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.

“No doubt, ART is my friend indeed…” A Community Profile to Mark 10 Years of Free ART in India

Naomi at the NNP+ offices in Nagaland (Photo: India HIV/AIDS Alliance)

Naomi at the NNP+ offices in Nagaland (Photo: India HIV/AIDS Alliance)

A member of India’s PLHIV community reflects on ten years of access to free antiretroviral treatment.

For Naomi Semy, life almost came to a standstill when she tested positive. “As I saw the test report, everything went blank. I just thought, ‘I am dead.’”

For many days, she did not talk to anyone and didn’t step out of her home. One day gathering courage, she decided to meet a doctor. Luckily for her, the doctor was supportive. He counselled her on how treatment could help her live a long and healthy life with HIV.

She promptly decided to begin antiretroviral treatment (ART). “I was buying medicines from a private clinic, and it was very expensive. The cost made things difficult, but I managed somehow.”

Then. in 2004, the government opened an ART centre in Kohima, Nagaland, that offered no-cost services. “There was no looking back since then. What more could I have asked for than to live healthy with HIV.”

Naomi today leads the Network of Naga People Living with HIV and AIDS (NNP+). The network has 4,000 registered members and is reaching out to 10,000 people living with HIV (PLHIV) in the state.

Having successfully managed HIV for 10 years now, Naomi is now a role model for other PLHIV. “How long we live is not important but how well we live is. This has guided me to live a fulfilling life despite being HIV positive. No doubt, ARV is my friend indeed.”

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With support from the Global Fund to Fight AIDS, Tuberculosis and Malaria, Vihaan is establishing 350 Care & Support Centres across India that will help expand access to services, increase treatment adherence, reduce stigma and discrimination, and improve the quality of life of PLHIV. The centres 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.

“ART is my partner for life…” A Community Profile to Mark 10 Years of Free ART in India

Kanjibhai and his wife in their home in Gujarat (Photo: India HIV/AIDS Alliance)

Kanjibhai and his wife in their home in Gujarat (Photo: India HIV/AIDS Alliance)

A member of India’s PLHIV community reflects on ten years of access to free antiretroviral treatment.

Kanjibhai B Gadhia is a content man. A well-settled farmer from Amreli district of Gujarat, he tested positive 11 years ago.

“I fell seriously ill then. My condition was deteriorating day by day, and my family had lost all hope. No doctor was ready to treat me,” he recounts.

Then a private doctor came forward as a lifesaver. He not only treated him but also advised him on the importance of treatment adherence.

“He cautioned me about possible side-effects of the drugs so that I was mentally prepared for them and would not discontinue the medicines.”

As free anti-retroviral treatment (ART) was not available then, Kanjibhai got his medicines from the same doctor.

“In the beginning, I had bouts of severe nausea, vomiting, lack of appetite, and stomach cramps. But I did not give up, and slowly the side-effects vanished,” he says. “But what was more harder to manage was the cost of medicines. My wife had also tested positive, and after buying the medicines, we had hardly anything left.”

Thankfully, the government’s initiative to provide free ART at government hospitals came to Kanjibhai’s rescue.

“A representative from the district-level network of people living with HIV (PLHIV) told me about the scheme. In no time, my wife and I had registered. Since that day, we have not missed even a single dose. It is due to this regular ART regime that I am living a healthy and content life. ART is my partner for life, and I will never give it up.”

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With support from the Global Fund to Fight AIDS, Tuberculosis and Malaria, Vihaan is establishing 350 Care & Support Centres across India that will help expand access to services, increase treatment adherence, reduce stigma and discrimination, and improve the quality of life of PLHIV. The centres 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.

Early TB testing is vital for an effective AIDS response: Government and civil society come together to reinforce this pledge on World TB Day

At the World TB Day press conference, representatives from the Department of AIDS Control, Central TB Division, civil society and affected communities discussed the need for early TB testing for PLHIV.

At the World TB Day press conference, representatives from the Department of AIDS Control, Central TB Division, civil society and affected communities discussed the need for early TB testing for PLHIV.

