What Difference Does Discrimination Make? Reflections for World AIDS Day 2013

Lord Fowler during his visit to Lakshya Trust in Surat, Gujarat. (Photo: India HIV/AIDS Alliance)

Lord Fowler during his visit to Lakshya Trust in Surat, Gujarat. (Photo: India HIV/AIDS Alliance)

I have just returned from a visit to India to see what is being done in tackling HIV and AIDS. Back at the start of the epidemic in 1986 I was health minister in Britain. We carried out a very high profile public education campaign using television, radio, poster sites to get the message through. We sent leaflets to every home in the country. Remember at this time there was no treatment. If you contracted HIV it was so often a death sentence.

But of course we were a relatively small country. India has a massive population of well over a billion and a vast area to cover. It is enormous credit to those early public health activists and to their successors on what has been accomplished. The creation of the National AIDS Control Organisation in itself was a massive achievement. Unlike some countries I have visited over the last 18 months there has been close cooperation with civil society organisations like India HIV/AIDS Alliance and many others. India put prevention first and the figures tell the story.

There has not been the explosion we have seen in Sub Saharan Africa where in one country almost a quarter of the population are infected. There may be two million people in India with HIV but compared with the population, prevalence is remarkably low. If you take injecting drug users then India has followed the sensible policy of providing clean needles. This should eliminate the spread of the infection by dirty needles being shared.

Does this mean then that all the problems in India have been solved? Of course not. No country can claim that. We still have a major problem of discrimination and stigma when it comes to  sexual minorities. Drug users are often treated with contempt as are transgender people who face particular prejudice. Sex workers continue to be exploited – although HIV transmission has fallen due to the vastly increased use of condoms. Men who have sex with men are still widely condemned.

And what difference does such discrimination make? It means that many men and women are unwilling to come forward for testing. They fear what the impact may be on their lives if it is known that they are positive. They fear the reaction in their families, in their communities and at work. And the effect is this: They are undiagnosed and continue to spread the virus. HIV and AIDS continue to increase. Deaths mount.

Of course this is not just a problem in India. It is a problem in every country in the world that I have visited. On this World AIDS Day we should vow to fight the discrimination and the stigma – and make a new effort to get people to test and get on treatment as it becomes more and more available. HIV is no longer a death sentence but the earlier a man or woman goes into treatment the longer life will be.

__________________________

The author of this blog, Lord Norman Fowler, was a member of Margaret Thatcher’s Cabinet and served as chairman of the Conservative Party under John Major between 1992 and 1994. He was instrumental in drawing public attention to the dangers of AIDS in Britain. He is the author of A Political Suicide: The Conservatives’ Voyage into the Wilderness and is currently writing a book on the global AIDS epidemic. Hosted by Alliance India, Lord Fowler recently visited New Delhi and Surat, Gujarat, to learn more about how this country has risen to the challenge of HIV.

Advertisements

Community Collectivisation to Sustain HIV Prevention: Findings from Avahan in Andhra Pradesh

_MG_8275 (2)

Community collectivisation empowers key populations such as female sex workers, men who sex with men and transgenders to voice their concerns and more confidently exercise their right to access healthcare and social welfare schemes. Photo by Peter Caton for India HIV/AIDS Alliance

Community collectivisation can help develop a stronger sense of purpose and interconnectedness among key populations (KPs) such as female sex workers, men who sex with men and transgenders. Sometimes known as ‘community mobilisation’, community collectivisation enables these groups to utilise their experience of vulnerability to overcome barriers they face and realize reduced HIV vulnerabilty and greater self-reliance. Collective action by KPs also empowers them to voice their concerns and more confidently exercise their right to access healthcare and social welfare schemes.

With support from the Bill & Melinda Gates-funded Avahan programme, a recent study led by Niranjan Saggurti of Population Council in collaboration with India HIV/AIDS Alliance was designed to demonstrate if community collectivisation is associated with consistent condom use and STI treatment seeking behaviours among female sex workers (n= 3,557) and high-risk men who have sex with men/transgenders (n=2,399) in Andhra Pradesh. Recently published in the journal AIDS Care, the study generated significant positive findings.

Entitled ‘Community collectivization and its association with consistent condom use and STI treatment seeking behaviors among female sex workers and high-risk men who have sex with men/transgenders in Andhra Pradesh, India’, the study showed that high levels  of collective action and participation in public events by both populations led to higher levels of consistent condom use, increased STI treatment seeking from government facilities, and improved ability to negotiate condom use.

The findings confirm the value of sustained community system strengthening to empower communities to meaningfully engage in national HIV prevention efforts and show the key role played by community collectivisation as an essential strategy to encourage consistent condom use and health seeking behaviours among KPs.

Read the complete study here.

___________________________

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.

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

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

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

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

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

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

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

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

___________________________

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

 Alliance India works closely with PLHIV in India through its Koshish programme which aims to strengthen civil society organisations and networks that represent and work with PLHIV and other marginalised groups, such as MSM, transgenders, sex workers and IDUs, to effectively advocate for policies to improve the sexual & reproductive health and rights (SRHR) of PLHIV in India. This project is funded by the European Commission  and is implemented in partnership with MAMTA, PWDS, VMM and CHETNA, along with state-level networks for PLHIV in Maharashtra, Tamil Nadu, Andhra Pradesh and Gujarat.

