“Do we count?” A question for AIDS 2014 and beyond

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Every two years, researchers, implementers, policy makers, and community activists come together at the International AIDS Conference to take stock of the pandemic: Where are we now? Where have we been? Where are we heading? Discoveries are heralded and strategies dissected. There are always more questions than answers, but there is one question that needs to be answered at AIDS 2014 and beyond: Do we count?

Do the lives of men who have sex with men, people who inject drugs, sex workers, transgenders and even people living with HIV — especially those from these key affected populations — really count? On a basic level, the answer must be a resounding and unequivocal “YES!” Every human life counts. Every life has equal value. Yet, while an affirmative chorus may echo in the halls of the conference, easy rhetoric will not be enough.

Data analysis by UNAIDS indicates that as many as half of all new HIV infections globally occur in key populations. This should come as no surprise. The disproportional concentration of the virus in these groups is hardly news, shaping the trajectory of the epidemic and driving the complex stigma that still defines HIV/AIDS.

Though we are frequently reminded that we are in the era of evidence-based public health, data-driven decision-making, and performance-based metrics, the evidence on HIV vulnerability in key populations is routinely ignored. We aren’t even counted in many places. Surveillance fails to find us. Not surprisingly, funding for HIV services responsive to our needs remains slight.

Slowly but surely the message is getting through. The large players in the global HIV response are lining up to affirm their commitment to these (new?) priorities. On July 11, 2014, the World Health Organisation released a long-awaited and rapidly developed publication, Consolidated Guidelines on HIV Prevention, Diagnosis, Treatment and Care for Key Populations. It is an impressive document written and reviewed by a Who’s Who of experts working with and representing these groups.

There can be no doubt about the sincerity or good intentions of the guidelines’ authors, and this document has the potential to influence policy and practice globally. Yet questions persist in the willingness of institutions — governments, donors, development agencies and civil society — to embrace their fundamental responsibility to the health of key populations and invest accordingly in a sustained and broad-based effort to end the unremitting toll of HIV and AIDS on our lives.

New technical guidelines and progressive policies can be applauded, but to make the difference intended, they must be applied. In order for them to be applied, investments must be targeted to fill these gaps and expanded to match the scale of our need. The proof of commitment will be in the expansion of funding invested in programming for key populations. Now is the time to prove we count.

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The author of this blog, James Robertson, is Executive Director of India HIV/AIDS Alliance  in New Delhi.

Alliance India brings together committed organisations and communities to support sustained responses to HIV in India. Complementing the Indian national programme, we work through capacity building, knowledge sharing, technical support and advocacy. In collaboration with partners across India, Alliance India supports the delivery of effective, innovative, community-based HIV programmes to key populations affected by the epidemic.

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.

Trans-formation to End Discrimination (#IDAHOT 2014)

Alliance India’s Simran Shaikh, a hijra and AIDS activist, speaks out against discrimination and for LGBT equality.

Alliance India’s Simran Shaikh, a hijra and AIDS activist, speaks out against discrimination and for LGBT equality.

May 17th marks International Day Against Homophobia and Transphobia (IDAHOT) around the world. I am sitting in my office at Alliance India in New Delhi as I gather my thoughts on the stigma and discrimination I have faced my whole life because I subvert gender conventions. My journey from a Parsi boy to a transgender activist has been filled with discrimination, stigma, violence, silent screams, and also triumphs. (Read more about Simran’s life.)

To honour this global day that celebrates sexual and gender diversity, I want to share my thoughts on the recent Indian Supreme Court judgement protecting the rights of transgenders.

On April 15th this year, the Supreme Court judgment recognised the third gender in India and granting legal recognition to Indians who identify as neither male nor female – to those of us those who identify as transgender women and men or as hijras. “Discrimination is no longer my favourite word,” I yelled with pride as my friends joined in the celebrations after this landmark judgment. The ruling guarantees the nation’s transgender population essential rights, including equal access to education and employment In India.

