too far behind. Sheela’s story illustrates the range of violence experienced by trans sex workers here. Hopefully, one day, we will we recognize gender diversity and respect sex workers. Until then, we have so much work left to do!


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

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,  SAATHIISangama, 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.

Keeping Violence at Bay in Andhra Pradesh: International Day to End Violence against Sex Workers 2013

Violence, stigma and discrimination decrease the capacity of sex workers to access health care and other social services. (Photo by Peter Caton for India HIV/AIDS Alliance)

Violence, stigma and discrimination decrease the capacity of sex workers to access health care and other social services. (Photo by Peter Caton for India HIV/AIDS Alliance)

“I filed an application for a ration card in the mandal (block) administrative office. The clerk made me come to office 15 times, and every time he slept with me,” rues Meena  (name changed), a sex worker from Andhra Pradesh. “Wherever we go – offices, schools, hospitals or banks – we are sexually exploited and discriminated against.”

Sex workers across the world are easy targets for violence and discrimination at work, at home and in society at large. Data show that violence faced by sex workers ranges from slapping to sexual assault, physical and psychological torture, and sometimes even murder. HIV programmes across the world are grappling with this reality of sex workers facing high levels of stigma, discrimination, gender-based violence and other human rights violations, which prevent them from accessing HIV information, health care and needed social services.

To tackle the problem, India HIV/AIDS Alliance has worked through our Avahan programme to develop community-led strategies for prevention and mitigation of violence among female sex workers and other sexual minorities. Working in a total of six states, the Avahan India AIDS Initiative is funded by the Bill & Melinda Gates Foundation. In Andhra Pradesh, our programme covered over 40,000 sex workers in 14 districts. Programme strategies on violence include: community mobilisation and empowerment, crisis response systems and teams; and sensitisation of police and other law enforcement agencies, media personnel and service professionals. The crisis response teams respond within 24 hours to any violence reported by liaising with legal services in the event of unlawful arrests, sexual assault, violence and other rights violations against sex workers.

Since 2006, our team has successfully sensitized around 7,000 police officials at state, district and block level. Over 700 community members have received training on law and human rights and have been recognized by the District Legal Cell Authority as para-legal volunteers (PLVs). PLVs from sex-worker communities provide support to those in need. In addition, community collectivization and legal education has empowered sex workers to recognize and address cases of violence against them.

Routine monitoring on violence and crisis response including data collected from Targeted Interventions for HIV prevention and from special Behavioural Tracking Surveys (BTS) among 2,000 female sex workers in five districts in Andhra Pradesh between 2009 and 2012 showed an improved response to violence in sex worker communities. The number of cases of violence against sex workers has declined by 68 percent, from 900 cases in 2009 to 288 cases in 2011. The BTS data indicate that there has also been a reduction in violence by police (from 29% in 2009 to 19% in 2011-12). The perception of fair treatment by police has increased from 14% (2009) to 29% (2011-12), and around 70 percent of sex workers now experience what they consider to be fair treatment at public institutions.

“Earlier we shuddered at the sight of police. Not anymore. We now know our rights and what to do in a crisis,” says Meena with confidence.


The author of this post, Dr. Parimi Prabhakar, is Director of Alliance India’s Regional Office in Hyderabad.

The Avahan India AIDS Initiative (2003-2014) 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, notably 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.

A Dark Day for India

shaleen_blog2I am crouched over my work desk at the Naz Foundation (India) Trust, combing through another draft of the Public Interest Litigation (PIL) against Section 377 of the Indian Penal Code, which criminalizes homosexuality. This case will be Naz India versus Government of India. This is 1999.

It will be another two years before we file the PIL through our lawyers, the Lawyers Collective HIV/AIDS unit. If the process of drafting the 200-odd page PIL was long and cumbersome, it was a cakewalk compared to the journey ahead.

I represented Naz India on this PIL on paper and in the courts. Week after week, there were hearings in the Delhi High Court after the petition was filed in 2001. Good judges and bad judges. Good hearings and bad hearings. And then, the nightmare! Delhi High Court rejected the petition on grounds that Naz India was not an ‘affected party’. An appeal in the Supreme Court and a win. The case back in high court. More hearings.

Then in 2009, the Delhi High Court upheld the PIL. Our celebration was ecstatic, but it has turned out to be premature. There was a counter-appeal in the Supreme Court. And, today, the day of judgement.

After fourteen years of struggle, in today’s ruling, Justice Singhvi stated that the 2009 Section 377 ruling was “constitutionally infirm” and set it aside.

I’m only just beginning to digest the news. This is too big a set-back, a devastating moment for millions of LGBT people in this country and around the world. The fight will go on, and we will rally for our rights as equal citizens. We will persevere, and we will triumph.


