World TB Day 2013: Reducing tuberculosis burden through verbal screening of most-at-risk populations in Andhra Pradesh, India

Under the verbal TB screening programme, peer educators and outreach workers identify clients with TB symptoms during couselling sessions and refer suspected cases for testing. (Photo by Prashant Panjiar for India HIV/AIDS Alliance)

Under the verbal TB screening programme, peer educators and outreach workers identify clients with TB symptoms during couselling sessions and refer suspected cases for testing. (Photo by Prashant Panjiar for India HIV/AIDS Alliance)

India’s tuberculosis (TB) burden accounts for one-fifth of the global cases of the disease. In 2011, there were an estimated 3.1 million Indians affected by active TB. The problem is further compounded by HIV/AIDS, which is driving the resurgence of TB not only globally but also in India. HIV increases TB risk approximately seven-fold. Of the estimated 1.42 million TB deaths across the world, 430,000 die due to HIV/TB co-infection.

Typically, the integration of TB interventions into HIV services has focused on generalised HIV epidemics, with less emphasis on key populations, including sex workers, men who have sex with men (MSM), and people who use drugs. Yet the engagement and participation of key populations can be a vital strategy to address HIV/TB co-infection and improve access to diagnostic and treatment services toward the goal of achieving zero TB deaths.

Recognising the vulnerability of key populations and the difficulties they face in accessing TB services, India HIV/AIDS Alliance under the Bill & Melinda Gates Foundation’s Avahan India AIDS Initiative has implemented a verbal TB screening programme in Andhra Pradesh since 2007. Under the screening programme, peer educators at health clinics and outreach workers in the field identify TB symptoms in key population clients and refer suspected cases for sputum testing.

Take the case of Satyanandam, a member of the local MSM community. During a regular medical check-up at one of Alliance India’s Mythri clinics, he was found through verbal screening to be suffering from symptoms of TB: cough and night sweats. He was referred to a designated microscopic centre for sputum testing. An outreach worker accompanied him to the facility where he was found positive for TB.

Satyanandam was then supported by a local non-profit organisation (NGO) to ensure he successfully completed treatment. An outreach worker kept tabs on his medicine intake and advised him to stop smoking and practice good cough etiquette. After six months of treatment, Satyanandam was cured of TB. “Thanks to the Mythri clinic, the outreach workers, and NGO staff who cared for me during my illness. Because of their support, my family and I are healthy and happy now,” he said.

In fact, there are many Satyanandams who have been cured due to early TB detection through verbal screening. To date, 54,000 people have undergone verbal screening in Andhra Pradesh and among them, almost 2,000 each year have been referred for sputum examination. The proportion of people who accessed TB treatment increased from 83% to 94% in three years.

The intervention demonstrated that integration of TB interventions into HIV prevention services for key populations is feasible and complements the Government of India’s goals and targets under the Revised National Tuberculosis Control Program (RNTCP). Partnership with most-at-risk communities, civil society organisations, healthcare providers and government should be a key strategy to realise a world with zero deaths from TB, so that every Sathyanandam can live a long and productive life without TB.

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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 (2003-2013) 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.
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Coffee, Noodles and Harm Reduction: A Menu to Reach Women Who Use Drugs in Manipur

A counsellor advises a client at the Chanura Kol drop-in centre in Imphal. (Photo © Prashant Panjiar for India HIV/AIDS Alliance)

A counsellor advises a client at the Chanura Kol drop-in centre in Imphal. (Photo © Prashant Panjiar for India HIV/AIDS Alliance)

In an effort to increase uptake of essential harm reduction services in Manipur, India, the Chanura Kol project did more than expand its service menu to reach women who inject drugs.

Early on, the Chanura Kol team realised that many women who inject drugs neither have the time nor inclination to stop by the project’s drop-in centre (DIC) in Imphal for counselling services or to meet a doctor. To encourage these women to avail these services, team members initiated special days when free coffee and the popular dish of chow mein noodles were served to visitors.

Soon, Chanura Kol’s ‘Chow Mein & Coffee Days’ gained popularity among community members, and the DIC saw more and more women stopping by and speaking with the doctor and counsellor on duty.

