curriculum guide - manas foundation

CG C

urri

culu

m G

uide

Curriculum Guide

CG

Pehchan Consortium Partners

India HIV/AIDS Alliance (www.allianceindia.org)Pehchan Focus: National coordination and grant oversight

Based in New Delhi, India HIV/AIDS Alliance (Alliance India) was founded in 1999 as a non-governmental organisation working in partnership with civil society and communities to support sustained responses to HIV in India. Complementing the Indian national program, Alliance India works through capacity building, technical support and advocacy to strengthen the delivery of effective, innovative, community-based interventions to key populations most vulnerable to HIV, including men who have sex with men (MSM), transgenders, hijras, people who use drugs (PWUD), sex workers, youth, and people living with HIV (PLHIV).

Alliance India Andhra PradeshPehchan Focus: Andhra Pradesh

Alliance India supports a regional office in Hyderabad that leads implementation of Pehchan in Andhra Pradesh and serves as a State Lead Partner of the Bill & Melinda Gates Foundation.

The Humsafar Trust (www.humsafar.org) Pehchan Focus: Maharashtra, Madhya Pradesh, Goa, Gujarat and Rajasthan

For nearly two decades, Humsafar Trust has worked with MSM and transgender communities in Mumbai, Maharashtra. It has successfully linked community advocacy and support activities to the development of effective HIV prevention and health services. It is one of the pioneers among MSM and transgender organisations in India and serves as the national secretariat of the Indian Network for Sexual Minorities (INFOSEM).

Pehchan North Region Office Pehchan Focus: Punjab, Delhi, Uttar Pradesh and Bihar

Alliance India supports a regional implementing office based in Delhi that leads implementation of Pehchan in four states of North India.

Solidarity and Action Against The HIV Infection in India (SAATHII) (www.saathii.org) Pehchan Focus: West Bengal, Manipur, Orissa and Jharkhand

With offices in five states and over 10 years of experience, SAATHI works with sexual minorities for HIV prevention. SAATHII works closely with the West Bengal’s State AIDS Control Society (SACS) and the State Technical Support Unit and is the SACS-designated State Training and Resource Centre for MSM, transgender and hijra.

South India AIDS Action Programme (SIAAP) (www.siaapindia.org) Pehchan Focus: Tamil Nadu

SIAAP brings more than 22 years of experience with community-driven and community development focussed programmes, counselling, advocacy for progressive policies, and training to address HIV and wider vulnerability issues for MSM, transgender and hijra community.

Sangama (www.sangama.org) Pehchan Focus: Karnataka and Kerala

For more than 20 years, Sangama has been assisting MSM, transgender and hijra communities to live their lives with self-acceptance, self-respect and dignity. Sangama lobbies for changes in existing laws that discriminate against sexual minorities and for changing public opinion in their favour.

Pehchan 1CG Curriculum Guide

ContentsAbout Pehchan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Training Curriculum Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

General Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Module Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Purpose of the Modules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Intended Audience for the Modules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

How to Use the Modules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Helping Participants Get the Most Out of Training . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Understanding Training Needs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Workshop Preparation Checklist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Beginning a Training . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Pehchan2 CG Curriculum Guide

About PehchanWith financial support from the Global Fund, Pehchan is building the capacity of 200 community-based organisations (CBOs) for men who have sex with men (MSM), transgenders and hijras in 17 states in India to be more effective partners in the government’s HIV prevention programme. By supporting the development of strong CBOs, Pehchan addresses some of the capacity gaps that have often prevented CBOs from receiving government funding for much-needed HIV programming. Named Pehchan, which in Hindi means ‘identity’, ‘recognition’ or ‘acknowledgement,’ this programme will reach 453,750 MSM, transgenders and hijras by 2015. It is the Global Fund’s largest single-country grant to date, focused on the HIV response for vulnerable sexual minorities.

Training Curriculum OverviewIn order to stimulate the development of strong and effective CBOs for MSM, transgender and hijra communities and to increase their impact in HIV prevention efforts, responsive and comprehensive capacity building is required. To build CBO capacity, Pehchan developed a robust training programme through a process of engagement with community leaders, trainers, technical experts, and academicians in a series of consultations that identified training priorities. Based on these priorities, smaller subgroups then developed specific thematic components for each curricular module.

Inputs from community consultations helped increase relevance and value of training modules. By engaging MSM, transgender and hijra (MTH) communities in the development process, there has been greater ownership of training and of the overall programme among supported CBOs. Technical experts worked on the development of thematic components for priority areas identified by community representatives. The process also helped fine-tune the overall training model and scale-up strategy. Thus, through a consultative, community-based process, Pehchan developed a training model responsive to the specific needs of the programme and reflecting key priorities and capacity gaps of MSM, transgender and hijra CBOs in India.


PrefaceAs I put pen to paper, a shiver goes down my spine. It is hard to believe that this day has come after almost five long years! For many of us, Pehchan is not merely a programme; it is a way of life. Facing a growing HIV epidemic among men who have sex with men (MSM), transgender, and hijra communities in India, a group of development and health activists began to push for a large-scale project for these populations that would be responsive to their specific needs and would show this country and the world that these interventions are not only urgently needed but feasible.

Pehchan was finally launched in 2010 after more than two years of planning and negotiation. As the programme has evolved, it has never stepped back from its core principle: Pehchan is by, for and of India’s MSM, transgender and hijra communities. Leveraging rich community expertise, the Global Fund’s generous support and our government’s unwavering collaboration, Pehchan has been meticulously planned and passionately executed. More than just the sum of good intentions, it has thrived due to hard work, excellent stakeholder support, and creative execution.

At the heart of Pehchan are community systems strengthening. Our approach to capacity building has been engineered to maximise community leadership and expertise. The community drives and energises Pehchan. Our task was to develop 200 strong community-based organisations (CBOs) in a vast and complex country to partner with state governments and provide services to MSM, transgender and hijra communities to increase the effectiveness of the HIV response for these populations and improve their health and wellbeing. To achieve necessary scale and sustain social change, strong CBOs would require responsive development of human capital.

Over and above consistent services throughout Pehchan, we wanted to ensure quality. To achieve this, we proposed a standard training package for all CBO staff. When we looked around, we found there really wasn’t an existing curriculum that we could use. Consequently, we decided to develop one not only for Pehchan but also for future efforts to build the capacity of community systems for sexual minorities. So began our journey to create this curriculum.

Building on the experience of Sashakt, a pilot programme supported by UNDP that tested the model that we’re scaling up in Pehchan, an involved process of consultations and workshops was undertaken. Ideas for each module came from discussions with a range of stakeholders from across India, including community leaders, activists, academics and institutional representatives from government and donors. The list of modules grew with each consultation. For example in Sashakt, we had a single training module on family support and mental health; in Pehchan, we decided that it would be valuable to spilt these and have one on each.

Eventually, we agreed on the framework for the modules and the thematic components, finding a balance between individual and organisational capacity. Overall, there are two main areas of capacity building: one that is directly related to the services and the other that is focused on building capable service providers. Then we began the actual writing of the curriculum, a process of drafting, commenting, correcting, tweaking and finalising that took over eight months.


Once the curriculum was ready to use, trainings-of-trainers were organised to develop a cadre of master trainers who would work directly with CBO staff. Working through Pehchan’s four Regional Training Centers, these trainers, mostly members of MSM, transgender and hijra communities, provided further in-service revisions and suggestions to the modules to make them succinct, clear and user-friendly. Our consortium partner SAATHII contributed particularly to these efforts, and the current training curriculum reflects their hard work.

In fact, the contributors to this work are many, and in the Acknowledgements section following this Preface, we have done our best to name them. They include staff from all our consortium partners, technical experts, advocates, donor representatives and government colleagues. The staff at India HIV/AIDS Alliance, notably the Pehchan team, worked beautifully to develop both process and content. That we have come so far is also a tribute to vision and support of our leaders, at Alliance India and in our consortium partners, Humsafar Trust, SAATHII, Sangama, and SIAAP, as well as in India’s National AIDS Control Organisation and at the Global Fund to Fight AIDS, Tuberculosis and Malaria in Geneva.

We would like to think of the Pehchan Training Curriculum as a game changer. While the modules reflect the specific context of India, we are confident that they will be useful to governments, civil society organisations and individuals around the world interested in developing community systems to support improved HIV and other health programming for sexual minorities and other vulnerable communities as well.

After two years of trial and testing, we now share this curriculum with the world. Our team members and master trainers have helped us refine them, and seeing the growth of the staff in the CBOs we have trained has increased our confidence in the value of this curriculum. The impact of these efforts is becoming apparent. As CBOs have been strengthened through Pehchan, we are already seeing MSM, transgender and hijra communities more empowered to take charge, not only to improve HIV prevention but also to lead more productive and healthy lives.

Sonal Mehta Director: Policy & Programmes India HIV/AIDS Alliance

New Delhi March 2013


General AcknowledgementsThe Pehchan Training Curriculum is the work of many people, including community members, technical experts and programme implementers. When we were not able to find training materials necessary to establish, support and monitor strong community-based organisations for MSM, transgenders and hijras in India, the Pehchan consortium collectively developeda curriculum designed to address these challenges through a series of community consultations and development workshops. This process drew on the best ideas of the communities and helped develop a responsive curriculum that will help sustain strong CBOs as key element of Pehchan.

