I was looking forward to meeting the leaders of community responses to HIV from across the world. We had decided the 2015 meeting would be in February in India, a country that has led the way developing the generic anti-retroviral drugs that keep millions alive, a country that has taught us how to mobilise and provide services to key populations (sex workers, men who have sex with men, transgender and hijras, drug users) at scale.
We were, it has to be said, disappointed. India's efforts to combat HIV are currently going through a rough old time of it. With budget cuts to the AIDS programme for 2015-16; structural changes to the National AIDS Control Organisation (NACO); ongoing difficulties in procuring antiretroviral drugs, diagnostic kits and condoms; and the re-emergence of homophobia in the wake of the Supreme Court Judgement on Section 377 of the Indian Penal Code re-criminalising same sex relations, a comprehensive HIV response is very much in jeopardy.
According to the UN Secretary General's Special Envoy for AIDS in Asia Pacific, Prasada Rao, in a recent article in the Hindustan Times, India needs to put another one million people on treatment and enhance testing and prevention programmes to cover 90% of key affected populations to achieve its target of ending AIDS as a public health threat.
Those key affected populations include marginalised groups such as men who have sex with men, the transgender and hijra communities. Despite Prime Minister Modi's reform agenda, Section 377 continues to cast a dark shadow over India's lesbian and gay population with minority rights being eroded away and individuals facing stigma, discrimination and violence, in some cases extortion and blackmail.
Photo by Soni Varghese for India HIV/AIDS Alliance
Abhina Aher, who herself belongs to the hijra community, is a programme manager with our partner organisation India HIV/AIDS Alliance, and spoke recently about the adverse impact that Section 377 is having. "All those people who came out as men who have sex with men have gone underground. You don't see them socialising any more. They don't even have sufficient access to condoms and HIV testing," she warned. "Sexual minorities are not being given enough support and face harassment because of punitive laws which have huge implications for the HIV response towards most at risk populations such as sexual minorities."
Even last April's landmark Supreme Court ruling which recognised transgender people's right to identify as a third gender has so far delivered little in terms of increasing access to healthcare and specifically HIV prevention, treatment, care, social welfare, equal rights and support services.
Initiatives like the ground-breaking Pehchan programme, funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria, are helping to bridge this gap by strengthening communities. Pehchan is the Hindi word for identity, recognition or acknowledgement, and the project's particular strength lies in the fact that, as Abhina put it, "communities are now in the driver's seat." Working with some 200 community-based organisations to provide effective, inclusive and sustainable HIV prevention programming in 18 states in India for nearly half a million men who have sex with men, transgenders and hijras, Pehchan was conceptualised at the community level and the services it supports have been shaped in direct response to the needs of the groups in question.
According to Abhina, "When I go to the transgender and hijra community and say why don't we go for HIV testing, they tell me that that's not their priority, that their priority is their mental health and the abuse they face, or that their priority is their feminisation, psychosocial support or needing legal advice."
However, with a 30% cut in the national HIV budget this year in India, it's clear that HIV prevention efforts on the ground will suffer. And with funding for Pehchan coming to an end in September this year, that raises a massive question mark over who picks up the baton. Abhina is worried that efforts made in reaching marginalised groups so far will be reversed by at least a decade. "What we have is a group of people who have come forward to create a better life for health and human rights. Pehchan is about dignity, it's about community strengthening, it's about creating a platform for sexual minorities who have been oppressed over the years. If we really want to create a different India and support the global goal to eradicate AIDS, we have to invest in most at risk communities."
The ten days in Delhi were intense. Incredible India has both the energy and the know how, will it invest in communities and continue to show the way?