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 26 th 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 Indias 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) Indias 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 2 nd July 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.

Gratitude NACO – 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

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