Changing a Habit of Addiction in the Land of the Gods

Severe punishments doled out to drug offenders in Uttarakhand have motivated users to shift from heroin and brown sugar to injecting pharmaceutical cocktails. (Photo by G. Charanjit Sharma for India HIV/AIDS Alliance)

Severe punishments doled out to drug offenders in Uttarakhand have motivated users to shift from heroin and brown sugar to injecting pharmaceutical cocktails. (Photo by G. Charanjit Sharma for India HIV/AIDS Alliance)

Uttarakhand’s natural beauty has captivated tourists and residents alike for centuries. Wildlife and nature enthusiasts, pilgrims, and even those wanting an escape from city life have turned to the serenity of Uttarakhand’s lush green mountains, fresh air, and the sacred Ganges river that runs through this North Indian state, often called ‘the Land of the Gods.’

Beyond its scenic beauty, Uttarakhand is also well-known for the cannabis that naturally grows all over the state. Cannabis has traditionally been associated with the holy men of this region but recently has seen an increase in consumption by the local population and tourists. Over the years, however, drug consumption has shifted towards heroin and brown sugar. Severe punishments given to drug offenders by the government for using these substance have motivated users to shift to injecting pharmaceutical cocktails, sold not by pharmacies but by local residents who bring them from outside the state.

New options for drug use have also led to an increase in number of people who inject drugs (PWID) and growing numbers who are infected with HIV, Hepatitis C and TB from sharing of syringes. Prolonged drug use impacts individual productivity. Most PWID are unable to keep steady jobs; they have limited financial resources, little family support or no meaningful access to drug treatment facilities. Social stigma and exclusion are constant features of daily life for PWID in Uttarakhand. Marginalized, they are routinely treated with disrespect and denied access to services they need, including healthcare.

Mindful of the current state of drug use in Uttarakhand, Alliance India’s Hridaya programme is working with seven organisations to offer harm reduction services in four districts, including the holy town of Haridwar and the state capital of Dehradun. Aiming to cover all PWID in these areas over the next two years, the programme will focus on the unmet needs of this vulnerable populations and complement activities in the state under India’s National AIDS Control Programme.

In addition to providing PWID with Hepatitis C education and overdose management, Hridaya will also encourage Hepatitis C testing, work with families of PWID to strengthen community mobilization, establish legal support and crisis response teams, and offer counselling on sexual and reproductive health, along with service referrals. To improve implementation and impact, the programme will also conduct drug pattern assessments to understand the dynamics of drug use in the state to respond more effectively to the needs of PWID.

In January 2013, the Hridaya team trained 30 newly recruited staff in Uttarakhand, including project officers, outreach workers, peer educators and peer counsellors from six CBOs. In these sessions, special effort has also been made to increase capacity overall and specifically train women in these roles to respond more effectively to the needs of female PWID. Similar staff trainings were held in Hridaya’s two other focus states, Haryana and Bihar.

Hridaya’s three-day training on harm reduction uses an intensive participatory workshop model featuring various techniques such as interactive presentations, group discussions, demonstrations, and feedback. Topics covered include: an overview of Hridaya; drug basics; drug-related harms; principles of harm reduction; outreach and peer education; Targeted Intervention (TI) prevention interventions under the national programme; needle and syringe exchange; operational aspects of interventions such as demand calculation, waste management and disposal; post-exposure prophylaxis for needle stick injury; sexually-transmitted infections; safer sex; drop-in-centres; service referrals; and networking.

As a guiding principle, Hridaya affirms the essential humanity and worth of PWID. This core value informs both the programme’s goals and its implementation. Building rapport with PWID and gaining their trust are essential steps in harm reduction programming, and Hridaya’s approach is designed to support the expansion of service offerings and demonstrate the importance of harm reduction as a key strategy to address HIV in PWID communities in India.

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The author of this blog, Francis Joseph, is Programme Officer for Alliance India’s Drug Use & Harm Reduction programmes and is based in New Delhi. 

Spanning five countries (India, China, Indonesia, Kenya, and Malaysia), Community Action on Harm Reduction (CAHR) expands harm reduction services to more than 180,000 injecting drug users (IDUs), their partners and children. The programme protects and promotes the rights of these groups by fostering an enabling environment for HIV and harm reduction programming in these five countries. CAHR is supported by the Ministry of Foreign Affairs, Government of Netherlands. 

