Avahan in Andhra Pradesh: Expanded Access and Increased Impact

Avahan 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.

____________________________

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, 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.

____________________________

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).

New Optimism, Old Challenges: Prioritizing High-Risk Groups at the Frontline of AIDS

In a new opinion piece published December 1st on OneWorld South Asia to commemorate World AIDS Day, Alliance India’s James Robertson argues that while India’s admirable progress in achieving a greater than 50 percent reduction in new HIV infections deserves accolades and emulation, it should not be mistaken for victory over the epidemic:

2012 has been a year of heightened public optimism about the future of HIV/AIDS. From UNAIDS audacious “Getting to Zero” campaign to US Secretary of State Hillary Clinton’s aspiration for an “AIDS-Free Generation,” everywhere it seems that the end of AIDS is finally on the horizon.

New strategies and new tools have injected new hope into the global response. Last summer’s International AIDS Conference was abuzz with the potential that antiretroviral treatment has to prevent HIV transmission by reducing a treated person’s infectivity. Our investments in treatment can now be understood to contribute to limiting the epidemic’s spread: a virtuous cycle of responsible public health. 

Yet this optimism has emerged as governments and donors are questioning the scope and scale of their HIV funding. Excitement notwithstanding, who will fund treatment as prevention when we still struggle to fund treatment as treatment? In low and middle income countries, we’re a long way from relying on drug regimens to control this epidemic. Barely a quarter of the 34 million HIV-positive people around the world are currently being treated, and the quality of care remains variable at best.

Political will to scale up treatment has not yet coalesced, and even if it does, it will not suffice. Pharmaceuticals and other tools remain only part of what is needed for us to master this epidemic. Expansion of treatment must be coupled with more and better-focused prevention. We need to significantly increase our efforts to address HIV among those most at-risk, even if they are not politically popular or socially accepted. And we must address larger structural factors that continue to impede our progress the world over.

To read the complete article, please click here.

_________________

James Robertson is Country Director of India HIV/AIDS Alliance in New Delhi.

What India’s Politicians Can Learn from President Obama’s Victory Speech

“I believe we can keep the promise of our founding, the idea that if you’re willing to work hard, it doesn’t matter who you are or where you come from or what you look like or who you love. It doesn’t matter whether you’re black or white or Hispanic or Asian or Native American or young or old or rich or poor, able, disabled, gay or straight. You can make it here in America if you’re willing to try.”

                     Excerpt from President Barack Obama’s Victory Speech, 7 November 2012

In his eloquent and unifying speech in Chicago following his re-election, President Obama did not fail to mention the gay communities who have strongly supported Obama; and they have every reason to do so. Among the milestones of Obama’s first term is an impressive record of protecting and advancing the rights of sexual minorities: the repeal of the ban on openly gay men and women serving in the military; his view that the Defense of Marriage Act was unconstitutional and would not be defended in court by his administration; expansion of legislation on hate crimes to include attacks based on the victim’s actual or perceived sexual orientation; and his public support for marriage equality and adoption. His victory gives hope to members of lesbian, gay, bisexual and transgender (LGBT) communities around the world who continue to struggle for justice, inclusion and respect.

In India, sadly, we have no elected leaders who echo similar sentiments. During our efforts to read down Section 377 of Indian Penal Code and decriminalize homosexuality, two ministries—the Ministry of Health & Family Welfare and the Ministry of Home Affairs—took contradictory stands in the Delhi High Court. In spite of support for decriminalization from the Ministry of Health and Family Welfare, the Additional Attorney General stood by the Ministry of Home Affairs’ affidavit, which justified retention of the archaic law by citing public morality: ‘…Indian society is yet to demonstrate willingness to show greater tolerance to practices of homosexuality.’

Following the judgment of the Delhi High Court to read down Section 377, the matter has been taken to the Supreme Court of India by an coalition of religious leaders across faiths, a rare occasion of the religious diversity of this country speaking with one voice, albeit misguided and bigoted. This time, however, in the Supreme Court, the Government filed an affidavit affirming that it abides by the Delhi High Court judgment. No elected leader has ever made such any statement—in the media or in parliament—so clearly supporting and defending human rights of sexual minorities.

