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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.
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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 Internalized homophobia and transphobia, low self-esteem and non-disclosure of sexual identity as factors contributing to HIV vulnerability of MSM, transgenders and hijrasExperience 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
HIV/AIDS in India • First case identified in 1986 • 0.31% 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 17.5-41%: 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 (2010-2015) 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 AP Andhra 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 CBOswill 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 sshaikh@allianceindia.org Like Alliance India on Facebook: facebook.com/indiahivaidsalliance