CAHR in India is called ‘Hridaya’ and is implemented by India HIV/AIDS Alliance in partnership with SASO, Sharan, and a number of community-based harm reduction organisations and networks. This programme helps build the capacity of service providers, makes harm reduction programmes more gender-responsive, improves access to services and advocates for the rights of PWIDs. In addition to providing services, Hridaya has a strong capacity building component to support advocacy, knowledge management and improved services for PWIDs.

From Addiction to Action

Photo: Francis Joseph ( in middle) during a meeting of Alliance India members. Francis is the Programme Officer for Hridaya, an HIV and harm reduction programme supported by the Community Action on Harm Reduction (CAHR), Netherlands and implemented by Alliance India. Photographer: G Charanjit Sharma

Francis Joseph (center) with Alliance India colleagues. [Photo by G. Charanjit Sharma]

Francis Joseph is Programme Officer for Hridaya, our HIV and harm reduction programme in India supported through the five-country Community Action on Harm Reduction (CAHR) programme with funding from the Government of the Netherlands. Hridaya works in partnership with SASO, Sharan, a number of community-based harm reduction organisations, and the Indian Drug User Forum (IDUF), a national network of people who use drugs.‎

In this interview, Francis discusses the National AIDS Control Organisation’s approach to prevent HIV among people who inject drugs (PWID) and the work that Hridaya does to provide an additional package of services to this community, their spouses, children and families. Francis offers us a glimpse into the personal and programmatic consequences of social and self-stigma against people who inject drugs, and opens up about his personal connection to the PWID community which inspires his work every day.

Q: Why is a programme like Hridaya important especially in a country like India?

Francis Joseph (FJ): The National AIDS Control Organisation has adopted harm reduction strategy under the National AIDS Control Programme Phase three (NACP III) to prevent HIV amongst people who inject drugs (PWID), and has scaled up services through targeted interventions implemented by NGOs. The primary objective under the NACP III was to halt and reverse the spread of the HIV epidemic by 2012 and to cover 80% of the overall population of PWIDs through targeted interventions. By reaching out to a significant proportion of the estimated injecting drug users (IDU) population, the NACP III laid the foundation for an effective and evidence-based comprehensive response to halt and reverse the HIV epidemic among IDUs.

While considerable progress was made under NACP III with respect to the scale-up of interventions for IDUs as well as quality assurance in the country there were areas that were identified as emerging areas of concern. Some of these services include sexual and reproductive health services for spouses/sexual partners of male PWID, inadequate regulated drug treatment services and active engagement of PWID within the programme. The country lacks leaders from this community and especially lacks networks of drug users.

Any successful harm reduction approach requires greater involvement of PWID. Hridaya aims to empower drug users, identify individuals and build them as leaders from this community so that they are informed, educated and can voice for their basic human rights. Hridaya’s overall aim is to empower the drug using community in each of its focus states so that they can strengthen the harm reduction approach at the state and district level, and develop a local resource pool for capacity building initiatives.

Q: There are so many preconceived notions about IDUs. How does this affect their ability to seek treatment? Can you talk a bit about stigma?

FJ: Generally, people perceive drug users as criminals, social outcasts, and a threat to society. This makes it difficult for people who want to reach out to them to even contact them, or to build rapport and trust with them, and this is incredibly important since these factors further fuel the HIV epidemic in the country.

PWIDs are generally assumed to be HIV positive and are, hence, refused treatment when care and treatment is required. There have been many instances of PWID being denied treatment at public health care facilities, getting arrested and being treated with police brutality, and experiencing community hostility.

All of this leads to a complete lack of access to treatment and other essential services. The shabbily dressed appearance and unhygienic conditions of a number of PWIDs leads to them being denied access to any service. This has led to a sense of mistrust and has fuelled stigma and discrimination.

There was an incident in Delhi where a PWID burst his femoral vein due to injecting and was rushed to a nearby hospital. He was bleeding profusely and needed immediate critical care. The doctor on duty refused to help this man before an HIV test had been done on him. All through this, the man continued to be in incredible pain and was near death, but no one would help him.

Q: What motivates you about your job? Are there people you’ve met who inspire you to continue working in this area?

FJ: I come from the same community of PWID and have also experienced the pain of rejection, isolation, denial from family, friends, relatives and society at large. I know exactly what it feels like being socially rejected and ostracized, denied for many social entitlements and disowned by my family. I have lived a life full of negativity and have seen the inside of treatment centres and incarceration.

There are millions of people like me and very few have been fortunate enough to have come out of their dependence. I feel that I have a special calling that has motivated me to do something for my community. I began my new life of sobriety from the very basics, taking one day at a time, and I painstakingly built it up to where I am now. Today, I’m at a level where my voice is heard and I can speak up for the needs of the people who share a common background with me.

