Women Out Loud: New UNAIDS/UNWomen Publication Cites Our Chanura Kol Project

UNAIDS and UN Women recently released Women Out Loud, a new report on women living with HIV and the key role that they play in ending the epidemic. A UNAIDS feature on the document’s release notes the following:

In a new report, entitled Women Out Loud, UNAIDS explores the impact of HIV on women and the instrumental role women living with the virus are playing to end AIDS. It includes the latest data and commentary from some of the leading advocates on women and HIV.

The report includes the voices of some 30 women living with HIV who have given their personal insights into how the epidemic is affecting women and on how women are actively working to reduce the spread and impact of AIDS.

HIV is continuing to have a disproportionate effect on the lives of women. It is still the leading cause of death for women of reproductive age, and gender inequalities and women’s rights violations are persistent in rendering women and girls more vulnerable to HIV and preventing them from accessing essential HIV services…

Marginalised women remain the most impacted by HIV

Sex workers and people who use drugs are particularly vulnerable to HIV. When sex is exchanged for money or drugs, women often exert little influence over a partner’s condom use. Female sex workers are 13.5 times more likely to be living with HIV than other women. Some countries reported an HIV prevalence of more than 20% among female sex workers in capital cities. Studies conducted in nine European Union countries have indicated on average a 50% higher prevalence of HIV among women who inject drugs than in men who inject drugs.

On page 21 of the report in the chapter on people who use drugs, the following point is made: “Women who use drugs are widely reported to experience disproportionate levels of stigma and discrimination, often compounded during pregnancy, and as mothers.” One of the three references for this observation is In the Shadows, the baseline findings report from our Chanura Kol project.

India HIV/AIDS Alliance is grateful to UNAIDS and UN Women for this citation of our work. Many thanks to the Chanura Kol team and particularly to our implementing partners, SASO and Shalom, for their many contributions to the report and to the project overall. To read more about our baseline findings, click here or on the report cover below.

In the Shadows: Chanura Kol Baseline Report_Alliance India 2011

Chanura Kol is funded by the Elton John AIDS Foundation and serves to expand interventions to decrease HIV transmission and reduce drug relapse among women who inject drugs. Based on a holistic and sustainable approach, the project was initiated in 2010 to address the root causes of vulnerability and the primary causes of relapse post-detoxification for women who inject drugs in India’s northeastern state of Manipur, many of whom are also sex workers. Chanura Kol provides these women with long-term shelter, creates opportunities for income generation outside of sex work, and helps them rebuild family relationships.

Chanura Kol is one of a handful of efforts in the region to address the distinct needs of women who inject drugs and reduce their vulnerability to HIV. To learn more, please see a recent slide show about the project:

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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.’

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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.

 

Is the Commonwealth ready for an AIDS-free generation?

Prasada Rao presents on the recently published report of the Global Commission on HIV and the Law at the International AIDS Conference in July 2012.

J.V.R. Prasada Rao blogs in New Statesman (London) about the importance of law reform in successfully addressing HIV/AIDS and how the Commonwealth can lead by example and take decisive actions to address the legal and structural barriers currently impeding the global HIV response:

Last week the European Parliament agreed on a new law to provide specific assistance and protection to people who suffer crime because of their sexual orientation, gender identity or, in a first for EU law, gender expression.

Can we expect the Commonwealth to adopt such a progressive approach on HIV and human rights issues? The annual meeting of the Commonwealth Foreign Ministers, coming up soon in New York, normally attracts attention for its economic and political agenda. But among the HIV/AIDS community, populations vulnerable to the infection and human rights activists, concern is centered on the fate of certain recommendations relating to the Commonwealth’s legal reform process….

To read the complete article, please click here.

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Prasada Rao is in the UN Secretary General’s Special Envoy on AIDS in the Asia Pacific region. He is former Director General of India’s National AIDS Control Organisation (NACO) and former Regional Director of UNAIDS in Asia and the Pacific. He served as a member of the Global Commission on HIV and the Law and is a trustee of both the International HIV/AIDS Alliance and India HIV/AIDS Alliance.

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.

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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.

