11 EQUIPPING AND OPERATING A VOLUNTARY “FIRE DEPARTMENT” MANAGED AND RUN BY HIGH RISK GROUPS TO ADDRESS THEIR FOREMOST CONCERNS, TACKLE VIOLENCE, ABUSE AND OTHER THREATS IN THEIR DAY TO DAY LIFE Experience from Avahan – India AIDS Initiative Mexico IAS Conference – Avahan Satellite Session August 4, 2008

22 SESSION STRUCTURE  Identifying the need for crisis response in Avahan  Steps in setting up a crisis response system  Management of crisis response at scale  Discussion Questions will be taken during the session at select points

33 Is there a need for crisis response interventions in HIV prevention programs?

44 SESSION STRUCTURE  Identifying the need for crisis response in Avahan  Steps in setting up a crisis response system  Management of crisis response at scale  Discussion Questions will be taken during the session at select points

ACHIEVING AND MAINTAINING SCALE Source: Avahan routine monitoring data Towns covered Peer educators High risk groups covered (figure in thousands) Condoms distributed and sold per month (figure in millions) Dec 03 Jun-04Dec-04Jun-05Dec-05Jun-06Dec-06Jun-07Dec-07 Districts (83) States (6) Intervention sites

66 VIOLENCE IS THE RESULT OF STIGMA AND DISCRIMINATION

77 VIOLENCE AMONG GROUPS AT HIGHEST RISK Perpetrators of Violence, Abuse, Harassment and Discrimination  Clients of sex workers  Pimps, brokers, and madams  Police  Gang members and hooligans  Neighbors and public  Regular partners or husbands  Family members  Health care workers, school and government officials Common Forms of Violence  Verbal and emotional abuse  Unpaid sex and forced sex  Partner physical abuse  Extortion  Wrongful arrest, denial of due legal process  Physical assault  Ostracism  Denial of medical, educational, and governmental services and benefits

88 PERPETRATORS OF VIOLENCE DIFFER BY TYPE OF HIGH RISK GROUPS 52 percent of the female sex workers and 63 percent of the men who have sex with men reported facing emotional, physical, or social violence during the previous three months Source: Tamil Nadu AIDS Initiative’s Survey, 2006 India Among FSWs in Tamil Nadu 2004 Among HR-MSM and TGs in Tamil Nadu 2004 Source: TAI Monitoring data, 2004

99 TRENDS SHOW LONG TERM IMPACT AND NEW CHALLENGES FOR FSW Source: TAI program monitoring data Note: Out of 1,023 total cases, cases for 2008 are only recorded through May Level of police and client violence experienced by female sex workers have decreased over three years but reports of partner violence are going up; this may be attributed to backlash violence or increased reporting.

10 EVIDENCE FROM CRISIS RESPONSE WITH THE HR-MSM COMMUNITY Source: TAI program monitoring data Note: Out of 261 total cases, cases for 2008 are only recorded through May Family violence is a problem for high-risk men who have sex with men, as well as violence from police and partners. All appear to be going down as their are being addressed by crisis response systems.

11 ADDRESSING VIOLENCE IS CRITICAL TO HIV PREVENTION Source: Karnataka Health Promotion Trust (KHPT), Bangalore, Integrated Biological and Behavioral Assessments among FSWs in selected districts of Karnataka, 2006

12 Participants Response

13 SESSION STRUCTURE  Identifying the need for crisis response in Avahan  Steps in setting up a crisis response system  Management of crisis response at scale  Discussion Questions will be taken during the session at select points

14 STEPS IN CRISIS RESPONSE 1.Assess the need for crisis response 2.Organize the crisis response team 3.Train the team members 4.Implement crisis response 5.Report and analyze data 6.Educate the community and the police 7.Build public acceptance and support for crisis response 8.Integrate crisis response with advocacy and community mobilization

15 ASSESS THE NEED Consultations with communities to  Determine nature and extent of violence  Assess the readiness of communities  Identify champions & network support  Identify lawyers  Understand local power structures (those exercising power over community) STEP 1

16 DEFINE CRISIS RESPONSE Immediate  Get to the scene >1 hour  Counseling for individual  Medical and resource support  Extraction from crisis situation (lawyer rushed to scene if needed)  Team negotiates / confronts/ counsels perpetrators Strategic  Counseling with family and community  Lawyers to work with authorities and train communities  Sensitization with police and other authorities  Advocacy and networking with other rights groups  Work with media to improve public perception  Reporting and documenting violence and crisis response STEP 1