Q: What do you wish more people in general society understood about harm reduction and IDUs?

FJ: There are three approaches to any drug treatment programme: Drug demand reduction, drug supply reduction and harm reduction. The first two approaches see the solutions to this problem as generating awareness in reducing the desire to use drugs and prevent and delay the onset of drugs use to disrupt the supply of drugs through the implementation of draconian laws. Both these approaches focus on abstinence, which has constantly proven to result in a very poor outcome.

We at Hridaya follow the harm reduction approach, which-as the name suggests–aims to reduce the harm associated with injecting drugs use, such as HIV and Hepatitis C, and not eliminate the drug use per se. General society perceives that the only option to treat drug users is for them to follow the route of abstinence, which is practically impossible since there may be a certain segment of people who would never be able to give up drugs completely. Hence, the harm reduction approach advocates for drug users to stay safe and healthy regardless of whether they are still doing drugs or of the conditions that they live in.

Q: Are there any resources that you would recommend for people who want to learn more about harm reduction in relation to injection drug use?

FJ: I urge people to read more about this topic. To break the stigma against IDUs, we need more informed people. For those who are interested in learning more, there are some very good resources available on www.unodc.org/India/harmreduction,   www.nacoonline.org/publications/harmreduction and www.aivl.org

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The subject of this post, Francis Joseph, is Programme Officer for Alliance India’s Drug Use & Harm Reduction programmes and is based in New Delhi.

Spanning five countries (India, China, Indonesia, Kenya, and Malaysia), Community Action on Harm Reduction (CAHR) expands harm reduction services to more than 180,000 injecting drug users (IDUs), their partners and children. The programme protects and promotes the rights of these groups by fostering an enabling environment for HIV and harm reduction programming in these five countries. CAHR is supported by the Ministry of Foreign Affairs, Government of Netherlands.

CAHR in India is called ‘Hridaya’ and is implemented by India HIV/AIDS Alliance in partnership with SASO, Sharan, and a number of community-based harm reduction organisations and networks. This project helps build the capacity of service providers, makes harm reduction programmes more gender-responsive, improves access to services and advocates for the rights of PWIDs. In addition to providing services, Hridaya has a strong capacity building component to support advocacy, knowledge management and improved services for PWIDs.

Their Voices Count: Stand with PLHIV on Human Rights Day!

HRday_logo_2012

Even after more than two decades of a coordinated national response to HIV/AIDS in India, stigma and discrimination towards people living with HIV (PLHIV) remain commonplace. These forces—and the violence and other rights violations that often accompany them—undermine the efforts of the government, civil society, and donors to mount a truly effective response to the epidemic.

December 10th is Human Rights Day. It is an opportunity to advocate for the full enjoyment of human rights by all people everywhere. This year’s theme is ‘My Voice Counts.’ For those of us working to address HIV/AIDS, it’s a moment to reflect on progress but also on how much more work remains. Just a few days ago, an incident took place in Jodhpur, Rajasthan that illustrates how far we still need to travel.

A couple living with HIV received regular support from a local NGO. A staff member from the NGO made a home visit and, while enquiring about the address of their house, inadvertently revealed that the couple was HIV-positive. Neighbors beat the couple and threw them out of their home. Presently, they are living on the streets. (The Deccan Herald reported on this incident in their November 30th issue.)

HIV was first identified in India in 1986. After more than 26 years of rigorous efforts to raise awareness about HIV/AIDS and increase understanding of the disease, our efforts to reduce stigma and discrimination remain inadequate as the Jodhpur case shows. While there are pockets of progress, the majority of the 2.4 million PLHIV in India still live in fear of being harassed, humiliated, stigmatized, beaten, and disowned.

The despicable treatment of the couple in Jodhpur was covered by the media, but numerous other such situations go unrecorded. What should our leaders do? What steps are needed to truly address the ignorance and fear that drives neighbors to hurt not help? The Supreme Court of India ruled that PLHIV are assured a right to treatment, but why are we so indifferent about protecting the right of PLHIV to lead full and productive lives?

The National AIDS Control Organisation (NACO) recognizes the important role that rights protections play in the AIDS response. NACO has a ‘Know Your Rights’ page on its website, but do PLHIV really know what measures they can take to protect themselves when faced with violations of their basic rights? And if they do, what happens when they stand up for themselves?