We would like to take this opportunity to acknowledge the contributions of those who helped in taking this process forward, including (in alphabetical order): Ajai, Praxis; Usha Andewar, The Humsafar Trust; Sarita Barapanda, IWW-UK; Jhuma Basak, Consultant; Dr. V. Chakrapani, C-Sharp; Umesh Chawla, UNDP; Alpana Dange, Consultant; Brinelle D’Sourza, TISS; Firoz, Love Life Society; Prashanth G, Maan AIDS Foundation; Urmi Jadav, The Humsafar Trust; Jeeva, TRA; Harleen Kaur, Manas Foundation; Krishna, Suraksha; Monica Kumar, Manas Foundation; Muthu Kumar, Lotus Sangama; Sameer Kunta, Avahan; Agniva Lahiri, PLUS; Meera Limaya, Consultant; Veronica Magar, REACH; Magdalene, Center for Counselling; Sylvester Merchant, Lakshya; Amrita Nanda, Lawyers’ Collective; Nilanjana, SAFRG; Prabhakar, SIAAP; Priti Prabhughate, ICRW; Nagendra Prasad, Ashodaya Samithi; Revathi, Consultant; Rex, KHPT; Amitava Sarkar, SAATHII; Dr. Maninder Setia, Consultant; Chetan Sharma, SAFRG; Suneeta Singh, Amaltas; Prabhakar Sinha, Heroes Project; Sreeram, Ashodaya Samithi; Suresh, KHPT; Sanjanthi Veul, JHU; and Roy Wadia, Heroes Project.

Once curricular framework was finalised, a group of technical and community experts was formed to develop manuscripts and solicit additional inputs from community leaders. The curriculum was then standardised with support from Dr. E.M. Sreejit and streamlined with support from a team at SAATHI, led by Pawan Dhall. This process included inputs from Sudha Jha, Anupam Hazra, Somen Achrya, Shantanu Pyne, Moyazzam Hossain, Amitava Sarkar, and Debjyoti Ghosh Dhall from SAATHII; Cairo Araijo, Vaibhav Saria, Dr. E.M. Sreejit, Jhuma Basak, and Vahista Dastoor, Consultants; Olga Aaron from SIAAP; and Harjyot Khosa and Chaitanya Bhatt from India HIV/AIDS Alliance.

From the start, the Government of India’s National AIDS Control Organisation has been a key partner of Pehchan. In particular, Madam Aradhana Johri, Additional Secretary, NACO, has provided strong leadership and steady guidance to our work. The team from NACO’s Targeted Intervention (TI) Division has been a constant friend and resource to Pehchan, notably Dr. Neeraj Dhingra, Deputy Director General (TI); Manilal N. Raghvan, Programme Officer (TI); and Mridu, Technical Officer (TI). As the programme has moved from concept to scale-up, Pehchan has repeatedly benefitted from the encouragement and wisdom of NACO Directors General, past and present, including Madam Sujata Rao, Shri K. Chandramouli, Shri Sayan Chatterjee, and Shri Lov Verma.

Pehchan is implemented by a consortium of committed organisations that bring passion, experience, and vision to this work. The programme’s partners have been actively engaged in developing the training curriculum. We are grateful for the many contributions of Anupam Hazra and Pawan Dhall from SAATHII; Hemangi, Pallav Patnaik, Vivek Anand and Ashok Row Kavi from the Humsafar Trust; Olga Aaron and Indumati from SIAAP; Vijay Nair from Alliance India Andhra Pradesh; and Manohar from Sangama. Each contributed above and beyond the call of duty, helping to create a vibrant training programme while scaling up the programme across 17 states.


India HIV/AIDS Alliance’s Pehchan team has been untiring in its contributions to this curriculum, including Abhina Aher, Jonathan Ripley, Yadvendra (Rahul) Singh, Simran Shaikh, Yashwinder Singh, Rohit Sarkar, Chaitanya Bhatt, Nunthuk Vunghoihkim, Ramesh Tiwari, Sarbeshwar Patnaik, Ankita Bhalla, Dr. Ravi Kanth, Sophia Lonappan, Rajan Mani, Shaleen Rakesh, and James Robertson. A special thank-you to Sonal Mehta and Harjyot Khosa for their hard work, patience and persistence in bringing this curriculum to life.

Through it all, the Global Fund to Fight AIDS, Tuberculosis and Malaria has provided us both funding and guidance, setting clear standards and giving us enough flexibility to ensure the programme’s successful evolution and growth. We are deeply grateful for this support.

Pehchan’s Training Curriculum is the result of more than two years of work by many stakeholders. If any names have been omitted, please accept our apologies. We are grateful to all who have helped us reach this milestone.

The Pehchan Training Curriculum is dedicated to MSM, transgender and hijra communities in India who for years, have been true examples of strength and leadership by affirming their pehcha-n.


Curriculum Acknowledgments Each component of the Pehchan Training Curriculum has a number of contributors who have provided specific inputs. For this component, the following are acknowledged:

Primary Authors Jhuma Basak, Consultant; SAFRG, New Delhi; Meera Limaya, Consultant; Muthu Kumar, Consultant; Dr. Maninder Singh Setia, Consultant; Agniva Lahiri, PLUS; Lakshmi Narayan Tripathi, Astitva; Gauri Sawant, Sakhi Char Choughi; A Revathi, Consultant; Ranjit Sinha, Bandhan; Sylvester Merchant, Lakshya Trust; Priti Prabhughate, ICRW; Monika Kumar, Manas Foundation; Sarita Barapanda, Consultant; Sreeram, Ashodaya; Aditya Bandopadhyay, Adhikaar; Dr. Vijay Prabhu, Consultant, Dr. Venkatesh Chakrapani, C-SHaRP; Dr. E. M. Sreejit, Consultant; M.L. Prabhakar; Dr Indumathi Ravishankar, SIAAP and Yashwinder Singh, Chaitanya Bhatt, Simran Sheikh, Yadavendra Singh, Harjyot Khosa, Sonal Mehta, from India HIV/AIDS Alliance

Compilation Dr. E. M. Sreejit, Consultant

Technical Inputs Debjyoti Gosh, SAATHII; Shantanu Pyne, SAATHII; Thomas Joseph, The Humsafar Trust; Olga Aaron, SIAAP; Souvik Ghosh, SAATHII; Sudip Chakraborty, SAATHII; Anupam Hazra, SAATHII; Vaibhav Sarai, Consultant; J. Robin, SIAAP; Bharat Patil, Lakshya Trust; Priti Parbhughate, ICRW; Ashish Agarwal , Samman Foundation; Harish Kamble, HST; Dr. Samarjeet Jana, Consultant, J. Robin, SIAAP; Bharat Patil, Lakshya Trust; Vijay Francis, Humsafar Trust; Krishna Kumar, Nokhu Ayakhu; Moyazam Hossain, SAATHII Sudha Jha, SAATHII; Aditya Bandopadhyay, Adhikaar; Amitava Sarkar, SAATHII, Ch. Priya Babu, Consultant; and Yashwinder Singh, Chaitanya Bhatt, Simran Sheikh, Rohit Sarkar, Yadavendra Singh, Sunita Grote, Vijay Nair, Abhina Aher, Harjyot Khosa, Sonal Mehta, James Robertson from India HIV/AIDS Alliance.

Coordination and Development Vahista Dastoor, C4D Consultant Pawan Dhall, SAATHII

Editors Sophia Lonappan and Dr. Ravikanth, India HIV/AIDS Alliance


BackgroundThough HIV prevalence in India is low in the general population, it remains disproportionately high among high-risk groups, such as injecting drug users (IDUs), female sex workers, men who have sex with men (MSM), transgenders (TG), and hijras. The vulnerability of MSM/transgenders/hijras (MTH) to HIV is amplified by social marginalisation, discrimination, and poor access to health services.

MTH populations are often difficult to reach with HIV prevention interventions, and many civil society partners lack adequate expertise or capacity to work with MTH populations. Community-based organisations (CBOs) established, led and staffed by MTH communities can be effective in reaching their peers with prevention and other HIV-related services. Though CBOs may struggle to develop robust management systems necessary to thrive, strong CBOs will be critical to the success of the National AIDS Control Programme Phase IV (NACP IV) and particularly its interventions among MTH.

Pehchan builds the capacities of MTH CBOs to be at the forefront of the HIV response. The core strategy of Pehchan is to support the establishment and strengthening of CBOs and develop community systems as a basis for long-term engagement with HIV and other issues affecting the health and wellbeing of these populations. A key goal is to support CBOs to become sufficiently capacitated to be contracted by the government to implement one of the National AIDS Control Programme’s Targeted Interventions (TIs) to provide HIV prevention services to MTH communities.

Purpose of this CurriculumCBO formation and strengthening is a long process but necessary for the development of strong CBO partners for the TI programme. Pehchan provides a range of technical support and capacity building, including training packages to build necessary competencies in CBO staff. The Pehchan training curriculum was developed to ensure that each member of the CBO staff understands technical issues and is able to address organisational and management challenges. While these modules have been developed for the Indian context, they can be adapted for different environments and cultural contexts.

Intended AudienceThese modules have primarily been developed to build the knowledge and skills of community volunteers, counsellors and outreach workers of NGOs and CBOs who work directly with MTH communities. In the context of Pehchan, the modules will be useful to guide a trainer from an SR partner who will train the staff of sub-sub-recipient (SSR) CBOs in key topic areas.


How to Use this CurriculumThe curriculum stresses participation. Depending on the objectives of each training module, the existing expertise of participants, and availability of resources, one may choose to use all or just some of the modules or sessions. Duration of sessions is described in each module. Each session outline contains a list of resources needed to run that session. Some understanding and knowledge of HIV and other issues related to MTH is desirable, but workshop facilitators do not need to be medical experts in HIV.

There are fifteen Pehchan modules in total. Each module is described briefly below, including the themes covered and the number of training days required for each. A training day typically covers 8 hours.

Module A

A1: Organisational DevelopmentThis module is designed to help training participants: 1) understand the importance of organisational development (OD) in bringing systematic, sustainable and planned change to support growth; 2) recognise how strengthening an organisation helps the growth and development of its employees; 3) develop skills to formulate organisational goals and effective strategies to attain them with the help of structured and documented processes; and 4) create clear and empowering communication channels to make the community a resource for its own problem-solving. In the Pehchan programme, this module is used to introduce organisational development principles to CBO Programme Officers as well as board members of Pehchan’s Community Advisory Boards (CABs).

