Providing aid to the unaided

Geetu Vaid

Reaching out to the groups that are marginalised and isolated due to a conservative social mindset is crucial for success of the AIDS awareness campaign.   And walking down this ‘road less taken’ is a  man with a royal lineage. Prince Manvendra Singh Gohil is bearing the torch for some of the extremely vulnerable and virtually “untouchable” sections of society — the MSMs (men who have sex with men) and transgender communities — for over a decade now. 

The Prince of Rajpipla in Gujarat, who had whipped up a storm of dissent for himself by coming out in the open about his gay status in 2006, has been working to spread awareness about AIDS in these communities through his Lakshya Trust established in 2000. He is currently the Goodwill Ambassador of AIDS Healthcare Foundation India Cares (AHF). Recipient of Civil Society Award from UNAIDS for outstanding performance in AIDS awareness among homosexuals, Manvendra has been associated with awareness campaigns since 1995 when he started working with Mumbai-based Humsafar Trust, which was the first organisation to work for MSM and transgender communities. “In the past 20 years there has been a significant change in perception regarding the disease and those suffering from it. Now, one can see AIDS prevention and treatment being discussed in medical seminars and in educational institutions. When we had started working then not only the educated people but also those in the medical profession would cringe and avoid dealing with anyone with HIV+ status.” Having seen the challenge of not getting volunteers to work with MNM and TG groups and being harassed and chased by cops in Mumbai during our condom-distributing campaigns, he says that it is the stigma, taboos and conservative mindset that poses the biggest challenge still in India. “We need to understand that AIDS is not just a health issue; it is a social issue and concerns with so many barriers and misconceptions aggravating the situation for vulnerable groups”, says this gay icon who has battled his own demons of guilt and societal pressures while coming to terms with his own sexuality. 

Thus, fighting this double battle has made him all the more sensitive about the vulnerability of these communities. “These minority groups are the most vulnerable and are an important focus area if we have to stem the spread of this deadly virus in our country,” he says, while highlighting the fact that it is difficult to identify the potential carriers who have no knowledge about the risk they are putting themselves through. 

“A person who is not fitting into the so-called normal standards of the society is under a lot of mental trauma and has virtually no avenues to discuss and address his concerns regarding HIV infection. This makes him all the more vulnerable. There is a need to offer platforms to support to these groups because of the threat they pose to their spouses and partners.” Working on his mission to connect all vulnerable populations with mainstream testing and treatment facilities, this Goodwill Ambassador is now using his popularity to address issues pertaining to HIV/AIDS for supporting AHF’s 20X20 goal of scaling up access to Antiretroviral Therapy (ART) for at least 20 million people by 2020. And by already drumming up support from IPL’s Kings XI Punjab and Bollywood actors he has put his goodwill mission on the right track.

Community-based testing needed

Community-based testing is a major initiative to reach out to such “isolated” vulnerable groups. In all HIV epidemic settings, community-based HIV testing and counselling for key populations, with linkage to prevention, care and treatment services is recommended, in addition to provider-initiated testing and counselling.

• It has been shared by WHO through its review of various case studies that the use of rapid HIV diagnostic tests using blood from a finger-prick sample taken by trained lay counsellors and community health workers has facilitated the expansion of HIV testing and counselling in community settings, including homes, transport stations, religious facilities, schools, universities, workplaces and venues frequented by key populations. 
• Community-based approaches have, in fact, increased rates of people testing for the first time and adults diagnosed with CD4 counts exceeding 350 cells/mm3. 
• The cost per person tested using facility and community-based testing found that thecost per person tested was found similar in both approaches.
• AHF, through its implementing partner in India, India Cares, has been conducting community based HIV screening since 2008. AHF India Cares has conducted these HIV testing and counselling through two mobile testing and counselling units in Delhi and 24 implementing partner NGOs in 11 states including Delhi in more than 44 sites.
• Integrated Counselling and testing centres (ICTC) are facility based where voluntary and Provider Initiated Counselling and Testing are practiced in a hospital or stand-alone stationary setting. In many rural areas the nearest ICTCs are farther than 10 km from the residential areas. Distance from the ICTCs and the timings of the ICTCs accentuate the barriers for access to HIV testing. The unavailability of test kit/ reagent stocks, staff and same-day reporting add to this problem as they cause loss of work hours and loss of faith in the health establishment. Similar issues of unavailability of ART stocks, CD4 reagents, staff and distance of the ART centre make it difficult for linkage after the seropositive identification. — GV