Field Visit Report 1

Support and Outreach is the heart of what Humsafar Trust (HST) does as an organization. Essentially, it provides a place for people to meet, and rejoice, and learn from each other. A space to be anything you want to be, maybe even yourself. It gets people, every day, who otherwise would not have gotten tested, to a clinic where they can meet face-to-face with doctors and counsellors. It comforts the young and the old unequivocally; offers solace, an ear to talk to, something to lean on. Mostly, I think, it gives people hope.

Let’s be honest, being different is never easy. And I bet there is a difference between mending someone who is broken, and mending someone who feels whole.

It is my humble presumption that in a country so discretionary as India, a primary and very fundamental tool for (any kind of) minority development is to learn to take care of themselves.

Emancipation is the lot of the resilient, the loud, the cunning & the brave.

There are simply too many in need for an outside appeal, and I believe that in so crowded a climate, you do have to make up your own space.

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Saturday, March 14 2015

For my first field visit I was invited to HST’s first drop-in centre, Aarambh I, which is situated near the Borivili Train Station. Arambh translates loosely into beginning.

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I met my coworkers at Santacruz Station.

After a brief game of “where on the platform?” and “How many 2nd class women’s compartments can there possibly be?”, we hopped onto a local train and enjoyed the big breezy gusts of watching the world go by. These field visits provide me the latitude to ask all the questions I can possibly think of, so I am extremely thankful, albeit I’ll admit that needing a translator for most of my conversations can be a tad frustrating.   

When asked about how the beginning had begun, a counsellor told me that the first real outreach worker had been “Amma,” which means mother. Mom, in this instance, is Ashok Row Kavi

Co-founder and current Board member of HST, Ashok is the only one of the original 3 members I have had the opportunity of meeting thus far. A journalist by trade, Ashok (pronounced Ashook) was, nay, is a pioneer. He has spent most of his adult life personally nurturing, consoling, encouraging, and motivating a large portion of the current staff at HST.

Coming from a North American culture, I admit it is strange to be evolving in a work environment where people genuinely look up to each other. This isn’t to say that everyone always gets along, but I feel that there is a mutual respect and empathy in the common struggle they share that transpires throughout most of their interactions.

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We arrived around 4pm, and climbed up the steel ladder towards the second-floor office.

HST currently operates 6 sites like Aarambh I in different districts across the city, providing client counselling, health services, and general sex education.  

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This particular site caters to approximately 1,500 people, and has specialized in HIV treatment and counselling. Most of the groundwork, however, is carried out by local community members at a ratio of 3 to 4 peer outreach workers (POW) per counsellor. POW’s are responsible for tallying the number of MSM (Men who have sex with Men – Gay is considered a Western label) that frequent each of the cruising sites. Cruising is slang for looking for a sexual partner in a public place. Hot Spots are places to have sex, also in public.

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Because homosexuality is pushed underground, an older generation of gay men tend to hang around train station bathrooms (in the darkened areas) and compartments, hoping to establish meaningful eye contact with a new conquest. Which, in my mind, constitutes a whole new world of come-hither staring contests. Often, used condoms are flushed down the toilet, which blocks up the whole system. Judging by the fantastic haut-le-coeur that overtook me even at a safe distance from the lavatory, this set-up isn’t the most alluring of prospects. 

POWs generally survey 4-5 sites, in 2-hour rotations, from 6pm onwards. Most of the POWs are recruited from the community, they have an easier time making contacts with Key Stakeholders (local peddlers, stall-operators, etc.) who facilitate the distribution of supplies, like condoms, by serving as point of contact during off hours. There are also condom stashes, one is under the main staircase railing, for clients who are running later operations, and wish to remain discreet. Stakeholders can also be key community figures who act as negative influencers. This sector of the outreach work constitutes a crucial part of the operations, and aims at leveraging these agents, mostly because they are the frontline source of first-hand information gathering. While outreach supervision was originally designed to function asymmetrically, practice has proven that a more lateral and holistic practice is better adapted to serving the needs of the community. Planning generally occurs on a month-to-month basis, adjusting to site objectives as they surface, and allows for more flexibility and quicker responses to program deliverables.