The women who visit are offered a range of services in addition to counselling: needle or syringe exchanges, free condoms, and health checks-up, including medicine for basic health conditions. Additionally, linkages to reproductive health and HIV-related care and clinic-based detoxification therapy are available along with overdose prevention education and Naloxone for overdose-related emergencies.

By offering the hospitality of a simple meal, the DIC has become a more welcoming and comfortable place for the women who use drugs that Chanura Kol is trying to reach. Many of them now refer to the DIC as a second home where they cannot only access health and harm reduction services but also build supportive connections with their peers.

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India HIV/AIDS Alliance in partnership with SASO, implements the Chanura Kol project in Manipur. Funded by the Elton John AIDS Foundation, Chanura Kol was initiated in 2010 and serves to expand interventions to reduce drug relapse among female injecting drug users. Based on a holistic and sustainable approach, Chanura Kol aims to address the root causes of vulnerability and the primary causes of relapse post-detoxification for women who inject drugs in India’s north-eastern state of Manipur, many of whom are also sex workers. Chanura Kol provides these women with long-term shelter, creates opportunities for income generation outside of sex work, and encourages the rebuilding of family relationships.

From Inequality to Inclusion: Recognizing the Vulnerabilities of Sexual Minorities in the Response to the Delhi Gang-Rape

The Justice J.S. Verma Commission stresses that the word ‘sex’ in the Constitution of India should be understood to include sexual orientation. (Photo © 2012 Peter Caton for India HIV/AIDS Alliance)

The Justice J.S. Verma Commission stresses that the word ‘sex’ in the Constitution of India should be understood to include sexual orientation. (Photo © 2012 Peter Caton for India HIV/AIDS Alliance)

Convened in the aftermath of the horrific gang-rape and murder of a 23-year-old woman in New Delhi this past December, a special commission headed by former Chief Justice J.S. Verma was tasked to suggest amendments to criminal laws to improve the security of women in India and ensure speedier justice.

In its 657-page report released in January 2013, the Commission has provided an initial set of recommendations, but it has also gone a step beyond its mandate. Unexpectedly and to its great credit, the report has made special mention of India’s sexual minorities, who are too often also victims of social stigma, discrimination and violence.

Even in the first chapter of the report, the Commission stresses the need to acknowledge differences in sexual orientation as ‘a human reality’ and recognizes the range of sexual and gender identities.  It also makes clear that the use of the word ‘sex’ in the Constitution of India should be understood to include sexual orientation. The full passage is a remarkable testament to social progress in India:

We must also recognize that our society has the need to recognize different sexual orientations a human reality. In addition to homosexuality, bisexuality, and lesbianism, there also exists the transgender community. In view of the lack of scientific understanding of the different variations of orientation, even advanced societies have had to first declassify ‘homosexuality’ from being a mental disorder and now it is understood as a triangular development occasioned by evolution, partial conditioning and neurological underpinnings owing to genetic reasons. Further, we are clear that Article 15(c) of the constitution of India uses the word “sex” as including sexual orientation.”

The report also powerfully justifies the inclusion of sexual minorities as indisputably entitled to their human and legal rights and fully embraced as equal citizens:

“Thus, if human rights of freedom mean anything, India cannot deny the citizens the right to be different. The state must not use oppressive and repressive labeling of despised sexuality. Thus the right to sexual orientation is a human right guaranteed by the fundamental principles of equality. We must also add that transgender communities are also entitled to affirmation of gender autonomy. Our cultural prejudices must yield to constitutional principles of equality, empathy and respect.”

The report proposes qualitative indicators measuring the perception of safety and security for women and other vulnerable groups as a tool to improve police performance and accountability. It also makes case for ‘community policing,’ a strategy to involve local populations and increase confidence in the safety of the citizenry. The report places emphasis of building capacities of the police on both gender-based violence and discrimination.

These suggestions and the arguments used to justify them are not only indicative of dynamic social change in India but also offer an unprecedented opportunity for civil society—including those of us working to improve the health and wellbeing of marginalized communities—to build and sustain collaboration with law enforcement agencies and the judiciary.

Through this engagement, we can begin to address some of the structural forces that increase vulnerability to HIV and hamper efforts to create an enabling environment for women, sexual minorities and other groups who continue to live in constant fear for their safety and security.

