Presentation by Vivek Raj Anand Chief Executive The Humsafar Trust Mumbai, India

HUMSAFAR Prevention, Care, Support and Treatment Minimum Service Delivery Package

~ Community Mobilization ~ Street Outreach and Condom Distribution ~ IEC Development and Distribution ~ STI Service and HIV Testing Facility ~ Care, Support and Treatment ~ Advocacy and Networking ~ Research and Training ~ Project Management Humsafar MSD Package Includes

~ Drop-in-center ~ Library and Archives ~ Face-to-face counseling ~ Help-line (Telephone and ) ~ Community Workshops ~ Skills Building Programs Community Mobilization

Outreach education on safer sex practices and increasing awareness on STIs among MSM and Tg and HIV and AIDS Conduct 1to1 and 1 to Group sessions Street Outreach

Condom Distribution – Free and Socially Marketed

Street Outreach - Lubes distribution Condom Demonstration and Condom Outlets

Street Outreach : IEC Development and Distribution

HST offers increased accessibility to high quality STI examination / treatment, HIV testing facilities HST links with Private Medical Practioners (PMPs) around hotspots to provide STI care and referrals for HIV testing STI and HIV Services

HST also provides general examination of routine illnesses to the MSM / TG Community at the HST Clinic HST counselors provide pretest and post test counselling to MSM and TG clients at HST clinic and its other referral linkages STI and HIV Services

Partner Notification HST encourages partner notification to MSM-PLWHA under its partner notification program

3 In house clinics and strategic linkages with public Health Care providers for care, support and treatment ~ Lokmanya Tilak Medical General Hospital ~ JJ Hospital ~ Thane Civil Hospital ~ MSF Treatment Center Referral Linkages

To meet the specific requirements of the MSM-PLWHA, HST initiated “Sanjeevani” a group formed by and for MSM-PLWHA Care, Support & Treatment

Safe space for positive men to meet and discuss their issues Initiate activities for getting family and community support Professional mental health support Initiate training and employment programs Sanjeevani

Initiating programs to promote healthy minds and healthy bodies Treatment of Opportunistic Infections (OIs) and enrollment in accessing ART Sanjeevani

Nutrition counseling and nutritive supplement support Provision of potable water and weighing machine at SSC premises Sanjeevani

Advocacy and Networking with different stakeholders and gatekeepers to create an enabling environment Advocacy is done at 2 levels Level 1 : direct influencers Level 2 : indirect influencers Advocacy & Networking

Level 1 : Direct Influencers ~ Police ~ Doctors / Counselors and Health providers ~ Lawyers ~ Educational Institutions ~ Job providers for employment of PLWHA ~ General Population Advocacy

Level 2 : Indirect Influencers ~ Municipal Corporators ~ Political parties ~ Policy makers ~ Press and media ~ Condom Manufacturers Advocacy

INFOSEM The Integrated Network for Sexual Minorities was set up in October 2003 Main objective : To join hands on vital issues of Sexuality, Health and Human Rights Members : 26 LGBT groups across the country Networking

Research Gather Information systematically and scientifically to show evidence for up scaling of MSM holistic projects in the country First Knowledge-Attitude-Behavior-(KAB) study in March 2000, baseline for its pilot project Second wave study in March 2002 – KAB among MSM Third wave study in May A HIV related risk behaviors of MSM in Mumbai & Thane Fourth wave study in 2005 Fifth wave study in 2007 ( Awaiting Dissemination )

Organize training programs for Outreach Workers (ORWs) and Peer Educators (PEs) led by trained community trainers. Training in MIS systems /Accounts / Financial management for the financial and administrative staff Training / sensitization for doctors and counselors specific to their respective roles Training for Community Counselors and CCHWs Training

Develop management information systems (MIS) Develop human resources policy (HRP) Strengthen financial management systems (FMS) Monitoring and evaluation systems (M&E) Advisory boards (Community and Health ) Project Management

Project Support Systems Crisis Management Cell Friday Workshop Panel Advocacy Panel Street Theater Group Project Management

CHALLENGES Reaching the un-reached Female partners and wives of MSM Female partners and wives of MSM Married and bisexual MSM Married and bisexual MSM Stigma and discrimination Disclosure of positive status reflected in Disclosure of positive status reflected in stigma onion of HST stigma onion of HSTMainstreaming Acceptance of rational attitudes to sexuality Acceptance of rational attitudes to sexuality

STIGMA ONION OF HST HIV + STATUS MSM Married to woman Cross-dresser Sex worker Socio economic status