Step Up the Pace Against Section 377 in India

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In December 2013, the Indian Supreme Court upheld Section 377 of the Indian Penal Code recriminalizing homosexuality in the country. The months since the judgement have been a time of uncertainty for the LGBT community about what lies ahead. The recent general elections saw political parties taking various positions on LGBT rights which resulted in heated debates in the media. Just last week in a surprise move, the new Health Minister spoke in support of gay rights. Through all this, the curative petition challenging the Supreme Court judgement is waiting to be heard.

The reaction from the LGBT community has ranged from anger and anguish to action inspiring the formation of new queer collectives and new projects responding to the needs of the community. The environment is a mixture of mistrust and determination, from watching one’s back to stepping up the tempo. This week, the International AIDS Conference is meeting in Melbourne, Australia to understand and discuss, among other issues, the HIV response for the communities of men who have sex with men and transgenders. Alliance India will be highlighting our “207 against 377” campaign that brings together the 207 organisations implementing Pehchan to fight Section 377.

As activists, community groups, and AIDS organizations come together to discuss important health and social issues facing sexual and gender minorities, it’s time to pause and take a hard look at what Section 377 means. It’s a law which oppresses LGBT communities for sure, but it is also an impediment to the realisation of basic human rights in the world’s largest democracy. Doing away with this law will influence other struggles against social injustice in a vastly complex country where people are oppressed not only because of their sexual orientation, but also their caste, class, religion and gender. Reading down 377 will be a victory for every citizen of India and for every human being across the world.

Please join Alliance India in the ‘207 against 377’ campaign. Visit our booth (#616) at AIDS 2014 to learn more.

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Shaleen Rakesh is a gay rights activist and was instrumental in filing the Section 377 petition on behalf of Naz Foundation (India) Trust in 2001. Shaleen manages the ‘207 against 377’ campaign at India HIV/AIDS Alliance, where he also serves as Director: Technical Support. The campaign brings together the 207 organizations implementing the Pehchan programme on a common platform to undertake advocacy at national, state and district levels to protest against the 11th December 2013 Supreme Court judgment upholding constitutional validity of Section 377 of the Indian Penal Code thereby recriminalizing same-sex sexual behaviour. 

Out of the Shadows: Women who Use Drugs in India

AIDS2014 _FB_Postcard_CK memeWomen who use drugs are collectively failed by India’s HIV response! This systemic neglect involves government departments, civil society and the private sector. While government programs have done well to address issues of women’s empowerment and increase their access to education, health and social entitlements more broadly, there are virtually no initiatives that address the various specific needs of women who use drugs.

Out of the 120 hospital-based de-addiction centres run by the Government of India’s Department of Health and Family Welfare and over 400 NGO-run centres through the Ministry of Social Justice and Empowerment, none are focused on issues of women, and most have little experience in supporting women who use drugs. A few private facilities cater to these needs, but they are expensive and out of reach for most women.

While the Department of AIDS Control is now funding Targeted Interventions for HIV prevention among these women, they are limited to the north-eastern part of the country. Besides this, interventions are primarily designed for male drug users, although some of which have been able to successfully reach their female partners with services.

Alliance India, along with NGOs like Sahara Aalhad, Voluntary Health Association of Meghalaya, SASO, Shalom and Dedicated Peoples Union to name a few, have demonstrated viable models of gender-responsive services for female drug using populations. Effective interventions include healthcare provided by female providers; counselling; referral to sexual & reproductive health services; harm reduction services (access to clean needles and syringes and Oral Substitution Therapy); detoxification and HIV-related care, diagnostics (blood tests required before and during antiretroviral therapy); prevention of parent to child transmission of HIV; safe spaces for women; and legal aid.

In our new film Out of the Shadows: Women Who Use Drugs in India activists and community members describe their challenges and their need for accessible, targeted, and quality harm reduction interventions to improve their health and protect their rights. Marginalized and unreached, these women are not well served by current interventions, and unsafe sexual behaviour and shared injecting equipment significantly increase their risk for HIV and hepatitis C infection. Exclusion, discrimination and violence further compound their vulnerability.

Women who use drugs need to emerge from the shadows, and programming in India can no longer afford to ignore them and the difficulties they face. There is a clear need for leadership and support to expand interventions for them by both government and civil society. We owe it to those women who are still in darkness and afraid to come out and live healthy and dignified lives.

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The author of this post, Simon W. Beddoe, is Advocacy Officer: Drug Use & Harm Reduction, at India HIV/AIDS Alliance in New Delhi.

With funding from European Union, the Asia Action on Harm Reduction project supports advocacy to increase access by people who inject drugs (PWID) in India to comprehensive harm reduction services and reduce stigma, discrimination and abuse towards this vulnerable population through engagement with PWID and local partners in Bihar, Haryana, Uttarakhand, Delhi and Manipur.

The Avahan Decade

Avahan India AIDS initiatiive focused its efforts on key populations

So much has been written about Avahan – by implementers, academics, and journalists – that to write more might be unnecessary. Many have reflected on the complexity of the programme and its ambition. What would it take to have an impact on the HIV epidemic in India’s highest burden states at a scale usually expected only of government? The learnings of Avahan are ample and thusly well documented. India’s fascination with Avahan’s donor surely was a story unto itself and told many times.

Yet, for me, the central contribution of Avahan is simple, and remarkably, it still remains radical today. Leveraging the prestige and resources of the Bill & Melinda Gates Foundation, Avahan focused its efforts on key populations, groups whose social marginalization previously all but ensured that their needs would not be adequately prioritized in spite of their disproportionate vulnerability to HIV.