The author, Shaleen Rakesh, is Director: Technical Support, India HIV/AIDS Alliance. Shaleen was instrumental in filing the PIL in Delhi High Court on behalf of Naz Foundation.

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

International Human Rights Day 2013: Reflections on Rights Situation of PLHIV and Key Populations in India

HRD_blogSince the United Nations adopted the Universal Declaration of Human Rights in 1948, there has been a slow but steady expansion of international agreements that promote and protect the rights and dignity of all people everywhere. But even today, people living with HIV (PLHIV) and members of key population groups, such as men who have sex with men, transgenders, hijras, people who inject drugs and sex workers, continue to face violations to their basic rights. They are denied recognition in society, face barriers in accessing basic services like healthcare and education, and are often victims of violence and other forms of discrimination and marginalization.

Protection and fulfilment of the human rights of vulnerable communities are at the core of India HIV/AIDS Alliance’s work. Although the full enjoyment of their rights remains a dream for too many people, there are stories of hope and courage. This Human Rights Day take a look at some of the challenges facing India and how we’re responding:

The Other Epidemic: Gender-based Violence in India

Gender-based violence is an epidemic facing India and the world, and like AIDS, it will require a sustained and committed effort to overcome. Attitudes must change. We must never tolerate violence against women and girls. We must never be blind to gender’s diversity. Read more.

Fighting for the Right to Health for Women Living with HIV: A Success in Gujarat

Stigma and discrimination remain among the primary barriers to achieving universal access to HIV treatment, care, and prevention. As HIV treatment programmes become increasingly available, access to these lifesaving services depends on the degree to which all health facilities welcome PLHIV and respect their rights. Read more.

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

India’s hijra community routinely experiences mistreatment at the hands of doctors and the health system. Progress is slow and often only as a result of significant advocacy by community organisations. Hijras and transgenders have the same right to health as any other citizen, and the government must act to protect their lives. Read more.

Confidentiality: A Health and Human Rights Issue for PLHIV

There is nothing more angering than the thought of stigma faced by people living with HIV (PLHIV). Take, for example, the situation where numerous PLHIV had their HIV status published on the front page of their medical history records, making confidential information available to anyone who glanced at their files. Read more.  

The Pain of Being ‘the Other’: How Stigma Fuels HIV/AIDS among People Who Inject Drugs in India

The vulnerability of people who inject drugs (PWID) is further fuelled by the fact that society perceives drug users as criminals and a threat to society. This makes it difficult for people who want to reach out to them to build rapport and trust. This demonization further fuels the HIV epidemic in the country. Read more.

Shedding Light on Abuse: Alliance India study shows that almost 50% of women who inject drugs in Manipur report harassment and abuse from community members

A study conducted by Alliance India sheds light on the extent of the social discrimination and isolation experienced by women who inject drugs in Manipur. The lack of a support system in the lives of women who inject drugs significantly increases their isolation and likelihood of engaging in sex work as a means of earning a living. Read more.

A Beacon of Hope in the Fight Against Child Marriage: One Girl’s Story

The issue of child marriage is a very common problem in Allahabad in the conservative Indian state of Uttar Pradesh. Here, girls are married early and are expected to bear children soon after.  Issues such as contraception, sexually transmitted infections, and reproductive rights of young people are met with a wall of silence. Read more.

World AIDS Day at 25: The Odds and Evens of a Quarter Century Fight against HIV/AIDS

HIV is not just a medical issue but also a social matter that requires a holistic, community-based response. (Photo by Peter Caton for India HIV/AIDS Alliance)

HIV is not just a medical issue but also a social matter that requires a holistic, community-based response. (Photo by Peter Caton for India HIV/AIDS Alliance)

It has been 25 years since the first observance of World AIDS Day on December 1, 1988. This quarter-century journey has been tumultuous. Denial of the epidemic and gross violations of the human rights led to the deaths of millions globally. People living with HIV spoke out and acted up. Others noticed, and slowly advocacy drove investment in HIV programmes by governments around the world.

In India, the first known case of HIV was diagnosed in 1986 in a female sex worker in Chennai. HIV remains concentrated in high-risk groups. While adult HIV prevalence stood at 0.27% in 2011, it continues to remain alarmingly high among men who have sex with men (MSM) at 4.43% and transgenders 8.82%. Pressed by community advocacy, the Government of India’s HIV response has prioritized prevention interventions for MSM. It has recently realized the necessity of developing a distinct HIV prevention strategy for transgender and hijra communities. By the end of 2012, 20 of the government’s targeted HIV prevention interventions were working exclusively with these populations.