 

What India’s Politicians Can Learn from President Obama’s Victory Speech

I believe we can keep the promise of our founding, the idea that if you’re willing to work hard, it doesn’t matter who you are or where you come from or what you look like or who you love. It doesn’t matter whether you’re black or white or Hispanic or Asian or Native American or young or old or rich or poor, able, disabled, gay or straight. You can make it here in America if you’re willing to try.”

                     Excerpt from President Barack Obama’s Victory Speech, 7 November 2012

In his eloquent and unifying speech in Chicago following his re-election, President Obama did not fail to mention the gay communities who have strongly supported Obama; and they have every reason to do so. Among the milestones of Obama’s first term is an impressive record of protecting and advancing the rights of sexual minorities: the repeal of the ban on openly gay men and women serving in the military; his view that the Defense of Marriage Act was unconstitutional and would not be defended in court by his administration; expansion of legislation on hate crimes to include attacks based on the victim’s actual or perceived sexual orientation; and his public support for marriage equality and adoption. His victory gives hope to members of lesbian, gay, bisexual and transgender (LGBT) communities around the world who continue to struggle for justice, inclusion and respect.

In India, sadly, we have no elected leaders who echo similar sentiments. During our efforts to read down Section 377 of Indian Penal Code and decriminalize homosexuality, two ministries—the Ministry of Health & Family Welfare and the Ministry of Home Affairs—took contradictory stands in the Delhi High Court. In spite of support for decriminalization from the Ministry of Health and Family Welfare, the Additional Attorney General stood by the Ministry of Home Affairs’ affidavit, which justified retention of the archaic law by citing public morality: ‘…Indian society is yet to demonstrate willingness to show greater tolerance to practices of homosexuality.’

Following the judgment of the Delhi High Court to read down Section 377, the matter has been taken to the Supreme Court of India by an coalition of religious leaders across faiths, a rare occasion of the religious diversity of this country speaking with one voice, albeit misguided and bigoted. This time, however, in the Supreme Court, the Government filed an affidavit affirming that it abides by the Delhi High Court judgment. No elected leader has ever made such any statement—in the media or in parliament—so clearly supporting and defending human rights of sexual minorities.

India’s founders had a dream too: to build a nation that promotes, protects and respects civil, political, cultural and legal rights of every citizen irrespective of caste, creed, religion, race, color and sex. Pandit Jawaharlal Nehru repealed the odious ‘Criminal Tribes Act’ in 1949 that criminalized the country’s hijra communities, reasoning that the Act constituted a negation of civil liberty. Today, do we have leaders who are so passionate about social welfare of the sexual minorities? Sadly, the answer remains no.

In 2011 during a public meeting, Union Health Minister Shri Gulab Nabi Azad called homosexuality ‘a disease’ and ‘unnatural.’ Shri Lalu Prasad Yadav, chief of the political party Rashtriya Janata Dal, made a similar statement during a debate in the Lok Sabha, the lower house of India’s parliament. He observed that the Delhi High Court judgment ‘degrades’ Indian values, and it demands a serious discussion in the Parliament. Though there was outrage against these parochial and prejudiced views, such statements from our politicians only make us wonder how much longer our fight will continue.

In the recently concluded American election cycle, voters in Wisconsin elected the first openly lesbian senator, Tammy Baldwin, who will represent the state in Washington, DC. She reflects a remarkable change in the United States: the popular election of sexual minorities to office as a routine fact of political life. This progress has been the result of advocacy by generations of LGBT Americans and reflects a growing affirmation of our communities and rights by straight politicians, including President Obama. When will India have a leader with the vision and courage to openly defend our rights with genuine zeal and interest? Though India’s journey to equality still rises ahead of us, we are not disheartened. Social evolution on another side of the world gives us more reasons to make our voices heard. We will continue our struggle, as we share the distinctly American optimism of Scarlett O’Hara: ‘After all, tomorrow is another day.’

_________________________

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

With support from the Global FundPehchan builds the capacity of 200 community-based organisations (CBOs) for men who have sex with men (MSM), transgenders and hijras in 17 states in India to be more effective partners in the government’s HIV prevention programme. By supporting the development of strong CBOs, Pehchan will address some of the capacity gaps that have often prevented CBOs from receiving government funding for much-needed HIV programming. Named Pehchan which in Hindi means ‘identity’, ‘recognition’ or ‘acknowledgement,’ this programme is implemented by India HIV/AIDS Alliance in consortium with Humsafar Trust, SAATHII, Sangama, and SIAAP and will reach 453,750 MSM, transgenders and hijras by 2015. It is the Global Fund’s largest single-country grant to date focused on the HIV response for vulnerable sexual minorities.