But will this stop people from staring at me on Delhi Metro trains, autorickshaw wallahs refusing me rides, and fellow passengers moving away from me on buses? Why do they do this you wonder? Because my existence bothers them. I don’t seem to fit the boxes they have neatly packed themselves into. I refuse to look and behave the way they expect. I offend their sensibilities by being me. Can a judgment validating my existence change all this? I don’t know, but it feels like we’re on the right track.

Homophobia is an aversion towards those whose sexual behavior differs from the heteronormative, and transphobia is an aversion to those whose gender identities transcend the male-female gender binary. Negative attitudes manifest in many ways, from contempt, fear and hatred to verbal abuse, harassment, and violence. Are these attitudes rational? In most cases,they are rooted in a belief that our differences are against the order of nature.

Over India’s history, hijras have been a revered community, but when this region was colonised by the British, regressive laws were put in place outlawing homosexuality and criminalising these communities. Sixty-seven years after independence from British rule, the third gender has been given legal protection in India. I don’t know how many more years will pass before the repeal of Section 377 of the Indian Penal Code that criminalises consensual same-sex sexual behavior.

While the struggle to end discriminatory laws continues, I am deeply troubled by the everyday injustices faced by my LGBT brothers and sisters. We need to fight the internalised homophobia and transphobia in our communities and transform our fear of our own gender and sexual identities. We must celebrate who we are. Violence and discrimination must not be tolerated anymore. It cannot be a crime to exist. To deny our right to exist is the crime!

I am a proud member of the hijra community. In my teens, rejected by my family, I was given shelter by a hijra when all other doors were closed to me. Even today there are few professional options for someone like me. As a member of the Alliance India team, I’m fortunate to be doing professional work in HIV/AIDS that can have such a great impact on the transgender community in India. I dream of a day when all who are like me are given equal opportunities to thrive. Equal opportunity on paper must be put into practice. Changing attitudes will open minds, and with open minds, we can trans-form the world.

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The author of this post, Simran Shaikh, is a Programme Officer for the Pehchan programme at India HIV/AIDS Alliance in New Delhi.

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 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, SAATHII, Sangama, Alliance 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.

Towards the Right Side of History

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As a gay rights activist, I am overjoyed by the recent Supreme Court ruling which gives legal protection to the transgender community. Ever since we heard the news, there has been an outpouring of celebration, joy and relief. The news has made the entire LGBT community in India smile, which is not something we did much of following the Section 377 ruling of the Supreme Court in December last year which recriminalized homosexuality.

So why is this ruling important? To begin with, it’s a significant step forward for our transgender friends who have been discriminated against for a long time. In their victory, we feel happy, proud and hopeful. It’s as much their success as it is success for the wider LGBT movement in India, of which the transgender community has been a vital and integral part. It’s true that transgenders in India, like elsewhere, are a more visible part of the community, so a decision that affirms their identity is a shot in the arm for LGBT activists and community alike.

The decision has also made me more confident that India is ready for a broader dialogue around gender identity and sexual orientation. It’s taken many years of struggle to get here, and I’m not sure how many more years it will take for our community to be treated as equals. Section 377 is again the most immediate hurdle which we face. Tagged with criminality, equality remains a luxury for LGBT Indians.

I want my country to support my desire to live openly as a gay man. My government should not undermine healthy and productive relationships in my life. Basic freedoms that most Indians take for granted are out of reach for the LGBT community because 377 remains the law of the land.

After this burst of celebration, I am left wondering how much longer I will have to wait to feel ‘legal’. Next week, the Supreme Court will hear the curative petition against Section 377. Like many LGBT Indians, I will be waiting anxiously to learn which side of history the court will stand.

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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. 

‘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.