Separate hospital wards for transgenders soon to be a reality

Friendly attitudes and responsive services by hospital staff help transgenders be comfortable and open about their health concerns to care providers. Photograph shows a visit by a transgender community member to a clinic in Andhra Pradesh
(Photo © Peter Caton for India HIV/AIDS Alliance)

In India, there is documented evidence of transgenders and hijras facing repeated stigmatisation and discrimination, in violation of their dignity and basic human rights. Pehchan, as part of the programme’s advocacy efforts to raise awareness and achieve equality for these communities, organised a sensitization workshop in collaboration with its CBO partner Sakha for the staff of the government-run Capital Hospital in Odisha on the problems faced by transgender community members seeking medical treatment. Simran Shaikh, Alliance India Programme Officer for Pehchan, gave an orientation to the participants on the lives of transgendered people.

Following the training, participants noted their appreciation and increased understanding. “It was nice to know the expectations and problems transgenders are facing while seeking medical treatment,” said a nurse who joined the session. Sudahsha Dash, the Chief Medical Officer of Capital Hospital, who was the chief guest at this occasion, proposed efforts to create a separate ward for transgender patients: “We would soon request the government to form a separate ward for the transgenders and sexual minorities here.”

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

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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.

HIV/SRHR Integration for MSM and Transgender People

Photograph © Prashant Panjiar for India HIV/AIDS Alliance

Men who have sex with men (MSM) and transgender people 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 protection from sexually transmitted diseases (STIs).

However, due to many factors, MSM and transgender people often experience greater vulnerability to SRH related ill health than other community members. They may experience 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 MSM and transgender people, such as in terms of their age, legal status, HIV status, sexual roles and whether they use drugs or are involved in sex work.

As a result, MSM and transgender people 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 issue brief specifically focuses on the importance, but also challenges, of HIV/SRHR integration for MSM and transgender people. 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 settings. These groups include the Badu Social Welfare Society in Bangladesh; Humsafar Trust, Family Planning Association, and SATHII in India; and Style in Cambodia. The work of these organisations offer 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 MSM and transgender people.

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.

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In 17 states of India, Pehchān is being implemented by a consortium of India HIV/AIDS Alliance, Humsafar Trust, SAATHII, SIAAP and Sangama to build the capacity of 200 CBOs to serve as effective HIV prevention partners with the National AIDS Control Programme (NACO) . By 2015, it will reach out to more than 450,000 MSM, transgenders and hijras using a community-driven and rights-based approach. Supported by the Global Fund, Pehchān remains their largest single-country grant to date focused on the HIV response for vulnerable and underserved sexual minorities.

HIV positive women who inject drugs provided with emergency support

A nurse at a Drop In Centre medically examining female injecting drug
user in Imphal. Photographer: Prashant Panjiar

Over the last year, Chanura Kol has reached out to more than hundred women who inject drugs, many of whom are HIV positive and all of whom were in need of general and emergency care.  Chanura Kol offered the women essential care and support services. This included emergency support such as providing them with food and medication for sexually transmitted infections, which a large proportion of the women were at risk as their primary source of income was sex work. In addition to this, women were tested for HIV and Hepatitis C.

Chanura Kol also filed cases on behalf of sex workers who were the victims of violence by either their pimps, clients or police officers. Physical and sexual violence are common occurrences in the lives of these women, a number of whom are also forced to consume alcohol and drugs by their clients. In a number of cases, this marks the beginning of their downward spiral into drug addiction. With little or no support to help them out, women, who have been successful in refraining from drug use, go back to sex work where they face the added risk of relapsing into drug addiction. In addition to the women that the Chanura Kol project has reached out till now, the programme aims to provide a holistic range of services to help 550 more women who inject drugs in Manipur by the end of three years.

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The India HIV/AIDS Alliance in partnership with SASO, implements the Chanura Kol project in Manipur. Funded by the Elton John AIDS Foundation, Chanura Kol was initiated in 2010 and serves to expand interventions to reduce drug relapse among female injecting drug users. Based on a holistic and sustainable approach, Chanura Kol aims to address the root causes of vulnerability and the primary causes of relapse post-detoxification for women who inject drugs in India’s Northeastern state of Manipur, many of whom are also sex workers. Chanura Kol provides these women with long-term shelter, creates opportunities for income generation outside of sex work, and encourages the rebuilding of family relationships.