Total Duration: One day

A2: Leadership and GovernanceThis module is designed to help training participants: 1) understand the importance of leadership and good governance in achieving the goals of an organisation; and 2) enhance individual leadership capacity to help develop a vision to improve the quality of life in the community. Interactive sessions in this module include group work, games, live projects, audio and video clips, role playing and case studies. In the Pehchan programme, this module is used to introduce leadership and governance principles to CBO Programme Officers as well as board members of Pehchan’s Community Advisory Boards (CABs).


A3: Resource Mobilisation and Financial ManagementThis module is designed to help training participants: 1) develop an understanding of resource mobilisation; 2) become familiar with resource mobilisation techniques; 3) develop a resource mobilisation strategy for the CBO; 4) develop an understanding about grant management and the basics of bookkeeping and accounting; and 5) review guidelines for strong and stable financial systems. Interactive sessions in this module include games, exercises, group discussions, presentations, case studies, and slide shows. In the Pehchan programme, this module is used to introduce resource mobilisation and financial management principles to CBO staff.

Total Duration: One and a half days

user

Highlight

user

Highlight

user

Highlight


Module B

B: Basics of HIV/AIDS Prevention and Outreach Planning (Pre-TI)This module is designed to help training participants: 1) learn basic facts about HIV/AIDS and STIs; 2) understand the roles and responsibilities of outreach workers and peer educators; and 3) appreciate the value of needs assessments, implementation planning, behaviour change communication, linkages and referrals, drop-in-centre management, condom promotion, and negotiation skills. In the Pehchan programme, this module orients participants on India’s National AIDS Control Programme and its Targeted Intervention prevention strategy, and it is used specifically with CBO Programme Managers, Programme Officers, Counsellors, and Outreach Workers.

Total Duration: Two days

Module C

C1: Identity, Gender and SexualityThis module is designed to help training participants: 1) gain a broad understanding of language and concepts relating to identity, gender and sexuality; 2) understand differences in gender, sex and sexuality; and 3) become familiar with the experience of stigma and discrimination in the lives of men who have sex with men (MSM), transgenders and hijras. In the Pehchan programme, this module is used to introduce principles of identity, gender and sexuality to CBO Programme Managers, Programme Officers, Counsellors, and Outreach Workers.


C2: Family Support This module is designed to help training participants: 1) develop a common understanding of the term ‘family’ from the perspective of men who have sex with men (MSM), transgenders and hijras (MTH); 2) identify different constructs of ‘family’ present in MTH communities; 3) explore the importance of ‘family’ in a person’s life; and 4) understand issues faced by MTH community members with regard to their families. In the Pehchan programme, this module is used to introduce principles of family support to CBO Outreach Workers and Counsellors.


C3: Mental Health This module is designed to help training participants: 1) become familiar with basic concepts of counselling; 2) develop skills to form a support relationship with a programme client within an ethical framework; 3) increase awareness of common mental health concerns among men who have sex with men (MSM), transgenders and hijras; 4) build capacity to assess and provide basic psycho-social support; and 5) promote positive mental health. In the Pehchan programme, this module is used to introduce principles of family support to CBO Outreach Workers and Counsellors. This module is designed to help CBOs’ Counsellors and Outreach Workers to introduce the concept of Mental Health and the importance of psycho-social support.



C4: MSM with Female PartnersThis module is designed to help training participants: 1) understand the issues of men who have sex with men (MSM) who also have sex with female partners; 2) become familiar with how gender impacts health; 3) learn basic sexual anatomy and differences between male and female; and 4) learn basic strategies to reach out to MSM with female partners and provide appropriate support and linkages to services. In the Pehchan programme, this module is used to familiarise CBO staff on the specific needs of MSM with female partners.


C5: Transgender and Hijra Communities This module is designed to help training participants: 1) understand the basics of transgender and hijra identity; and 2) become familiar with the challenges facing transgender and hijra community members in the current context. In the Pehchan programme, this module is used to familiarise CBO Programme Managers, Counsellors, and Outreach Workers on the specific needs of transgender and hijra-identified individuals.


Module D

D1: Human and Legal RightsThis module is designed to help training participants: 1) understand basic human rights and their importance to work with sexual minorities; 2) learn how to apply the principles of International Human Rights to local settings; 3) understand human and legal rights from the perspective of men who have sex with men (MSM), transgenders and hijras; and 4) build skills to recognise rights violations and mitigate them. In the Pehchan programme, this module is used to introduce basic principles of human and legal rights to CBO Programme Managers and Outreach Workers.


D2: Trauma and ViolenceThis module is designed to help training participants: 1) deepen their understanding of trauma and violence; 2) identify different forms of violence; 3) understand the connection between violence and exploitation; 4) learn strategies to address violence; and 5) develop an action plan to respond to trauma and violence in their local context. In the Pehchan programme, this module is used to introduce basic principles of trauma and violence to CBO Counsellors and Outreach Workers.


D3: Positive LivingThis module is designed to help training participants: 1) understand clinical basics of HIV and AIDS, with special reference to People Living with HIV (PLHIV); 2) become familiar with Antiretroviral Treatment (ART) and treatment adherence; 3) identify specific needs of PLHIV; and 4) learn principles of caregiving for PLHIV. In the Pehchan programme, this module is used to introduce basic principles of positive living to CBO Programme Managers, Counsellors, and Outreach Workers.



D4: Community Friendly ServicesThis module is designed to help training participants: 1) understand the concept of friendly services for men who have sex with men (MSM), transgenders and hijras; 2) document existing services in the local context; 3) access and coordinate with these services or create community friendly services if none exist. In the Pehchan programme, this module is used to introduce basic principles of community friendly services to CBO Counsellors, Outreach Workers and Advocacy Officers.


D5: Community Preparedness for Sustainability This module is designed to help training participants: 1) understand the concept of community preparedness; 2) become familiar with the rationales and processes to shift the focus of programmes for men who have sex with men (MSM), transgenders and hijras (MTH) from HIV-centric to community-centric; 3) learn strategies to help MTH communities become self-reliant and sustainable; and 4) appreciate the importance of critical thought processes in planning for strong CBOs and communities. In the Pehchan programme, this module is used to introduce basic principles of community preparedness to CBO Programme Managers, Counsellors, and Outreach Workers.


D6: Life Skills EducationThis module is designed to help training participants: 1) understand the basic concepts and principles of Life Skills Education (LSE) for men who have sex with men (MSM), transgenders and hijras (MTH); 2) provide skills to sensitise CBO staff on life skills and equip them to respond to the needs of MTH community members; 3) learn techniques to build self-worth and enhance self-esteem of CBO clients; 4) develop listening and communication skills; and 5) build staff capacity to respond to difficult situations constructively. In the Pehchan programme, this module is used to introduce basic principles of LSE to CBO Counsellors.



Helping Participants Get the Most Out of Training(Adapted from Human Rights and Prison: Trainers Guide on Human Rights Training for Prison Officials. 2005. United Nations, Office of the High Commissioner for Human Rights.)

Role of the FacilitatorThe role of the facilitator is to enable and empower participants to develop their knowledge on topics included in the training curriculum. In order for them to do this, the facilitator should:

• Understand the areas in which the participants work and gather information and resources that can be used in their work at the field level.

• Go through the curriculum and handouts before the training workshop is conducted and should feel confident to answer all the issues that will be raised through the toolkit.

• Create a learning atmosphere where training exercises are designed in such a way to allow participants to share their experiences, ideas and views on various issues, including those traditionally considered taboo, such as gender, sexuality, etc.

• Ensure that each participant is comfortable and feels supported.

• Be willing to look inside and assess his/her own attitudes and values that might affect the workshop.

• Understand who the participants are and where they come from.

• Remember that the information being provided may be new and quite different from what participants have learned earlier. Keep information and definitions simple.

Training MethodologyA variety of methods are used for training, including brainstorming, group work, case studies, role plays, presentations, and panel discussions. For optimum results and use of resources, the facilitator may adapt the suggested methodology to the intended audience. The goal is to use the most appropriate method or methods to build on existing knowledge and skills and hold the attention and interest of participants.

Here is a list of some of the different methods and tools used in these modules.

Problem-solving and BrainstormingIn this method, participants are asked to develop and propose ideas and solutions to both theoretical and practical problems on specific issues or topics proposed by the facilitator. Brainstorming helps promote creative thinking among the participants and makes them understand different approaches to solving a problem or addressing an issue.


Group Discussions (or Working Groups)Group discussions are conducted in small groups of 4-5 participants. Here participants discuss and come up with ideas and opinions on a particular topic or issue. A facilitator may, where necessary, be assigned to each group. After these smaller groups have met, all participants are then reconvened, and a summary of the deliberations of each group is presented by a spokesperson for the group. The facilitator should exercise care in structuring the topic and framework and then help guide participants through the discussion to keep focus.

Case StudiesCase studies are detailed descriptions of a person, group or situation over a period of time. Case studies will be used where there is a need for participants to be presented with scenarios they can analyse to understand a particular problem or solution. Trainers can use questions along with case studies to help participants discuss and try to understand the key ideas that are conveyed through the case study.

Role PlaysRole plays encourage participants to understand an issue by placing them in the ‘shoes’ of individual facing a particular challenge by having them act it out in front of the larger group. Role plays help bring real life situations to the forefront of discussions during trainings.

Presentations/LecturesThese are a common method for training in this curriculum. PowerPoint slides help a facilitator present ideas in a succinct manner. Flip charts and whiteboards may also be simultaneously used along with presentations for elaborating certain points of discussion.

The following pointers should be noted while making presentations or lectures:

• Speak slowly, clearly and in an audible manner.

• Use simple language.

• Make eye contact with participants.

• Encourage questions and discussions.

• Do not read from notes – use a conversational tone. No matter how interesting the material is, a monotone presentation will fail to grasp your audience’s attention.

• Be mindful of the time – measure the length of your presentation beforehand and keep tab of clock while making it.

