“Fearless”: Improving Sexual & Reproductive Health of Female Sex Workers

Targeted Interventions allow female sex workers to access services in a more supportive and less stigmatizing environment as compared to government hospitals. (Photo by Peter Caton for India HIV/AIDS Alliance)

Targeted Interventions allow female sex workers to access services in a more supportive and less stigmatizing environment as compared to government hospitals. (Photo by Peter Caton for India HIV/AIDS Alliance)

In India, as elsewhere, female sex workers (FSW) have considerable unmet sexual & reproductive health (SRH) needs due to their occupation and social marginalization. They shy away from accessing SRH services due to stigma and discrimination, negative attitudes of healthcare providers, and fear of law enforcement agencies, clients and people opposed to sex work.

Under the country’s National AIDS Control Program (NACP), targeted interventions (TIs) for FSWs are implemented to provide access to HIV prevention services. TIs allow FSWs to access services in a more supportive and less stigmatizing environment as compared to government hospitals. Unfortunately, TIs do not include SRH services in spite of the immediate relevance of these services.

Evidence, both global and national, has shown that linking HIV and SRH services provide a valuable impetus to encourage uptake of prevention, treatment, and care and support services, especially by people living with HIV (PLHIV) and key populations, including FSWs. With this approach in mind, India HIV/AIDS Alliance with support from MAC AIDS Fund has initiated a pilot programme Abhaya – meaning ‘fearless’ in Hindi – for FSWs in Andhra Pradesh and Gujarat.

Within existing TIs for FSWs, Abhaya expands access to complementary SRH services. The project enables FSWs and their partners to reach to a broader range of services like SRH information, counselling, referral and linkages to facilities providing relevant services. Along with this, the intervention also builds the capacity of existing healthcare providers and other relevant stakeholders to ensure a responsive attitude towards FSWs. Abhaya will also engage in advocacy with the government to identify opportunities to adapt and scale-up these expanded services in a stigma-free environment as a part of the national strategy.

Abhaya gives a significant role to FSWs and their partners in the implementation of the programme at all stages to increase ownership and the potential for sustainability of the initiative. Over the pilot year, the programme will reach 3,000 FSWs, helping them to better identify their SRH needs and access quality services thus empowering them to protect their overall health and wellbeing.

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The author of this blog, Kumkum Pal, is Programme Officer: HIV & SRHR at India HIV/AIDS Alliance.

Supported by the MAC AIDS Fund, Abhaya expands access to sexual and reproductive health (SRH) services as part of HIV prevention interventions for female sex workers (FSWs) in Andhra Pradesh and Gujarat. The programme will complement the existing targeted intervention (TI) programme under the country’s National AIDS Control Program (NACP) by providing key SRH services and linkages and increase the desirability and value of the TIs for FSWs. Alliance India is implementing the programme with support from Sakhi Jyot in Gujarat and Prema Sangam Mahila Mandali in Andhra Pradesh.

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

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Stigma and discrimination often prevent women living with HIV from accessing the essential health care services. (Photo by Prashant Panjiar for India HIV/AIDS Alliance)

It was 5am. Anita (name changed) was about to give birth. The labour pain was leaving her numb. Her family rushed her to the nearby government hospital, but the doctors refused to attend her. She kept fighting the pain. The morning of hope soon turned into an evening of despair. Anita had a stillbirth. Her only fault: she is HIV positive.

Sadly, Anita’s case in Palanpur city of Banaskantha district of Gujarat is not unique. Women living with HIV (WLHIV) face discrimination everywhere: they are ostracized by their families, ridiculed and abused by society, and refused healthcare by providers.

Following the incident, a number of protests were held by Banaskantha Network of Positive People (BanasNP+) but all in vain. Seeing no action at local level, Gujarat State Network of Positive People (GSNP+) picked up the case. Along with BanasNP+, GSNP+ submitted a detailed report to the health commissioner of the state and Gujarat State AIDS Control Society (GSACS).

Fortunately, the health commissioner was proactive. He immediately took up the case and sent a team to Palanpur for further investigation. A circular was also issued to all the hospitals citing a high court ruling that states that people living with HIV (PLHIV) should not be denied care and treatment because of their positive status.