Read our January 3rd blog, The Other Epidemic: Gender-based Violence in India.

Read the complete report here.

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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 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.

Avahan in Andhra Pradesh: Expanded Access and Increased Impact

ai_avahan_cover_low resAvahan India AIDS Initiative is a focused prevention initiative funded by the Bill & Melinda Gates Foundation that works in six states of India to reduce HIV transmission and the prevalence of sexually transmitted infections (STIs) in vulnerable high-risk populations—female sex workers (FSWs), men who have sex with men (MSM) and transgenders—through prevention education and services. The programme’s main components are condom promotion, STI management, behavior change communication, community mobilisation, and advocacy. Avahan also supports the creation of an enabling environment through individual and organisational capacity building to increase the effectiveness of the HIV response.

India HIV/AIDS Alliance is a state lead partner for Avahan in Andhra Pradesh. Alliance India’s efforts in the state have strengthened the capacity of NGOs and CBOs to implement quality HIV and STI programming in close partnership with the State AIDS Control Society (SACS) and in accordance with the National AIDS Control Programme.

Alliance India’s work with Avahan in Phase I covered 13 districts of the Telangana and Rayalseema regions in Andhra Pradesh and reached nearly 72,000 FSWs and MSM. Now in Phase II, Alliance India is transitioning programme activities to the state government as planned and supporting efforts to further strengthen community mobilisation with beneficiary groups to ensure sustainability of prevention activities under government support.

To learn more about our Avahan work in Andhra Pradesh, please download our brochure here.

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The author this post, Dr. M. Ravikanth, is Documentation & Communication Specialist, India HIV/AIDS Alliance.

The Avahan India AIDS Initiative (2003-2013) 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. Avahan works in six states, and Alliance India is a state lead partner in Andhra Pradesh.

Uniting Against Discrimination: Women form advocacy groups to respond to cases of violence

Building on the sense of community that exists within this peer group, the Chanura Kol has created Advocacy Groups to deal with challenges faced by female injecting drug users. Photographer: Prashant Panjiar

Building on the sense of community that exists within this peer group, Chanura Kol has created advocacy groups to deal with challenges faced by female injecting drug users. Photographer: Prashant Panjiar

Alliance India understands the power of community participation and engagement. In partnership with the Manipur-based local NGO, Social Awareness Service Organisation (SASO), the Chanura Kol project has established four Core Advocacy Groups to help women who inject drugs, many of whom are sex workers.

Each advocacy group, comprised of 10-15 members consisting of female injecting drug users, sex workers or their pimps, serves to address stigma and discrimination faced by women who inject drugs as well the frequently reported cases of violence experienced by them. Group members have received training on advocacy and documentation and, since the establishment of the groups in early 2011, have responded close to 100 cases of violence, harassment and extortion by women who inject drugs.

The reported incidents that these advocacy groups have responded to included domestic violence and harassment by sexual partners and security forces. The latter are notorious for extorting money particularly from female injecting drug users who engage in sex work. Each of the reported incidents was responded to within 48 hours during which time the advocacy groups provided support to those affected and their families.

Group members also held sensitization and advocacy meetings with those involved in perpetrating the violence. Although these advocacy groups were initiated last year, SASO has implemented the creation of support groups since 2007 in keeping with its belief that these groups play an important role in garnering community involvement and family support, facets that are integral to the recovery of vulnerable women who inject drugs.

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India HIV/AIDS Alliance in partnership with SASO, implements the Chanura Kol project in Manipur. Funded by the Elton John AIDS Foundation, the project serves to expand interventions to decrease HIV transmission and reduce drug relapse among female injection drug users (FIDUs).

Join us for the World AIDS Day All-India Run & Cultural Event! (Sunday, 2 December 2012 in New Delhi)

World AIDS Day 2012 All-India Run and Cultural Event
***8am-2pm (***PLEASE note EARLIER starting time!)
Sunday, 2 December 2012

New Delhi

Organized by: India HIV/AIDS Alliance

Co-sponsored by: Population Council; Citibank; UNDP; Centre for Advocacy & Research (CFAR); Delhi Frontrunners; and Blind Relief Association

RSVP: Please let us know if you’ll join us. Click here!