 

Media Advocacy for addressing MTH issues

Alliance India in Andhra Pradesh conducted a Media Advocacy Meet this week (September 17, 2012) in Hyderabad to discuss the human right issues of men who have sex with men, transgender and hijras (MTH) and the role of media in representing their issues. The meet was conducted in collaboration with Center for Advocacy and Research (CFAR) and State AIDS Control Society (APSACS). Representatives from all major national and local print and electronic media houses attended the meeting.  Community members shared their experiences of representation of their human rights violations in print and electronic media.

At the end of the discussion, the senior journalists suggested the following: (a) to create district level consortium of media and health groups working on HIV prevention, (b) to request the health department of the media houses to foreground the MTH issues, (c) to form a state level action team/committee that can respond to violation of rights of MTH populations in the media, and (d) to conduct a workshop with the management of print and electronic media entities at the state level to sensitize them to MTH media needs.

Mr. Kailashditya, Joint Director, APSACS and Dr. P. Prabhakar, Director, Alliance India in Andhra Pradesh welcomed the suggestions and proposed efforts to initiate advocacy with media in a more focused manner.

This meet received wide attention from various quarters and positive reports in the media. To read the press coverage, click here.

____________________

The author this post, Rambabu Mudraboyina, is Advocacy Officer for Alliance India’s Pehchan Programme in Andhra Pradesh

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 will address some of the capacity gaps that have often prevented CBOs from receiving government funding for much-needed HIV programming. Named Pehchan which in Hindi means ‘identity’, ‘recognition’ or ‘acknowledgement,’ this programme is implemented by India HIV/AIDS Alliance in consortium with Humsafar Trust, SAATHII, Sangama, and SIAAP and will reach 453,750 MSM, transgenders and hijras by 2015. It is the Global Fund’s largest single-country grant to date focused on the HIV response for vulnerable sexual minorities.

How integration responds to the SRHR needs of sex workers

Sex workers have the same sexual and reproductive rights as anyone else – such as to choose who to have sex with and to have sexual relations free from violence. They also share many of the same needs for SRHR information, support, commodities and services – such as advice about family planning.

However, due to many factors, sex workers often experience greater vulnerability to SRH ill health than other community members. They may experience one or all of: specific or more complex SRHR needs; additional or stronger barriers to accessing SRHR services; and weaker capacity or opportunities to demand SRHR services . These factors are further affected – sometimes complicated – by the differences between individual sex workers, such as in terms of their gender and sexual orientation (including whether they are female, a man who has sex with men (MSM) or transgender), age, legal status, HIV status, socio-economic status and whether they use drugs.

As a result, sex workers often have significant unmet needs for SRHR. These can ‘fall through the net’ of both: HIV services (often designed to address specific risk behaviors rather than the ‘whole person’); and SRHR services (often designed for the general public and focused on mainstream services, such as family planning).

This brief specifically focuses on the importance, but also challenges, of HIV/SRHR integration for sex workers. It is based on the experiences of a growing number of groups working with such communities to put integration into practice in a range of setting. These have given important insights into ‘what works’. But they also highlight that everyone is still learning and questions remain about what constitutes good practice.

This issue brief promotes integration as a desirable goal in the long-term. However, it also emphasizes that organizations must work in a way and at pace that is appropriate and feasible for them – to ensure that the joining of HIV and SRHR services and systems enhances, rather than compromises, support for sex workers.

This review was commissioned by the India HIV/AIDS Alliance with support from the European Union under the Action Project and explores experiences and lessons from around the world including Asia and the Pacific. This issue brief is part of a series of materials resulting from a review of good practice in the integration of HIV and sexual and reproductive health and rights for key populations.

Download brief from here.

_______________

Alliance India is a state lead partner in Andhra Pradesh for implementing the Avahan India AIDS Initiative (2003-2013) which works in six states of India and 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, specifically female sex workers, MSM, and transgenders, through prevention education and services such as condom promotion, STI management, behavior change communication, community mobilization, and advocacy.

Engaging Law Enforcement Authorities for HIV Prevention: Experiences from Avahan in Andhra Pradesh

As police are the mandated protectors of the civil rights of all the citizens, they need to be aware of, and protect, the rights of sex workers and men who have sex with men (MSM). Also, police personnel themselves are vulnerable to HIV due to factors of age (25-40 years) and longtime separation from their families.

To enhance and support the functioning of the Targeted Intervention in Andhra Pradesh (AP) and to reduce vulnerability of police to HIV, India HIV/AIDS Alliance conducted police advocacy trainings in the state as part of Avahan India AIDS Initiative. To achieve this, Alliance India held consultative meetings with partners of the AP State AIDS Control Society to develop a state-level training module, and then selected state- and district-level stakeholders, including trainers, police officers, community personnel, and NGOs, to conduct advocacy trainings at the district level. Approximately 4,000 police personnel were trained as part of this initiative .

As a result of these advocacy efforts, there has been: a noticeable drop in unlawful arrest/detention of key populations, such as sex workers and MSM; a decline in police-related violence; improved safeguarding of minors to keep them out of sex work; and increased awareness and adoption of healthy sexual behavior/practices by police personnel.

____________________

The author this post, Dr. M. Ravikanth, is Documentation and Communication Specialist, India HIV/AIDS Alliance, Andhra Pradesh.

The Avahan India AIDS Initiative (2003-2013) 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, specifically 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.