World TB Day is observed every year on March 24th. To mark this occasion, India HIV/AIDS Alliance today joined the Department of AIDS Control (DAC) and the Central TB Division (CTD) to create awareness about the importance of early detection and treatment of tuberculosis (TB) among people living with HIV (PLHIV) and strengthening HIV/TB collaborative activities at all levels.

In collaboration with DAC and with support from the Global Fund, Alliance India implements Vihaan, a care & support programme for PLHIV in 31 states and territories. The programme works with 17 regional and state level partner organisations and is establishing 350 Care & Support Centres across India that will help expand access to services, increase treatment adherence, reduce stigma and discrimination, and improve the quality of life of PLHIV.

Vihaan is actively working to ensure that its frontline workers are supporting a range of HIV/TB collaborative activities in coordination with the district level TB units. James Robertson, Executive Director of India HIV/AIDS Alliance commented, “Vihaan is committed to increasing awareness of TB among the PLHIV served by the programme and, through intensified testing, ensuring that co-infected clients are fully supported to complete the full course of treatment.”

Tuberculosis (TB) is a major concern for PLHIV as their impaired immune systems make them particularly vulnerable to the disease. In spite of this, it remains difficult to persuade PLHIV to undergo testing for TB. The double stigma of TB and HIV often keeps PLHIV from visiting clinics to learn their TB status.

Manoj Pardesi, General Secretary of the National Coalition of PLHIV in India (NCPI+) said, “PLHIV are among the most vulnerable to falling ill with TB. We need to do more to diagnose PLHIV infected with TB and reach out to them with treatment.”

The total number of PLHIV in India is currently estimated at 21 lakh, which is third highest in the world (Source: Annual Report 2012-13, Department of AIDS Control). India is also has the highest TB burden in the world with an estimated 2.2 million new TB cases occurring annually. TB is the most common Opportunistic Infection (OI) among PLHIV in India.

Dr. R.S. Gupta, Deputy Director General, CTD, said at the event, “Regular screening of all PLHIV for TB is utmost important for prevention of TB mortality in this group.”

HIV and TB co-infection can be fatal. It is estimated that nearly 25% of AIDS deaths in India are TB-related. TB infection increases progression of HIV infection to AIDS and contributes to accelerated mortality. In 2007, it was estimated that 4.85% of TB cases in India are in patients who are also HIV-positive. Of more than 100,000 presumptive TB cases identified among PLHIV at ART Centres, more than 20% were found to have TB (Source: TB India 2011-Annual Status Report).

Dr. A.S. Rathore, Deputy Director General, Care, Support and Treatment at DAC observed, “It is important for PLHIV in India to get tested for tuberculosis. A lack of early testing increases morbidity and mortality in HIV/TB co-infected patients.”

Mona Balani, a woman living with HIV, noted that, “In too many cases, detection of TB happens too late. Many PLHIV patients reach treatment facilities at a terminally-ill stage.”

Early detection of HIV/TB co-infection and prompt provision of Antiretroviral Treatment (ART) and Anti-TB Therapy (ATT) are key interventions to reduce mortality in this population. Increased joint action by government and civil society to initiate early detection of TB among PLHIV is an important step toward addressing the challenge of HIV/TB co-infection and improving the health and wellbeing of PLHIV in India.

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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.

World TB Day 2014: New poster campaign to increase awareness among PLHIV of TB co-infection (Hindi version)

FB_TBposters_hindiMarch 24 is World TB Day. Tuberculosis (TB) is a major concern for people living with HIV (PLHIV) as their impaired immune systems make them particularly vulnerable to the disease. Providing the right care & support to PLHIV with TB co-infection remains a priority to reduce related morbidity and mortality.

