Where there is a will !

MSM and Transgender persons in Mumbai : Creating

Friendly environments for access to health care

Vivek Anand : CEO -The Humsafar Trust, Mumbai ,India

26th July 2012 : XIX International AIDS Conference : Washington DC

Background

In India Section 377 of the Indian Penal Code

criminalized same sex behaviour

Section 377 is an archaic British law made in 1865 and

passed on to an independent India.

New Beginnings

In 1990 India’s first registered LGBT magazine

Bombay Dost was launched

New Beginnings

In 1994 the board of Bombay Dost came together to set up “The Humsafar Trust” (Companions on a

journey) India’s first community based organisation for Gay men / Kothis / MSM / and LBT

communities in Mumbai

Strategic Decisions

• To work with Local and National Government

• To work within Public health care settings in Mumbai and not replicate services

• To create friendly environments for MSM and TG to access health care services

Sensitization and Negotiations

• In 1996 Sensitization and negotiation with LTMG - a medical teaching college and public Hospital in Central Mumbai began

• Student interns were invited to attend community meetings• LTMG started posting students train them on issues of MSM and

Transgenders and provide services• DHS sensitization resulted in MSM and TG site mapping and

MDACS commissioned pilot prevention programme

Integrated Counseling and Testing Center & STI clinic

• In 1999 ICTC and a STI clinic was set up by NACO within CBO to provide treatment for STIs and HIV testing

• Student interns from LTMG managed the clinic• Community Health worker was posted at LTMG to provide support

Integrated Counseling and Testing Center & STI clinic

• HIV positive were referred to LTMG for treatment of OIs and future follow up.

• 5 ART centers started in 2003• MSM/TG/ MSW living with HIV started registering at the LTMG -

ART center

Prevention/Care Support and Treatment Services

• The Humsafar Trust outreach programme reaches out more than 13,500 MSM and TG distributing free condoms and provide information on safer sex.

• Provides STI services and free HIV testing to 8000 MSM and TG every year.

• Nearly 1000 MSM and TG are registered for ART services at the 3 ART centres for care, support and treatment services

• Humsafar – LTMG model is considered a good practise model of public private partnership

The Humsafar Outreach Team

HIV Support Group

• Support group for HIV positive MSM and TG was established in 2003

• Safe space for positive men to meet and discuss their issues

• Initiate activities for getting family and community support

HIV Support Group

• Professional mental health support• Treatment of Opportunistic Infections (OIs) and enrollment in

accessing ART• Nutrition counseling and nutritive supplement support• Health workers became the linkage between Humsafar and Public

health systems• The model was replicated in three other public hospitals

Research Support • Set up in 2004• IRB registered with NIH and FWA certification• The Research Unit aims at community based research

and concentrates on studies that strengthen its services to the community and act as evidence for the national programme.

• Regular dissemination in public health care settings in an ongoing effort to create friendly services to MSM/TG and MSW communities

Research Support • Ongoing baseline studies• Mental health issues of MSM• Married MSM and their vulnerability to HIV • HPV prevalence among MSM and TG• Impact of stigma and depression on sexual risk behaviour of MSM

and TG• Advancing HIV trial preparedness among MSM in India• ISHKonnect : Internet based HIV prevention for MSM in India• SHAKTI : Stigma reduction, health care providers, awareness and

knowledge enhancement on Transgender issues in India.

Learning

A clear sense of purpose with active involvement of the community and ongoing sensitization and negotiation

with public health delivery systems helped create friendly services for MSM and TG in Mumbai despite laws

criminalizing same sex behaviour

Finally….

• NACO scaled up Targeted Interventions with MSM and TG from 32 TIs to around 300 TIs by the end of March 2012 in NACP III

• Consenting same sex between adults (above 18 years)was decriminalised and Section 377 was read down by Delhi High Court on 2nd July 2009. NACO provided support affidavit.

Finally….• The Delhi High Court

judgement was challenged by 16 opponents in the Supreme Court of the country

• The hearings in Supreme Court ended in March 2012

• The judgement and fate of millions of LGBT is AWAITED from the apex court of the country.

GratitudeNACO – MDACS

UNDP - UNAIDS

USAID – FHI

USAID – AVERT

BMGF – FHI

EU-HIVOS

SIDA -RFSU

GFATM Round 9 - India HIV AIDS Alliance

Fenway Community Health

University of Minnesota

Baldwin Wallace College-Ohio

CIHR-University of Toronto

UCSF

NIH – ICMR

MCC-CMC

NARI – TISS - MGM

ICRW

LSHTM – Welcome Trust

Friends of Humsafar

Thanks for your patience...