36,656,825 and Counting

Larry Kramer

In 1983, Larry Kramer wrote an article for the New York Native filled with righteous anger, brilliant insight and, reading it now more than 30 years later, electric prophecy. It began, “If this article doesn’t scare the shit out of you, we’re in real trouble.” He proceeds to catalogue the inaction and sheer terror that defined the emerging epidemic.

Kramer recounts the failures of government officials, the medical establishment, researchers, the media, and the gay community itself. With prescient accuracy he connects disenfranchisement with vulnerability to HIV and describes the unrelenting stigma that even today shapes our still inadequate response to the epidemic. He is perceptive as he is relentless. His message: “we must fight to live.”

Kramer’s article was titled “1,112 and Counting.” After three decades, we’re still counting. More than 36 million people have died from AIDS and nearly as many are living with HIV. In India, roughly 150,000 people died from AIDS-related causes last year, ten times the number in the United States. For all our progress, the fight is not over.

Larry Kramer wrote “The Normal Heart” in 1985 during the grimmest and most uncertain days of the epidemic. No other play – no other work of art really – comes as close to capturing those times, and it resonates even today. A long time coming, the film version from HBO brings us back and in doing so reminds us what it takes to act up and fight back.

“The Normal Heart” aptly gets its title from a W.H. Auden poem “September 1, 1939” written as the world teetered on the brink of another epochal tragedy, World War II. What was true in 1939 was true in 1985 and remains true today:

Hunger allows no choice
To the citizen or the police;
We must love one another or die.

The AIDS epidemic has reached across the world in ways that perhaps only Larry Kramer would have imagined in those early days, and there is still no choice.


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

Alliance India 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.

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United Against Homophobia: Bringing Pehchan’s Human Rights Model to Uganda

Vijay Nair (left) from Alliance India with workshop participants from Sexual Minorities Uganda and Alliance colleagues, Enrique Restoy and Mala Ram.

Vijay Nair (left) from Alliance India with workshop participants from Sexual Minorities Uganda and Alliance colleagues, Enrique Restoy and Mala Ram.

“It was my view that homosexuality should be punished harshly in order to defend our society from disorientation.” – Yoweri Museveni, President of Uganda, while signing Anti-Homosexuality Bill into law on February 25, 2014.

 “While reading down Section 377 IPC, the Division Bench of the High Court overlooked that a miniscule fraction of the country’s population constitute LGBT…in its anxiety to protect the so-called rights of LGBT persons…” – The Supreme Court of India on December 11, 2013, while delivering its judgment on Section 377 of the Indian Penal Code that recriminalizes same-sex sexual behavior.

While Uganda and India may be separated by 3,500 miles, they have one thing in common: unjust laws against sexual minorities. Uganda recently adopted harsh new laws that further criminalize homosexuality, while last December India recriminalized gay sex, reversing a 2009 Delhi High Court decision. Consequently, both nations have witnessed a significant rise in acts of violence against the LGBT community, driving an already marginalized community further underground and making the uptake of HIV services all the more difficult.

In response to these disturbing developments, the International HIV/AIDS Alliance is rolling out the Human Rights Management Reporting System (HRMRS), a community-based system to monitor and respond to barriers to accessing HIV services. The system, once fully operational, will allow community-based organizations, the Alliance’s Linking Organizations, and other partners to collect and analyse data on human rights violations experienced by programme beneficiaries and clients. The evidence generated by the system will be used to improve interventions, ensure protection of rights, and inform advocacy.

As an early step in this process, the development of the HRMRS has been informed by a dialogue with members of Uganda’s LGBT community. I travelled to Entebbe from my home in Hyderabad to provide technical support to this process, building on my almost four years with India HIV/AIDS Alliance (Alliance India) in Andhra Pradesh. Sexual Minorities Uganda (SMUG) is a key implementing partner for this initiative.

As a gay man living with HIV, I know too well how important it is to confront the human rights barriers that prevent sexual and gender minorities from reaching HIV services. It was an honour for me to share Alliance India’s experience from the Global Fund-supported Pehchan programme rolling out Crisis Response Teams (CRTs) at the grass-root level in India.

In a dynamic discussion with the board and staff of SMUG as well as other community leaders, the Pehchan CRT model was discussed in detail, including: team formation; inclusion of key stakeholders; building capacities of team members; data collection and documentation of cases of violence and harassment; redressal of such cases; advocacy initiatives and solidarity events at national, state and district level; and sensitization meetings with law enforcement agencies, media and health care providers. Based on Pehchan’s learnings, this process helped frame HRMRS components on stigma, discrimination, impact of violence, and support systems.