• Move around; do not present in one place. When responding to a question, approach the person who asked it. If someone seems inattentive, approach and try to engage him/her in a discussion.

• Use visual aids; these should be simple and not overloaded with information. Detailed information can be provided in the handouts.


• Prepare in advance – know your subject. Follow these basic steps in preparing your session:

• Refer to the training materials provided and to the agenda;• Note the time available for the session;• Prioritise the subject matter – be sure to cover the important points;• Draft your speaking points (introduction, body, conclusion, summary of

major points);• Select the exercise and questions to be used;• Select or prepare your visual aids (handouts, etc.); and• Practice your presentation so that it can be delivered confidently and within

the time limit.• Ensure that all information is accurate and up-to-date.

• Encourage participants to read the printed annexures in the class. Materials that are not discussed or read during the course are likely never to be read ever.

• Acknowledge the value of comments of every participant.

• Set ground rules for the session and ensure that no discriminatory or intolerant comments are made either by the facilitator or participants. Such comments, if any arise, should be addressed immediately in a tactful manner.

• Be prepared to address myths and stereotypes that may come up during the course of a discussion.

• Structure your presentation – every presentation should have an introduction, a body, and a conclusion.

• Always summarise the discussions.

Question BoxThe facilitator may provide a question box with paper and pens beside it. This allows participants to ask questions anonymously that they might not be comfortable asking in public. The facilitator should periodically review the question box and ensure that questions are answered at an appropriate time during the workshop.

Statements (Myths/Realities)In a few exercises, participants are presented with various statements whose truth and veracity can be debated. The facilitator should help clear away myths and misconceptions and help participants get clarity about key issues presented.

Panel DiscussionsIn some modules, it may be useful to have a panel discussion. The formation of a panel of presenters or experts, possibly following a presentation by one or more of them, is a useful training methodology. Such an approach is particularly effective when presenters have expertise in different thematic areas. However, time and availability of experts are constraints in holding a panel discussion in a workshop.

Use of Visual AidsVisual aids, such as audio-visual clips, PowerPoint presentations, etc., have been used throughout the curriculum to illustrate and complement oral presentations, Ensure that visual aids used are clear, readable/audible, and not overloaded with too much information.


Key Considerations for Training• Describe competencies: Training of different cadres of staff should be

competency-based, with the relevant competencies known well before a workshop is organised.

• Optimise group size: To ensure there is a good use of resources, training/workshop should not exceed 15-20 participants.

• Adopt interactive training strategies: This curriculum suggests use of various interactive training methodologies. It is important to remember that that the objective of interactive training techniques should always be:

• To receive information and knowledge (about what we do not know)• To acquire skills (what shall we do with what we know?)• To sensitise (are we practicing ourselves what we know?)

• Use a participatory approach: The facilitator should lay out basic ground rules and offer an overview of the planned session. Thereafter, the facilitator should involve the participants in a moderated/guided discussion to flesh out the main issues.

• Assess participant knowledge levels: Assess participants’ current knowledge with a pre-training questionnaire. This information can then be used to refine the training. At the end of the training, the same questionnaire can be administered to determine how much knowledge and skills the participants have gained and how effective the training has been. (See section on pre- and post-training assessment for more details.)

• Respect participants: Respect for participants is crucial to the success of a training. Participants will carry with them their own professional expertise and practical experience, which if acknowledged and respected, can be tapped for the benefit of the training. The skill with which the facilitator does this will determine participants’ attitude, approach, and reaction to the training. An atmosphere needs to be created where an exchange of expertise and experience is facilitated, and it will encourage the participants to become more responsive.


Understanding Training Needs

Pre- and Post-training AssessmentPre-training assessments are designed to help the facilitator assess the level of knowledge and skills of participants. A pre-training assessment helps to structure a training to respond to the needs of participants. Post-training assessments are undertaken at the end of a workshop to assess participants’ understanding of the sessions as well as to assess the performance of facilitators. Written assessments can help determine if the objectives of the exercises have been met and whether participants have learned what they expected. Assessment can also be done through a participatory method in which participants speak about key learnings and whether their expectations have been met.

Follow UpAny effective training should ideally involve regular follow-ups about the impact of the training and the need for further training.


Workshop Preparation Checklist

Checklist Check

Objectives of workshop identified

Facilitators identified

Announcement/publicity/invitations disseminated

Realistic timeframe planned

Appropriate workshop venue assessed and booked

Agenda and activities planned

Evaluation forms prepared

Participants information

Confirmed number of people attending in the workshop

Background of participants (job, experience, human rights knowledge)

Any specific dietary requirements of the participants

Time and date of workshop suitable

Workshop logistics

Adequate size of room

Check for visual obstructions

Plan seating arrangements for interaction

Check noise level, heating adjustment, air conditioning

Equipment needs: sound system, audio-visual, etc.

Convenient rest rooms

Refreshments and meals

Handouts

Relevant information on handouts: check if large print is required

Materials for workshop activities

Sufficient copies for participants and some extras

Evaluation forms

Materials/equipment

Laptop, projector, screen

Flipcharts and easel

Markers or chalk

Notebooks and folders

Pens and pencils

Masking tape, Blu-Tack, flip charts

Scissors

Extra paper, marker pens, sketch pens

Paper clips, writing pads, ballpoint pens

Workshop scheduling

Registration

Introductory activities


Beginning a TrainingThe session below is recommended for use at the beginning of all workshops planned under this curriculum. The overall objective is to enable the facilitator to get to know the participants and also for the participants to meet each other.

Getting to Know Each Other: Welcome and Introductions Duration: 50 Minutes

Learning Objectives:

To help participants

• Feel comfortable and get to know each other;

• Arrive at a set of ground rules to be followed throughout the training; and

• Map the training expectations of participants.

Session Overview

Step Time Content Activity/Method Resources Needed

1 10 minutes Welcome Address Facilitator presentation/Discussion

None

2 25 minutes Game/Ice Breaker Facilitator presentation/Game

Flip chart/ Marker pens

3 10 minutes Mapping Training expectations

Facilitator presentation/Discussion


4 5 minutes Setting Ground Rules Facilitator presentation/Discussion


Resources Required Flip chart, paper pieces, markers


Step 1: Welcome Address

Duration: 10 minutes

The facilitator can start the session by welcoming participants and introducing him/herself and other members of the workshop organising team. The facilitator may do this using some of the following points:

• Thank participants for arriving on time;

• Acknowledge their commitment to the programme and their decision to work with Pehchan;

• Motivate participants by saying that their efforts will benefit the MTH community;

• Explain how it is not only facilitators who are bringing important information to the training but also participants bring their valuable experience and skills;

• Assure them of your constant support throughout the learning process;

• Express hope that the training is going to be successful with their active participation;

• Explain how the training will be a fun-filled exercise because of the interactive sessions and methods such as role plays, games, group works, etc;

• Seek their cooperation during the training period;

• Encourage all participants to be present for the entire training; and

• Explain the importance of commencing training sessions on time.

Note to FacilitatorAsk participants if they have any health problems or other apprehensions. Address their anxieties and concerns. This helps in creating a supportive atmosphere for training. For example if anyone is suffering from health problems either due to travel or any other reason, provide them with the necessary help and support. This is important as it will also make other participants feel comfortable.


Step 2: Game/Ice BreakerDuration: 25 minutes

The main objective of the ‘Ice-breaker session’ is to create an opportunity for participants to get to know each other and gain a sense of who they are working with. It will also help create a congenial environment for training and make participants more receptive for interactive learning. This can be done through the following exercise.

Write down the words given below in the table on small pieces of paper and fold them to conceal the contents and put them in a box or another available container. Ask each participant to pick one and then identify their ‘partner’ based on the pairings given below. After identifying their partners, give them five minutes to interact. These interactions may involve the pair introducing themselves and gathering information on the following questions:

• What is your favorite recipe?

• What is favorite hobby?

• What is their greatest expectation from this training?

After their interactions within each pair, each participant then introduces his/her partner to the rest of the group and shares the information gathered through the questions above. The facilitator can make up for a missing partner if there are an odd number of participants.

Sample pairs

Guru Chela

Hero Heroine

Bride Groom

King (Maha Raja) Queen (Maha Rani)

Honey Bee

Sun Moon

Husband Wife

Flight Airport

Brother Sister

Sugar Sugar cane

Milk Butter

Train Railway station

Coconut Tender coconut

Morning Evening

Rose Lotus

If you need additional pairs, avoid words that are seen as provocative or potentially offensive to the sentiments of the

participants, such as ‘police’ and ‘thief’ or ‘clever’ and ‘fool’.


Step 3: Mapping Training expectations Duration: 10 minutes

It is important that the session achieves the learning objectives identified in the module and that the specific needs and learning outcomes of the participants are met. Pre-session activities can help assess participants existing knowledge levels about the topic, and their expectations for the session. It may be done in two ways depending upon the availability of resources:

• Formally using questionnaires: Here workshop organisers can send out a questionnaire to each participant approximately four weeks in advance. The questionnaire will allow you to find out about participants’ work responsibilities, skills and knowledge, prior experiences and their specific learning needs or expectations. Ask them to return the questionnaires at least a week before the start of the session.

• Informally during the workshop: Here the facilitator calls upon participants after introductions to share their expectations from the workshop. One of the participants may take the lead and write down the expectations of other participants on a flip chart. After writing down the expectations, the facilitator may then classify themes or highlight the key ones from the list. Keep the chart paper up throughout the training to act as reminder for the facilitator to fulfill these expectations.

Step 4: Setting the Ground RulesDuration: 5 minutes

Ask participants to list out the ground rules they think are important for making the training more efficient. Add the ones you think are also important and read them aloud with the help of the flipchart. See box for some of the common ground rules.

Illustrative Ground Rules:• Attend all the sessions in the workshop;

• Respect other’s point of view;

• Give everybody an equal opportunity to talk;

• Avoid cross-talking or using mobile phones during sessions;

• Maintain confidentiality;

• Be punctual; and

• Encourage participants to respect individual differences.

