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Towards A More Enabling Environment For Effective HIV/AIDS Responses

Shobha Shukla
By Shobha Shukla, CNS

February 24, 2012
The author is the Managing Editor of Citizen News Service (CNS). She is a J2J Fellow of National Press Foundation (NPF) USA. She has worked earlier with State Planning Institute, UP and taught physics at India's prestigious Loreto Convent. She also co-authored a book (translated in three languages) "Voices from the field on childhood pneumonia" and a report on Hepatitis C and HIV treatment access issues in 2011. Email:, website:

(CNS): A regional consultation, organized jointly by South Asian Association for Regional Co-operation in Law (SAARCLAW), UNAIDS Technical Support Facility for South Asia (TSF-SA) and Maitri, was held recently in New Delhi. It was part of the UNDP funded project ‘Support to the development of enabling environment by scanning of laws that impede effective HIV and AIDS responses in India,’ which aims to develop a comprehensive study on the issue, informed by engagement with the affected communities and other stakeholders during the consultations.

The meeting focussed on the legal and social environments that support or hinder programmes for populations that are vulnerable to, and affected by HIV and AIDS. The session proved to be highly interactive wherein all the participants shared their experiences on strategies, effective partnerships, and policies that can overcome the legal barriers to treatment, care and prevention efforts with key populations at high risk of HIV in India, and suggested recommendations to be reflected in the final report.

It was unanimously agreed that along with amending regressive laws, it will be in the interest of Key Affected Populations (KAP) to interact with the law enforcers, in order to sensitize them about them the problems faced by the communities. There is documented evidence to show that partnerships between law enforcement authorities and affected communities play a crucial role in increasing access to HIV prevention and reducing stigma.

Some good practice targeted interventions (TI) shared by the participants were:-
(i) A very community friendly and successful targeted intervention (TI) program being run amongst Injecting Drug Users (IDUs) in Kozikhode, Kerala for the last 12 years. The program involves participation of the law enforcers with a community friendly approach. The team leader of this TI, started by NACO, was an advocate, who collaborated with the police and narcotics department, making DIG a contact person. Many IDUs in this area are fishermen who need fresh needles when they return from fishing around 3 am when no TI works. On their suggestion, clean needles and other equipment are kept hidden in some pre-selected spots, from where the fishermen pick them up at their convenience.

(ii) A good practice TI program being run by Bharosa in Lucknow for the MSM community. Bharosa has organized around 5 workshops during the last 3 years, to train/ sensitize more than 900 policemen over MSM and HIV issues. Thus the community and the law enforcers have come together on one platform and made each other understand that homosexuality is neither wrong nor illegal. This unified action and regular interaction with the police has empowered the community, who now are no longer easy targets for police harassment. The havildar may still not know the connection between MSMs and HIV issues. But they at least understand that there are people like MSMs who are normal like anyone else.

(iii) Excellent intervention programs have also been initiated by law enforcers in Kolkata and Asansol amongst IDUs and sex workers. In Andhra Pradesh also there are good practices and the DGP works with the community and.

But such examples are few and far between. Some bad and ineffective practices were also mentioned, like some interventions for MSMs by church led groups in Kerala, where MSM intervention is supported by State AIDS Control Society (SACS) of Kerala. The group would invite gay people to attend church services so that they could be counselled to become straight. When asked if they promoted condom use, they said that condoms were given after the person got married. Similarly Delhi SACS was cited to have engaged a church based organization which distributes bibles to MSMs and tries to change their behaviour asking them to become straight.

There were concerns about the confusion around the meaning of ‘enabling environment’ as, even some of the law professionals are not clear about what this environment is. TIs are a component of enabling environment and National AIDS Control Organization (NACO) should clearly define and spell out the guidelines as to what is meant by enabling environment.

It was felt by all participants that there is a dire need for legal aid cells/clinics in every state. Legal aid delivery systems for PLHIV are not operative in most states, especially in rural areas. It was recommended that all SACS should have selected lawyers on their payroll, who are made members of these cells. They should be sensitized and trained in the basic issues pertaining to PLHIV, like Lesbian, Gay, Bisexual, Transgender community (LGBT), sex workers, and women. Any community member should be able to avail of their services free of cost to settle any legal dispute. This is already happening in Kerala, (where Kerala SACS has trained and empanelled 70 lawyers from 40 districts) and needs to be replicated in other states. This would go a long way in creating an enabling environment by taking care of legal problems of key affected populations, especially of women who are thrown out of their houses without getting any share in property. As of now, KAP do not know whom to approach for legal advice.

Aditya Bandopadhyaya, an activist, pleaded for targeted interventions to be led by Community Based Organizations (CBOs) and not by NGOs, as is currently happening. He was emphatic that, “effective empowerment of community will happen only when NACO junks its policy of supporting NGOs and favours targeted interventions only through the medium of CBOs. It is high time that NGOs restrict themselves to be technical support agencies and TIs be CBO led without any NGO intervention.”

Many from KAP felt that there should be no line/forced testing for HIV. Currently everyone in the TI has to be tested for HIV twice a year, and get his/her details recorded. This or any other kind of coercive regimen can never lead to any positive steps in the field of HIV. It has perhaps led to 50% fall in attendance, across the country, at Integrated Counselling and Testing Centres during the past one year.

National programs should also address gender inequality so that women have the power to negotiate for condom use and safe sex practices, which are currently male-dominated. Female condoms should be promoted (many women are not even aware that such a thing exists). Also PLHIV should have the right to marriage, and to have/adopt children. NACO should have a special policy/program to address the problems of HIV widows and orphans, whose numbers have increased over the years.

PLHIV should be made to understand that they can only get empowered to fight for their rights if they do not self-discriminate. They should feel comfortable to talk about their sexuality and HIV status. Also, when we talk of stigma we will have to go beyond affected communities. Stigma is there because unaffected populations do not understand the issue. So everyone should be made aware of the issues of HIV and LGBT. Health education must become a compulsory part of school/college curriculum where all information about reproductive and sexual health rights, safe sex practices, HIV/AIDS should be told to students, as there is a near total lack of awareness about all this which often lands youngsters in dire situations.

Sarita from the United Nations Development Programme stressed upon the need for documentation and compilation of all the good/bad practices of NGOs/CBOs, and other HIV related issues, on one platform in the public domain, to be shared with communities of different states in their local language. Interstate/community exchange/dissemination of practical doable strategies and other HIIV/AIDS related information is the need of the hour. Alongside, we can have annual high level intellectual discussions on law with likeminded people, and disseminate the information to community groups, for them to know their rights and responsibilities, and also connect them with policy makers. This knowledge sharing would also make them treatment/prevention literate and dispel several misconceptions, like becoming victims of false promises of cure made by quack doctors. Many such doctors operate not only in villages but even close metro cities.

The final report, will be a comprehensive overview of the laws impeding an effective HIV and AIDS response, reflecting the situation on the ground, the realities of affected communities and the views of key stakeholders working in the field in India, based upon the recommendations from all the regional consultations. It is hope that the report will act as a comprehensive resource document and advocacy tool that stakeholders can use to advocate for an environment that is legally and socially enabling for PLHIV as well as key populations at high risk of HIV/AIDS. (CNS)

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Posted on: February 24, 2012 02:43 PM IST


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