When Naz Male Health Alliance (NMHA) was founded in 2011, the challenges we had to go up against were numerous. Despite our unfaltering dedication and motivation, we were at first unsure about how much we could achieve. Working in a constitutionally Islamic country, with a visibly conservative society and an unaccommodating state, the amount of integration NMHA would find with the community it was seeking to serve was murky at the beginning. Now in its fifth year only, NMHA can confidently say that despite the odds it has built successful partnerships with the community, civil society and government agencies.
With its six service delivery sites, NMHA has been purposefully delivering services to both the community it seeks to serve and the activists it takes on board as employees. From the scale up of the community that worked with us to the development of the community we provided services to, from successfully lobbying with national agencies to building alliances across the globe, NMHA has achieved laurels and yearns to achieve many more. Our work speaks for itself, and so do the people directly affected by our work; thanks to the unfaltering support of The Global Fund and UNDP, and their model of Community Systems Strengthening that has provided the theoretical fuel to design our interventions.
NMHA is one of 11 sub-recipients under the Multi-Country South Asia Global Fund HIV Programme (Phase 2) – a regional HIV programme operating in eight countries in the region and funded by the Global Fund to fight AIDS, Malaria and Tuberculosis. The overall goal of the programme is to reduce the impact of, and vulnerability to, HIV of men who have sex with men, hijras and transgender people through Community Systems Strengthening. UNDP Bangkok Regional Hub serves as the grant’s Principal Recipient. For more information, follow the programme on Facebook and Twitter or visit the website.
Many of our employees identify as LGBT individuals and members of the hijra communities. Being marginalized members of the society, many of them had faced widespread discrimination at the workplace. At the very least, they had to work while being closeted and being constantly on the watch. This resulted in extreme self-stigma that curtailed personal and professional growth for many. Joining NMHA provides them new avenues for healthier and safer personal and professional development. To address what matters to community members, we need to change the conditions in which we live and we start it right here right now in our working environment. NMHA strives to create an atmosphere where our employess feel comfortable being themselves. “At my previous workplace I was constantly thinking about acting straight. I was always asking myself whether my behavior was masculine enough or not,” remembers Awais William, the newly promoted Monitoring Officer at Parwaz Male Health Society in Karachi. “Now I have learnt to be proud about myself. I am gay and I am proud of who I am.” Awais was an Outreach Worker at Parwaz since 2012 and based on his professional development has recently been promoted to the position of Monitoring Officer. “I have grown as a professional and as an LGBTI activist. I have learnt a lot and will continue to do so,” believes Awais.
At my previous workplace I was constantly thinking about acting straight. I was always asking myself whether my behavior was masculine enough or not. Now I have learnt to be proud about myself. I am gay and I am proud of who I am.
Improving management and strengthening organisational systems
Coming out is a tough thing to do in every society. But in Pakistan, the mere act of working in a community based organisation surmounts to coming out. Many people are reluctant about working with a community based organisation as they are concerned about their safety, both physical and social. Despite the stigma, many community members come forward to serve the community. Their dedication, commitment and confidence drives our work. An indicator of our success would be that these workers, after facing the brunt face-on, feel satisfied and fulfilled. Zehrish Soomro is a transwoman activist hailing from Thatta. She has moved almost a thousand miles away from her hometown to Lahore and works at Khwaja Sira Society (KSS) in Lahore as a Monitoring Officer. “Working in KSS I feel as an honest and loyal activist. I previously worked with an organisation in Karachi where there was widespread fraud and data manipulation. Here at NMHA, the work is transparent and honest,” confesses Zehrish. NMHA has a composite M&E Policy that ensures that quality and validity of the data is maintained. Being a first of its kind organisation, our workers know the sheer value of the data we collect.
Zehrish Soomro addressing the participants of South-Asia Transgender-Hijra Consultation in Nepal, February 2015
“I believe that there is a serious HIV epidemic in the transgender women population. Much more needs to be done especially for young transwomen as they are the most at-risk,” Said Zehrish. She recently attended the Asia Pacific Transgender Health Blueprint consultation in Nepal and raised the issue of making health policies inclusive of young transgendered people.