All-India Run: Participants will include people affected by the epidemic, their friends and families, community members, students and other stakeholders motivated to raise awareness of HIV in India, including the private sector. At least 500 participants are expected to participate in the run, and medals will be awarded to the top finishers in the men’s, women’s and transgender categories.

Members of affected communities have also been invited to speak and serve as judges for the run. Representatives from a range of stakeholders have also been invited, including NACO, UN agencies, international donors and NGOs, along with Alliance India implementing partners and beneficiary communities from all over India.

Activities will begin at 8am at Safdarjung Tomb. The run will start around 9am and will follow Lodhi Road, ending at the Blind Relief Association (aka Delhi Blind School), near the Oberoi Hotel. The Cultural Event will take place immediately following the race on the ground of Delhi Blind School and will last until 2pm. (For detailed route information, please see map below.)

Starting Line:
Safdarjang Tomb, Lodi Estate
(At the intersection of Safdarjang Road and Aurobindo Marg)

Metro Station: Jor Bagh

Finish Line:
Blind Relief Association (aka Delhi Blind School)
Lal Bahadur Shastri Marg
Lodhi Road H.O.

(Near Oberoi Hotel)

Cultural Event: Immediately following the run, the Cultural Event will take place at Delhi Blind School. Celebrating life and creativity in the face of the epidemic, the cultural event will consist of music and drama performances. The jazz and rock bands invited have members from communities affected by the epidemic. Co-sponsor Population Council will organize a skit presentation between music acts to highlight issues of at-risk populations. Lunch will be available. In addition, stalls will be set up by sponsors and other national and international organisations, including Population Council, Citibank, and UNDP, to present their work addressing HIV/AIDS and supporting communities.

This event is open to the public. There is no fee for participation. Participants are encouraged to wear red or white, but all will be welcomed. 

Jamia Millia Islamia, Indira Gandhi National Open University, Bhim Rao Ambedkar College, and Amity University are collaborating with Alliance India to provide volunteers for the event and organise student participation.

If you have any questions, please email us at: worldaidsday@allianceindia.org

Poster: Help get the word out about this event. Print out our poster and display it in your community. Thanks!

Map of World AIDS Day All-India Run Route and Cultural Event Location

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Alliance India’s World AIDS Day 2012 Objectives
  • To raise awareness on the need for continued support to address HIV among high-risk groups
  • To celebrate the diversity of affected communities with a focus on living lives free from stigma and discrimination
  • To acknowledge and encourage stakeholders, including government, civil society and the private sector, to intensify efforts to ensure a continuum of care services for affected communities
India HIV/AIDS Alliance

Based in New Delhi, Alliance India was founded in 1999 as a non-governmental organization operating partnership with civil society and communities to support sustained responses to HIV in India. Complementing the Indian national program, Alliance India works through capacity building, technical support and advocacy to strengthen delivery of effective, innovative, community- based interventions to key populations affected by the epidemic. The organization’s programs focus on those most vulnerable to HIV, with a particular emphasis on marginalized populations, such as men who have sex with men, people who use drugs, transgenders, and sex workers.

World AIDS Day Background

World AIDS Day has been observed since 1988. HIV/AIDS has become one of the defining health and development issues of our time. Low- and middle-income nations, even those with increasingly powerful economies like India, still face serious shortfalls in resources for AIDS. Stigma and discrimination toward those affected by the epidemic continue to create significant barriers to effective responses. Two-thirds of those who require antiretroviral treatment to live healthy lives still do not have access to these life-saving drugs. Investment in programming for high-risk populations such as men who have sex with men, sex workers, people who use drugs, and transgenders continue to be grossly insufficient. Worldwide HIV has infected an estimated 34 million people. In India, the National AIDS Control Organisation estimates overall adult HIV prevalence at 0.31%, which translates into roughly 2.4 million people living with HIV in India.

2012 Global Theme for World AIDS Day

The theme for World AIDS Day as chosen by UNAIDS and its partners is Getting to Zero: Zero New HIV Infections, Zero Discrimination and Zero AIDS Related Deaths. World AIDS Day advocacy will focus on ensuring universal access to services including prevention, care, support and treatment and of fulfilling human rights.

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.