17 IDENTIFY RESOURCES Local System (coverage of 40,000 in an urban area)  Six designated community members (they may rotate monthly)  Six mobile phones  Local transport budget  Meeting place  Lawyer(s) 24x7  Crisis hotline Card  Crisis management reporting forms  Alliances with other groups STEP 1

18 ORGANIZE THE CRISIS RESPONSE TEAM STEP 2

19 DEFINE ROLES AND RESPONSIBILITIES OF CRISIS RESPONSE TEAM Selection Criteria  Representative of the localities and typologies of the community (e.g., brothel-based and street-based sex workers)  Participate in initial training and all follow-up trainings  Available by phone 24 hours a day when they are on duty  Committed to respond immediately Scope of Work  Respond to crises 24 x 7  Follow up  Document  Capacity building  Sensitization  Build Alliances and Advocacy STEP 2

20 TRAIN THE CRISIS RESPONSE TEAM Content for the training  Function; roles, responsibilities  Sources of and reasons for violence  Types of crises to be addressed; geographic focus and populations to be served  Stakeholder analysis (perpetrators, influencers, supporters)  Legal rights and speaking to police  Communication skills: listening, negotiation, conflict management, etc.  Recordkeeping and documentation  Media advocacy Audiences  community, police, local leaders, local power structures Done in phased and participatory manner STEP 3

21 Participant Questions

22 RESPOND WHEN CRISIS OCCURS Immediate 1. Dispatcher gets call 2. Informs team 3. Crisis team arrive (in 30 min.) 4. Verify details of the crisis 5. Arrange for legal and medical support 5. Address the perpetrators (if possible) Next Day 6. Documentation of the crisis 7. Crisis response team meets a) advocacy committee and NGO staff b) other community members Within the First Week 8. Final resolution documented STEP 4

23 CRISIS PHONE NETWORK & PUBLICITY STEP 4 Media  Informed coverage of crisis  Sensitive to rights of individuals  Train high risk spokespeople  Develop skills to work with media  Install discretionary policies Networking  Gain training and skills support  immediate back-up for advocacy,

24 REPORT AND ANALYZE DATA STEP 5 Data Collection should Include  Time and location  Nature  Perpetrator and target  Who responded  Response time  Nature of any follow-up  Nature of legal action

25 REPORTING FORMAT STEP 5

26 WORK WITH POLICE AND LEADERS STEP 6  Police endorsed ID cards  Monthly meetings  ‘Go to’ officer established  Recognition for supportive  Integrate information in police training schools curriculum  Advocate for workplace polices for police (prohibit mandatory testing) Work with police to gain support for peers and stop discrimination

27 BUILD PUBLIC ACCEPTANCE STEP 7

28 Participant Questions

29 SESSION STRUCTURE  Identifying the need for crisis response in Avahan  Steps in setting up a crisis response system  Management of crisis response at scale  Discussion Questions will be taken during the session at select points

30 MANAGEMENT OF CRISIS RESPONSE SYSTEM AT SCALE  Collect and Use data - learn  Advocacy at higher level  Local and community led  Review and establish milestones  Use common training resources  Define common minimum standards  Part of comprehensive work

31 INTEGRATE STEP 8

32 Experience Sharing by Communities

33 KARNATAKA – HIV ANC PREVALENCE 2006 Source: NACO’s Sentinel Surveillance data: ANC sites (2006)

34 HIV PREVALENCE IN MAHARASHTRA (2006) Source: NACO’s Sentinel Surveillance data: ANC sites (2006)

35 HIV PREVALENCE IN TAMIL NADU (2006) Source: NACO’s Sentinel Surveillance data: ANC sites (2006)

36 SESSION STRUCTURE  Identifying the need for crisis response in Avahan  Steps in setting up a crisis response system  Management of crisis response at scale  Discussion Questions will be taken during the session at select points

37 Thank you Karnataka Health Promotion Trust

38 Is there a need for crisis response interventions in HIV prevention programs?

39  Extra slides incase they are needed to answer questions.

40 CRISIS INTERVENTIONS IN THE LAST SIX MONTHS ( BANGALORE MSM)

41 POSITIVE CHANGE IN ATTITUDES BY PROFESSIONAL CATEGORY

42 POLICE TRAINING

43 GROWING NUMBER OF SPOKESPEOPLE FROM THE COMMUNITY OF SEX WORKERS 25% of the spokespeople trained were quoted on the media – their experiences/ challenges/ achievements in motivating the community

44

– 06 = 348 stories 2006 – 07 = 770 stories TRENDS IN HIV/AIDS MEDIA COVERAGE – 2 YEAR COMPARISON

46 BREAK UP OF MEDIA COVERAGE BY LANGUAGE - HIV/AIDS AND KEY POPULATION NEWS – OVER TWO YEARS