Keeping Violence at Bay in Andhra Pradesh: International Day to End Violence against Sex Workers 2013

Violence, stigma and discrimination decrease the capacity of sex workers to access health care and other social services. (Photo by Peter Caton for India HIV/AIDS Alliance)

Violence, stigma and discrimination decrease the capacity of sex workers to access health care and other social services. (Photo by Peter Caton for India HIV/AIDS Alliance)

“I filed an application for a ration card in the mandal (block) administrative office. The clerk made me come to office 15 times, and every time he slept with me,” rues Meena  (name changed), a sex worker from Andhra Pradesh. “Wherever we go – offices, schools, hospitals or banks – we are sexually exploited and discriminated against.”

Sex workers across the world are easy targets for violence and discrimination at work, at home and in society at large. Data show that violence faced by sex workers ranges from slapping to sexual assault, physical and psychological torture, and sometimes even murder. HIV programmes across the world are grappling with this reality of sex workers facing high levels of stigma, discrimination, gender-based violence and other human rights violations, which prevent them from accessing HIV information, health care and needed social services.

To tackle the problem, India HIV/AIDS Alliance has worked through our Avahan programme to develop community-led strategies for prevention and mitigation of violence among female sex workers and other sexual minorities. Working in a total of six states, the Avahan India AIDS Initiative is funded by the Bill & Melinda Gates Foundation. In Andhra Pradesh, our programme covered over 40,000 sex workers in 14 districts. Programme strategies on violence include: community mobilisation and empowerment, crisis response systems and teams; and sensitisation of police and other law enforcement agencies, media personnel and service professionals. The crisis response teams respond within 24 hours to any violence reported by liaising with legal services in the event of unlawful arrests, sexual assault, violence and other rights violations against sex workers.

Since 2006, our team has successfully sensitized around 7,000 police officials at state, district and block level. Over 700 community members have received training on law and human rights and have been recognized by the District Legal Cell Authority as para-legal volunteers (PLVs). PLVs from sex-worker communities provide support to those in need. In addition, community collectivization and legal education has empowered sex workers to recognize and address cases of violence against them.

Routine monitoring on violence and crisis response including data collected from Targeted Interventions for HIV prevention and from special Behavioural Tracking Surveys (BTS) among 2,000 female sex workers in five districts in Andhra Pradesh between 2009 and 2012 showed an improved response to violence in sex worker communities. The number of cases of violence against sex workers has declined by 68 percent, from 900 cases in 2009 to 288 cases in 2011. The BTS data indicate that there has also been a reduction in violence by police (from 29% in 2009 to 19% in 2011-12). The perception of fair treatment by police has increased from 14% (2009) to 29% (2011-12), and around 70 percent of sex workers now experience what they consider to be fair treatment at public institutions.

“Earlier we shuddered at the sight of police. Not anymore. We now know our rights and what to do in a crisis,” says Meena with confidence.

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The author of this post, Dr. Parimi Prabhakar, is Director of Alliance India’s Regional Office in Hyderabad.

The Avahan India AIDS Initiative (2003-2014) is funded by the Bill & Melinda Gates Foundation. The programme aims to reduce HIV transmission and the prevalence of STIs in vulnerable high-risk populations, notably female sex workers, MSM, and transgenders, through prevention education and services such as condom promotion, STI management, behavior change communication, community mobilization, and advocacy. Avahan works in six states, and Alliance India is a state lead partner in Andhra Pradesh.

A Dark Day for India

shaleen_blog2I am crouched over my work desk at the Naz Foundation (India) Trust, combing through another draft of the Public Interest Litigation (PIL) against Section 377 of the Indian Penal Code, which criminalizes homosexuality. This case will be Naz India versus Government of India. This is 1999.

It will be another two years before we file the PIL through our lawyers, the Lawyers Collective HIV/AIDS unit. If the process of drafting the 200-odd page PIL was long and cumbersome, it was a cakewalk compared to the journey ahead.

I represented Naz India on this PIL on paper and in the courts. Week after week, there were hearings in the Delhi High Court after the petition was filed in 2001. Good judges and bad judges. Good hearings and bad hearings. And then, the nightmare! Delhi High Court rejected the petition on grounds that Naz India was not an ‘affected party’. An appeal in the Supreme Court and a win. The case back in high court. More hearings.

