Internalized homophobia and transphobia, low self-esteem and non-disclosure of sexual identity as factors contributing to HIV vulnerability of MSM, transgenders and hijras Experience from the Global Fund-supported Pehchān program in India Authors: S. Shaikh, S. Lonappan, G. Kummarikunta, K. Biswas, S. Rakesh, A. Aher, S. Mehta, J. Robertson India HIV/AIDS Alliance, New Delhi, India Abstract Number: THAD0505 MSM: The Impact of Internal and External Stigma on a Personal and Social Level 26 July 2012  14:30-16:00  Session Room 8

HIV/AIDS in India First case identified in % national adult HIV prevalence 2.4 million PLHIV Concentrated epidemic: sex workers and clients; MSM; transgenders/hijra; IDUs; migrants Coordinated national response: NACO, SACS and civil society Prevention emphasis on High Risk Groups (above) MSM HIV prevalence: 5.1% (2011 NACO provisional data) Transgender HIV prevalence: not yet measured nationally (studies range from %: UNDP, 2010)

Pehchān Global Fund-supported HIV programme that will strengthen 200 community-based organisations (CBOs) to partner with government HIV prevention interventions to reach 453,750 MSM, transgenders and hijras in 17 states over five years ( ) Key features: Establishes and strengthens CBOs to implement the government’s Targeted Intervention (TI) strategy 90 new & 110 existing CBOs Builds capacity of organisations and individuals Strengthens community systems Supports development of community-friendly services Undertakes advocacy, policy and operations research initiatives Uses community-driven and rights-based approaches 15% of population reached transgender or hijra

Pehchān Consortium India HIV/AIDS Alliance (PR)National coordination & grant oversight The Humsafar Trust Goa, Gujarat, Madhya Pradesh, Maharashtra & Rajasthan SAATHIIJharkhand, Manipur, Odisha & West Bengal Sangama Karnataka & Kerala SIAAPTamil Nadu Pehchān North Region OfficeBihar, Delhi, Punjab & Uttar Pradesh Alliance India APAndhra Pradesh

Self-Stigma in MSM & Transgenders Internalized stigma, homophobia and transphobia contributes to: – Non-disclosure of sexual identity – Low self-esteem – Increased vulnerability to HIV – Reduced overall health and wellbeing Internalized stigma is formed and reinforced by external stigma, homophobia and transphobia in families and society at large.

Methods Cross-sectional baseline study to understand demographics, behavior and needs of Pehchān target populations Sample size: 2,762 MSM, transgenders and hijras (TG/H: 16.55%) – 95% level of confidence with a power of 80 and design effect of 2 to measure incremental changes in behaviour over time (midline & endline planned) Geographic coverage: 55 districts across 10 states Fieldwork: June & July 2011 Time and Location Cluster Sampling (TLCS) used as subjects hard-to-reach and relatively mobile SPSS employed for data analysis

Results Self-disclosure of sexual identity: With community peers (67%) With siblings (22%) With parents (21%) Fears related to disclosure included: neglect, rejection, isolation, verbal/physical abuse, being rendered homeless and adverse legal consequences. Feelings associated with sexual identity among study subjects: Shame (33%) Self-blame (28%) Guilt (26%) 30% have actively attempted to avoid disclosure of their sexual identity.

Conclusions Low self-esteem among MSM, transgenders and hijras and fear of rejection contributes to non- disclosure of sexual identity. Building on insights from the baseline, Pehchān developed a life-skills training module that places greater emphasis on coping, communication and interpersonal skills to address sexual identity. Through support groups and related services, Pehchān-supported CBOs will help community members manage disclosure more successfully. Pehchān plans messaging to address societal attitudes about homosexuality and gender identity in families and communities in India.

Thank you! Simran Shaikh Programme Officer: Pehchān India HIV/AIDS Alliance Like Alliance India on Facebook: facebook.com/indiahivaidsalliance