Stigma in India

Serving a rejected and stigmatised group: people who use drugs in India

A context of insecurity, poverty and marginalization often pushes people to use drugs. People who use drugs (PUDs) are frequently stigmatised by society, harassed by police, rejected by their families, and frequently denied medical care by government hospitals. Without support, services or assistance, PUDs and their partners are exposed to greater and greater risk, and the impact inevitably extends to the wider community. In many areas of India (such as Nagaland) there’s easy availability of drugs like spasmo proxyvon, a prescription only painkilling medication, leading to high levels of use. This has become a driving force behind the spread of HIV.

“Spasmo-proxyvon ... is used more widely than heroin. It’s a driving force behind the spread of HIV”

A JTF project which started in April 2008 set out to tackle this seemingly intractable problem. It was directed not just at PUDs, but at three other “Key Populations” (KPs) – men who have sex with men (MSMs), sex workers (SWs) and people living with HIV (PLHIV). Many amongst these KPs were engaging in behaviour and practices with serious impacts on their sexual and reproductive health (SRH). IPPF’s Member Association FPAI (Family Planning Association India) sought JTF funding for a project focused on a simple clear-cut objective: to increase access to SRH information and services for the KPs.

By March 2010, the project (operating through four sites in Chennai, Kohmia, Kolkata and Mumbai) had recorded an impressive set of results. Independent analysis of the outcomes at three of the sites, across the two years, revealed that over 14,000 consultations took place - counselling, vaccinations, screening, testing, treatment, referrals and training sessions – equivalent to 135 consultations per week, every week, for 24 months. There were major training and sensitisation exercises with a total of over 550 police, railway police, doctors, outreach workers, peer educators and nursing staff. 85 support groups were set up. And ultimately, over 5,000 people from the KPs were able to access services.

“At three sites, in two years, a total of over 14,000 consultations took place”

What was critical to the success of the project (and one of the key intentions of the work) was the sensitive integration of HIV and STI services for the KPs into FPAI’s existing SRH facilities. Despite initial unease (from many other service users and even from staff at some locations) about mixing marginalised and stigmatised individuals with general service users, the “all under one roof” approach to SRH provision realised substantial benefits. Peer educators and drop-in centre activity encouraged KPs to explore new avenues for identification of SRH problems and to access treatment.

There’s a 34 page Evaluation Report which itemises all the objectives, actions and outcomes of this particular project. But perhaps what’s most convincing is the personal testimony of the individuals who benefited from the programme. There are countless stories of people who have been supported by FPAI’s JTF-funded work. Athozo (his name has been changed for privacy reasons) related the following to IPPF:

“My friends who are working in FPA India introduced me to the office by contacting me at my place in one of those fixing joints and motivated me to drop in at their centre which is providing services for people like me.

“My friend in the FPAI office showed me the way beyond addiction ... it’s changed my life”

“I got an access card [an ID card which allows the client to access any SRH and HIV related service from the project free of cost]. I started accessing the services like HIV testing, Hep B testing, and also consulted with the doctor for my health complications. From time to time I used the counselling service from the counsellor and I came to learn so many things to protect myself from HIV.

“Through them I changed my life to a great extent. FPAI staff referred me to Kripa Foundation rehabilitation centre where I completed my treatment and now I am staying clean and sober. This has happend because of the help, care and support that I received from FPAI staff. I want to thank you for making me a better person.

Athozo’s testimony bears witness to the immense value of this JTF project. There is both pride in its success, and confidence that yet more can be done. A second phase of work was approved for the period April 2010 to March 2012. The impact of the work will extend far beyond India’s borders. What FPAI has learned over the past three and a half years will be absorbed into IPPF’s thinking and practice around the world, and further fuel the organisation’s over-riding ambition: a world in which sexual and reproductive health and rights are recognised as a human right, equally enjoyed by all.

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