With support from the Global Fund, our Vihaan programme is launching a national campaign on March 24, World TB Day 2014, to increase TB testing and treatment among vulnerable PLHIV. Under the campaign, Vihaan Care & Support Centres (CSCs) will launch posters and organise TB/HIV co-infection awareness activities for clients across the country. A look at the posters launched today:

Poster: Promoting early testing of TB among PLHIV

Hindi Poster-1

Poster: Encouraging adherence to TB treatment among PLHIV

Hindi Poster-2

Poster: Encouraging completion of DOTS for TB treatment among PLHIV

Hindi Poster-3

World TB Day 2014: New poster campaign to increase awareness among PLHIV of TB co-infection (English version)

FB_TBposters_englishMarch 24 is World TB Day. Tuberculosis (TB) is a major concern for people living with HIV (PLHIV) as their impaired immune systems make them particularly vulnerable to the disease. Providing the right care & support to PLHIV with TB co-infection remains a priority to reduce related morbidity and mortality.

With support from the Global Fund, our Vihaan programme is launching a national campaign on March 24, World TB Day 2014, to increase TB testing and treatment among vulnerable PLHIV. Under the campaign, Vihaan Care & Support Centres (CSCs) will launch posters and organise TB/HIV co-infection awareness activities for clients across the country. A look at the posters launched today:

Poster: Promoting early testing of TB among PLHIV

POSTER-1

Poster: Encouraging adherence to TB treatment among PLHIV

POSTER-2

Poster: Encouraging completion of DOTS for TB treatment among PLHIV

POSTER-3

World TB Day 2014: Increasing PLHIV Access to TB Testing and Treatment in India

India has the highest TB burden in the world, and it is estimated that nearly 25% of AIDS deaths in India are TB-related. (Photo of Mycobacterium tuberculosis bacteria, courtesy of CDC/Dr Ray Butler/Janice Haney Carr)

India has the highest TB burden in the world, and it is estimated that nearly 25% of AIDS deaths in India are TB-related. (Photo of Mycobacterium tuberculosis bacteria, courtesy of CDC/Dr Ray Butler/Janice Haney Carr)

Tuberculosis (TB) is a major concern for people living with HIV (PLHIV) as their impaired immune systems make them particularly vulnerable to the disease. In spite of this, it remains difficult to persuade PLHIV to undergo testing for TB. The double stigma of TB and HIV often keeps PLHIV from visiting clinics to learn their TB status. Unfriendly attitudes of clinical staff only makes things worse.

Take the case of Shanti (name changed), a PLHIV from East Godavari district in Andhra Pradesh. She was found bedridden by an outreach worker (ORW) from our Vihaan programme during a routine visit. Shanti’s son explained that she had rapidly lost weight in the previous weeks and was coughing continuously. The ORW noted some other symptoms possibly indicating TB and suggested that Shanti get a TB test. She refused as during earlier visits clinic staff had not treated her well due to her positive status. She remembered how they had made her rush from one department to other for a simple test.

After much persuasion by the ORW and assurance that she will be treated respectfully, Shanti agreed to visit the district medical centre. She was found TB-positive and was immediately put on Directly Observed Treatment, Short-Course (DOTS). Shanti is now three months into her treatment course. She has regained weight and is on her way back to good health.

Shanti’s experience is all too familiar. India has the highest TB burden in the world, with an estimated 2.2 million new TB cases occurring annually. It is estimated that nearly 25% of AIDS deaths in India are TB-related. In most cases, detection of TB happen too late. Many patients reach the hospital at a terminally-ill stage. Managing side-effects and complications of anti-TB treatment (ATT) and anti-retroviral treatment (ART) is another major challenge for co-infected patients. Ensuring adherence to both treatment regimens remains an uphill task. It has been observed that when some clients show improvements within four to six months, they stop taking their ATT, believing they are fine. But incomplete treatment can lead to further complications, including multi-drug-resistant (MDR) TB.

Providing the right care & support to PLHIV with TB co-infection remains a priority to reduce related morbidity and mortality. With support from the Global Fund, our Vihaan programme is launching a national campaign on March 24, World TB Day 2014, to increase TB testing and treatment among vulnerable PLHIV. Under the campaign, Vihaan Care & Support Centres (CSCs) will launch a poster campaign and organise TB/HIV co-infection awareness activities for clients across the country. The CSCs will also hold special sensitisation workshops for stakeholders on the need for friendly and responsive services for co-infected patients.

