Non-Formal Education and Income Generation Programs Strengthen HIV Prevention in Male-to-Female Transgender Community Gr

1. Non-Formal Education and Income Generation Programs Strengthen HIV Prevention in Male-to-Female Transgender Community Groups in Rural India Main author: Amitava Sarkar, Solidarity and Action Against The HIV Infection in India (SAATHII), India. Co-authors: Sk. Jalaluddin, Santi Seva, India; Dr. L. Ramakrishnan, Mitali Mohanty, Pawan Dhall, SAATHII, India. Track: E21 / Poster number: THPE1096 • ISSUES • Global evidence shows that poverty and illiteracy are correlated with high risk sexual behaviours in male-to- female transgender (MTF TG) populations. * • Experience from Bangladesh has shown that training programmes in non-formal education, health and legal rights education, organizational development and leadership skills are associated with safer sex behaviours.** • Successful experiences from Tamil Nadu and Mumbai of Transgender Rights Association and Humsafar Trust in integrated livelihood options (including vocational training and income generation activities) need to be replicated. • Assessment of SAATHII and partner NGO Fellowship in Bhadrak, Orissa also has identified education and livelihood options as critical needs of MTF TG populations along with the ongoing HIV/AIDS services in India. • DESCRIPTION • SAATHII strengthens HIV response of government and non-government sectors in eight states of India. In 2004, SAATHII set up an HIV/AIDS Support Centre in Calcutta to scale up HIV response among MSM and MTF TG populations in eastern India.*** The centre addressed gaps in enabling environment for these populations. • In 2006, SAATHII assisted Fellowship in Bhadrak district of Orissa state to begin mobilizing an informal rural and semi-urban network of about 200 Maichiyas, Hijras and other MTF TG persons into a support group called Santi Seva. BHADRAK – ORISSA – INDIA • Group formation was part of an HIV targeted intervention of Fellowship funded by Orissa State AIDS Control Society (OSACS). But group agenda was set by its members to include social security needs along with health services delivery. Key needs identified by Santi Seva members: Action taken by Santi Seva, Fellowship, SAATHII to meet key needs (2006-08): • MSM and MTF TG community leaders from Tamil Nadu and West Bengal met Santi Seva members to motivate them • Employment ensured for at least two Santi Seva members as Peer Educators to lead and coordinate group activities • Exposure visits organized for Santi Seva members to queer networking and advocacy events in Calcutta and Chennai • Drop-in centre (DIC) set up in Bhadrak town to provide: (a) Safe space for monthly open and planning meetings; (b) Library with audio-visual and other educational aids; (c) Psycho-social counseling services; (d) Non-formal education classes (beginning with basic literacy skills) – 9 individuals attended 116 classes in 2007-08 with average attendance of 66% per individual • Income generation program started to support Santi Seva members in running small businesses – interest free loans of Rs.2,000 (US$ 50) each provided to 6 individuals in 2006-07 (with near 100% loan recovery in little over one year) • Loan amount increased to Rs.4,000 (US$ 100) in 2007-08 and number of beneficiaries increased to 11 • General health, hygiene and sanitation education added to existing HIV targeted intervention program of Fellowship • Emergency health services access fund created for HIV positive and other members of Santi Seva • Leaderships skills building, civil rights education and access to social welfare schemes facilitated • In early 2008, a consolidated program including all the above started for capacity building of Santi Seva and its members – MTF TG staff from SAATHII assigned to coordinate program Funds raised by Fellowship and SAATHII for these activities from: • LESSONS LEARNT • 1. Impact on health services delivery under existing HIV targeted intervention of Fellowship started in 2006: • Popularity of Santi Seva group meetings, education and livelihood activities at DIC space made access and health communication with MTF TG people in Bhadrak district easier for targeted intervention program staff. • Fellowship’s assessment showed that rate of protected penetrative sexual acts among Santi Seva members went up from 20% in 2006 to 34.20% in 2007.