Then in 2009, the Delhi High Court upheld the PIL. Our celebration was ecstatic, but it has turned out to be premature. There was a counter-appeal in the Supreme Court. And, today, the day of judgement.

After fourteen years of struggle, in today’s ruling, Justice Singhvi stated that the 2009 Section 377 ruling was “constitutionally infirm” and set it aside.

I’m only just beginning to digest the news. This is too big a set-back, a devastating moment for millions of LGBT people in this country and around the world. The fight will go on, and we will rally for our rights as equal citizens. We will persevere, and we will triumph.

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The author, Shaleen Rakesh, is Director: Technical Support, India HIV/AIDS Alliance. Shaleen was instrumental in filing the PIL in Delhi High Court on behalf of Naz Foundation.

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.

Shivananda Khan, OBE (1948-2013)

Shivananda Khan, OBE (1948-2013)

India HIV/AIDS Alliance remembers the life and achievements of Shivananda Khan, one of South Asia’s leading activists who left an indelible mark on the global LGBT rights movement and did so much to expand the HIV response for sexual minorities all over the world. The following remembrance and poem were written by Alliance India staff members who worked closely with Shiv over the years.

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Celebrating Shiv
A remembrance by Shaleen Rakesh

In the summer of 2000, I was invited as a guest speaker at one of India’s first national gay conferences in Hyderabad. The event was organised by a man I had heard much about, Shivananda Khan. Holding a regional conference of this scale was not an easy task in those days. I met several activists there for the first time, people who are leaders of the movement today like Laxmi Narayan Tripathi, Vijay Nair, and Sunil Menon, among many others. Shiv was his usual dramatic self: cracking quips with elan, cigarette in hand, a perfect blend of ice and fire.

Shiv and I bonded from the start. He told me to be bold and chart my own course. Sometimes he would look at me with a long stare and say I was meant to be an activist. He said he never saw me happier than when I put on the activist hat. Shiv was the conduit for funding from the UK Lotteries Commission that supported the programme I headed at the Naz Foundation (India) Trust working with men who have sex with men and transgenders. I used to joke with Shiv that the British put in place Section 377, a colonial law against homosexuality, and now British money was funding efforts to have it revoked!

I will never forget the hours we spent together at Hotel Samrat in New Delhi, where Shiv, the author Jeremy Seabrook, and I would have long conversations on the nature of gay identity in India and alternative pathways to freedom. In Shiv, I had a soulmate with whom I could speak intelligently of repression and its costs.

Shiv’s contributions to the queer movement are too many to count. Though he had a global influence, the focus of his life’s work was always South Asia. In recognition of his efforts, he was awarded the Order of the British Empire in 2005, perhaps an ironic if deserved reward for someone who had worked so hard to achieve freedom for sexual minorities in a post-colonial world.

To a fellow activist and my dear friend, a final goodbye.

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Remembering Shivananda Khan
A poem by Yadavendra Singh

Though the sun was shining bright
The winds were blowing hot
Yet it felt like a cold and silent night
Night of December
‘Coz you were no more amongst us
Us – Lesbians, Gays, Bisexuals, Transgenders, Hijras,
We all want to thank you – yet again
You shall continue to inspire generations to come
With your charisma, your leadership
Your vision, your zeal
None can ever have this cut healed
Today we remember you – with our eyes closed, with our breath silent
We are sad but we won’t shed a tear
As we have a long way to clear
And we all want to thank you – yet again.

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Confronting Quackery, Demanding Care: India’s Hijras Seek Access to Sex Reassignment Surgery Services

Friendly attitudes and responsive services by hospitals can help transgender patients be comfortable and speak about their health concerns. (Photo by Peter Caton for India HIV/AIDS Alliance)

Friendly attitudes and responsive services by hospitals can help transgender patients be comfortable and speak about their health concerns. (Photo by Peter Caton for India HIV/AIDS Alliance)

Malika (her name changed) remembers feeling helpless when a government hospital refused to treat her for a painful and dangerous infection that had resulted from her sex reassignment surgery (SRS). Malika is a hijra and her story is not unique. Many others in her community sadly face similar problems.