In the meantime, GSNP+ documented various cases of such stigma and discrimination against WLHIV by healthcare providers across Gujarat. GSNP+ then organised a state-level advocacy meeting with GSACS and presented these documented cases. Following this, GSACS decided to conduct priority visits to the districts along with GSNP+. A meeting was called by GSACS in Palanpur that brought together the resident medical officer (RMO), gynaecologists, ART medical officer, paediatric doctors, and staff from the District AIDS Prevention and Control Unit (DAPCU). The discussion clarified the roles and responsibilities of each medical department and highlighted the particular role of gynaecologists. The meeting sought commitment from healthcare providers that WLHIV shall not be discriminated against and will get the same treatment as other patients.

The impact of this advocacy meeting was visible within a few weeks. One WLHIV who had earlier been asked to go to Ahmedabad for delivery by the hospital was now given proper care. She delivered healthy twins.

In Palanpur, these efforts have paid off and shown how partnership and coordination with the concerned government departments can work positively, creating a win-win situation. Yet 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 our rights.

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The author of this post, Daxa Patel, is head Gujarat State Network of Positive People (GSNP+). One of India’s most prominent HIV activists, Daxa collaborates with India HIV/AIDS Alliance on our Koshish and Vihaan Programmes.

With funding from the European Union, our Koshish programme strengthens civil society organizations and networks that work with PLHIV and other marginalized groups, such as men who have sex with men, transgenders, sex workers and people who inject drugs, to effectively advocate for policies to improve the sexual and reproductive health and rights of PLHIV in India. This programme 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.

With support from the Global Fund to Fight AIDS, Tuberculosis and Malaria, Vihaan is establishing 350 Care & Support Centres across India that will help expand access to services, increase treatment adherence, reduce stigma and discrimination, and improve the quality of life of PLHIV. The centres will support PLHIV, including those from underserved and marginalized populations who have had difficulty in accessing treatment including women, children and high-risk groups in 31 states and territories.

International Women’s Day 2013: Empowering Women Living with HIV

Celebrate International Women’s Day with almost one million Indian women living with HIV.  (Photo © 2012 Prashant Panjiar for India HIV/AIDS Alliance)

Celebrate International Women’s Day with almost one million Indian women living with HIV. (Photo © 2012 Prashant Panjiar for India HIV/AIDS Alliance)

International Women’s Day was first officially observed in 1911 and remains an annual opportunity to call for change and celebrate the many acts of courage and determination by ordinary women who play an extraordinary role in the world’s future.

It’s hardly been three months since India came to a standstill after the gruesome gang rape in New Delhi. The incident generated national and international attention and was condemned in India and abroad. It has left us determined to find answers to difficult but basic questions: Are India’s women really safe, both inside and outside their homes? Can they celebrate their freedom? How can we ensure that all women are able to pursue their dreams?

Over the years, considerable effort has gone into social, political and economic empowerment of women, but progress has been too slow. For women living with HIV (WLHIV) in India, the challenges are multiple. These women encounter daily stigma & discrimination and face barriers to accessing HIV prevention, treatment and care as well as sexual and reproductive health (SRH) services. WLHIV often lack status and decision-making power and have inadequate control over financial resources and limited mobility to travel to find better jobs. Even today, laws and policies impede their access to health care and other services.

Though the sexual reproductive health and rights of people living with HIV (PLHIV) remain largely unrealized in this country, India HIV/AIDS Alliance is working to address some of the issues faced by WLHIV through our Koshish Project. With financial support from European Commission, Koshish affirms the principles of empowerment and partnership as core strategies to tackle the problems faced by these women, including stigma & discrimination, inaccessibility and non-availability of services and the lack of comprehensive SRH for PLHIV.

Through partners in Andhra Pradesh, Gujarat, Maharashtra and Tamil Nadu including PLHIV networks in these states, Koshish works with providers and decision-makers to help make barrier-free services available and formulate sensitive and progressive policies for PLHIV and key populations. Programme partners have proactively engaged these stakeholders to advocate for quality SRH services. Advocacy has focussed on issues like maternal health services for WLHIV, cervical cancer screening, quality counselling and increased awareness of SRH and rights.

It is a now time for us to look ahead and celebrate the untapped potential and opportunities that await future generations of women including WLHIV. As we enjoy the song One Woman  to be released by UN on this International Women’s Day, let us dedicate our time and resources and pledge our commitment to WLHIV by mobilizing and empowering them and jointly advocating for their rights and needs in India and all over the world.

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The author of this post, Kumkum Pal, is Programme Officer for Alliance India’s Koshish programme.