India’s founders had a dream too: to build a nation that promotes, protects and respects civil, political, cultural and legal rights of every citizen irrespective of caste, creed, religion, race, color and sex. Pandit Jawaharlal Nehru repealed the odious ‘Criminal Tribes Act’ in 1949 that criminalized the country’s hijra communities, reasoning that the Act constituted a negation of civil liberty. Today, do we have leaders who are so passionate about social welfare of the sexual minorities? Sadly, the answer remains no.

In 2011 during a public meeting, Union Health Minister Shri Gulab Nabi Azad called homosexuality ‘a disease’ and ‘unnatural.’ Shri Lalu Prasad Yadav, chief of the political party Rashtriya Janata Dal, made a similar statement during a debate in the Lok Sabha, the lower house of India’s parliament. He observed that the Delhi High Court judgment ‘degrades’ Indian values, and it demands a serious discussion in the Parliament. Though there was outrage against these parochial and prejudiced views, such statements from our politicians only make us wonder how much longer our fight will continue.

In the recently concluded American election cycle, voters in Wisconsin elected the first openly lesbian senator, Tammy Baldwin, who will represent the state in Washington, DC. She reflects a remarkable change in the United States: the popular election of sexual minorities to office as a routine fact of political life. This progress has been the result of advocacy by generations of LGBT Americans and reflects a growing affirmation of our communities and rights by straight politicians, including President Obama. When will India have a leader with the vision and courage to openly defend our rights with genuine zeal and interest? Though India’s journey to equality still rises ahead of us, we are not disheartened. Social evolution on another side of the world gives us more reasons to make our voices heard. We will continue our struggle, as we share the distinctly American optimism of Scarlett O’Hara: ‘After all, tomorrow is another day.’

_________________________

The author of this post, Yadavendra Singh, is Senior Programme Officer: Capacity Building for Alliance India’s Pehchan Programme.

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

 

Separate hospital wards for transgenders soon to be a reality

Friendly attitudes and responsive services by hospital staff help transgenders be comfortable and open about their health concerns to care providers. Photograph shows a visit by a transgender community member to a clinic in Andhra Pradesh
(Photo © Peter Caton for India HIV/AIDS Alliance)

In India, there is documented evidence of transgenders and hijras facing repeated stigmatisation and discrimination, in violation of their dignity and basic human rights. Pehchan, as part of the programme’s advocacy efforts to raise awareness and achieve equality for these communities, organised a sensitization workshop in collaboration with its CBO partner Sakha for the staff of the government-run Capital Hospital in Odisha on the problems faced by transgender community members seeking medical treatment. Simran Shaikh, Alliance India Programme Officer for Pehchan, gave an orientation to the participants on the lives of transgendered people.

Following the training, participants noted their appreciation and increased understanding. “It was nice to know the expectations and problems transgenders are facing while seeking medical treatment,” said a nurse who joined the session. Sudahsha Dash, the Chief Medical Officer of Capital Hospital, who was the chief guest at this occasion, proposed efforts to create a separate ward for transgender patients: “We would soon request the government to form a separate ward for the transgenders and sexual minorities here.”

This workshop received wide attention from various quarters and positive reports in the media. To read the press coverage, click here.

______________________

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.

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.

____________________

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.

An Amazing Story of Grit and Determination

When the going gets tough, the tough gets going! HAMAZOR an International magazine catering to the Zoroastrian community celebrates Simran Shaikh’s Programme Officer for Alliance India’s Pehchan Programme, spirit of unshakeable willpower.

With the resolve to never give up, her story of grit and determination made her emerge as a winner. What makes her story truly inspirational in the way she has battled the odds to rewrite the story of her own life.

Here is an excerpt from the story:

The word family brings a tinge of sadness to Simran Shaikh’s voice. When Simran, an attractive, strapping member of the Hijra community in New Delhi, sees fellow hijras living with their families, she is reminded of the middleclass Parsi household where she grew up in Mumbai’s Dadar Parsi colony, a family for whom she is as good as dead. A rejection of her identity is what drove Simran to leave home and brave the mean streets of Mumbai, working as a bar dancer and sex worker.

You can read the entire story here.