In India, hijras have a long and remarkable history, spanning 4,500 years. They are mentioned in ancient religious texts as symbols of dignity and courage. Yet modern Indian society fails to offer them respect or treat them with even basic human dignity. With limited livelihood options, most hijras turn to sex work, begging or other professions that offer them a meagre salary.

With limited resources, many hijras turn to quacks for SRS services since most of them are unable to afford the high rates charged by private clinics. Without national standards for SRS, most of these surgeries are legally ambiguous and performed in miserable conditions by ill-trained surgeons. In Malika’s case, the ‘clinic’ turned out to be a house without proper lighting, surgical facilities or even a recovery bed. If Malika had known and understood the risks, she would not have travelled some 600 kilometres from her hometown Kolkata in West Bengal to the state of Bihar for the operation.

Whether hijras are operated on by quacks or in more expensive private clinics, they tend to experience the same lack of physical and psychological care that is essential after SRS. Happy to accept fees for the surgery itself, doctors fail to provide their patients with appropriate pre- and post-operative counselling or checkups following surgery.

When Malika felt the intense pain that racked her body and realised that she was suffering from a severe urological infection caused by the surgery, she sought help at a government hospital. Both transgender and HIV-positive status, she was refused a hospital bed and any of the care she urgently needed.

On hearing about Malika’s situation, team members from the Global Fund-supported Pehchan programme organised meetings with the project director of the West Bengal State AIDS Programme & Control Society (WBSACS) and with doctors at two hospitals, including the one that had turned Malika away. They also met with members of the press to raise awareness about Malika’s story. The WBSACS project director wrote Malika a support letter, as did the West Bengal health minister. Armed with these letters, Malika underwent treatment at the hospital that had initially turned her away.

After two months recuperating, Malika was discharged from the hospital. Seeing Malika’s resilience and the bold way she handled her situation, the Gokhale Road Bandhan, a community-based organisation that is a sub-sub-recipient partner of Pehchan, offered Malika a job as an outreach worker. “The job has not only helped me deal with my financial instability but has also instilled a sense of self-confidence and self-esteem especially since many of my peers abandoned me because of my HIV-positive status,” says Malika.

Malika’s story reveals the mistreatment that our country’s hijra community experiences at the hands of doctors and the health system. Progress is slow and often only as a result of significant advocacy by community organisations. While we have our own health priorities such as SRS, India’s hijras and transgenders have the same right to health as any other citizen, and the government must act to protect our lives, provide access to care, and ensure the fulfilment of our full rights. Our community cannot be silent!

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The author of this post, Simran Shaikh, is Programme Officer: Pehchan.

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.

Slow but steady: India’s march to equality for sexual minorities

With the Indian government adopting new measures, sexual minorities in India see a new ray of hope. (Photo by Peter Caton for India HIV/AIDS Alliance)

With the Indian government adopting new measures, sexual minorities in India see a new ray of hope. (Photo by Peter Caton for India HIV/AIDS Alliance)

Over the past five years or so, India has witnessed seismic shifts in matters concerning the human rights of sexual minorities. Despite being stymied by right-wing groups cutting across religious lines, the Government of India has stood by its commitment to protect the rights of these stigmatised and ignored communities.  Though it is too early to predict how new measures will change the lives of sexual minorities in India, it is encouraging to see the government acknowledge their existence and provide some hope of change.

Consider some of the actions by the Government of India:

Section 377 of Indian Penal Code

On July 2, 2009, in a landmark judgment, Delhi High Court ruled that Section 377 of Indian Penal Code violates Articles 21, 14 and 15 of the Indian Constitution. The judgment was widely celebrated and appreciated across the nation. But even before euphoria could lessen, a panoply of religious institutions queued up at the Supreme Court of India to challenge the Delhi High Court judgment. In total, 15 Special Leave Petitions (SLPs) challenging the decision were submitted to the apex court including petition from the Delhi Commission for Protection of Child Rights.