Alliance India works closely with PLHIV in India through its Koshish programme which aims to strengthen civil society organisations and networks that represent and work with PLHIV and other marginalised groups, such as MSM, transgenders, sex workers and IDUs, to effectively advocate for policies to improve the sexual & reproductive health and rights (SRHR) of PLHIV in India. This project is funded by the European Commission 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.

Falling Through the Net No More: Community Advocacy Expands Sexual & Reproductive Health Services for PLHIV

Alliance India’s Koshish programme supports advocacy to improve sexual & reproductive health services for PLHIV and other key populations at government facilities. (Photo © 2012 Peter Caton for India HIV/AIDS Alliance)

Alliance India’s Koshish programme supports advocacy to improve sexual & reproductive health services for PLHIV and other key populations at government facilities. (Photo © 2012 Peter Caton for India HIV/AIDS Alliance)

Sexual & reproductive health (SRH) services must become responsive to the specific needs of people living with HIV (PLHIV). Unfortunately, this is typically not the case in India. PLHIV face barriers in accessing basic SRH services or they have needs that go beyond mainstream services. These challenges are compounded because HIV services do not target the holistic needs of PLHIV and these patients are not encouraged to demand expanded access to suitable SRH services. As a result, PLHIV frequently ‘fall through the net’ of HIV and SRH services.

Facing these difficulties, what has Alliance India’s Koshish programme done to improve the SRH of PLHIV and fulfill their basic human rights claims such as the right to health? With funding from the European Commission, Koshish has supported the formation and growth of four state-level advocacy coalitions in Andhra Pradesh, Gujarat, Maharashtra, and Tamil Nadu. These coalitions are organised by PLHIV and comprise of stakeholders representing key population networks, media, mainstream development organisations and civil society. In each state, the coalition identified SRH and rights needs of PLHIV and charted out advocacy strategies targeting these unfulfilled needs.

A state-level meeting organised by the coalition in Andhra Pradesh highlighted the urgent need for the government health system to ensure the availability and accessibility of testing and treatment for cervical cancer among women living with HIV. A similar initiative was undertaken in Tamil Nadu and Maharashtra. The effort in Maharashtra also advocated for initiating Pap smear tests at government hospitals for eligible women living with HIV. To achieve these goals, the advocacy event began by recognising and appreciating the work of healthcare providers in providing care for PLHIV and then sensitising them about the value of the Pap smear test for women living with HIV and requesting their support.

Press conferences in Maharashtra and Andhra Pradesh helped get coverage of the unmet SRH needs of PLHIV in the popular media. A workshop in Gujarat in December 2012 also trained 77 print and electronic media representatives. Workshop participants learned about Koshish and actively interacted with PLHIV community members, discussing their SRH needs, service availability, and the frequency of rights violations.

Community advocacy supported by Koshish has helped draw state and national level attention to the SRH and rights needs of PLHIV. And this is just the beginning. PLHIV are essential partners is India’s response to AIDS. By empowering PLHIV with advocacy tools, Koshish and our state partners continue to promote policies and strategies to improve the lives of PLHIV in India and build them as the natural leaders of these efforts.

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The author of this post, Kumkum Pal, is Programme Officer for Alliance India’s Koshish programme.

 Alliance India works closely with PLHIV in India through its Koshish programme which aims to strengthen civil society organisations and networks that represent and work with PLHIV and other marginalised groups, such as MSM, transgenders, sex workers and IDUs, to effectively advocate for policies to improve the sexual & reproductive health and rights (SRHR) of PLHIV in India. This project is funded by the European Commission  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.

 

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 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).

Women Out Loud: New UNAIDS/UNWomen Publication Cites Our Chanura Kol Project

UNAIDS and UN Women recently released Women Out Loud, a new report on women living with HIV and the key role that they play in ending the epidemic. A UNAIDS feature on the document’s release notes the following:

In a new report, entitled Women Out Loud, UNAIDS explores the impact of HIV on women and the instrumental role women living with the virus are playing to end AIDS. It includes the latest data and commentary from some of the leading advocates on women and HIV.

The report includes the voices of some 30 women living with HIV who have given their personal insights into how the epidemic is affecting women and on how women are actively working to reduce the spread and impact of AIDS.