“The situation in Uganda is extremely grim and a matter of great concern. After the Anti-Homosexuality Law was passed, communities have gone underground, accounts on social media have been deleted, and HIV-related service uptake has been hampered drastically. Despite Section 377, India has a gay movement that has been successful in generating support from a wide range of stakeholders, including India’s Department of AIDS Control, the media, and even a few political parties. Though social settings are quite different in each country, Uganda can learn a lot from India,” said Edith Mukisa, Executive Director of Community Health Alliance Uganda (CHAU).

She further proposed to visit India along with doctors and officials from Uganda’s Most At Risk Populations Initiative” (MARPI) to understand Pehchan’s advocacy efforts. With support from the Centres for Disease Control and Prevention, MARPI supplements the Ugandan Ministry of Health efforts to expand interventions to MARPs.

As both Uganda and India share a bitter colonial past and an ugly history of homophobia, it is essential that we work together, share our successes, prepare together for our challenges, and strive as one for a better tomorrow for sexual and gender minorities all over the world.

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The author of this post, Vijay Nair is a Programme Manager: Pehchan at India HIV/AIDS Alliance in Andhra Pradesh. 

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 addresses 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, SAATHIISangamaAlliance India Andhra Pradesh, and SIAAP and will reach more than 450,000 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.

Keep the light on HIV: International AIDS Candlelight Memorial 2014

candlelightmemorial2014_blogAt least 35 million people are estimated to be living with HIV globally, with more than 2.1 million in India alone. Advancements in antiretroviral treatment (ART) have transformed the lives of people living with HIV (PLHIV). With access to ART, life expectancy of a positive person can be as long as someone who is not infected. But in spite of so much progress, AIDS is not over. Too many people don’t know they’re infected. Too many don’t have access to prevention, treatment, care, and support services. Too many are still at risk.

The light must be kept on HIV. Our concerted and committed efforts to fight the epidemic are still needed. To mark International AIDS Candlelight Memorial 2014, India HIV/AIDS Alliance joins with other organisations and communities around the world to remember those we have lost and recommit to a strong, effective and sustained response to HIV/AIDS.

Coordinated by the Global Network of People living with HIV (GNP+), the International AIDS Candlelight Memorial is one of the world’s oldest and largest grassroots mobilisation campaigns for HIV awareness. Started in 1983, the event takes place every third Sunday in May and is led by a coalition of some 1,200 community organisations in 115 countries. By mobilizing communities, the campaign raises social consciousness about HIV/AIDS and builds global solidarity in the response to the epidemic.

Today remember our work is not over. Services still do not reach all those who need them. Stigma and discrimination are a daily fact of life for PLHIV and other marginalized communities. Laws criminalize those most at risk, increasing their vulnerability. The end of AIDS will remain only a dream if we do not finish what we’ve started. Today light a candle and remember those we’ve lost, those who fought with us and in whose memories we continue this fight. Today and every day, let’s keep the light on HIV.

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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.

Trans-formation to End Discrimination (#IDAHOT 2014)

Alliance India’s Simran Shaikh, a hijra and AIDS activist, speaks out against discrimination and for LGBT equality.

Alliance India’s Simran Shaikh, a hijra and AIDS activist, speaks out against discrimination and for LGBT equality.

May 17th marks International Day Against Homophobia and Transphobia (IDAHOT) around the world. I am sitting in my office at Alliance India in New Delhi as I gather my thoughts on the stigma and discrimination I have faced my whole life because I subvert gender conventions. My journey from a Parsi boy to a transgender activist has been filled with discrimination, stigma, violence, silent screams, and also triumphs. (Read more about Simran’s life.)

To honour this global day that celebrates sexual and gender diversity, I want to share my thoughts on the recent Indian Supreme Court judgement protecting the rights of transgenders.

On April 15th this year, the Supreme Court judgment recognised the third gender in India and granting legal recognition to Indians who identify as neither male nor female – to those of us those who identify as transgender women and men or as hijras. “Discrimination is no longer my favourite word,” I yelled with pride as my friends joined in the celebrations after this landmark judgment. The ruling guarantees the nation’s transgender population essential rights, including equal access to education and employment In India.

But will this stop people from staring at me on Delhi Metro trains, autorickshaw wallahs refusing me rides, and fellow passengers moving away from me on buses? Why do they do this you wonder? Because my existence bothers them. I don’t seem to fit the boxes they have neatly packed themselves into. I refuse to look and behave the way they expect. I offend their sensibilities by being me. Can a judgment validating my existence change all this? I don’t know, but it feels like we’re on the right track.

Homophobia is an aversion towards those whose sexual behavior differs from the heteronormative, and transphobia is an aversion to those whose gender identities transcend the male-female gender binary. Negative attitudes manifest in many ways, from contempt, fear and hatred to verbal abuse, harassment, and violence. Are these attitudes rational? In most cases,they are rooted in a belief that our differences are against the order of nature.

