Multi Country South Asia – Project DIVA - VHS Multispeciality Hospital & Research Institute in Chennai

Background

DIversity in Action (DIVA) project is a Multi-country South Asia (MSA) Global Fund supported program implemented in 18 states in India. The project is funded by United Nations Development Programme (UNDP-Asia Pacific Region Centre) from November 2014 - December 16 and Save the Children International (SCI) from January 2017 – September 2018. The VHS-MSA DIVA project is implemented under the guidance of National AIDS Control Organisation (NACO) and in partnership with respective State AIDS Control Society (SACS). To know more about VHS-MSA DIVA project repository please visit https://diva.vhschennai.org

Goal

To reduce the impact of, and vulnerability to HIV in Transgender/Hijra people through targeted sensitisation, capacity building and structural intervention programs in India.

Objectives

Improve the delivery of HIV prevention, care and treatment services.
Improve the policy environment on TG and HIV related issues.
Improve strategic knowledge about the impact of HIV on TG/Hijra population.

Focus Areas

Approach

The DIVA project aimed to achieve its objective of reducing the impact of HIV on TG/H population by not only improving the delivery of HIV prevention, care and treatment services but also building an enabling environment in which TG/H persons can thrive. To effectively achieve this objective, the project developed the D2IF approach – Discover needs, Design initiatives and involve stakeholders, Implement initiatives and Follow-up, employing innovation at each stage. This approach is briefly described below:

Activities

Capacity building programmes for CBO/CSO TI staff for improved service delivery
Sensitisation programmes to foster an enabling environment
National / State / Local level structural intervention programmes for a progressive legal and social environment
Community systems strengthening for enhanced community participation
Research to strengthen the knowledge base
Innovative fast-track models to boost coverage

Mental health interventions through CBOs - scaled up to entire India:

As per NACO’s (National AIDS Control Organisation) Sankalak fifth edition, Status of national AIDS and STD response, India is estimated to have around 24.67 lakh people living with HIV (PLHIV) in 2022 with an adult prevalence of 0.20%. The estimated KPs in the country are 9.9 lakh FSWs, 0.96 lakh transgender, 3.51 lakh MSMs and 2.81 lakh IDUs in the country.
Access to mental health care remains a significant concern with considerable gaps in access to and quality of treatment and limited availability of mental health professionals, especially in rural areas. Inadequate infrastructure, lack of awareness and insufficient integration into primary health care systems hinder access to appropriate care.
The success of the crisis response system implemented in Tamil Nadu by VHS was replicated across India. More than 500 CBO leaders through 39 TG/Hijra CBOs were sensitized about mental health related issues and were empowered to refer / handle the mental health related problems of their peer communities.

Key Achievements

From 2014-2018, VHS-MSA DIVA project has substantially contributed to the decline in HIV prevalence among Transgender/Hijra people from 8.82% (2010-11) to 3.14 % (2016-17) Source: NACO. The project was instrumental in delivering improved HIV services to Transgender/Hijra population. With the extensive, comprehensive, sustained and strategic service delivery and sound support from the key stakeholders, the project has achieved success of their concerted efforts.

Preparing India to Success

DIVA was instrumental in the decision by 16 states to declare April 15^th as Transgender day.
DIVA initiated efforts for Transgender Persons (Protection of Rights) Bill to be passed in Upper House of Parliament. Advocating for passing of the bill by Lower House of Parliament.
DIVA conceptualized and established Transgender Welfare Board declared in five States -Andhra Pradesh, Bihar, Chandigarh, Chhattisgarh and Rajasthan and another three states are in progress - Delhi, Uttar Pradesh and Gujarat.
DIVA supported and developed the state policy for Transgender/Hijra persons in three States - Kerala, Odisha and Andhra Pradesh and another two states are in progress - Gujarat and Chandigarh.
DIVA contributed for developing master trainers whose expertise can be utilized by SACS for training their teams on Targeted Intervention focusing TG people.
DIVA contributed for publishing positive media stories on TG/H people in print / electronic media, which is the result of its sensitization programme to media personnel at state / regional/national levels.