HIV is continuing to have a disproportionate effect on the lives of women. It is still the leading cause of death for women of reproductive age, and gender inequalities and women’s rights violations are persistent in rendering women and girls more vulnerable to HIV and preventing them from accessing essential HIV services…

Marginalised women remain the most impacted by HIV

Sex workers and people who use drugs are particularly vulnerable to HIV. When sex is exchanged for money or drugs, women often exert little influence over a partner’s condom use. Female sex workers are 13.5 times more likely to be living with HIV than other women. Some countries reported an HIV prevalence of more than 20% among female sex workers in capital cities. Studies conducted in nine European Union countries have indicated on average a 50% higher prevalence of HIV among women who inject drugs than in men who inject drugs.

On page 21 of the report in the chapter on people who use drugs, the following point is made: “Women who use drugs are widely reported to experience disproportionate levels of stigma and discrimination, often compounded during pregnancy, and as mothers.” One of the three references for this observation is In the Shadows, the baseline findings report from our Chanura Kol project.

India HIV/AIDS Alliance is grateful to UNAIDS and UN Women for this citation of our work. Many thanks to the Chanura Kol team and particularly to our implementing partners, SASO and Shalom, for their many contributions to the report and to the project overall. To read more about our baseline findings, click here or on the report cover below.

In the Shadows: Chanura Kol Baseline Report_Alliance India 2011

Chanura Kol is funded by the Elton John AIDS Foundation and serves to expand interventions to decrease HIV transmission and reduce drug relapse among women who inject drugs. Based on a holistic and sustainable approach, the project was initiated in 2010 to address the root causes of vulnerability and the primary causes of relapse post-detoxification for women who inject drugs in India’s northeastern 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 helps them rebuild family relationships.

Chanura Kol is one of a handful of efforts in the region to address the distinct needs of women who inject drugs and reduce their vulnerability to HIV. To learn more, please see a recent slide show about the project:

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Creating Change One Peer Group at a Time

An Action Project peer group leader (centre) meets with her youth group members. These meetings offer a space for group members to share any SRHR related concerns they may have about issues like child marriage, HIV, safe sex and family planning.

The Action Project empowers youth by educating them about issues that are important to them and discussing subjects that no one has talked to them about before. In conservative areas such as Allahabad where speaking about sexual, reproductive or health rights (SRHR) is considered taboo, discussing these issues openly, especially by youth, is a concept that took a while to be accepted. However, the difficulty or novelty of this situation did not prevent youth from working as peer leaders with the Action Project in order to pass on information about contraception, HIV prevention and care, STIs, hygiene, pregnancy or nutrition to other youth in their village.

Peer leaders are integral to the work that the Action Project does. The project’s partner NGOs in Allahabad and Manipur train youth peer leaders on how to create groups that they go on to mentor, and teaches them how to lobby for district and state-wide policy changes on issues related to youth and sexual reproductive health.

Savera (name changed), a 20-year-old peer leader, says, ”I was completely unaware about hygiene and nutrition during menstruation, safe sex, condom use or consensual sex. I also learned so much about HIV prevention and care here.” Remembering when she first started working as a peer leader, she recalls, “the village people used to call me ‘characterless’ because I spoke openly about sexual reproductive rights which was something ‘nice, conservative girls’ aren’t allowed to talk about. Now, however, my uncles and other village elders ask me to get their daughters involved in the project.”

And more and more girls are doing just that. Another peer leader who joined the Action Project, Divya (name changed) found the information she received from the Action Project to be helpful on a very personal level. The 19-year-old explains, “I met this boy in college three years ago and we began to like each other and he asked me to have sex with him. After everything I had learnt from this project, I knew that I didn’t want to have sex with him and I had the right to say ‘No’, and so I refused. I’m happy that I had the right information and was able to protect myself from potentially ruining my life.”

It is important to note that having the right information isn’t enough if it isn’t coupled with the confidence to share the information or to quest for more information. While speaking about her exposure to health camps and information sharing meetings with doctors, Savera said, “I would never have dreamed of speaking to a doctor even about my own health problems. Now I can openly ask doctors questions about HIV and other issues and I can see how amazed they are that I, being a village girl, am able to confidently ask these things.” Kavita added, “I used to be ashamed when they taught us about SRHR but now there is no shame and our perspectives have changed. Now I feel confident and at ease sharing information about SRHR.”

With the right type of support and access to information, the Action Project is building the capacity of these young leaders and offering them a sense of confidence they never had before, while also empowering them to change the social landscape of their villages one peer group at a time.

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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.