Over the course of the following month, CSCs will hold support group meetings (SGMs) on TB/HIV co-infection. District TB Officers (DTOs) will be engaged to train CSC staff across India on TB/HIV co-infection, the importance of early detection, verbal screening and TB care. Wherever feasible, DTOs and other medical officers will be called to facilitate discussion in these SGMs. Since more than 50% of staff at CSCs are from the PLHIV community, staff members will also be encouraged to go for TB screening to set an example to fellow community members.

In solidarity with World TB Day, Vihaan is committed to increasing awareness of TB among the PLHIV served by the programme and, through intensified testing, ensuring that co-infected clients are fully supported to complete DOTS. As our campaign posters say, TB can be cured! Access to TB care is a basic human right, and Vihaan will do all we can to ensure that PLHIV in India have full access to TB testing and treatment!

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The author of this post, Mona Balani, is Programme Officer: Vihaan 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 across India that will help expand access to services, increase treatment adherence, reduce stigma and discrimination, and improve the quality of life of PLHIV. The centres 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.

‘207 against 377’: A Step Towards Reclaiming Our Rights

The national Pehchan consultation on Section 377 was attended by more than 100 community stakeholders and activists, including prominent transgender leader Lakshmi Narayan Tripathi. (Photo by India HIV/AIDS Alliance)

The national Pehchan consultation on Section 377 was attended by more than 100 community stakeholders and activists, including prominent transgender leader Lakshmi Narayan Tripathi. (Photo by India HIV/AIDS Alliance)

December 11th, 2013 was a black day in the history of India’s human rights movement. On this day, the Supreme Court of India set aside the historic judgment of Delhi High Court in 2009 and, by affirming the constitutionality of Section 377 of the Indian Penal Code, recriminalized same-sex sexual behavior. The judgment, best described as ‘regressive’ and ‘derogatory’, noted that lesbian, gay, bisexual and transgender (LGBT) people are a ‘miniscule minority’ and our rights are ‘so-called’.

The Constitution of India guarantees a life of equality and dignity to every citizen, irrespective of caste, creed, religion and sex, but the Supreme Court lost the opportunity to protect the rights of sexual and gender minorities. The denial has made India’s LGBT community yet more vulnerable to stigma, harassment and violence. The court dealt another blow to the community in early 2014 when it also rejected all petitions to review the judgment.

The judgment was a huge setback to a marginalized and often hidden community that was beginning to come out of the closet after the 2009 decision, but the spirit to fight back and reclaim our rights is now even stronger. There has been a concerted effort by a range of civil society organisations, such as Voices Against 377, Lawyers Collective and Naz Foundation (India) among others, to make sure that this community momentum leads toward a coherent movement that will in time overturn the Supreme Court’s backward judgment.

The Global Fund-supported Pehchan programme is joining the challenge. Pehchan works with MSM, transgender and hijra (MTH) communities on issues of HIV and health in 17 states of India through consortium partners including India HIV/AIDS Alliance, Humsafar Trust, SAATHII, Sangama, SIAAP, Pehchan North Region Office (PNRO) and Alliance India Andhra Pradesh. In collaboration with the 200 community-based organisation supported under Pehchan, these 207 partners leveraged their collective passion and determination and launched the 207 against 377’ campaign.

Through the campaign, partner organisations will reach out to various stakeholders including political parties, religious leaders, media and educational institutions to sensitise them on the challenges facing LGBT communities. The campaign will contribute to the public discourse on Section 377 and will highlight how the law undermines the fundamental rights of LGBT people in India. The campaign will influence general attitudes and government policies so as to protect the wellbeing and dignity of LGBT Indians.