BACKTOTOP NEXTMODULE


Notes

India HIV/AIDS Alliance6, Zamrudpur Community Centre

Kailash Colony Extension New Delhi – 110048

www.allianceindia.org

Follow Alliance India and Pehchan on Facebook: https://www.facebook.com/indiahivaidsalliance

Published in March 2013

Images © Peter Caton and Prashant Panjiar, for India HIV/AIDS Alliance

Unless otherwise stated, the appearance of individuals in this and other Alliance India publications gives no indication of their HIV or key

population status.

Information contained in the publication may be freely reproduced, published or otherwise used for non-profit purposes without permission

from India HIV/AIDS Alliance. However, India HIV/AIDS Alliance requests to be cited as the source.

Recommended Citation: India HIV/AIDS Alliance (2013). Pehchan Training Curriculum: MSM,

Transgender and Hijra Community Systems Strengthening. New Delhi: India HIV/AIDS Alliance.

© 2013 India HIV/AIDS Alliance

Pehchan is funded with generous support from:

Pehchan Training Curriculum MSM, Trangender and Hijra Community Systems Strengthening

module

C

module

A

module

C

module

D

A1 Organisational Development

A2 Leadership and Governance

A3 Resource Mobilisation and Financial Management

module

B B Basics of HIV Prevention and Outreach Planning (Pre-TI)

C1 Identity, Gender and Sexuality

C2 Family Support

C3 Mental Health

C4 MSM with Female Partners

C5 Transgender and Hijra Communities

D1 Human and Legal Rights

D2 Trauma and Violence

D3 Positive Living

D4 Community Friendly Services

D5 Community Preparedness for Sustainability

D6 Life Skills Education

CG Curriculum Guide CG

CG C

urri

culu

m G

uide

A1 O

rgan

isat

iona

l Dev

elop

men

t

Facilitator Guide

Organisational Development

A1

Pehchan 1A1 Facilitator Guide: Organisational Development

ContentsAbout this Module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

About Pehchan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2


Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3


Module Acknowledgments: Organisational Development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

About the Organisational Development Module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Module Reference Materials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Activity Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Activity 1: Introduction to Organisational Development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Activity 2: Steps in Strategic Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Activity 3: Creating Tagline and Database for the CBO Members . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Activity 4: Conflict Resolution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Activity 5: Inter-personal Communication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Activity 6: Wrap-up . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

Annexure 1: Case Studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Annexure 2: About Me . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Annexure 3: PowerPoint Presentation – Introduction to Organisational Development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

Pehchan2 A1 Facilitator Guide: Organisational Development

About this ModuleThis module is designed to help training participants: 1) understand the importance of organisational development (OD) in bringing systematic, sustainable and planned change to support growth; 2) recognise how strengthening an organisation helps the growth and development of its employees; 3) develop skills to formulate organisational goals and effective strategies and to attain them with the help of structured and documented processes; and 4) create clear and empowering communication channels to make the community a resource for its own problem-solving. In the Pehchan programme, this module is used to introduce organisational development principles to Community Base Organisation (CBO) Programme Officers as well as board members of Pehchan’s Community Advisory Boards (CABs).





Module Acknowledgments: Organisational DevelopmentEach component of the Pehchan Training Curriculum has a number of contributors who have provided specific inputs. For this component, the following are acknowledged:

Primary Author Jhuma Basak, Consultant


Technical Input Pawan Dhall and Debjyoti, SAATHII; Thomas Joseph, The Humsafar Trust


References • Buchanan, David A., and Andrzej Huczynski. (1997) Organisational Behaviour an

Introductory Text: Integrated Readings. London and New York: Prentice Hall.

• Robbins, Stephen P. (1986) Organisational Behavior: Concepts, Controversies, and Applications. London and New York: Prentice Hall.

• Davidoff, Linda L. (1980) Introduction to Psychology. 2nd Ed. Columbus. McGraw-Hill

• Welling, Grant. (2011) Are Your Policies and Procedures a Barrier to Growing your Company? California. Pacific Crest Group.

• Wamwangi, Kinuthia. (2003) Organizational Development as a Framework for Creating Anti-Poverty Strategies and Action Including Gender Mainstreaming. Washington, DC. World Bank Institute.

• Rocket Singh: Salesman of the Year 2009, motion picture, Yash Raj Films, India.


About the Organisational Development Module

No. A1

Name Organisational Development

Pehchan Trainees • Project Managers/Programme Officers

• Counsellors

• Outreach workers

Pehchan CBO Type Pre-TI, TI Plus

Training Objectives By the end of the training, the participants will:

• Understand what Organisational Development is in simple terms;

• Understand basic tools of strategic planning;

• Know the basics of conflict resolution; and

• Understand the importance of inter-personal communication in organisations.

Total Duration One day. A day’s training typically covers 8 hours.

Module Reference MaterialsAll the reference material required to facilitate this module has been provided in this document and in relevant digital files provided with the Pehchan Training Curriculum. Please familiarise yourself with the content before the training session.

Attention: Please do not change the names of file or folders, or move files from one folder to another, as some of the files are linked to each other. If you rename files or change their location on your computer, the hyperlinks to these documents in the Facilitator Guide will not work correctly.

If you are reading this module on a computer screen, you can click the hyperlinks to open files. If you are reading a printed copy of this module, the following list will help you locate the files you need.

Audio-visual Support 1. PowerPoint presentation on ‘Organisational Development’.2. Audio-video clip from the movie ‘Rocket Singh’.

Annexures 1. Annexure 1 on ‘Case Studies’.2. Annexure 2 on ‘About Me’.


Activity Index1

No. Activity Name Time Material1 Audio-visual Resources

Take-home material

1 Introduction to Organisational Development

1 hour 30 minutes

N/A Refer to the PowerPoint presentation ‘Introduction to Organisational Development’

N/A

2 Steps in Strategic Planning

1 hour 30 minutes

Printouts of Annexure 1 on ‘Case Studies’

Refer to the slides titled ‘Steps in Strategic Planning’ from the PowerPoint presentation ‘Introduction to Organisational Development’

N/A

3 Creating a Tagline and a Members’ Database for the CBO

Lunch break

Printouts of Annexure 2 on ‘About Me’

N/A N/A

4 Conflict Resolution

2 hours 30 minutes

N/A N/A N/A

5 Interpersonal Communication

2 hours Blindfolds N/A N/A

6 Wrap-up 30 minutes N/A Refer to the slides titled ‘Lessons from Rocket Singh’ from the PowerPoint presentation ‘Introduction to Organisational Development’ (includes audio-video clip from the movie ‘Rocket Singh’)

N/A

1 Overhead projector, laptop, sound system and whiteboard should be provided at every training.

file:///C:\Users\hkhosa\AppData\Local\Temp\wzc953\B1%20-%20Organisational%20Development\B1_AVSupport\RocketSingh.flv

file:///C:\Users\hkhosa\AppData\Local\Temp\wzc953\B1%20-%20Organisational%20Development\B1_AVSupport\RocketSingh.flv


Activity 1: Introduction to Organisational Development

Time 1 hour 30 minutes

Learning Outcomes By the end of this activity, the participants will be able to:

• Define the term ‘Organisational Development’;

• Outline the characteristics of a developed organisation; and

• Articulate the steps involved in organisational development.

Materials N/A

Audio-visual Support Refer to the PowerPoint presentation on ‘Introduction to Organisational Development’.

Take-home Material N/A

Methodology

Part I Divide the participants into groups based on their organisation and ask them to spend ten minutes in developing an oral presentation about their organisation. The presentation should include the following information:

• Name of their organisation;

• Name of the parent NGO (if there is one);

• Whether it is a community-based organisation; and

• What work the organisation does.

Completion of at least three of the phrases on the PowerPoint slide titled ‘My Organisation’ (these would help participants articulate the values of their organisation)

Ask each group to nominate a member to present their discussion to other participants in the room. Ensure that while they are presenting their organisation, they elaborate sufficiently about what their organisation does; if necessary, ask leading questions.

Thank the participants for sharing information about their organisations. At the end of all the presentations from groups write the term ‘Organisation’ on a flip-chart. Ask participants to give words or phrases which best describe the term ‘Organisation’ for them.

On another flip-chart, write the term ‘Development’, and ask them to give words or phrases which they associate with this term.

Once you have sufficient number of responses, conduct an interactive discussion during which you clearly define the following terms:

• Organisation;

• Non-governmental organisation (NGO);

• Community-based organisation (CBO); and

• Organisational development (OD).

Organisational culture: when defining organisational culture, reflect on the way participants described their organisational values during their presentations, and point out that organisational development places human-centred values above everything else.

Note to FacilitatorValues are those intangible beliefs, feelings, and notions that are part of individuals because of their family upbringing, educational background, religious or cultural heritage, work environment, or other factors.

Values help people understand the importance of friends, family, work, etc.

These will be different for each individual but in a community there are usually values that are shared. This shared set of values is the basis on which the organisational vision is built.


Part IIDraw two columns on the board. At the top of the first column, write ‘A Developed Organisation’. At the top of the second, write ‘An Underdeveloped Organisation’.

Ask the participants to come up with six to eight attributes which portray the characteristics of a developed organisation vis-à-vis an underdeveloped one.

Write each attribute on the board under the appropriate heading and allow an interactive discussion between participants; however, ensure that their views refer to general cases and participants do not use specific organisation’s or individual’s names.

Ask participants to elucidate what steps they think would be necessary if an organisation felt that a certain area needs improvement. After they share their responses, display the PowerPoint presentation titled ‘Introduction to Organisational Development’, and point out that:

• For organisational development to be successful, the key ingredient is direction. “Does the organisation know where and what it wants to develop or change (problem scenario) ... and what the changed state would be?”