Final Supreme Court hearings appealing the 377 decision began in February 2012. When the Supreme Court requested the Government of India clarify its stand on the Delhi High Court decision, the government came out in support of decriminalising homosexuality and indicated that it would not challenge the verdict. In March 2012, the Supreme Court reserved the matter for judgment. In addition, the Government of India has accepted one of the recommendations in the UN’s 2012 periodic review of human rights and has agreed to study the implications of the decriminalisation of same sex sexual relations in light of ongoing homophobia throughout India society.

A country-level report published by the UN Working Group on Human Rights in India entitled ‘Human Rights in India – Status Report 2012’ includes a case study on Professor Siras, an scholar at Aligarh Muslim University, whose rights of privacy, housing, and employment were denied by the University due to his sexual orientation. His death in April 2010 continues to remain uninvestigated, a situation that indicates that even though same-sex behavior may be decriminalized, there remains significant societal stigma that continue to prevent the full enjoyment civil, legal and human rights by LGBT Indians.

Increased Access to Social Schemes

The Aadhar card is a social scheme initiated by the Indian government in 2009. It includes a 12-digit individual identification number issued by the Unique Identification Authority of India and is equivalent to the Social Security card in the United States. In Aadhar’s second phase, the government has included an additional category under sex in addition to male and female: transgender. Similar provisions have been made in voter ID cards and passports, but in each case the option is ‘other,’ not ‘transgender.’ Recently, the government issued an order allowing hijras to use their guru’s name instead of their father’s/mother’s when applying for a voter ID card. (A ‘guru’ is the head of a hijra family or community.) This decision recognizes that many hijras are estranged or rejected by their biological families.

National Youth Policy

In 2012, the Government of India has included issues of sexual minorities in its National Youth Policy for the first time. The draft document says, ‘Transgenders have for long been the butt of ridicule and derision of the society. They have virtually lived a life of complete segregation from the mainstream, and gays and lesbians have never been accepted in the society as same gender sex has always been treated in our society as perverted and immoral behaviour. The result of these deeply embedded stereotypes and biases has been that gays and lesbians are reluctant to express their sexual preferences openly.’ The policy also mentions that special efforts will be made for employment and entrepreneurship for marginalised youth and for building the capacities of community-based organisations to create awareness of HIV and its social and health-related implications.

Justice Verma Committee Report on Rape Laws

In January 2013, Justice Verma committee submitted its report to the Home Ministry. The special committee was constituted following the brutal gang rape and murder of a female student in New Delhi in December 2012. In its report, the committee observed that there is an immediate need to recognise different sexual orientations as an authentic part of the human condition and that the use of word ‘sex’ in the Article 15(c) of the Indian Constitution includes sexual orientation as well. One of the recommendations of the committee is to disseminate correct knowledge in respect of sexuality and sexual options, without enforcing gender stereotypes. The report stresses the importance of communication efforts to encourage respect and understand gender, sexuality and gender relations amongst youth. The report also suggests making rape laws gender-neutral as sexual assault of males and transgenders is a reality.

 It is laudable that the Government of India has taken such positive steps towards making equality a reality for sexual minorities. Though these efforts suggest that India’s sexual minorities have entered a period of social restructuring, India remains a long way from realizing the dream of full equality, in law, policy and practice. For example, the recent law on surrogacy states that only a man and a woman who are married for at least two years will be allowed to engage surrogacy services in India. While facing ongoing barriers to equality, we should not be discouraged from claiming our status as full and equal citizens of India. As Martin Luther King, Jr. once said, ‘Change does not roll in on the wheels of inevitability, but comes through continuous struggle. And so must straighten our backs and work for our freedom.

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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.