In early November, a group of 70 PLHIV walked into Bihar State AIDS Control Society to demand a meeting. The crowd was angry as there had been an interruption in the supply of antiretroviral drugs in the state. Such gaps can significantly undermine the effectiveness of treatment and lead to drug resistance. The group protested in loud voices, and in the process, a couple of flowerpots were broken. The police were called, and Gyan Ranjan Khatri, president of Bihar Network of People Living with HIV, was arrested. Getting him bailed out was difficult, and locals report that a case may be filed against him. The question remains: How can it be a criminal offence to demand the government protect the basic right of PLHIV to health?

If India is to progress towards UNAIDS’ global strategic goal of ‘Getting To Zero,’ then we must recognize that our efforts to achieve ‘Zero Discrimination’ need new energy and focus. Like it or not, HIV still inspires irrational fear. Today, on Human Rights Day, we should ask ourselves what we must to do to protect the rights of PLHIV here in India and all around the world. While there can be many solutions—and many are needed—we must listen to PLHIV. Their voices count.

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The author of this post, Francis Joseph, is Programme Officer for Alliance India’s Drug Use & Harm Reduction programmes, based in New Delhi.

Spanning five countries (China, India, Indonesia, Kenya, and Malaysia), Community Action on Harm Reduction (CAHR) expands harm reduction services to more than 180,000 injecting drug users (IDUs), their partners and children. The programme protects and promotes the rights of these groups by fostering an enabling environment for HIV and harm reduction programming in these five countries. CAHR is supported by the Ministry of Foreign Affairs, Government of Netherlands.

In India, CAHR is called Hridaya and is implemented by Alliance India in partnership with SASO, Sharan, and a number of community-based harm reduction organisations and networks. This project helps build the capacity of service providers, makes harm reduction programmes more gender-responsive, improves access to services and advocates for the rights of PWIDs. In addition to providing services, Hridaya has a strong capacity building component to support advocacy, knowledge management and improved services for PWIDs.

Making Pehchan: Why the Global Fund Matters for Sexual Minorities

Alliance India’s own Sonal Mehta is now a blogger for The Huffington Post’s “Big Push” campaign, an effort to galvanize increased support for The Global Fund to Fight AIDS, Tuberculosis and Malaria.

In her first post, she describes how leaders in India’s MSM and transgender communities conceived, designed and led the implementation of Pehchan, the Global Fund’s largest single-country grant to date focused on the HIV response for vulnerable sexual minorities:

In late 2007, a group of advocates for men who have sex with men (MSM) and transgenders in India were concerned that efforts to strengthen community systems for vulnerable sexual minorities were not getting the attention or funding needed.

The group organized around a basic but compelling principle: “MSM and transgender communities in India must act as equal partners in the national HIV response and work collectively to increase funding and expand programming for these populations.”

Over the next two years, this core group, together with other key leaders working with sexual minorities in India, went on to become the driving force behind the successful Global Fund proposal which has become the Fund’s largest single-country grant to date focused on the HIV response for vulnerable sexual minorities….

To read the complete article, please click here.

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Sonal Mehta is Director of Policy & Programmes at India HIV/AIDS Alliance in New Delhi. She leads a diverse and growing programme portfolio that includes 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.

Sharing Experiences Across Borders: Alliance India Hosts International Horizontal Learning Exchange on MSM and Transgender Programming and Advocacy

Participants in the Horizontal Learning Exchange on MSM and Transgender Programming and Advocacy with Alliance India team members in New Delhi

Last week, Alliance India hosted a four day information sharing and learning exchange for Alliance partner organisations from Mongolia, Myanmar, Kenya and Indonesia. Comprised of discussions, workshops and visits to Pehchan field sites, the Horizontal Learning Exchange on MSM and Transgender Programming and Advocacy provided a rare opportunity for its international participants to share experiences, ask questions and discuss the challenges that they have come across in their own cultural contexts of working with MSM, transgender and hijra (MTH) groups. Discussions centred around a range of issues including those related to capacity building, addressing and overcoming stigma and discrimination experienced by the MTH community, and the methods of working with government partners on MTH and HIV programming.

Day one consisted of oral presentations and workshops such as the one moderated by Ashok Row Kavi in which participants learnt about the history of the lesbian, gay, bisexual and transgender (LGBT) movement in India and the sexual and gender differences that exist here and in other participating countries. These sessions, coupled with an informative film screening by Sridhar Rangayan on the social impact of the media’s representation of the LGBT community, led to a thought-provoking discourse on issues of gender, sexual identities and behaviour, and the factors that influence and shape them. These discussions offered participants the opportunity to compare the similarities and differences between how these factors impact the HIV response and the solidarity of the LGBT communities in the unique context of their own countries.

