“11 for ICAAP 11”: A Selection of Alliance India Posters at ICAAP (November 17-22, 2013, Bangkok, Thailand)

Alliance India is presenting a total of 31 posters at the 11th International Congress on AIDS in Asia and the Pacific (ICAAP 11) in Bangkok, Thailand, 17-22 November 2013. To mark the 11th ICAAP, below are a selection of 11 of our posters displayed in Bangkok that detail our work supporting community-based programming for people living with HIV (PLHIV), men who have sex with men (MSM), transgenders, hijras, sex workers and people who inject drugs (PWID), all key priorities to addressing India’s complex epidemic.

Paving the Pathway: PLHIV community consultations enhance national care and support programme in India

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Factors Influencing SRH Service Uptake by PLHIV: Findings from the Koshish baseline study in India  

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An Emergent Crisis: Addressing the Hepatitis C Epidemic in People Who Inject Drugs (PWID) in India

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By the Community, For the Community: Involving PWID in Assessment of Drug-using Patterns Assessments

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Identifying Access Barriers for Transgenders Seeking Gender Transition Services in India

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Community-led Advocacy to Address SRH Needs of PLHIV: Experience from the Koshish programme in India

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Service without a Smile: Pehchan study of the friendliness of HIV services to sexual minorities in India

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Positive Rights and Sexual Health: A review of SRH laws and policies for PLHIV in India

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Tracking Organisational Development of Sexual Minority CBOs in India Using Pehchan’s ‘CBO CyclePoster_Page_10

Power in Our Hands: Increasing involvement by sexual minorities in HIV programme oversight in India 

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Promoting Entrepreneurship among Sex Workers to Reduce HIV Vulnerability in Andhra Pradesh

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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.

Renewing Our Commitment to the Global Response to HIV/AIDS

Image 1Globally, the incidence of new HIV infections and the number of AIDS-related deaths are decreasing. According to a recent report by UNAIDS, the annual number of deaths fell from 2.3 million in 2005 to 1.6 million last year. In 2001, there were more than half a million new HIV infections in children; in 2012, there were just over a quarter of a million.

Much of this progress is due to significantly expanded access to antiretroviral drugs particularly in low- and middle-income countries. Investment in antiretroviral drugs increased from $3.8 billion in 2002 to $18.9 billion last year. Significant results have also been achieved in reducing the number of deaths among those co-infected with TB and HIV, which have declined by 36% since 2004.

Despite flattening donor funding for HIV, which remains around 2008 levels, domestic spending on HIV has increased, accounting for 53% of global HIV resources in 2012. Nonetheless, the total global resources available for HIV in 2012 were estimated to be roughly US$ 3-5 billion short of the US$ 22-24 billion estimated to be needed annually by 2015.

The UNAIDS report also reviews progress on ten specific targets which were set by United Nations member states in the 2011 Political Declaration on HIV and AIDS. Progress has been slow in protecting human rights, securing access to HIV services for people most at risk of HIV infection, and in preventing violence against women and girls––all key factors in reducing vulnerability to HIV. Gender inequality, punitive laws and discriminatory actions continue to hamper national responses to HIV, and concerted efforts are needed to address these persistent obstacles to the scale up of HIV services for people most in need.

With support from donors like the Global Fund, PEPFAR, and the Bill & Melinda Gates Foundation, India HIV/AIDS Alliance in collaboration with hundreds of organisations across the country supports sustained and effective community-based responses to HIV. We focus our efforts on populations most affected by the epidemic, including men who have sex with men, transgenders, hijras, people who inject drugs and sex workers, as well as people living with HIV from all walks of life, including women and children.

Watch for our social media series, ‘The Six Strides’. Over the coming week, we will highlight the progress that we have made with our partners in six of the ten HIV/AIDS targets defined by the UN in the 2011 Political Declaration.

Advocating for Cervical Cancer Testing for Women Living With HIV: Experiences from the Koshish Programme in India

Koshish_thumbSexual & reproductive health (SRH) services must respond to the specific needs of people living with HIV (PLHIV). Unfortunately, this is typically still not the case in India. PLHIV face barriers in accessing basic SRH services or have needs that go beyond mainstream services.

After almost two years of rigorous work, Alliance India’s European Union‐supported Koshish programme — named after the Hindi word for ‘effort’— has emerged as a strong initiative to support policies and strategies on SRH for PLHIV in India. Our new case study ‘Advocating for Cervical Cancer Testing in Women Living With HIV’ highlights these efforts to address the challenges that PLHIV face in fulfilling their SRH needs, in this case concerning access to Pap smear testing for women living with HIV (WLHIV).