To initiate this national effort, Pehchan organized a daylong national consultation on February 6th that was attended by LGBT community members and leaders from across India including Ashok Row Kavi, Lakshmi Narayan Tripathi and Manohar Elavarthi. Speakers emphasized the importance of political engagement and the involvement of religious leaders. It was agreed that there is a need for a clear strategic plan of action against the Supreme Court judgment.

During the consultation, community members voiced their concerns about Section 377. Arvind Narain from the Alternative Law Forum provided a legal overview of the judgment and Anand Grover from Lawyers Collective discussed the next legal steps. The consultation generated an active dialogue and generated multiple ideas to build advocacy momentum. As next steps, the consultation identified priority actions to move advocacy forward:

  • Documentation of cases of stigma, discrimination and violence faced by the LGBT community;
  • Sensitization of judges at district, state and national level;
  • Dialogue with religious leaders and political parties;
  • Engagement of the media to highlight the challenges caused by the judgment;
  • Regular rallies; and
  • Linking activities to other rights movements in India.

The ‘207 against 377’ campaign will also organize 17 state-level consultations – one in each Pehchan state – on Section 377 and 200 district-level consultations through Pehchan CBOs.

This is just the beginning. The national campaign will reach out to the LGBT community and stakeholders at all levels. We will keep you updated on progress.

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

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

Zero Discrimination Day 2014: Ending the epidemic of discrimination against PLHIV in India

Children living with HIV have the same right of education as others. (Photo by Prashant Panjiar for India HIV/AIDS Alliance)

Children living with HIV have the same right of education as others. (Photo by Prashant Panjiar for India HIV/AIDS Alliance)

March 1 is Zero Discrimination Day. HIV-related discrimination continues to plague the lives of people living with HIV (PLHIV). They are treated in dehumanizing ways, face barriers in accessing basic services like healthcare and education, and are often victims of violence and other forms of discrimination and marginalization.

Take the case of 13-year-old Prashant (name changed), from Kathua district in Jammu state in India. He is HIV-positive. His school learned of his status. The teachers mocked at him, and his peers abused him. His brother, two years elder to him, was also picked on.

“It was a horrifying experience. We were treated with disgrace. School was my favourite place to spend my day. No more!” recounts Prashant.

The mother of the boys made several rounds to school authorities, all in vain. She then approached the local Care & Support Centre (CSC) established under Alliance India’s Vihaan programme with support from the Global Fund. Responding to discrimination is a central activity of every CSC. The CSCs have established Discrimination Response Team (DRT) at district level to address these challenges. DRTs provide not only psychological support to PLHIV who have faced discrimination but also advocate on their behalf in response to discrimination they have experienced. The teams inform appropriate district or government authorities about the incidents of discrimination faced by PLHIV and take appropriate steps to address the same.

In this case, the DRT promptly organized a meeting with the sarpanch (head of the village government) and discussed the issue. The DRT educated him that the behavior of the school towards the boys was wrong. Together they approached the school authorities and encouraged them to treat the boys as any other students. The authorities were convinced after several rounds of discussions and committed to be fair to the boys.

“I am happy to be back to school. Though I see a change in behavior of my teachers and peers, it will take some time for me to adjust again,” says Prashant.

Discrimination denies PLHIV their dignity and respect and leads to reduced self-confidence, loss of motivation and withdrawal from society. This discrimination has profound implications on all HIV-related services, from prevention to treatment, care and support. It reduces people’s willingness to be tested for HIV, to disclose their HIV status, to practice safer sex and to access health care. Vihaan is committed to creating a stigma and discrimination-free environment for PLHIV, and the DRTs are already proving to be effect tools to proactively respond to discrimination.

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The author of this post, Ankita Bhalla, is Communications Associate at India HIV/AIDS Alliance.

With support from the Global Fund to Fight AIDS, Tuberculosis and Malaria, Vihaan is establishing 350 Care & Support Centres across India that will help expand access to services, increase treatment adherence, reduce stigma and discrimination, and improve the quality of life of PLHIV. The centres 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.