HIV/SRHR Integration for Key Populations

HIV/SRHR Integration for Key Populations: A review of experiences and lessons learned in India and globally

This report summarises the findings of a review commissioned by India HIV/AIDS Alliance and funded by the European Union of experiences and lessons from integrating HIV and sexual and reproductive health and rights (SRHR) in programmes for key populations which include people living with HIV (PLHIV), sex workers, men who have sex with men (MSM), transgender people and people who use drugs.The report outlines definitions and benefits of HIV/SRHR integration for these key populations and presents some general lessons learned about good practice. It also addresses each of the selected key populations – describing issues to consider within integrated HIV/ SRHR support, sharing key strategies and providing examples of integration in action.

The review was carried out within a context of growing interest in HIV/SRHR integration. There is a growing wealth of evidence that the strategy ‘makes good sense’ and brings concrete benefits – including to people, services and national health systems.

The review specifically responded to the ‘push’ for HIV/SRHR integration within the changing and increasingly complex environment for responses to HIV. Within this context – one characterised by constrained resources, increased demands for cost-efficiency and political re-positioning (with HIV increasingly integrated into wider frameworks for health) – integration is clearly an important strategic option. It also, however, risks being seen as a ‘magic bullet’.

In India – as well as other countries in the Asia and the Pacific Region and globally – there is increasing policy support for the concept of HIV/SRHR integration. However, there remain significant questions and uncertainties about what such programming means in practice. This is particularly the case within the context of a concentrated HIV epidemic – where little is still known about what integration should ‘look like’ (for groups such as sex workers and men who have sex with men) and what practical opportunities and challenges it involves.

However, while integration is a desirable goal in the long-run, concerns remain that the joining of programmes and systems that are not ready could, in fact, compromise the quality of and access to services for key populations. This review identifies a number of challenges and recommendations for SRHR/HIV integrated programmes. These challenges need to be taken into account when national responses aim to scale up SRHR/HIV integrated programming. While this approach clearly has the potential to increase reach and improve quality of interventions, integrating services and systems that are not ready may in the short-run actually compromise outcomes for key populations.

A number of critical questions remain outstanding. These include: Do we have strong evidence to support HIV/SRHR integration as an effective approach to improve both SRHR and HIV outcomes specifically for key populations? If so, what needs to be taken into account to ensure that integration does not compromise access to services for key populations? For example, what type, pace and scale of integration works best for specific populations in specific contexts? And what is possible in the short-term and what goals should be set for long-term?

To download publication click here.

Sneak Preview: Alliance India Sessions, Thursday, July 26 at AIDS 2012

Our work has received tremendous interest and response with HIV clinicians, researchers, advocates, activists, and others from across the globe. Through the course of AIDS 2012: XIX International AIDS Conference, Alliance India has presented programming experiences highlighting the challenges and successful approaches used in integrated programmes specific to key populations such as MSM and Transgender people, Sex Workers, PLHIV and People Who Use Drugs.

Today, 26 July Alliance India staff and trustees are participating in a panel discussion, oral session, poster presentations, satellite session and a press conference. The roadmap gives more details including timing and location of all these sessions. Don’t miss our sessions! We look forward to sharing with you what we’re doing in India to turn the tide against the epidemic.

Satellite session

How Can Civil Society Measure Value for Money and Prove Their Worth?          Mini Room 10, 7:00-8:30am

The session is organised by Alliance and the World Bank. The panel will discuss on the increasing importance to demonstrate aid effectiveness and value for money. It will include India HIV/AIDS Alliance’s Kaushik Biswas, Manager for Monitoring and Evaluation, for a complete overview of session visit here.

Oral Session

Internalized homophobia and transphobia, low self-esteem and non-disclosure of sexual identity as factors contributing to HIV vulnerability of men who have sex with men (MSM), transgenders and hijras: Experience from the Global Fund supported Pehchān                                                                                                  Session Title: MSM: The Impact of Internal and External Stigma on a Personal and Social Level, Session Room 8, 2:30-4:00pm

Panel Discussion

On the Edge of the Cliff: Debating the Challenges of the Response

The panel discussion will include India HIV/AIDS Alliance’s Charanjit Sharma, Program Manager for Hridaya, the Community Action on Harm Reduction (CAHR) program in India.                                                                                                                       Regional Session: Asia and the Pacific Thursday, July 26, Session Room 5, 2:40pm-4:00pm

