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

AIDS2014 _FB_Postcard_Do we count meme

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.

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36,656,825 and Counting

Larry Kramer

In 1983, Larry Kramer wrote an article for the New York Native filled with righteous anger, brilliant insight and, reading it now more than 30 years later, electric prophecy. It began, “If this article doesn’t scare the shit out of you, we’re in real trouble.” He proceeds to catalogue the inaction and sheer terror that defined the emerging epidemic.

Kramer recounts the failures of government officials, the medical establishment, researchers, the media, and the gay community itself. With prescient accuracy he connects disenfranchisement with vulnerability to HIV and describes the unrelenting stigma that even today shapes our still inadequate response to the epidemic. He is perceptive as he is relentless. His message: “we must fight to live.”

Kramer’s article was titled “1,112 and Counting.” After three decades, we’re still counting. More than 36 million people have died from AIDS and nearly as many are living with HIV. In India, roughly 150,000 people died from AIDS-related causes last year, ten times the number in the United States. For all our progress, the fight is not over.

Larry Kramer wrote “The Normal Heart” in 1985 during the grimmest and most uncertain days of the epidemic. No other play – no other work of art really – comes as close to capturing those times, and it resonates even today. A long time coming, the film version from HBO brings us back and in doing so reminds us what it takes to act up and fight back.

“The Normal Heart” aptly gets its title from a W.H. Auden poem “September 1, 1939” written as the world teetered on the brink of another epochal tragedy, World War II. What was true in 1939 was true in 1985 and remains true today:

Hunger allows no choice
To the citizen or the police;
We must love one another or die.

The AIDS epidemic has reached across the world in ways that perhaps only Larry Kramer would have imagined in those early days, and there is still no choice.


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, 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.

‘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.

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.

The Long Road Ahead

_MG_5246On 11 December 2013, the streets outside the Supreme Court of India thronged with a dazed crowd, hugging, sobbing and not quite sure what had happened. Inside the hushed courtroom, the judges had just passed a devastating ruling. Lesbians, gays, bisexual and transgender (LGBT) people in India had once again been labelled criminals. Section 377, the 152-year-old colonial law that banned gay sex, had been upheld by the Highest Court of Law of India saying that amending or repealing Section 377 should be a matter left to Parliament, not the judiciary.

For gay and lesbian Indians, the Supreme Court verdict means that they become vulnerable to harassment all over again. In India, domestic partnership and adoption—things that straight people take for granted—cannot even be discussed by activists because Section 377 makes it illegal to engage in gay sex. Under the colonial law, men could be jailed for 10 years for having sex with men, an act which was classed as an ‘unnatural offence’ along with paedophilia and bestiality. How can one talk about rights when the legal framework makes you a criminal?

In 2001, on behalf of the Naz Foundation (India) Trust and with the help of the NGO Lawyers Collective, I began to put together the public interest litigation against Section 377. Apart from just coming out and shouting from the rooftops about our human rights, trying to change the law was the only thing we could do. The everyday harassment of gay men by police and thugs also strengthened my resolve to fight for this cause. Although gay men are rarely prosecuted under Section 377, they are often intimidated or exploited because of it.

Once, while I was coordinating the Naz Foundation’s programme for men who have sex with men’ (MSM), a whole group of our clients were badly beaten up. They were walking home from a support meeting when they were attacked by some street boys with iron bars and hockey sticks. Many of them got their heads smashed that night and had to be taken to the hospital. We knew who did it. I wanted to make a police complaint but we could not because of the law. The police had a history of raiding groups who worked with gay men and of rounding up and arresting outreach workers. We were afraid. The men who were beaten up were also afraid to speak out. They were not ready to own up to being gay publicly; they thought they would be criminalised. In the end we made no complaint.

I had begun my journey to becoming a gay rights activist when, as an 11-year-old schoolboy in Delhi, I realised I was attracted to men. I grew up surrounded by a ‘conspiracy of silence’, in which nobody even spoke of the possibility of homosexuality. I would have been happy to hear something I could latch onto or fight with, but there was just silence—a mind-numbing and suffocating silence. There was this hypocrisy—it’s okay to do what you want to do in the bedroom but you do not talk about it in the living room. I found this appalling.

I got into gay activism in my early twenties. I realized that voicing my feelings openly began to heal the years of silence and oppression that I had faced as a gay boy growing up. But before I could go public, I had to tell my mother. After having kept my sexuality secret from family and friends for a decade I came out to my mum, whose matter of fact reply was such a delightful relief for me. She said simply, “So what?”

Most gay Indians do not have the privilege of being born to such liberal parents. After confiding in my family, I began working with gay organisations, starting with the Humsafar Trust in Mumbai and then Naz in Delhi. I became an open gay rights activist. I wrote a magazine column. I did training workshops and seminars. I was vociferous in the media. I organised protests and did work with the National Human Rights Commission on the psychiatric mistreatment of homosexual patients by the medical fraternity.

Gay men are more than fifteen times more likely to contract HIV than the average Indian, and many groups lobbied for Section 377 to be overturned on the grounds that it pushes gay men underground, increasing vulnerability to HIV. The National AIDS Control Organisation (NACO), the governmental leading the response to the epidemic in India, came out against Section 377 in 2006, arguing that the law made HIV prevention more difficult. The then Health Minister of India Shri Anbumani Ramadoss and many AIDS organisations, including the India HIV/AIDS Alliance where I now work as a Director, also called for the law to be abolished in order to protect public health. Our consistent efforts did lead to a sweet victory (now turned sour) when Section 377’s criminalisation of consensual sex between adults was declared unconstitutional by the Delhi High Court in July 2009. Constitutional morality had prevailed upon public morality, but this victory was short-lived.

