Wrapping Up ICAAP11 (November 22, 2013, Bangkok, Thailand)

Today concludes the 11th International Congress on AIDS in Asia and the Pacific (ICAAP 11) in Bangkok, Thailand. Alliance India is wrapping up our participation in the meeting with two sessions focused on the sexual and reproductive health (SRH) of people living with HIV (PLHIV) and a closing press conference on building the capacity of MSM and transgender organisations to partner with government to improve HIV prevention. Don’t miss this last opportunity: please join us!

Skills Building Workshop:

  • Beyond My Infection: A workshop to build capacities of PLHIV and Key Populations as advocates on Sexual and Reproductive Health and Rights (SRHR)

        Friday, November 22, 10:00am-1:00pm, Hall O, QSNCC

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Poster Discussion:

  • Cervical Cancer Awareness in Women Living with HIV: Findings from the Koshish Baseline in India

        Friday, November 22, 12:45-1:45pm, Plaza, QSNCC

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Press Conference:

  • Building capacity of MSM & TG CBOs to partner with Government HIV prevention interventions in India

        Friday, November 22, 2-3pm, Press Conference Room, QSNCC

Please download our roadmap of sessions at ICAAP that include Alliance India team members or discussions of our work. It includes a full list of our 31 posters describing our responses to a range of key priorities in India’s epidemic. Please also visit our Community Booth (#C3) to learn more about our work.

Advocating for Cervical Cancer Testing for Women Living With HIV: Experiences from the Koshish Programme in India

Koshish_thumbSexual & reproductive health (SRH) services must respond to the specific needs of people living with HIV (PLHIV). Unfortunately, this is typically still not the case in India. PLHIV face barriers in accessing basic SRH services or have needs that go beyond mainstream services.

After almost two years of rigorous work, Alliance India’s European Union‐supported Koshish programme — named after the Hindi word for ‘effort’— has emerged as a strong initiative to support policies and strategies on SRH for PLHIV in India. Our new case study ‘Advocating for Cervical Cancer Testing in Women Living With HIV’ highlights these efforts to address the challenges that PLHIV face in fulfilling their SRH needs, in this case concerning access to Pap smear testing for women living with HIV (WLHIV).

WLHIV are more vulnerable to cervical cancer and as early detection can lead to improved survival, it is even more imperative to address cervical cancer risk as an advocacy priority, particularly through the promotion of Pap smear testing. In the programme’s four implementation states (Andhra Pradesh, Gujarat, Maharashtra, and Tamil Nadu), Koshish advocacy coalitions have prioritised prevention and early diagnosis of cervical cancer among WLHIV as a key advocacy agenda at state and district levels. The partners have initiated advocacy efforts to make Pap smear testing a mandatory part of the care for every WLHIV and, in doing so, expand its availability to all women.

Read more about this effort here.

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India HIV/AIDS Alliance works closely with PLHIV in India through its Koshish programme which strengthens civil society organizations and networks that represent and work with PLHIV and other marginalized groups, such as MSM, transgenders, sex workers and IDUs, to effectively advocate for policies to improve the sexual and reproductive health and rights 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.

New Advocacy to Address Cervical Cancer in Women Living with HIV

Early detection of cervical cancer can help WLHIV live longer and more productive lives. (Photo by Prashant Panjiar for India HIV/AIDS Alliance)

Early detection of cervical cancer can help WLHIV live longer and more productive lives. (Photo by Prashant Panjiar for India HIV/AIDS Alliance)

Alliance India’s Koshish programme advocates for policies and strategies on sexual and reproductive health (SRH) and rights for people living with HIV (PLHIV) in India. The programme is implemented in Maharashtra, Tamil Nadu, Andhra Pradesh and Gujarat.

During community consultations with PLHIV in these four states, the Koshish team noticed that women living with HIV (WLHIV) had low awareness of cervical cancer and seldom go for testing. HIV-infected women with advanced immunosuppression (CD4 count < 200 cells/µL) are particularly vulnerable to infection with human papillomavirus (HPV) that leads to cervical cancer.

As the availability of ART has increased, it has given greater hope to WLHIV to live healthier and longer lives. With improved survival, it has become even more imperative to address cervical cancer risk as a priority. Early detection of cervical cancer is possible through a Pap smear test. While not available at primary health centres, the test should be available at every government district hospital’s gynecological departments. Unfortunately, access is limited due to non-availability of kits or lack of trained lab technicians. Typically WLHIV are referred for the test only if doctors think the woman is vulnerable, basing their decision on certain symptoms.

HIV programming needs to integrate Pap smear testing into routine care. Koshish has been actively pushing for regular Pap smear test for WLHIV at civil hospitals. Our partners in Maharashtra, Mamta and the Maharashtra Network of People Living with HIV/AIDS (NMP+) have been successful in motivating Pap smear testing in five implementing districts, Nagpur, Amravati, Kolhapur, Ahmed Nagar and Thane.

In Ahmed Nagar, the team organises a health camp on the first and third Saturday of every month. In these camps, 25 women are screened for cervical cancer. In Thane, the civil surgeon has arranged for a monthly camp for 30 women. The camps in Kolhapur have begun and are being organised on Tuesday and Saturday, while in Nagpur the camps are being successfully held with support from the Indian Cancer Society. In Amravati district, the civil surgeon has issued a circular instructing routine Pap smear testing for WLHIV. Of the WHLIV tested for cervical cancer so far, nearly 10% have tested positive.