• When an organisation embarks on change, it should use its vision, mission, goal and objective statements as a benchmark to ensure that it is moving in the right direction. Sometimes, organisational development also means revisiting and amending these; and

• In the case of CBOs or even other NGOs, it is imperative that community mobilisation is an integral part of organisational development. “What change to bring about, what new state to achieve, looking at the organisation’s vision, mission, goals and objectives, what relevant community members need to be mobilised and involved?”

Check that all participants understand the distinctions between an organisation’s vision, mission and goals:

• A vision is the desired end, or an image of the future toward which an organisation is committed.

• A mission statement is a statement of purpose and the primary reason for which plans and resources, including administrative and programmatic staff, are directed. It should be general and not include measurable goals which may be subjected to change. The mission aims to realise/achieve the vision.

• Goals are what an organisation needs to work towards or needs to do in order to fulfil its mission and achieve its vision. A goal should be achievable after implementing a series of actions within the time-frame of a strategic plan.

Background Information(Wamwangi, 2003)

Organisational development is a change management strategy which has been in operation for the last 40 years or so. It is based on the understanding of behavioural sciences and is concerned with how people and organisations function and how they can be made to function better through effective use of human and social processes.

OD may simply be described as a methodology or a technique used to effect change in an organisation or section of an organisation with a view to improving the organisation’s effectiveness. It has the following attributes:

• A planned process of change.

• Applies behavioural science knowledge.

• Aims at changing organisation culture.


• Aims at reinforcement of organisation strategies, structures and processes for improving organisation’s effectiveness and health.

• Applies to an entire system of an organisation, a department or a group as opposed to an aspect of a system.

• Targets long-term institutionalisation of new activities such as operation of self-managed or autonomous work teams and other problem-solving capabilities.

• Encompasses strategy, structure and process changes.

• A process managed from the top.

OD is not a business plan or a technological innovation model but rather an easy and flexible process of planning and implementing change. OD places human-centered values above everything else. They are the engine of its success. These values include mutual trust and confidence, honesty and open communication, sensitivity to the feeling and emotions of others, shared goals, and a commitment to addressing and resolving conflict (Buchanan and Huczynski, 1997). There are organisations that value these human attributes above all other quick fix benefits. Below mentioned points expresses these human values more concisely as follows (Robbins, 1986):

• The individual should be treated with respect and dignity.

• The organisational climate should be characterised by trust, openness and support.

• Hierarchical authority and control are not regarded as effective mechanisms.

• Problems and conflicts should be confronted, and not disguised or avoided.

• People affected by change should be involved in its implementation.

Vision, Mission and Goals of an Organisation

Definition of a Vision StatementA vision is the desired end, or an image of the future toward which an organisation is committed.

Definition of a Mission StatementA mission statement is a statement of purpose and the primary reason for which plans and resources, including administrative and programmatic staff, are directed. It should be general and not include measurable goals which may be subject to change. The mission aims to realise/achieve the vision. The mission statement may include the following:

• The target groups.

• The problem the organisation is addressing.

• The products and services being provided.

• The organisation’s values.

• The organisation’s future focus.

Questions to Help with Writing Mission Statements• What does the organisation do?

• In what does the organisation believe?

• Who does the organisation serve?

• What needs does the organisation meet?

• What makes the organisation unique?


What is an Organisational Goal?Goals are what an organisation needs to work towards or needs to do in order to fulfil its mission and achieve its vision. A goal should be achievable after implementing a series of actions within the time-frame of the strategic plan. The following three-step process can be used to develop meaningful goals.

1. Write down the current problem that the organisation needs to address to be able to achieve its vision. For example:

• Inadequate access to ____________________ ; or

• Arbitrary decision-making when giving employees ___________________.

2. Rewrite these problems as positive statements. For example:

• Need to improve access to____________________ ; or

• Need to create guidelines for giving employees’ _________________.

3. Rewrite these positive statements as goals: For example:

• Enable access to___________________ ; or

• Ensure that policies and guidelines are developed for giving employees ______________.


Activity 2: Steps in Strategic Planning


Learning Outcomes By the end of this activity, the participants will:

• Know how to conduct SWOT analysis; and

• Understand the basic tools of strategic planning, goal-setting, designingobjectives and action plans.

Materials Annexure 1 on ‘Case Studies’.

Audio-visual Support Refer to the slides titled ‘Steps in Strategic Planning’ from the PowerPoint presentation ‘Introduction to Organisational Development’.


Methodology

Part I: Reviewing Capacity and Potential Introduce the SWOT (strength, weakness, opportunity and threat) analysis matrix to the participants, explaining that it is a strategic tool which can be used not just in organisational contexts, but also in any decision-making situation when a desired end-state (objective) has been defined.

Using the PowerPoint Slide titled ‘SWOT Analysis’, explain the purpose of the four quadrants of the matrix.

Divide the participants into three groups, giving each group one case from Annexure 1. Give each group chart papers and markers, and ask them to develop SWOT analysis of organisational capacity and potential of the organisation in the case study given to them.

After ten minutes, ask each group to present its findings and discuss the following:

• Why is SWOT analysis helpful?

• How can it be used in organisational development?

• How can SWOT analysis be converted into goals?

Part II: Steps in Achieving Goals and Objectives Ask participants if there is any difference between goals and objectives. Point out that often the terms are used interchangeably; however in strategic planning terms, the two terms have different implications.

• Goals are general guidelines that explain what you want to achieve in the long-term.

• Objectives are the different outcomes or results organisations would like toachieve to reach a goal. Unlike goals, objectives are specific, measurable, andhave a defined completion date. They are more specific and outline the ‘who,what, when, where, and how’ of reaching the goals. Introduce participants to theconcept of SMART objectives (specific, measureable, achievable, realistic, andtime-bound).

Note to FacilitatorPolicies:

• Are general in nature

• Are normally describedusing simple sentencesand paragraphs

• Identify company rules

• Explain why they exist

• Tell when the rule applies

• Describe who it covers

• Show how the rule isenforced

• Describe theconsequences

Procedures:

• Identify specific actions

• Explain when to takeactions

• Describe alternatives

• Show emergencyprocedures

• Include warnings andcautions

• Give examples

• Show how to completeforms

• Are normally written usingan outline format

file:///C:\Users\abhalla\AppData\Local\Microsoft\Windows\Temporary%20Internet%20Files\Content.Outlook\MVD37J9J\A1b_Annexure%2002_Organisational%20Development_Case%20Studies.docx


Ask the participants to work in the same groups, and, based on the learning from the SWOT analysis:

• Set at least two goals for the organisation; and

• Develop at least two SMART objectives for each goal.

Ask the participants to:

• Define the term ‘Activity’: activities are actual tasks which are conducted in order to achieve the strategies and objectives.

• Briefly explain that activities can be of six broad types: ‘overall organisational-development related’, ‘programmatic’, ‘administrative’, ‘financial’ (including fund raising), ‘in-house capacity building’ and ‘monitoring and evaluation’.

• For each of the SMART objectives in their case study, they should design at least three activities that would help them achieve the objective. They should also keep in mind that different types of activities would be needed for achieving different objectives.

Ask participants how they would develop an action plan and prioritise activities. Using their case studies:

• Demonstrate short-term and long-term prioritisation;

• Distinguish between ‘urgent’ and ‘important’ activities; and

• Elaborate on other factors that affect planning of activities, such as resources availability, order of events, current and anticipated capacity of the team etc. Ask them to refer to the SWOT matrix developed earlier to see what factors could affect planning.

Next, describe how written ‘policies’ and ‘procedures’ are hallmarks of a developed organisation. CBOs should strive to develop these for all the major areas of management and operations. Some examples are human resource policies, including policies on hiring and firing, remuneration, leave management, gender and equity, non- discrimination based on HIV status, etc.

A policy is a predetermined course of action which is established to provide a guide toward accepted business strategies and objectives (Welling, 2011). In other words, it is a direct link between an organisation’s vision and their day-to-day operations, and is guided by the organisation’s values.

Policies identify the key activities and provide a general strategy to decision-makers on how to handle issues as they arise. This is accomplished by providing limits and a choice of alternatives that can be used to guide their decision-making process as they attempt to overcome problems.

The ultimate goal of every procedure, on the other hand, is to provide a clear and easily understood plan of action required to carry out or implement a policy. A well-written procedure will also help eliminate common misunderstandings by identifying job responsibilities and establishing boundaries for job holders. Good procedures actually allow managers to control events in advance and prevent the organisation (and employees) from making grave mistakes. You can think of a procedure as a road map where the trip details are highlighted in order to prevent a person from getting lost or wandering off from an acceptable path identified by the company’s management team.


Sum up the session by pointing out that this activity has introduced to them the concept of Strategic Planning, an essential part of Organisational Development. Define the terms ‘Plan’ and ‘Strategic Planning’:

• A plan is a series of thoughts, processes, and actions, written and agreed in the present, in order to achieve a particular goal.

• Strategic planning is a systematic process aimed at identifying and addressing specific issues in a participatory manner in order to attain the desired outcomes. The process takes into consideration contextual environmental issues and has specific goals and objectives to be implemented or carried out in the future.

However, explain to the participants that the process of Strategic Planning does not end here. In the subsequent sessions, there would be learning on more issues involved in Strategic Planning. Module A ends with a discussion of the ‘Organisational Development Cycle’ (A3) that will help sum up the learnings in this part of the curriculum.

Box 1: An Exercise on Vision, Mission, Goal and Objective

• Participants are lined up with components of an OD cycle written on sheets of paper.

• An interactive game is carried out. Some of the participants are asked to assemble in the order they think is necessary for OD.

• Rectifications are carried out by other participants and the facilitator to put the components in the right order, along with imagery that could be used to explain each component of the cycle.

• The imagery, on past occasions when this exercise was carried out, has included the following:• Problem scenario: a spider-web; • Community mobilisation: a chain of hands; • Long-term vision (or goal): stairs, ladders, with the person on the top; • Short-term vision (or goal): opening a door, stairs or ladders with the person on the first step; • Mission statement(or objectives): pathway; • Activities: birds making a nest; • Policy (gender policies, leave policies, office timings etc.): books; • Strategising: chessboard (the very same activity or process that helps design this OD cycle); • Resources needed: human resources, equipment, office space, medicines, condoms, etc;• Budget: money bags; • Activity plan: a form, checklist or document (framework of who would do what and when); and• Monitoring and Evaluation: a magnifying glass.