The 2009 ruling had a huge impact, opening the floodgates of demand for social acceptance by LGBT people. Cities including Delhi and Mumbai have held gay pride marches; young gay people and their families are being interviewed by journalists on primetime television; Bollywood films now have gay characters. Bombay Dost, a gay magazine, has been re-launched and is no longer sold furtively wrapped in brown paper. This cultural shift gave us some degree of comfort to believe that the general population was ready for real social change. But there was plenty of opposition too. Religious groups, leaders of the BJP (the Hindu nationalist party), and hundreds of millions of ordinary Indians, especially those in rural areas, still find homosexuality unacceptable.

This social discrimination will be much harder to change now that the law again upholds it instead of denigrating it. In small towns of India, it is still not easy for people to reveal their sexual orientation to their family. Even in Delhi, young gay men need guidance and support to come out. Gay men succumb to the social pressure around them and keep their sexuality secret. When I was in my late teens I asked a man I met at a cruising spot whether he would ever get married (to a woman). “I already am,” he replied, “Isn’t everyone?”

But despite these challenges, things can improve if we choose to believe in ourselves. When I chose to come out and start working as a gay rights activist, I used the very stigma which tried to oppress gay men as a weapon to create my own life of freedom and help others along the way. Today I am not only a political activist working on sexuality issues but also a writer on the subject. My sexuality, a source of anxiety in my early years, has defined, quite successfully, who I am and what I have chosen to do with my life.

And even as I write this, the Government of India has appealed to the apex court seeking a review of its judgment on Section 377, saying that ruling falls foul of the principles of equality and liberty. Let us hope that all our rights will once again be preserved.

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The author of this post, Shaleen Rakesh, serves as Director of Technical Support at India HIV/AIDS Alliance. He initiated the fight against Section 377 of Indian Penal Code while on staff at the Naz Foundation (India) Trust in 2001. A collection of his poems,The Lion and The Antler, was recently published.

A version of this blog was published on Citizen News Service and Asian Tribune in December 2013. 

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.

International Human Rights Day 2013: Reflections on Rights Situation of PLHIV and Key Populations in India

HRD_blogSince the United Nations adopted the Universal Declaration of Human Rights in 1948, there has been a slow but steady expansion of international agreements that promote and protect the rights and dignity of all people everywhere. But even today, people living with HIV (PLHIV) and members of key population groups, such as men who have sex with men, transgenders, hijras, people who inject drugs and sex workers, continue to face violations to their basic rights. They are denied recognition in society, face barriers in accessing basic services like healthcare and education, and are often victims of violence and other forms of discrimination and marginalization.

Protection and fulfilment of the human rights of vulnerable communities are at the core of India HIV/AIDS Alliance’s work. Although the full enjoyment of their rights remains a dream for too many people, there are stories of hope and courage. This Human Rights Day take a look at some of the challenges facing India and how we’re responding:

The Other Epidemic: Gender-based Violence in India

Gender-based violence is an epidemic facing India and the world, and like AIDS, it will require a sustained and committed effort to overcome. Attitudes must change. We must never tolerate violence against women and girls. We must never be blind to gender’s diversity. Read more.

Fighting for the Right to Health for Women Living with HIV: A Success in Gujarat

Stigma and discrimination remain among the primary barriers to achieving universal access to HIV treatment, care, and prevention. As HIV treatment programmes become increasingly available, access to these lifesaving services depends on the degree to which all health facilities welcome PLHIV and respect their rights. Read more.

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

India’s hijra community routinely experiences mistreatment at the hands of doctors and the health system. Progress is slow and often only as a result of significant advocacy by community organisations. Hijras and transgenders have the same right to health as any other citizen, and the government must act to protect their lives. Read more.

Confidentiality: A Health and Human Rights Issue for PLHIV

There is nothing more angering than the thought of stigma faced by people living with HIV (PLHIV). Take, for example, the situation where numerous PLHIV had their HIV status published on the front page of their medical history records, making confidential information available to anyone who glanced at their files. Read more.  

The Pain of Being ‘the Other’: How Stigma Fuels HIV/AIDS among People Who Inject Drugs in India

The vulnerability of people who inject drugs (PWID) is further fuelled by the fact that society perceives drug users as criminals and a threat to society. This makes it difficult for people who want to reach out to them to build rapport and trust. This demonization further fuels the HIV epidemic in the country. Read more.

Shedding Light on Abuse: Alliance India study shows that almost 50% of women who inject drugs in Manipur report harassment and abuse from community members

A study conducted by Alliance India sheds light on the extent of the social discrimination and isolation experienced by women who inject drugs in Manipur. The lack of a support system in the lives of women who inject drugs significantly increases their isolation and likelihood of engaging in sex work as a means of earning a living. Read more.

A Beacon of Hope in the Fight Against Child Marriage: One Girl’s Story

The issue of child marriage is a very common problem in Allahabad in the conservative Indian state of Uttar Pradesh. Here, girls are married early and are expected to bear children soon after.  Issues such as contraception, sexually transmitted infections, and reproductive rights of young people are met with a wall of silence. Read more.