Candidly Transgender: Government of India officially recognises third gender

Government of India (GoI) has taken a commendable step towards mainstreaming hijras and transgenders by recognising their gharana system. The Election Commission of India has for the first time ‘recognised’ transgenders and modified the Form of Oath or Affirmation for the applicants by incorporating the words ‘chela’ (disciple) after son/daughter and ‘guru’ (teacher) after parents at relevant sections in order to facilitate registration of transgenders in the electoral rolls. The form can now be signed either by their guru or parents; this landmark guideline will now mean that if the transgender applicant does not have address proof or other documents, those of their gurus will suffice.

Also, in the second phase of AADHAR, project initiated by the GoI to deliver unique identification numbers to every resident across the country has a made a separate provision for registration of transgender individuals (as ‘T’). Aadhaar card has been recognised by the Government as a multipurpose card which can be used for implementation of various welfare schemes and also as proof of photo identity. The government has also been extensively popularising this new addition through  advertisements which states ‘All residents of India, including children, transgenders and the differently-abled are entitled to get the AADHAR card’.

The Pehchān programme welcomes this decision of the government in recognising and promoting the dignity and equality of transgender and hijras across India and is hopeful that this step will further contribute to increased responsiveness to the concerns of transgenders and greater understanding of diversity in gender and sexuality.

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

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 PLHIV

People living with HIV (PLHIV) have the same sexual and reproductive rights as anyone else – such as the right to choose who to have sex with and to have sexual relations free from violence. They also share many of the same needs for sexual and reproductive health and rights (SRHR) information, support, commodities and services – such as advice about family planning.

However, due to many factors, PLHIV often experience greater vulnerability to SRH related ill health than other community members. They may experience  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 PLHIV, such as in terms of their gender, age, legal status and whether they use drugs or are involved in sex work.

As a result, PLHIV 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 people living with HIV (PLHIV). 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 groups include MAMTA and the India HIV/AIDS Alliance in India; TASO in Uganda; RHAC in Cambodia; and POZ in Haiti. The work of these groups offers important insights into ‘what works’. But they also highlight that everyone is still learning and questions remain about what constitutes good practice.

The 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 PLHIV.

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.

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Alliance India works closely with PLHIV in India through its Koshish project which aims to strengthened 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 Commison 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.

Silent No More: Empowering Young People to Speak Out about Sexual & Reproductive Health and Rights

A youth group leader (left) in Allahabad speaks to members of her group.

When the Action Project first started working in Uttar Pradesh and Manipur, the shyness displayed by young people when speaking about subjects considered taboo—including their sexual & reproductive health and rights (SRHR)—were obvious to the Action Project team. This proved to be a dilemma since vocal and outspoken discussions regarding these issues was exactly what the project’s team members wanted these young people to participate in.

Given that child marriages were a common occurrence, following which young girls were pressured to start having children, discussing issues such as family planning, contraception or HIV prevention was critical to reversing this trend.  The Action Project slowly started discussing issues related to SRHR with young people and soon saw a gradual change in their understanding of and confidence in speaking out about these subjects.

Now, Action Project members say that there is a stark difference in the confidence levels of youth members as compared to when the project was first initiated. Young people are now more able and willing to discuss topics related to their SRHR and have increased knowledge on prevention, HIV, safer sex and condom use, and are better prepared to access health services.  Peer leaders report mentoring other youth group members who have felt pressured to get married early or to have sex by their partners.

Additionally, the new found confidence and respect experienced by youth group members have allowed them to raise their concerns with the pradhan (village council leader) and other village government officials who have started to pay attention and have responded to their suggestions on village development. Female youth group members have also reported a reduction in their experience of gender discrimination. Young peer leaders in Uttar Pradesh have even been selected by a radio programme sponsored by the Directorate of Information and Broadcasting to talk about SRHR on the show. These are changes that youth group members have catalyzed through their engagement with the Action Project. Silent no more, they now speak up and make their claim for a better tomorrow in their communities.

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The Action Project is funded by the European Commission and endeavours to strengthen and empower civil society organisations and youth groups to advocate for more responsive policies addressing the sexual and reproductive health and rights (SRHR) of young people. The project focuses on the most marginalised young people—MSM and transgender community members, drug users, sex workers and those living with HIV. The project is being implemented in partnership with MAMTA and SASO in India and by HASAB in Bangladesh.  By 2013, the Action Project will have contributed to shaping SRHR policies and their implementation in India and Bangladesh by supporting the meaningful participation of young people in relevant processes and programmes.