Poster Exhibition

Reaching men who have sex with men (MSM) and transgenders in SRHR/HIV Integration: Recommendations from a global intervention review to identify strategies to increase the responsiveness and relevance of integrated programming to address SRHR needs of high-risk groups        

                                                          

Mobilizing community collectivization among female sex workers (FSWs) to promote STI service utilization from the government health care system: Experience from Avahan in Andhra Pradesh, India

       

Strengthening case finding through verbal TB screening among most at risk populations in concentrated epidemics: Experience from Avahan in Andhra Pradesh, India

                                                                                                      

Combination Collaboration: Leveraging government commitment, donor processes and community mobilization to develop a national program to build the capacity of MSM and transgender populations as HIV prevention partners: Making the Global Fund-supported Pehchan program in India

Thursday, July 26, Exhibition Hall, Level 2

Press Conference

Turning the Tide: Addressing SRH Needs of Key Populations in AIDS Programs   Media Center Press Conference Room 2, 3:30-4:00pm

Over the course of AIDS2012, Alliance India has presented 18 posters detailing our work. You can view or download them through our blog page. Come visit and know more about Alliance’s work at the exhibition booth #102. If you have any questions, please contact us at info@allianceindia.org.

Join Alliance India Sessions on Wednesday, July 25 at AIDS 2012

India HIV/AIDS Alliance has lined up an action packed day for you today (Wednesday 25 July) at the International AIDS conference, you are cordially invited to attend all our sessions to learn more about our work in India to improve the AIDS response for communities most affected by the epidemic. Our commitment is to make sure the voices of these communities are heard at AIDS 2012 and beyond.

Our sessions today range from a panel discussion to oral presentations and poster exhibits, and highlight our experiences in a wide variety of areas, including reaching key populations in SRH/HIV integration; addressing the unmet sexual and reproductive health and rights of people living with HIV; mobilizing female sex workers to increase STI service utilization; findings from our baseline study on people who inject drugs and why we should support the decriminalisation of drug use; and more!

Panel Discussion

Criminalise Hate Not HIV: Why the HIV/AIDS community should support the decriminalisation of drug use.

Organised by INPUD, HRI, IPPF, IFRC and the Alliance, this panel is chaired by Prasada Rao, the UN Secretary-General’s Special Envoy for HIV in Asia and the Pacific and an Alliance Trustee.                                                                                              Wednesday, July 25, Global Village Harm Reduction Zone, 11:00am-12:00 noon

Oral Presentation                                                                                                   

Reaching Key Populations in SRH/HIV integration: Recommendations from a global intervention review to identify strategies to increase the responsiveness and relevance of integrated programming to the sexual and reproductive health and rights (SRHR) needs of high-risk groups, including sex workers, MSM, transgenders, IDUs and PLHIV Session Title: Expanding Covering and Quality: Approaches to Scaling-Up, Mini Room 3,  1:00-2:00pm 

Addressing the unmet sexual and reproductive health and rights (SRHR) of people living with HIV (PLHIV): The results from a baseline study in four states in India.                                                                                                                                Session Title: Expanding Covering and Quality: Approaches to Scaling-Up, Mini Room 3, 1:00-2:00pm 

Poster Exhibition                                                                                                        Wednesday, July 25, Exhibition Hall, Level 2

Beyond Heroin: Patterns of drug choice diversity among People Who Inject Drugs (PWID) in three Indian states: Findings from the Hridaya baseline study.

Identifying quality-of-life priorities for People Who Inject Drugs (PWID): Findings from the Hridaya baseline study in three Indian states.

                            

What’s harming harm reduction? Reducing HIV vulnerability among women who inject drugs in South Asia.    

 

Reaching people who use drugs (PWUD) in SRH/HIV integration: Recommendations from a global intervention review to identify strategies to increase the responsiveness    

Public private partnership as a sustainable model for STI service delivery: Evidence from Avahan-supported interventions in Andhra Pradesh, India                        

The roadmap contains a full list of posters being exhibited. You can also pick up material about our work at the Alliance exhibition booth #102. If you have any questions, please contact us at info@allianceindia.org.