WLHIV are more vulnerable to cervical cancer and as early detection can lead to improved survival, it is even more imperative to address cervical cancer risk as an advocacy priority, particularly through the promotion of Pap smear testing. In the programme’s four implementation states (Andhra Pradesh, Gujarat, Maharashtra, and Tamil Nadu), Koshish advocacy coalitions have prioritised prevention and early diagnosis of cervical cancer among WLHIV as a key advocacy agenda at state and district levels. The partners have initiated advocacy efforts to make Pap smear testing a mandatory part of the care for every WLHIV and, in doing so, expand its availability to all women.

Read more about this effort here.

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India HIV/AIDS Alliance works closely with PLHIV in India through its Koshish programme which strengthens civil society organizations and networks that represent and work with PLHIV and other marginalized groups, such as MSM, transgenders, sex workers and IDUs, to effectively advocate for policies to improve the sexual and reproductive health and rights of PLHIV in India. This project is funded by the European 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.

New Advocacy to Address Cervical Cancer in Women Living with HIV

Early detection of cervical cancer can help WLHIV live longer and more productive lives. (Photo by Prashant Panjiar for India HIV/AIDS Alliance)

Early detection of cervical cancer can help WLHIV live longer and more productive lives. (Photo by Prashant Panjiar for India HIV/AIDS Alliance)

Alliance India’s Koshish programme advocates for policies and strategies on sexual and reproductive health (SRH) and rights for people living with HIV (PLHIV) in India. The programme is implemented in Maharashtra, Tamil Nadu, Andhra Pradesh and Gujarat.

During community consultations with PLHIV in these four states, the Koshish team noticed that women living with HIV (WLHIV) had low awareness of cervical cancer and seldom go for testing. HIV-infected women with advanced immunosuppression (CD4 count < 200 cells/µL) are particularly vulnerable to infection with human papillomavirus (HPV) that leads to cervical cancer.

As the availability of ART has increased, it has given greater hope to WLHIV to live healthier and longer lives. With improved survival, it has become even more imperative to address cervical cancer risk as a priority. Early detection of cervical cancer is possible through a Pap smear test. While not available at primary health centres, the test should be available at every government district hospital’s gynecological departments. Unfortunately, access is limited due to non-availability of kits or lack of trained lab technicians. Typically WLHIV are referred for the test only if doctors think the woman is vulnerable, basing their decision on certain symptoms.

HIV programming needs to integrate Pap smear testing into routine care. Koshish has been actively pushing for regular Pap smear test for WLHIV at civil hospitals. Our partners in Maharashtra, Mamta and the Maharashtra Network of People Living with HIV/AIDS (NMP+) have been successful in motivating Pap smear testing in five implementing districts, Nagpur, Amravati, Kolhapur, Ahmed Nagar and Thane.

In Ahmed Nagar, the team organises a health camp on the first and third Saturday of every month. In these camps, 25 women are screened for cervical cancer. In Thane, the civil surgeon has arranged for a monthly camp for 30 women. The camps in Kolhapur have begun and are being organised on Tuesday and Saturday, while in Nagpur the camps are being successfully held with support from the Indian Cancer Society. In Amravati district, the civil surgeon has issued a circular instructing routine Pap smear testing for WLHIV. Of the WHLIV tested for cervical cancer so far, nearly 10% have tested positive.

The risk of cervical cancer remains high in developing countries due to a lack of prevention and screening programmes. Under Koshish, partners have already started advocacy with decision-makers at State AIDS Control Societies to make annual Pap smear testing a mandatory part of the care for every WLHIV over 30 years of age who is on ART. Data collected from each state will support national level advocacy with decisional-makers at India’s National Health Mission and the National AIDS Control Organisation to ensure that prevention of cervical cancer among WLHIV is a priority. Koshish is committed to empowering PLHIV in India with advocacy tools to promote policies and strategies to improve their lives and build them as the natural leaders of these efforts.

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India HIV/AIDS Alliance works closely with PLHIV in India through its Koshish Project which strengthens civil society organizations and networks that represent and work with PLHIV and other marginalized groups, such as MSM, transgenders, sex workers and IDUs, to effectively advocate for policies to improve the sexual and reproductive health and rights of PLHIV in India. This project is funded by the European 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.

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.