The risk of cervical cancer remains high in developing countries due to a lack of prevention and screening programmes. Under Koshish, partners have already started advocacy with decision-makers at State AIDS Control Societies to make annual Pap smear testing a mandatory part of the care for every WLHIV over 30 years of age who is on ART. Data collected from each state will support national level advocacy with decisional-makers at India’s National Health Mission and the National AIDS Control Organisation to ensure that prevention of cervical cancer among WLHIV is a priority. Koshish is committed to empowering PLHIV in India with advocacy tools to promote policies and strategies to improve their lives and build them as the natural leaders of these efforts.

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India HIV/AIDS Alliance works closely with PLHIV in India through its Koshish Project which strengthens civil society organizations and networks that represent and work with PLHIV and other marginalized groups, such as MSM, transgenders, sex workers and IDUs, to effectively advocate for policies to improve the sexual and reproductive health and rights 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.

International Women’s Day 2013: Empowering Women Living with HIV

Celebrate International Women’s Day with almost one million Indian women living with HIV.  (Photo © 2012 Prashant Panjiar for India HIV/AIDS Alliance)

Celebrate International Women’s Day with almost one million Indian women living with HIV. (Photo © 2012 Prashant Panjiar for India HIV/AIDS Alliance)

International Women’s Day was first officially observed in 1911 and remains an annual opportunity to call for change and celebrate the many acts of courage and determination by ordinary women who play an extraordinary role in the world’s future.

It’s hardly been three months since India came to a standstill after the gruesome gang rape in New Delhi. The incident generated national and international attention and was condemned in India and abroad. It has left us determined to find answers to difficult but basic questions: Are India’s women really safe, both inside and outside their homes? Can they celebrate their freedom? How can we ensure that all women are able to pursue their dreams?

Over the years, considerable effort has gone into social, political and economic empowerment of women, but progress has been too slow. For women living with HIV (WLHIV) in India, the challenges are multiple. These women encounter daily stigma & discrimination and face barriers to accessing HIV prevention, treatment and care as well as sexual and reproductive health (SRH) services. WLHIV often lack status and decision-making power and have inadequate control over financial resources and limited mobility to travel to find better jobs. Even today, laws and policies impede their access to health care and other services.

Though the sexual reproductive health and rights of people living with HIV (PLHIV) remain largely unrealized in this country, India HIV/AIDS Alliance is working to address some of the issues faced by WLHIV through our Koshish Project. With financial support from European Commission, Koshish affirms the principles of empowerment and partnership as core strategies to tackle the problems faced by these women, including stigma & discrimination, inaccessibility and non-availability of services and the lack of comprehensive SRH for PLHIV.

Through partners in Andhra Pradesh, Gujarat, Maharashtra and Tamil Nadu including PLHIV networks in these states, Koshish works with providers and decision-makers to help make barrier-free services available and formulate sensitive and progressive policies for PLHIV and key populations. Programme partners have proactively engaged these stakeholders to advocate for quality SRH services. Advocacy has focussed on issues like maternal health services for WLHIV, cervical cancer screening, quality counselling and increased awareness of SRH and rights.

It is a now time for us to look ahead and celebrate the untapped potential and opportunities that await future generations of women including WLHIV. As we enjoy the song One Woman  to be released by UN on this International Women’s Day, let us dedicate our time and resources and pledge our commitment to WLHIV by mobilizing and empowering them and jointly advocating for their rights and needs in India and all over the world.

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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.

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.

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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.

 

Advocating for Cervical Cancer Testing for Women Living With HIV

It is essential that the public health system ensures the availability and accessibility to testing and treatment of cervical cancer for women living with HIV, who are five times more likely to be affected by cervical cancer.

The Koshish Project recently held an advocacy meeting to discuss frequent non-compliance with the National AIDS Control Organisation’s (NACO) Revised Technical Guidelines on ‘Laboratory Monitoring for Patients at ART Centre/LAC/LAC Plus’ to test women on ART for cervical cancer, a disease that is five times more likely to affect women living with HIV.

Initiated by Alliance India’s Koshish partners Vasavya Mahila Mandala (VMM) and the Telegu Network of People Living with HIV/AIDS (TNP+), the state-level advocacy meeting highlighted the need for the public health system to ensure the availability and accessibility to testing and treatment for cervical cancer among women living with HIV (WLHIV). 

The meeting took place at the Andhra Pradesh State AIDS Control Society (APSACS) where VMM and TNP+ were joined by 23 district-level PLHIV networks to present a memorandum to the Project Director of APSACS.  They advocated for the urgent need for public healthcare facilities in Andhra Pradesh to implement NACO’s ART guidelines to improve the quality of life for WLHIV vulnerable to cervical cancer.

Dr. B. Jayamma, Additional Project Director, APSACS, chaired the meeting and, in her closing address, she assured the participants that the NACO revised technical guidelines on ART would be reviewed and SACS would take immediate action to implement the guidelines.  

Koshish held a similar meeting in Tamil Nadu, at which J.S. Malliga from the Cancer Institute carried out a presentation demonstrating the high level of vulnerability to cervical cancer experienced by WHLIV. This meeting also saw the release of a baseline study conducted by India HIV/AIDS Alliance, Tamil Nadu Positive Women Network and Palmyrah Workers Development Society for the Koshish Project. The study found that PLHIV felt that their SRH rights were being violated, with ten percent of PLHIV surveyed for the study stating that they were unaware of where they could go to receive information related to sexual health, contraceptives, and related care and treatment.

These meetings highlight  the urgency with which PLHIV need to be informed about their SRH rights and the SRH services available to them, and the necessity for cervical cancer testing to be a part of these services for WHLIV.

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India HIV/AIDS Alliance works closely with PLHIV in India through its Koshish Project which strengthens civil society organizations and networks that represent and work with PLHIV and other marginalized groups, such as MSM, transgenders, sex workers and IDUs, to effectively advocate for policies to improve the sexual and reproductive health and rights 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.