Over India’s history, hijras have been a revered community, but when this region was colonised by the British, regressive laws were put in place outlawing homosexuality and criminalising these communities. Sixty-seven years after independence from British rule, the third gender has been given legal protection in India. I don’t know how many more years will pass before the repeal of Section 377 of the Indian Penal Code that criminalises consensual same-sex sexual behavior.

While the struggle to end discriminatory laws continues, I am deeply troubled by the everyday injustices faced by my LGBT brothers and sisters. We need to fight the internalised homophobia and transphobia in our communities and transform our fear of our own gender and sexual identities. We must celebrate who we are. Violence and discrimination must not be tolerated anymore. It cannot be a crime to exist. To deny our right to exist is the crime!

I am a proud member of the hijra community. In my teens, rejected by my family, I was given shelter by a hijra when all other doors were closed to me. Even today there are few professional options for someone like me. As a member of the Alliance India team, I’m fortunate to be doing professional work in HIV/AIDS that can have such a great impact on the transgender community in India. I dream of a day when all who are like me are given equal opportunities to thrive. Equal opportunity on paper must be put into practice. Changing attitudes will open minds, and with open minds, we can trans-form the world.

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The author of this post, Simran Shaikh, is a Programme Officer for the Pehchan programme at India HIV/AIDS Alliance in New Delhi.

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 addresses 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, Alliance India Andhra Pradesh, and SIAAP and will reach more than 450,000 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.

Vihaan: A Ray of Hope in the Lives of PLHIV in India

People living with HIV are at the heart of Vihaan programme. (Photo by Prashant Panjiar for India HIV/AIDS Alliance)

People living with HIV are at the heart of Vihaan programme. (Photo by Prashant Panjiar for India HIV/AIDS Alliance)

“We are thankful to the government for providing free ART treatment. Without their support, we might not be alive today,” says Preeti with gratitude in her eyes. In her mid-thirties, Preeti is a mother of two from a backward district in Bihar. She contracted HIV at the young age of 18.

“I had no idea what to do and who to approach back then. HIV and AIDS were taboo. Now we have ART, and what we need along with treatment is care and support. Medication without proper support is of no use. I want to be an earning member of my family. My children are growing, so are their needs and still no one wants to offer jobs to people living with HIV,” she says.

Care and support are essential to effective ART programmes. PLHIV need support to access and adhere to treatment, to strengthen the capacity of families to manage HIV infection, to maximize the value of referrals and linkages to social protection schemes and services, to address instances of stigma and discrimination, and to reinforce positive prevention strategies.

To address these needs, India HIV/AIDS Alliance, working closely with the Department of AIDS Control (DAC) and with funding from the Global Fund, has initiated the Vihaan programme to scale-up care and support services for PLHIV in India. Meaning ‘dawn’s first light’ in Sanskrit, Vihaan complements the national treatment programme and has been designed in line with the National AIDS Control Programme IV (NACP IV) which promises “…universal access to comprehensive, equitable, stigma-free, quality care, support and treatment services to all PLHIV using an integrated approach.” Vihaan is the largest care & support programme ever launched.

PLHIV are at the heart of Vihaan. The programme ensures a robust, holistic care & support system for PLHIV – including high-risk groups, women and children – in 31 states and territories of India. The programme is establishing 350 Care & Support Centres (CSCs) as part of the national effort to improve treatment outcomes and to respond more effectively to the needs of people living with HIV. CSCs provide a range of care & support services and timely linkages to other government schemes to improve treatment adherence, overall social protection, and quality of life of PLHIV.

Vihaan relies on a range of civil society organisations and partnership with government to ensure the success of the programme. PLHIV organisations are key partners at every level. Nearly three-quarters of Vihaan’s implementing partners are PLHIV networks at state and district levels. Of the nearly 2,000 people engaged in the programme, roughly sixty percent are from the PLHIV community. Within the first three years, the programme expects to reach more than 1.2 million PLHIV.

Fatima, another woman living with HIV in Bihar, expresses her growing confidence, “Being positive myself, I realise how important care and support are in the lives of PLHIV. I am excited to be part of Vihaan and to make a difference in the lives of so many.”

Note: Names of community members mentioned in this blog have been changed to protect their identities.

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The author of this blog, Rosenara Huidrom, is Associate Director: Care & Support at India HIV/AIDS Alliance in New Delhi.

With support from the Global Fund to Fight AIDS, Tuberculosis and Malaria, Vihaan is establishing 350 Care & Support Centres (CSCs) across India that will help expand access to services, increase treatment adherence, reduce stigma and discrimination, and improve the quality of life of PLHIV. CSCs will support PLHIV, including those from underserved and marginalized populations who have had difficulty in accessing treatment including women, children and high-risk groups in 31 states and territories.