Stigma in India
Against a backdrop of insecurity, poverty and marginalization, people with few opportunities sometimes feel that drugs are the best option. People who use drugs are frequently stigmatized by society, harassed by police, rejected by their families and denied medical care by government hospitals. Without support, services or assistance, these vulnerable individuals and their partners are exposed to greater and greater risks, and the impact inevitably extends to the wider community. In many areas of India (such as Nagaland) drugs like spasmo proxyvon, a prescription-only painkilling medication, are widely and easily available. High levels of drug have 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.”
To tackle this problem, the Family Planning Association of India (FPAI) sought Japan Trust Fund (JTF) resources for a project focused on a simple clear-cut objective: to increase access to sexual and reproductive health information and services for the most vulnerable groups. It aimed to reach not only people using drugs, but 3 other vulnerable groups – men who have sex with men (MSMs), sex workers and people living with HIV (PLHIV).
By March 2010, the project was operating at 4 sites in Chennai, Kohmia, Kolkata and Mumbai. It recorded an impressive set of results. Independent analysis of the outcomes at 3 of the sites revealed that over 14,000 consultations took place over 2 years, the equivalent of 135 consultations per week, every week. These consultations included counselling, vaccinations, screening, testing, treatment, referrals and training sessions.
In addition, FPAI conducted training and sensitisation exercises with more than 550 police, railway police, doctors, outreach workers, peer educators and nursing staff. They set up 85 support groups. And ultimately, over 5,000 people from the target groups accessed services.
“At 3 sites, in 2 years, more than 14,000 consultations took place.”
The sensitive integration of HIV and STI services for the target groups into FPAI’s existing SRH facilities was critical to the success of the project. Despite initial unease about introducing marginalized and stigmatized individuals into service settings utilized by the general population, the 'all under one roof' approach to SRH provision produced substantial benefits. Peer educators and drop-in centre activities encouraged vulnerable populations to explore new avenues for identification of SRH problems and to access treatment.
The Evaluation Report provides all the details about the outcomes of this project, but perhaps the personal testimony of the individuals who benefited from the programme is the most convincing. There are countless stories of people who have been supported by FPAI’s JTF-funded work. Athozo said: “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, and I started accessing services like HIV testing, Hep B testing, and also consulted the doctor for my health complications. From time to time I used the counselling service 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 pride in its success, and confidence that more can be done.
A second phase of work was approved for the period April 2010 to March 2012, and the impact of the work will extend far beyond India’s borders. What FPAI has learned will be absorbed into IPPF’s thinking and practice around the world, and further fuel the Federation's ambition: a world in which sexual and reproductive health is recognized as a human right, equally enjoyed by all.