Despite many years of work, HIV prevalence remains high in MSM, transgender and hijra (MTH) communities in India for complex reasons. Starting at the individual level, internalised homophobia and transphobia plagues many MTH community members. Often rejected by their families, there is lack of meaningful social support for them that adds to their vulnerability to HIV.

Society at large is still not comfortable with MTH communities. This is even more true for transgenders and hijras. They are more visible which often makes them targets. Lack of recognition of their gender identities by the government makes their lives difficult. Without proper identity documentation, they cannot access education, life insurance, bank loans and various social entitlement schemes.

Though the Delhi High Court read down Section 377 of Indian Penal Code in 2009, the ruling was appealed to the Supreme Court of India. The judgement is expected in December 2013. Activists in India and across the world are eagerly awaiting word from the Supreme Court. If the court upholds the Delhi High Court decision, it will be a landmark in the history of human rights.

We must be relentless in our pledge to make HIV history. In this, our governments and our communities are equal partners. HIV is not just a medical issue, and it never has been. It’s a social matter that requires a holistic response that puts affected communities at the centre. This World AIDS Day and every day, we need to strengthen community action on AIDS.


The author of this post, Yadavendra Singh, is Advocacy Manager at India HIV/AIDS Alliance in New Delhi.

This blog was published on The Alternative on 1st December 2013.

The Pain of Being ‘the Other’: How Stigma Fuels HIV/AIDS among People Who Inject Drugs in India

People who inject drugs face widespread discrimination, physical violence, hostility and harassment that limits their access to lifesaving health services. (Photo by Prashant Panjiar for India HIV/AIDS Alliance)

People who inject drugs face widespread discrimination, physical violence, hostility and harassment that limits their access to lifesaving health services. (Photo by Prashant Panjiar for India HIV/AIDS Alliance)

Born in a poor family in a remote district of Haryana, Paul (name changed) learnt from childhood to be by himself. He was dragged to work at the age of 10. It was here, copying older boys, he got into the habit of smoking ganja (cannabis). Soon his peers influenced him enough to experiment with stronger substances like smack (a heroin derivative). As his cravings increased, he was soon hooked on injecting pharmaceutical drugs, unaware that sharing needles and syringes could make him vulnerable to HIV.

Paul’s story is shared by many people who inject drugs (PWID) in India. There are thousands in India, who feel helpless because drugs control their bodies and minds. Addiction compels them to keep ‘using’ despite horrendous physical and mental consequences and unaware of their increased risk for HIV. It is estimated that the HIV prevalence amongst 180,000 PWID in India is approximately 7.1%.

Their vulnerability is further fuelled by the fact that society perceives drug users as criminals and a threat to society. This makes it difficult for people who want to reach out to them to build rapport and trust. This demonization further fuel the HIV epidemic in the country.

PWIDs are often assumed to be HIV-positive and refused treatment when clinical care is needed. There have been many instances of PWID being denied services at public healthcare facilities and instead getting arrested and suffering police brutality.

“When I tested HIV-positive, hell broke on me. Going for treatment was scary as there was so much stigma attached with being a PWID,” recalls Paul.

Sensitization efforts by India HIV/AIDS Alliance’s Hridaya programme with healthcare facilities and psychosocial interventions with PWID have helped community members living with HIV avail stigma-free antiretroviral treatment. Hridaya follows a harm reduction approach, which – as the name suggests – aims to reduce the harm associated with injecting drug use, such as vulnerability to HIV and Hepatitis C infection, rather than trying to eliminate drug use per se.

“Thanks to Hridaya, I am now comfortable with myself, comfortable with the fact that I am positive,” says Paul.

This year the global theme of World AIDS Day is “Getting to Zero”: zero new infections; zero AIDS-related deaths; and zero discrimination. For the first two to happen, eliminating discrimination is essential. Building rapport with PWID and gaining their trust are essential in harm reduction programming and are the first steps towards getting to zero with PWID.


The author of this post, Francis Joseph, is Programme Officer: Drug Use & Harm Reduction at India HIV/AIDS Alliance 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 (PWID), 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.

This blog was published on The Alternative on 2nd December 2013. 

A Long Way to Zero… | World AIDS Day 2013

(Photo by Peter Caton for India HIV/AIDS Alliance)

(Photo by Peter Caton for India HIV/AIDS Alliance)

“Getting to zero” is the theme of this year’s World AIDS Day. It is an ambitious goal, to be sure. Three goals, in fact. Three zeros. Zero new HIV infections. Zero AIDS deaths. Zero stigma and discrimination. Are we now so close to declaring victory? Are we really on a path to an AIDS-free world? Is the end of AIDS on the horizon?

On one hand, we have never been better positioned to achieve such goals. We have good epidemiological data. We know where the epidemic thrives. We know who are most at risk, and we have the tools to reduce their vulnerability. For those infected, we have treatment.