Improving the policy environment
Building a community led response to the HIV crisis entails building a concurrent rapport with government institutions. Unless the community has multi-level partnership with government agencies, very little can be achieved. This becomes an even bigger hurdle for a country like Pakistan where NGOs and donor-led initiatives are treated with suspicion and scorn. A similar observation is shared by Kashif Abdul Rasheed, the Drop-In Center (DIC) Coordinator at Humraz Male Health Society in Haiderabad. “When we started initially, people spread rumors that this is a brothel of male sex workers. The police used to harass us and our field workers. Very few people were willing to show up in our clinic and DIC due to the lack of trust,” remembers Kashif. Humraz however took a 180 degrees turn and now maintains a very healthy inflow of more than a 100 community members weekly. “We, however, successfully lobbied with the local police authorities and made them realize the value of our work. Some of them even contacted us privately and got registered with us.”
When we started initially, people spread rumours that [our drop-in centre] is a brothel of male sex workers. The police used to harrass us and our field workers. Now, some of [the police] even contact us privately and get registed with us.
NMHA has recently successfully gotten included the coverage of MSM in the National HIV Policy 2015-2020. Previously, Pakistan’s HIV policy did not contain MSM and only covered male sex workers. The inclusion now paves the way for including MSM individuals in the national HIV coverage. It also allows more room for strategic information to be collected regarding the situation of MSM in Pakistan. Because of zero coverage of this community, no strategic data is present, makes evidence-based advocacy very difficult. The employees of NMHA utilise the data collected through our service delivery and through the activities of the DIC. Many of them have successfully conducted researches on the data and presented their abstracts in Bangkok, Melbourne and Dhaka. We believe in the importance of research and collecting strategic information to guide our advocacy and planning.
It is crucial to engage men who have sex with men and transgender individuals in the HIV response as key populations. Not only are they the at-risk populations, they are also critical partners in developing a community led solution. NMHA has successfully engaged the community not only as recipients of our services but also as key stakeholders in developing a community led response to the HIV epidemic.
“We have successfully engaged our community in our work,” believes Khursand Bayyar, the Drop-In Center Coordinator in Lahore. “The people coming to our DIC know that it’s not just a big party. We are all geared towards something big!”
Making the community realize its worth in the HIV response is a critical step in engaging the community as this would ensure the sustainability of the response once international funds dry up. “The young lot that comes to us is highly motivated. They ask us what’s going to happen next. Where will this project lead to? How can they be of any help? And that motivates me to continue this work for my community. Because if even half of the community that comes in to our center comes back and wants to be of assistance, I consider it a victory,” exclaims Khursand with a proud smile.
Larkana is a city with a significant HIV epidemic among the MSM and transgender community – the latest government data states that HIV prevalence among transgender people in the city is an alarming 15 percent. The conservative, feudal culture there provides enough breathing space for broad-scale sexual abuse and exploitation of effeminate boys, transgender women and men who have sex with men. Being a patriarchal society, many of these men are also married men owing to social pressures and hence act as a bridging population. Engaging them in a culture like Larkana’s is an accomplishment of sheer magnitude.
Wajid (second from left), Simran and Suhaag (fourth and fifth from left) with community leaders during a field visit
“I have no words to explain how proud I am of what we’ve done here, but at the same time I know a lot more still needs to be done,” says Wajid Ali, the Project Manager of Pireh Sehat Markaz in Larkana. “There is a major overlap between young men who have sex with men, effeminate men and transgendered women in our area. Because Pireh is for both MSM and transgender people, this has resulted in our engaging with all these communities successfully. Designing projects in light of the local cultural context is crucial to the success of a project,” says Wajid. He has over 40 years of experience in the HIV sector and is a successful advocate and community leader.
Designing projects in light of the local cultural context is crucial to the success of a project.
Providing quality services, that are accessible to all who need them and that serve the needs of the community at-risk, is the backbone of any successful project. NMHA through its six service delivery points across 5 cities has managed to provide community specific services, with utmost importance to quality and confidentiality. We provide behavior change counselling to our clients to engage in safer sex practices; voluntary counselling and testing services for HIV; treatment of sexually transmitted infections and provision of free condoms and lubricants. In 2014, NMHA and UNDP jointly produced two short films highlighting the importance of these services.
But making sure that services are available to key populations and are accessible to all is a difficult feat to achieve. “It’s a great achievement I believe,” says Umais Bin Tahir, the Project Manager of Dareecha Male Health Society in Rawalpindi. “It is very difficult to reach our community as most are unwilling to come out, or to even attend the clinics. Despite this we have created such an environment that community members want to come to our center and use our services confidently. I personally never thought this would be possible, but seeing this happen makes me very happy.”
Today, we have successfully registered more than 60,000 men who have sex with men and 13,000 transwomen and hijras within our programme. But this is just the beginning. Over time this community-led initiative can and will achieve the goal of ensuring equal access to essential health services for all.