By the Community, for the Community: India’s Own Curriculum for Vulnerable Sexual Minorities

mods2Pehchan (which in Hindi means ‘identity’ or ‘recognition’) is one of the largest programme of its kind not just in India but in the world catering to the health and development needs of men who have sex with men, male-to-female transgender and hijra (MTH) populations. The five-year programme, which began in 2010 with support from the Global Fund is implemented in 17 states by India HIV/AIDS Alliance through six regional partners – Humsafar Trust, Pehchan North Region Office, SAATHII, Sangama, SIAAP and Alliance India Andhra Pradesh. The six regional partners together support 200 community-based organizations (CBOs) of MTH people. These CBOs are at the frontline of programme implementation at the district-level.

One of the biggest programmatic exercises in the first phase of Pehchan (2010-12) was the development of a comprehensive package of thematic training modules for the CBO staff. The themes ranged from Pehchan-specific management issues to leadership and organizational development; basics of STI and HIV prevention, care, support and treatment to mental health concerns; identity-gender-sexuality to family support and issues of MTH individuals with female partners; legal and human rights to trauma and violence; positive living to life skills education. It is unlikely that such a diverse set of training modules  – 16 in all – have ever before been prepared for any marginalized community in the context of national programmes focused on HIV and associated issues of sexual and reproductive health (SRH) and rights.

The scale of development of Pehchan Training Curriculum: MSM, Transgender & Hijra Community Systems Strengthening was not only in keeping with the scale of Pehchan itself, but also in terms of the objectives of the programme. ‘Community System Strengthening’ – catchwords for the programme – is envisaged in two ambitious ways –  formation and strengthening of 200 MTH CBOs across 17 states of India; and provision of a comprehensive basket of SRH and HIV services to 453,750 MTH through these CBOs. Pehchan not only seeks to complement the National AIDS Control Programme but has also put in place a precedent for future health and development programmes for MTH or even larger LGBT populations.

The module development exercise went through three broad phases. In the first phase, experts were involved in a civil society consultation to glean inputs for each of the modules. This resulted in the development of information rich pre-modules. In the second phase, the module contents were embedded with adult-learning focused training techniques and activities through a workshop involving the master trainers who were supposed to deliver the training to CBO staff. The workshop also provided the master trainers a rehearsal on the training skills and approaches they needed to adopt for a target audience that would largely consist of first-time learners.

The modules were further streamlined in the third phase to match the programmatic priorities as well as trainee profiles and learning abilities. The third phase exercise was the most challenging as it required a team of experts and master trainers to pare down the content to make it precise, relevant, visually compelling and feasible for conveying message in a limited period of time. This phase also led to the development of the modules in manual form, which provided clear instructions to the trainers on the “how-to” of administering each module.

At a personal level I enjoyed my involvement in all stages of the module development exercise, but more so during the third phase when I led the final editing of some of the modules. The completion of work on each module provided a moment of satisfaction after weeks and months of intensive writing and re-writing. Here I must acknowledge the work done by all co-developers, topic experts, master trainers and colleagues from all partner agencies to make the modules a reality.

Of course, the exercise was far from perfect. The deployment of the training modules in the first phase of the project provided hands-on learning on the effectiveness of the modules. In the second phase of Pehchan, when cadre-based trainings have replaced theme-based trainings, the use of job aids based on the modules will provide further feedback on how the modules could be improved. However, even in their present form – as at the time of the launch – the modules are a rich repository of information and knowledge available for anyone and everyone – in India and around the world – interested in applying them in their work, or better adapting, translating, replicating and improving them!

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The author of this blog, Pawan Dhall, is a gay rights activist in India and was instrumental in drafting of the Pehchan Training Curriculum: MSM, Transgender & Hijra Community Systems Strengthening. He has been involved in queer community mobilization and development in eastern India since the early 1990s and also works with SAATHII, a non-profit that builds the capacities of individuals and agencies in the areas of sexual and reproductive health and HIV. His newest venture is Varta, which promotes dialogue on gender and sexuality as issues intimate and integral to human development in India through newspapers and other publications.

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