Yet mastering this epidemic remains elusive. Why does there still seem to be zero chance that we will achieve any of UNAIDS’ zero targets anytime soon? Although it’s no longer popular to say so, AIDS remains exceptional. As a virus, it has proved remarkably resourceful, outwitting scientists and keeping a vaccine or cure out of reach.

But for all its microscopic muscularity, HIV is still winning because we’re letting it win. Those most at risk — sex workers, men who have sex with men, people who inject drugs, transgenders and hijras — remain on the margins, socially stigmatized and victimized by legal discrimination. People living with HIV bear a daily burden of society’s cruelty and inaction.

Don’t get me wrong. Things are better than they’ve ever been, but better isn’t good enough. Our tools and knowledge can only stifle this epidemic if they are marshaled to the task. Government coordination must be matched with community mobilization and sustained in collaboration with civil society. National treasuries, donor governments, corporate houses and private citizens alike need to pitch in to support these efforts.

This World AIDS Day, even as we appreciate progress in India and elsewhere, we should not lose our momentum or let crumble the foundation that has been built in the quarter century since the first World AIDS Day in 1988. The path to zero is still long, even if the destination is clear.


The author of this blog, James Robertson, is Executive Director of India HIV/AIDS Alliance in New Delhi.

This blog was republished on One World South Asia on 2nd December 2013. 

AIDS Response at Crossroads: World AIDS Day 2013


This year’s World AIDS Day will not just be a string of events the world community observes every year on December 1st, reiterating our resolve to combat the pandemic. This year, it will occur at a defining moment in the global response when all stakeholders are standing at crossroads, looking to where we should head.

There is celebration, sometimes excessive, about the successes achieved since 2001 when the rules of engagement with HIV/AIDS changed from appeasement to aggressive combat, denial to ownership, and condemnation to meaningful participation by communities infected and affected by the epidemic. The resource base for AIDS programmes moved to billions, and affordable generic medicines have been made available, saving the lives of 10 million people. New infections have made an appreciable decline of 33% in the Ground Zero of the epidemic, sub-Saharan Africa. Most important, there has been an aggressive breakthrough in reducing the number of children born with HIV, and the target of zero new infections among children by 2015 appears feasible.

Encouraged by this impressive progress, world leaders have started talking about an AIDS-free society as an achievable goal in a finite time frame. Secretary-General United Nations has spoken on more than one occasion about the emergence of an AIDS-free world. The UN Joint Programme on AIDS (UNAIDS) has adopted the achievement of three zeroes as a global strategy. A new Commission established jointly by UNAIDS and Lancet has ‘what will it take to end AIDS’ as one of its three overarching objectives.

An outsider who is not familiar with the history of the epidemic can be led to believe that success is on hand and an AIDS-free world is just round the corner. This is the pitfall in crying victory too early when there are many challenges lying ahead, including sustainable financing and political support for AIDS programmes. While new infections are on decline in Africa and Asia-Pacific, they are still on rise in Eastern Europe, Middle East and Northern Africa. Another 5 million more people are in need of treatment, and this number will increase further with the new WHO guidelines on treatment. The biggest obstacle is however the adverse legal environment surrounding the people living with HIV and key affected populations. Progress on decriminalising these behaviours has been extremely slow and in some countries negative.

Resource availability for AIDS programmes has been impressive until now, but it is uncertain whether countries will commit matching domestic resources to cover the gap left by withdrawal of donors from AIDS financing. Evidence shows that external financing has funded prevention programmes focussing on vulnerable key populations. These communities are apprehensive about whether countries would continue with this prioritisation once the external funds are withdrawn. And for political leaders at country level, AIDS is no more a challenge. By providing treatment services to infected populations and preventing them from dying, they feel they have won the battle.

The added challenge on this World AIDS Day is the ongoing global dialogue on defining the post-2015 development agenda for the next 15 years. In the next year, world leaders will be actively negotiating various components of a new development regime where priority will be accorded to issues like environment and sustainable development. There is overall concern whether health and HIV will get the right priority in the post-2015 agenda. As this will evolve through an intergovernmental process in the UN General Assembly, much depends on what priority country leadership, especially non-health actors, will accord to AIDS and whether emergence of an AIDS-free society would be considered by them as an achievable goal.

On this World AIDS Day, we need to be vigilant and work closely with country leadership and UNAIDS to ensure that AIDS is not dropped just at a time when the battle is half won.


The author of this post, J.V.R. Prasada Rao, is UN Secretary-General’s Special Envoy for AIDS in Asia and the Pacific and serves as chair on the board of India HIV/AIDS Alliance.