Activity 3: Creating Tagline and Database for the CBO Members

Time 1 hour (during lunch break)

Learning Outcomes By the end of this activity, the participants will be able to create:

• A database of members of their CBO; and

• A tagline for their CBO.

Materials Annexure 2 on ‘About Me’.

Audio-visual Support N/A


Methodology

Part I: Pre-lunch Before breaking for lunch, tell the participants that they would be having a working lunch; however, assure them that the work would be creative and fun, and that this exercise will help them showcase work of their CBO.

Remind them that they have already prepared a description of their CBO at the beginning of the day’s activities; now it’s time to create a tag-line. Explain that a tag-line is a one or two lines phrase which could describe their CBO, its philosophy or vision, its work or any other aspect; however it should be short and apt. The tag line also has to be interesting. It could be serious or funny, in rhyme or in prose, but needs to be something that has recall value. Tell them to think about advertisements they have seen in magazines and on TV, and get them to recall some of their favourites.

Additionally, give each participant a printout of the Annexure 2 ‘About Me’, and ask each one to fill in the sheet during lunch. Assign a team leader to each organisation and encourage them to make sure that everyone participates, has time for lunch and has fun while doing the exercises.

Part II: Post-lunchWhen the participants assemble after lunch, ask each organisation to share their tag-lines as well as to share some of the information from their filled in sheets on ‘About Me’. Ask the team leaders of each organisation to collect these filled sheets from the participants and file them when they go back to their offices.

Note to FacilitatorSome common taglines you can remind the participants about.

• SBI: ‘With you all the way’

• NDTV Profit: ‘News you can use’

• Indian Railways: ‘Life Line of India’

• Jet Airways: ‘The joy of flying’

• Airtel: ‘Express yourself’

• Big Bazaar:‘Is se sasta aur achcha kaheen nahee milega’


Activity 4: Conflict Resolution

Time 2 hours 30 minutes


• Understand the different types of conflict that can occur in an organisation; and

• Formulate conflict resolution strategies.

Materials N/A



MethodologyUsing the PowerPoint Slide titled ‘Organisational Development is…’ summarise some of the important points of the earlier activities. Introduce the human resources element into the context of organisational development, and conduct a brief brainstorming on issues like teamwork and communication.

Invite the participants to describe the term ‘conflict’. After they share their responses (you can list these on a flip-chart), define the word ‘conflict’ as:

‘Any situation where incompatible goals, attitudes, emotions or behaviours lead to disagreement between two or more parties.’ (Robbins, 1986)

Introduce participants to the following types of conflict, asking them to first give examples of each type, and then to attempt a definition of each type.

• Intra-personal conflict.

• Inter-personal conflict.

• Inter-group conflict.

• Individual-group conflict.

• Organisational-level conflict.

Divide the participants into teams of two to three members and tell each team to select a type of conflict. Tell the teams that they have ten minutes to prepare a storyline around their selected type of conflict, and that they would be required to enact the storyline through role-play.

After ten minutes, invite each team to perform their role-play, while the other participants observe. After the role-play is done, invite the observing participants to comment on the conflict, and to provide ways in which the conflict could be resolved.

As suggestions come in, ask the role-playing team to enact the conflict again, this time moving towards a resolution of the conflict. Help participants to state issues in a positive rather than accusing or blaming manner, and to focus on the problem at hand, rather than on fixing blame and finding fault.

Finally, indirectly guide the members to articulate problems without being biased or blaming any specific individual for the situation.

Note to FacilitatorConflict Resolution is a very important and delicate aspect of organisational and human behavioural exchange. Hence quality time needs to be allotted here with very sensitive/careful handling of the situation.

Encourage the group to share examples from their experiences so that there is absolute clarity of different kinds of conflict that one faces. However, ensure that all participants agree that confidentiality would be maintained, and that any of the information shared will not be used against each other once outside the classroom.


Background Information on Conflict Types(Davidoff, 1980)

Intra-personal ConflictIntra-personal conflict is also called intra-psychic conflict. It occurs within you. This conflict can develop out of your own thoughts, ideas, emotions, values and predispositions. Intra-personal conflict occurs when you internally argue with yourself about something, such as when you want a new pair of shoes but you know you should not spend the money on them.

Inter-personal ConflictIn inter-personal conflict, you are in conflict with other individuals. This is considered a major level of conflict and can occur between co-workers, siblings, spouses, roommates and neighbours. This is the form of conflict most people have in mind when they think about being in conflict.

Inter-group ConflictA circumstance in which groups take antagonistic actions towards one another to control some outcome important to each, or display an overt expression of tensions between the goals or concerns of one party and those of another.

Individual-group Conflict These arise frequently due to an individual’s inability to conform to the group norms.

Organisational-level ConflictThis is a state of discord caused by the actual or perceived opposition of needs, values and interests between people working together. Conflict takes many forms in organisations. There is the inevitable clash between formal authority and power and the individuals and groups affected. There are disputes over how revenues should be divided, how the work should be done and how long and hard people should work. There are jurisdictional disagreements among individuals, departments, and between unions and management. There are subtler forms of conflict involving rivalries, jealousies, personality clashes, role definitions, and struggles for power and favour.


Activity 5: Inter-personal Communication

Time 2 hours


• Understand the importance of specific and clear instructions when guiding other team members towards achieving a goal.

Materials Cloth strips to blindfold approximately one-third of the participants.



MethodologyThe methodology used for this activity is a game that involves moving around of participants in a large space, either a large room with scattered chairs and tables as obstacles or an open area threaded with pathways, trees and plants.

Divide the participants into three-member teams, making sure that there is an even number of teams. Pair the teams up, naming one team in each set as Team A, and the other as Team B.

Inform the participants that there would be two rounds of activity—in the first round all the teams named A would be the ‘actors’ while all the teams named B would be ‘observers’. In the second round, the roles would be reversed.

The task for all the teams named A would be to select a ‘messenger’ among their members who would deliver a document to a place designated by their partnering B team, the catch being that the messenger would be blindfolded.

The other members in the team A would instruct their messenger on how to reach the designated space. In the meanwhile, the partnering team B would observe the communication between the members of their team A, and make notes for de-briefing.

After round one, tell the teams to reverse roles. The members of all the teams named B would be required to deliver a document to a designated area (with one member of the team blindfolded and the other two giving instructions), and the members of their partnering team A observing.

After both teams have played their part, gather the participants together for a de-briefing. Ask them the following:

• What problems did the blindfolded messengers face when following instructions?

• What problems did the instructors face when giving instructions?

• Were there gaps between the instruction and the action taken? If so, what caused the gaps? How could these gaps be minimised?

• How did the participants feel when their instructions were not properly followed?

• How did the blindfolded messengers feel when they were given instructions that were not clear?

• Since all the teams named B were observers in round one, they had a chance to note the difficulties that the members of the teams named A had faced. Were they able to learn from the observations, and was their performance any better?


Ask participants how they felt during the activity, as actors, messengers, receivers of messages and observers, and point out that good inter-personal communication is needed to:

• Get acquainted;

• Express emotions to others;

• Share information;

• Make others understand our perspectives on subjects; and

• Build relationships.

Remind participants that communication in an organisation can be formal and informal, verbal and non-verbal, and that successful interpersonal communication is one of the means through which an organisation functions smoothly.


Activity 6: Wrap-up

Time 30 minutes


• Summarise the learnings of the day’s activities.

Materials N/A

Audio-visual Support PowerPoint slides titled ‘Lessons from Rocket Singh’ (includes audio-video clip from the movie ‘Rocket Singh’) from the PowerPoint presentation ‘Introduction to Organisational Development’.


MethodologyBrief the participants that they are going to watch a clip from a popular Bollywood film titled ‘Rocket Singh’. While many participants may be familiar with the film, for the benefit of those who are not, give a brief introduction to the movie. (See box.)

Screen the video clip.

After the screening, facilitate a discussion on the film, using the questions below:

• What were the two characters arguing about?

• Did the participants feel from the conversation that ‘Rocket Singh’ had leadership qualities?

• If yes, why? If not, why not?

• Why are people important for an organisation?

• Are human resources more important or less important than other resources?

Using the PowerPoint slides titled ‘Lessons from Rocket Singh’; reiterate the learning’s of the session.

Wrap up the day’s activities by inviting questions from the participants.

About ‘Rocket Singh’A salesman, nicknamed Rocket Singh, decides that people are the basis of a good business, and starts a business of his own, where everyone is an equal partner, bringing talent to the table without discrimination, including the office peon.

However, he does this surreptitiously in his employer’s organisation, who, after finding out, forces a take-over.

The video clip starts when the employer goes back to Rocket Singh, and hands him back his company.


Annexure 1: Case Studies

Case Study A: Jhakaas SangamJhakaas Sangam is a community-based organisation (CBO) that has been legally registered as a trust. It works in three districts of Gujarat. The organisation is 11 years old and has a 10,000-strong membership of men who have sex with men (MSM).

The CBO is getting some support from the State AIDS Control Society. As most of the budget of Jhakaas Sangam is being received from a single donor agency, the members of the organisation are not concerned about financial sources. But now the funding agency has decided to cut down the budget since last year. This has created a big problem for Jhakaas Sangam.

The leadership of the organisation lacks individuals with skills for resource mobilisation. The organisation never thought of the possibility of such a problem and when someone asked about making the organisation sustainable, they would give a very easy answer, ‘It will remain sustainable until the donor gives it funds!’

As a result of the decision of the donor agency, a dispute has occurred in the working committee over who should leave and who should continue in Jhakaas Sangam.