The learning exchange sessions also examined sexual health and HIV prevention-related issues for the MTH community in India as well as in other participating countries. Day two started off by looking at Pehchan’s implementation model and the emphasis that the programme places on community mobilisation, capacity building and collaboration with the National AIDS Control Programme. Once participating countries had shared their experiences in the areas of programming and community mobilisation, they discussed how they could learn from each other about identifying good practices, and the opportunities and barriers to developing effective HIV/STI programming for MSM and transgender communities.

Field visits and direct interaction with key populations enriched participants’ understanding of the Pehchan project. Participants had the opportunity to visit Community Advisory Boards and regional offices set up by Pehchan. On day three, a site visit to one of Pehchan’s community-based organisation (CBO) for MSM, Mitra Trust, offered participants the opportunity to directly learn about CBO development and governance, resource and community mobilisation, and outreach strategies for MSM. Another site visit to a Pehchan Transgender CBO, Kinnar Bharati, enriched participants’ knowledge about the specific issues and challenges – including stigma and discrimination, and its effect on access to essential services – experienced by transgender and hijra communities in India. Participants were also treated to a cultural event organised by the CBO members, which ended day three on an entertaining note. Participants spent the following day sharing their thoughts and feedback on the site visits and ended the Horizontal Learning Exchange by discussing the way forward for each of the countries to work effectively with MSM and transgender communities. 

The organisations that participated in this learning exhange consisted of the Kenya AIDS NGOs Consortium (KANCO), Rumah Cemara, the National AIDS Foundation Mangolia, and Alliance Myanmar. All the participating organisations, which are Linking Organisations with the International HIV/AIDS Alliance, support and develop programmes run by other non-governmental organisations and CBOs in their own countries.

The Horizontal Learning Exchange offered participants an exceptional opportunity to gain invaluable information based on each other’s experiences. Participants left the learning exchange excited to take their own next steps while staying abreast with future plans of other participants. We hope that the learning exchange paved the way for similar information sharing meets to take place in the future, and are excited to see how participants use their newfound knowledge in their own corners of the globe to continue building a world where no one dies of HIV.

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

Increasing Civil Society Involvement in the Fight Against HIV in China

Chinese delegates with Alliance India members in New Delhi

India HIV/AIDS Alliance recently hosted a study tour of the Pehchan project for the China Association of STD and AIDS Prevention and Control (AIDS Association). This tour came in the wake of a significant decision made by the Chinese Government a few years ago to support the increased involvement of civil society organisations (CSOs) in the response to AIDS in China.  To support this goal, the AIDS Association was selected by the Global Fund to handle its contribution of $18 million for Community Based Organisations (CBOs). The journey ahead for the AIDS Association is an exciting one especially given the scale of its responsibilities, which include establishing an independent grant management mechanism managed by civil society.

The visiting team, consisting of delegates from the AIDS Association, China CDC, Ministry of Health, Chengdu Gay Care Organisation (CGCO), State Council AIDS Working Committee Office (SCAWCO) and UNAIDS China, were given a complete overview of the National AIDS Control Programme in India. They met with various stakeholders in NACO, SACS, UNAIDS, and the Bill & Melinda Gates Foundation to understand the role of the government, UN agencies and big donors in promoting the participation of the CSOs in the national AIDS response. The delegates also visited a Hijra CBO in Hyderabad, supported by the Andhra Pradesh State AIDS Control Society (APSACS), which offered them the opportunity to interact with CSO members and hear their experiences about working with the government.

The team learned about Alliance India’s work, particularly the Pehchan programme, and received technical inputs on developing systems and mechanisms in the areas of M&E and finance. They also learned about the various systems which have been developed by Alliance India to provide technical support to CSOs and to build their capacities in the effective management of data and grants.

As the visit came to an end, the Chinese delegates shared a few insights gathered from their trip which resonated strongly with them. Amongst these was Pehchan’s ability to reach the hard-to-reach populations which the government would otherwise find difficult to make contact with. These interventions serve as a bridge to build the capacities of CBOs and to link communities to government supported HIV programmes. The delegates also stated that Pehchan’s ability to align the cost of the Global Fund programme with the Government’s unit costs is essential for the sustainability of the programme once the Global Fund’s support has ended.

You can learn more about the work being done on HIV and MSM by civil society organisations in China by clicking on Alliance China’s report, Community Response to HIV among Men who have sex with Men in China.