Before Avahan arrived, India had already recognized that sex workers were an important driver of the country’s epidemic. The data told this story, and the government had a plan. Other key population groups like men who have sex with men and people who inject drugs were similarly targeted. Yet, capacity in the government to meet these challenges was limited. Apprehension about HIV was just part of the problem. How does a government effectively protect the health of groups that are criminalized and pushed to the margins of society?

What Avahan did – putting key populations first – should have been game-changing for the global AIDS response. How little the global AIDS response has actually changed now a decade later is testament to how difficult it is to break through the stigma and discrimination that define this disease. For all our talk in public health about evidence-based responses, what is done about AIDS still passes through a moral and political filter. Though we know we can find HIV concentrated in sex worker, MSM and drug using populations worldwide, we still don’t invest resources to match the relative scale of the epidemic in these groups.

Avahan showed it can be done. The Gates Foundation deserves great praise for its vision and resolve. The Government of India’s National AIDS Control Organisation (now, Department of AIDS Control) and the State AIDS Control Societies were essential collaborators, giving the programme the space it needed to show impact. Avahan’s implementing partners took the programme to the community level in six states across the country, with Alliance India working in Andhra Pradesh. Together, over the Avahan decade, we had the journey of a lifetime, empowering vulnerable communities and changing the trajectory of India’s epidemic.

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The author of this post, James Robertson, is Executive Director of India HIV/AIDAlliance. This post is based on his foreword to the Alliance India publication Empowering Key Populations for Sustainable HIV Prevention: Avahan in Andhra Pradesh 2003-2014.

Avahan India AIDS Initiative (2003-2014) was a focused prevention initiative funded by the Bill & Melinda Gates Foundation that worked in six states of India to reduce HIV transmission and lower the prevalence of sexually transmitted infections in vulnerable high-risk populations – female sex workers (FSWs), men who have sex with men (MSM), transgenders, people who inject drugs (PWID) – through prevention education and services, such as condom promotion, STI management, behaviour change communication, community mobilization, and advocacy. Alliance India was a state lead partner for Avahan in Andhra Pradesh (AP).

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

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

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

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

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

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

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

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

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

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

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

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

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

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

With support from the Global FundPehchan builds the capacity of 200 community-based organisations (CBOs) for men who have sex with men (MSM), transgenders and hijras in 17 states in India to be more effective partners in the government’s HIV prevention programme. By supporting the development of strong CBOs, Pehchan addresses some of the capacity gaps that have often prevented CBOs from receiving government funding for much-needed HIV programming. Named Pehchan which in Hindi means ‘identity’, ‘recognition’ or ‘acknowledgement,’ this programme is implemented by India HIV/AIDS Alliance in consortium with Humsafar Trust, PNRO, SAATHIISangamaAlliance India Andhra Pradesh, and SIAAP and will reach more than 450,000 MSM, transgenders and hijras by 2015. It is the Global Fund’s largest single-country grant to date focused on the HIV response for vulnerable sexual minorities.

Keep the light on HIV: International AIDS Candlelight Memorial 2014

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

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

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

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

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India HIV/AIDS Alliance (Alliance India) is a diverse partnership that brings together committed organisations and communities to support sustained responses to HIV in India. Complementing the Indian national programme, Alliance India works through capacity building, knowledge sharing, technical support and advocacy. Through our network of partners, Alliance India supports the delivery of effective, innovative, community-based HIV programmes to key populations affected by the epidemic.

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.

Beyond Punishment: A Conversation about the Government of India’s Support for Drug Users

Rajesh Nandan Srivastava (right) in conversation with Francis Joseph in Vienna, Austria. (Photo: India HIV/AIDS Alliance)

Rajesh Nandan Srivastava (right) in conversation with Francis Joseph in Vienna, Austria. (Photo: India HIV/AIDS Alliance)

Rajesh Nandan Srivastava, India’s Director of Narcotics Control, was in Vienna last month to attend the High-Level Segment of the 57th Session of the UN Commission on Narcotic Drugs (CND). Francis Joseph, Alliance India’s Programme Officer for Harm Reduction & HIV, caught up with him there to discuss issues facing people who use drugs in India. Edited excerpts of the interview follow.

 Francis: There are estimated to be two million people dependent on various drugs in India, but only 400 drug treatment centres? Is that adequate?

Rajesh: In addition to the 400 centres run by civil society organisations with support from Union Ministry of Social Justice, there are also 120 de-addiction centres being run in various government hospitals with support from Union Ministry of Health & Family Welfare. It is the responsibility of these two ministries to establish such centres. Civil society should advocate with these ministries and ask for more drug treatment centres at district hospitals and more trained doctors. As far as our department is concerned, we are already supporting the National Drug Dependence Treatment Centre (NDDTC), and the All India Institute of Medical Sciences (AIIMS) in New Delhi is training 500 doctors on issues concerning drug use in the country.

Francis: Section 64A of the Narcotic Drugs & Psychotropic Substances (NDPS) Act allows people arrested for using drugs to be exempted from prosecution if they volunteer for treatment, yet we still see many unlawful detentions.

Rajesh: The problem is lack of awareness among both people who use drugs (PWUD) and policemen about this provision (Section 64A). Civil society organisations need to sensitise both PWUD and police personnel on this provision at national, state and district-level.

Francis: An important step to ensure proper implementation of section 64A is getting accurate numbers on how many people are imprisoned in India for drug use. Some NGOs have tried to get data, but what they receive from government is highly disaggregated, unclear and incomplete?

Rajesh: It is necessary to have data on the types of drug offences for which people are imprisoned, and the Narcotics Control Bureau (NCB), the coordinating agency on drug matters under the Ministry of Home Affairs, should be able to provide this informations. NGOs can even approach National Crime Records Bureau and request such data. If gathering accurate data on the number of PWUD in prisons requires additional money, a proposal to fund the same could be made under National Fund for Control of Drug Abuse (under section 7A of the NDPS Act).

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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.