 In India, the National AIDS Control Organization (NACO) is responsible for establishing a standardized set of guidelines and rolling out support programs, like free condoms. The Aarambh I site, however, launched in 1999, and thus predates any kind of large-scale government initiative. One of the problems with NACO’s policies is that they define high-risk individuals as a person having more than 10 sexual encounters a week, with moderates averaging around 5 encounters or less. These data delimitations were transferred from an assessment of typical female sex workers client rations, and I am told that it is very rare for an MSM to have so many in a week. Male sex work generally pays much more, and can sometimes be seen as a way to get some quick cash or a lifestyle choice, rather than as a means of subsistence. Because of the high rate of HIV infection in the MSM population (estimated at 14.3% by NACO in 2012) the fact that these parameters fail to produce a realistic assessment of the situation, is a genuine cause for concern. For targeted interventions to be effective, it seems imperative that guidelines be based on accurate representations, and addressed in light of their specific dynamics. This is where the research team at HST steps in.

 Apart from doing prevention, there is also a need for regular advocacy sessions with local law enforcement in order to raise awareness about prevention efforts. Lack of information seems to be a recurring problem, as most police officers are unaware that the free condoms being distributed are part of the government’s anti-AIDS policies. I am told that there have been cases where police officers, in civil dress, perform sting operations, where they attempt to extort or blackmail MSMs or sex workers by threatening to disclose their identities to their families, requisitioning mobile phones in order to appropriate contacts. In certain cases, the would-be victims have retaliated, insinuating that law enforcement could not possibly bring a solid case in court, because their motives for being at the scene are certainly questionable. I am of the opinion that these situations hold a potential for rapid escalation regarding direct and indirect violence, where law enforcement may feel threatened or challenged and be tempted to assert their authority further by using coercive means. With regards to predatory behaviours, the Borivili staff has also confirmed that the cruising sites also house a number of local hustlers/goons (gundas) who pray on more the effeminate or weak sections of the clientele.

 Beyond getting clients to open up about their problems, other obstacles, such a class differences, denial and fear of identity disclosure, create further challenges for MSM outreach. More significantly, because the main motivation for frequenting a cruising site is to hook up, attendees aren’t necessarily interested in about prevention. Admittedly, it’s not a very sexy subject.

“If they see the Humsafar Trust backpack, they will often interrupt and say they have already been tested,” confides one outreach worker. Other clients are reluctant, and use a number of subterfuges to introduce touchy subjects: one gentleman was using his brother’s identity, claiming that he was a migrant worker, and that the upcoming visit with his wife was problematic because he had noticed STD symptoms. Partners are another hard-to-reach demographic, because so many of them are kept in the dark (consciously or unconsciously) and usually completely unaware of the risks their husbands bring home. It also the general assumption of the staff that Kothis (Bottoms) most often bear the responsibility of securing contraceptives, because they run the higher risk of contamination.

 It generally takes 2 to 5 meetings with a counsellor, over a period of 1 or 2 months, before a client gets comfortable enough to start addressing his or her issues. I am told that clients usually feel more comfortable discussing their issues with people their own age. Most of the younger MSM crowd, however, doesn’t usually hang around cruising sites. They are more easily found on sites like Planet Romeo or using Grindr. Furthermore, because POWs aren’t allowed to distribute condoms to minors, this removes the carrot and stick incentive for certain clients. On a side note, I was told that most of the pilot projects for condom vending machines were largely unsuccessful.

Health programs also include networking with partner organizations to provide complimentary services, like nutritional counselling for the HIV+ or ration support. I was told that the government has a food subsidy program that offers 2 meals a day, but that the registration process is so lengthy and tedious, that most people in need don’t even bother. There is also the issue of a counsellor’s or a POW’s own emotional well-being, as emotional dependence is common. In a social structure that encourages “chaperoning”, taking someone under your wing bears the risk of becoming the sole source of salvation for an individual in need. Expectations tend to run quite high, and this as proven to be problematic at time.

Before we took our leave, I decided to ask the staff how many among them were “out” to their parents. Five out of the 11 present responded affirmatively, with one young gentleman raising his hand quite high and quite proudly. This, for me, epitomizes the work HST has managed to accomplish in supporting their members.