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

Is the Commonwealth ready for an AIDS-free generation?

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

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

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

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

To read the complete article, please click here.

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

How integration responds to the SRHR needs of sex workers

Sex workers have the same sexual and reproductive rights as anyone else – such as to choose who to have sex with and to have sexual relations free from violence. They also share many of the same needs for SRHR information, support, commodities and services – such as advice about family planning.

However, due to many factors, sex workers often experience greater vulnerability to SRH ill health than other community members. They may experience one or all of: specific or more complex SRHR needs; additional or stronger barriers to accessing SRHR services; and weaker capacity or opportunities to demand SRHR services . These factors are further affected – sometimes complicated – by the differences between individual sex workers, such as in terms of their gender and sexual orientation (including whether they are female, a man who has sex with men (MSM) or transgender), age, legal status, HIV status, socio-economic status and whether they use drugs.

As a result, sex workers often have significant unmet needs for SRHR. These can ‘fall through the net’ of both: HIV services (often designed to address specific risk behaviors rather than the ‘whole person’); and SRHR services (often designed for the general public and focused on mainstream services, such as family planning).

This brief specifically focuses on the importance, but also challenges, of HIV/SRHR integration for sex workers. It is based on the experiences of a growing number of groups working with such communities to put integration into practice in a range of setting. These have given important insights into ‘what works’. But they also highlight that everyone is still learning and questions remain about what constitutes good practice.

This issue brief promotes integration as a desirable goal in the long-term. However, it also emphasizes that organizations must work in a way and at pace that is appropriate and feasible for them – to ensure that the joining of HIV and SRHR services and systems enhances, rather than compromises, support for sex workers.

This review was commissioned by the India HIV/AIDS Alliance with support from the European Union under the Action Project and explores experiences and lessons from around the world including Asia and the Pacific. This issue brief is part of a series of materials resulting from a review of good practice in the integration of HIV and sexual and reproductive health and rights for key populations.

Download brief from here.

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Alliance India is a state lead partner in Andhra Pradesh for implementing the Avahan India AIDS Initiative (2003-2013) which works in six states of India and 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, specifically female sex workers, MSM, and transgenders, through prevention education and services such as condom promotion, STI management, behavior change communication, community mobilization, and advocacy.

How Integration Responds to the SRHR Needs of PLHIV

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

However, due to many factors, PLHIV often experience greater vulnerability to SRH related ill health than other community members. They may experience  specific or more complex SRHR needs; additional or stronger barriers to accessing SRHR services; and weaker capacity or opportunities to demand SRHR services. These factors are further affected – sometimes complicated – by the differences between individual PLHIV, such as in terms of their gender, age, legal status and whether they use drugs or are involved in sex work.

As a result, PLHIV often have significant unmet needs for SRHR. These can ‘fall through the net’ of both: HIV services (often designed to address specific risk behaviors rather than the ‘whole person’); and SRHR services (often designed for the general public and focused on mainstream services, such as family planning).

This brief specifically focuses on the importance, but also challenges, of HIV/SRHR integration for people living with HIV (PLHIV). It is based on the experiences of a growing number of groups working with such communities to put integration into practice in a range of setting. These groups include MAMTA and the India HIV/AIDS Alliance in India; TASO in Uganda; RHAC in Cambodia; and POZ in Haiti. The work of these groups offers important insights into ‘what works’. But they also highlight that everyone is still learning and questions remain about what constitutes good practice.

The issue brief promotes integration as a desirable goal in the long-term. However, it also emphasizes that organizations must work in a way and at pace that is appropriate and feasible for them – to ensure that the joining of HIV and SRHR services and systems enhances, rather than compromises, support for PLHIV.

This review was commissioned by the India HIV/AIDS Alliance with support from the European Union under the Action Project and explores experiences and lessons from around the world including Asia and the Pacific. This issue brief is part of a series of materials resulting from a review of good practice in the integration of HIV and sexual and reproductive health and rights for key populations.

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Alliance India works closely with PLHIV in India through its Koshish project which aims to strengthened civil society organizations and networks that represent and work with PLHIV and other marginalized groups, such as MSM, transgenders, sex workers and IDUs, to effectively advocate for policies to improve the sexual and reproductive health and rights of PLHIV in India. This project is funded by the European Commison and is implemented in partnership with MAMTA, PWDS, VMM and CHETNA, along with state-level networks for PLHIV in Maharashtra, Tamil Nadu, Andhra Pradesh and Gujarat.

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

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

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

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

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

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

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