Innovating to Success

Prevention & treatment cascade mobile application - The project has piloted a prevention and treatment cascade app in collaboration with the Delhi State AIDS Control Society thus reducing the workload of the outreach workers so that they can concentrate on their outreach.
Piloted various models through innovation and learning site for improving HIV service delivery among TG/H people. The project developed 4 learning sites: Karnataka (Payana), Odisha (SAKHA), Delhi (Kinnar Asmita), Andhra Pradesh (KYSS).
To understand and gain more insights about the priority areas in each state, DIVA developed the CBO Assessment (CBO Assessment) to assess the CBO as well as State level needs and priorities. It benefited them to customize their focus areas based on CBO and State requirements.
Helped to develop comprehensive/differential TI package for the TG/H people and also utilized community people to become master trainers.
Used ICT applications in outreach the TG/H people.
DIVA captured many success stories about Transgender response in India. It invested time and resources to distill, document the best practices and the lessons learnt in key areas of Transgender issues and needs and how can we improve service delivery to them.

Partnering to Success

The partnership between VHS, Global Fund, Save the Children and the GOI (national & state level) serves as a successful model for collaborative program management for innovative, improved, and sustainable HIV services to Transgender/Hijra population in India.

Collaborating to Success

To understand and gain more insights about the priority areas in each state, DIVA developed the CBO Assessment (CBO Assessment) to assess the CBO as well as State level needs and priorities. It benefited them to customize their focus areas based on CBO and State requirements.
The project established an Transgender community resource directory (www.diva.vhschennai.org) of best practices, government policies/schemes, training manual, IEC material, networking resources, other relevant information around transgender and also HIV/AIDS for knowledge sharing.
DIVA has conducted sensitization, training and capacity building programs for more than 1,100 people on issues affecting Transgender/Hijra persons, HIV and human rights.
DIVA developed guidelines and toolkits for CBO Need Assessment, BCC material on various topics to ensure quality and consistency in implementation of these services by various partnering agencies in different states.
"Facilitators Guide" on NACO Operational Guidelines for HTG people was developed.
The project developed a TG Stigma index, the first ever initiative in the country.
The project facilitated the national TG/H policy framework for the country.

Noticeable & Significant Events

The major events that were substantial in taking the project where it is today are depicted in the timeline below:

To know more about VHS-MSA DIVA project repository please visit https://diva.vhschennai.org

Impact

In a short span of four years, DIVA was able to develop standardized products, tools, guidelines and manuals for customized and improved delivery of HIV services to the TG/H community. The project has been able to build capacity of 4169 participants through 175 programmes, sensitised 1056 media, 703 law enforcement agencies, 674 judicial members, 933 government & key stakeholders and 84 master trainers. DIVA piloted various innovative models through four learning sites within four states in India for new TI packages towards the national programme and developed 66 knowledge products for CBO capacity building, sensitisation, resource mobilization, system strengthening and structural interventions.

Way Forward

To sustain a strong forward journey of this initiative, DIVA has identified the following next steps:

DIVA will help develop a pipeline of projects for the different states, based on the specific needs and priorities of different states and CBOs. It will include project plans and proposals, the funds required and the measurable outcomes.
DIVA will disseminate the project’s results and lessons learnt through donor / partner conclave and showcase its innovative practices and approaches to reach the TG/H community.
DIVA has demonstrated new approaches and innovative practices in other project countries. The project will share these approaches and their proven methodologies for possible replication and scaling upto reach the TG/H people.
DIVA is looking at setting up a networking platform for individuals and organisations at the national level and creating an e-newsletter to share experiences, lessons learnt and best practices for reducing stigma and discrimination against the TG/H community.

Key Publications

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