**** • Targeted intervention served both Santi Seva core group members and other MTF TG in Bhadrak district. But its impact was better on Santi Seva core group members who were also beneficiaries of education and livelihood activities, compared to other MTF TG. • Members of core group reported greater use of condoms and lubes for penetrative sexual acts (vaginal sex, receptive / penetrative anal sex).***** - Elton John AIDS Foundation, London - American Jewish World Service, New York - OSACS, Bhubaneswar - Queer communities in Calcutta and other parts of India (through fundraisers) - Own corpus funds • Sk. Samser: • - My social and economic • status is improving • - I am increasing my literacy • skills • - My knowledge of safer sex has • improved • - I would like to continue as an active member • of Santi Seva • - I would like to participate in more and more • training activities • Personal testimonies of change****** • Sk. Jalaluddin: • - My literacy level has improved • - I have learnt some counseling • skills • - I now know more about • HIV/AIDS • - I am now more respected in my family • - My role in the community has changed because I • have become a community leader and have more • responsibilities • Success story of ‘SMG’******* • In early 2008, Santi Seva member SMG (name initials), who is HIV positive, left home because of an altercation with her family. S/he shifted to the shrine of a Pir Baba (Muslim holy leader) not far from her home, and stopped taking care of personal health and nutritional needs. • Her health deteriorated. But s/he refused to return home or take any medicines till Pir Baba appeared in her dreams to grant her a wish she nurtured for long. • Santi Seva members and staff from Fellowship and SAATHII took turns to visit SMG with food and water and tried to make her change her mind. They involved religious leaders in Bhadrak to persuade SMG that if s/he did not stay healthy, there would be no point in her wish being granted. • This move worked and SMG agreed to a CD4 count test at the Beherampur ART Centre and to take her medicines regularly. Her travel from Bhadrak to Beherampur was funded from the group’s emergency health fund. • SMG has now resumed attending Santi Seva’s group meetings and other activities. She talks to other MTF TG persons in Bhadrak about HIV prevention and safer sex, and has become a role model for her group and community. • NEXT STEPS • Even small initiatives that address socio-economic and civil rights needs of MTF TG persons can have a significant impact on their self esteem, receptivity to sexual health messages and ability to access HIV services. • Santi Seva members will be trained to share their experiences with other MTF TG networks in India. • SAATHII and Fellowship intend to scale up the consolidated Santi Seva development program in coming months – focusing on education, livelihood and other social security needs of MTF TG persons in Bhadrak district. End line study to be conducted in early 2009. • Impact of program on Fellowship’s HIV targeted intervention will also be documented through end line study and findings shared with government bodies, funding bodies and civil rights organizations. • India’s National AIDS Control Programme – Phase III (NACP – III) stresses development of enabling environment. Learning from Santi Seva’s program will provide strategies for incorporation of non-formal education, livelihood and other social security measures into HIV targeted interventions being scaled up under NACP-III. • Lessons learnt from Santi Seva’s program will be replicated with MTF TG and MSM populations in other parts of Orissa and India. SAATHII and Fellowship have buy in of OSACS for replication in other districts of Orissa. * “HIV Risk Behaviors Among Male-to-Female Transgender Persons of Color in San Francisco”; Tooru Nemoto, Don Operario et al; Center for AIDS Prevention Studies, University of California, San Francisco; 2004 ** Badhan Hijra Sangha, supported by CARE Bangladesh, Dhaka (abstract for International AIDS Conference, Bangkok, 2004) ***With funding support from Elton John AIDS Foundation, London **** Evaluation of Fellowship’s HIV targeted intervention in 2007. ***** Baseline study in March-April 2008 conducted for consolidated Santi Seva development program. ******Extracts from March-April 2008 baseline study for consolidated Santi Seva development program funded by AJWS, New York • ******Santi Seva 2008 baseline study • Photograph credits: SAATHII, Kallol Nath. All photographs included with consent