Case Study B: Hocus Pocus FoundationRajnikant who, until few years back used to teach at a local primary school, is the Chairperson of the Hocus Pocus Foundation. The Hocus Pocus Foundation was founded with health-and income-generation as its mission.

Presently, Rajnikant runs counselling centres, health education centres, HIV service centres for transgender people and MSM with the support of a donor agency. Though monthly savings are being generated after formation of self-help groups (SHGs) for income-generation, programs have not been carried out for the skill-development of women due to lack of the required capital.

The working committee of the Hocus Pocus Foundation has 11 members, but due to lack of skill and knowledge of organisational development and resource mobilisation, Rajnikant has not been able to achieve anything much towards development, other than the HIV health program granted by the donor agency.

A majority of the SHG members are inactive while some have stopped building savings because they have not been able to use the savings made in their SHG for income-generation. Rajnikant always pressurises one of the members to write a project proposal and go to meet a donor agency.


Case Study C: Maharathi OrganisationMaharathi is a CBO founded in 1998 with the objective to work for the uplift of the transgender (TG) community. The CBO has its own structure. The Executive Committee of the CBO is represented by individuals with skilled leadership qualities, as a result of which it has been receiving resources from various sectors. Under its Executive Committee (or Working Committee) is a Sub-Committee for Resource Mobilisation. The Sub-Committee works at the local and national level to expand relations with various organisations and collect resources.

The CBO runs programs in two districts. Local government, private sector and international agencies have been providing financial, technical and other cooperation to the CBO. Starting this year, the CBO is running adult-care program and income-generating programs for the community, in addition to partnering two other big CBOs in four districts.

With the cooperation of local volunteers, it runs a social awakening campaign against prevailing harmful traditions, health issues, HIV issues and takes up cases where legal services may be required. The CBO also runs counselling centres, health-education centres, and cultural centres with wide participation of local volunteers.

Maharathi has its own policies and regulations and good governance is strong. It has been running programs as per its target. The CBO’s work has been respected at the national and international levels. Other small organizations take Maharathi as their model.


Annexure 2: About MePlease fill the following form to become a member of our organisation. We assure that the information received will be kept confidential.

Name

Age

Address/ contact number (optional)

Please mention your identity by ticking the preferred choice

Transgender MSM Hijra Others (please specify)

No. of family members

No. of earning members

Blood group

Any significant health issue

Educational qualifications

Skills

Work experience

Thank you!


Annexure 3: PowerPoint Presentation – Introduction to Organisational Development


BACK TO TOP NEXT MODULE


Notes






Image © Peter Caton for India HIV/AIDS Alliance


population status.







module

C

module

A

module

C

module

D




module



C2 Family Support

C3 Mental Health





D3 Positive Living





A1 O

rgan

isat

iona

l Dev

elop

men

t


A2 L

eade

rshi

p an

d Go

vern

ance

Facilitator Guide

Leadership and Governance

A2

Pehchan 1A2 Facilitator Guide: Leadership and Governance

ContentsAbout this Module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

About Pehchan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2


Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3


Module Acknowledgements: Leadership and Governance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

About the Leadership and Governance Module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9


Activity Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Activity 1: Introduction to Leadership . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Activity 2: Styles of Leadership . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Activity 3: Power versus Responsibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Activity 4: Leadership Skills: Multi‑tasking, Time Management and Decision‑making . . 17

Activity 5: Introduction to Governance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Activity 6: What is Good Governance? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Activity 7: Guidelines on Rewards and Punishments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Annexure 1: Power and Responsibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Annexure 2: PowerPoint Presentation – Leadership and Governance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

Pehchan2 A2 Facilitator Guide: Leadership and Governance

About this Module This module is designed to help training participants: 1) understand the importance of leadership and good governance in achieving the goals of an organisation; and 2) enhance individual leadership capacity to help develop a vision to improve the quality of life in the community. Interactive sessions in this module include group work, games, live projects, audio and video clips, role playing and case studies. In the Pehchan programme, this module is used to introduce leadership and governance principles to CBO Programme Officers as well as board members of Pehchan’s Community Advisory Boards (CABs).

About PehchanWith financial support from the Global Fund, Pehchan is building the capacity of 200 community‑based organisations (CBOs) for men who have sex with men (MSM), transgenders and hijras in 17 states in India to be more effective partners in the government’s HIV prevention programme. By supporting the development of strong CBOs, Pehchan addresses some of the capacity gaps that have often prevented CBOs from receiving government funding for much‑needed HIV programming. Named Pehchan, which in Hindi means ‘identity’, ‘recognition’ or ‘acknowledgement,’ this programme will reach 453,750 MSM, transgenders and hijras by 2015. It is the Global Fund’s largest single‑country grant to date, focused on the HIV response for vulnerable sexual minorities.


Inputs from community consultations helped increase relevance and value of training modules. By engaging MSM, transgender and hijra (MTH) communities in the development process, there has been greater ownership of training and of the overall programme among supported CBOs. Technical experts worked on the development of thematic components for priority areas identified by community representatives. The process also helped fine‑tune the overall training model and scale‑up strategy. Thus, through a consultative, community‑based process, Pehchan developed a training model responsive to the specific needs of the programme and reflecting key priorities and capacity gaps of MSM, transgender and hijra CBOs in India.


PrefaceAs I put pen to paper, a shiver goes down my spine. It is hard to believe that this day has come after almost five long years! For many of us, Pehchan is not merely a programme; it is a way of life. Facing a growing HIV epidemic among men who have sex with men (MSM), transgender, and hijra communities in India, a group of development and health activists began to push for a large‑scale project for these populations that would be responsive to their specific needs and would show this country and the world that these interventions are not only urgently needed but feasible.


At the heart of Pehchan are community systems strengthening. Our approach to capacity building has been engineered to maximise community leadership and expertise. The community drives and energises Pehchan. Our task was to develop 200 strong community‑based organisations (CBOs) in a vast and complex country to partner with state governments and provide services to MSM, transgender and hijra communities to increase the effectiveness of the HIV response for these populations and improve their health and wellbeing. To achieve necessary scale and sustain social change, strong CBOs would require responsive development of human capital.





Once the curriculum was ready to use, trainings‑of‑trainers were organised to develop a cadre of master trainers who would work directly with CBO staff. Working through Pehchan’s four Regional Training Centers, these trainers, mostly members of MSM, transgender and hijra communities, provided further in‑service revisions and suggestions to the modules to make them succinct, clear and user‑friendly. Our consortium partner SAATHII contributed particularly to these efforts, and the current training curriculum reflects their hard work.







General AcknowledgementsThe Pehchan Training Curriculum is the work of many people, including community members, technical experts and programme implementers. When we were not able to find training materials necessary to establish, support and monitor strong community‑based organisations for MSM, transgenders and hijras in India, the Pehchan consortium collectively developeda curriculum designed to address these challenges through a series of community consultations and development workshops. This process drew on the best ideas of the communities and helped develop a responsive curriculum that will help sustain strong CBOs as key element of Pehchan.

We would like to take this opportunity to acknowledge the contributions of those who helped in taking this process forward, including (in alphabetical order): Ajai, Praxis; Usha Andewar, The Humsafar Trust; Sarita Barapanda, IWW‑UK; Jhuma Basak, Consultant; Dr. V. Chakrapani, C‑Sharp; Umesh Chawla, UNDP; Alpana Dange, Consultant; Brinelle D’Sourza, TISS; Firoz, Love Life Society; Prashanth G, Maan AIDS Foundation; Urmi Jadav, The Humsafar Trust; Jeeva, TRA; Harleen Kaur, Manas Foundation; Krishna, Suraksha; Monica Kumar, Manas Foundation; Muthu Kumar, Lotus Sangama; Sameer Kunta, Avahan; Agniva Lahiri, PLUS; Meera Limaya, Consultant; Veronica Magar, REACH; Magdalene, Center for Counselling; Sylvester Merchant, Lakshya; Amrita Nanda, Lawyers’ Collective; Nilanjana, SAFRG; Prabhakar, SIAAP; Priti Prabhughate, ICRW; Nagendra Prasad, Ashodaya Samithi; Revathi, Consultant; Rex, KHPT; Amitava Sarkar, SAATHII; Dr. Maninder Setia, Consultant; Chetan Sharma, SAFRG; Suneeta Singh, Amaltas; Prabhakar Sinha, Heroes Project; Sreeram, Ashodaya Samithi; Suresh, KHPT; Sanjanthi Veul, JHU; and Roy Wadia, Heroes Project.


From the start, the Government of India’s National AIDS Control Organisation has been a key partner of Pehchan. In particular, Madam Aradhana Johri, Additional Secretary, NACO, has provided strong leadership and steady guidance to our work. The team from NACO’s Targeted Intervention (TI) Division has been a constant friend and resource to Pehchan, notably Dr. Neeraj Dhingra, Deputy Director General (TI); Manilal N. Raghvan, Programme Officer (TI); and Mridu, Technical Officer (TI). As the programme has moved from concept to scale‑up, Pehchan has repeatedly benefitted from the encouragement and wisdom of NACO Directors General, past and present, including Madam Sujata Rao, Shri K. Chandramouli, Shri Sayan Chatterjee, and Shri Lov Verma.



India HIV/AIDS Alliance’s Pehchan team has been untiring in its contributions to this curriculum, including Abhina Aher, Jonathan Ripley, Yadvendra (Rahul) Singh, Simran Shaikh, Yashwinder Singh, Rohit Sarkar, Chaitanya Bhatt, Nunthuk Vunghoihkim, Ramesh Tiwari, Sarbeshwar Patnaik, Ankita Bhalla, Dr. Ravi Kanth, Sophia Lonappan, Rajan Mani, Shaleen Rakesh, and James Robertson. A special thank‑you to Sonal Mehta and Harjyot Khosa for their hard work, patience and persistence in bringing this curriculum to life.





Module Acknowledgements: Leadership and GovernanceEach component of the Pehchan Training Curriculum has a number of contributors who have provided specific inputs. For this component, the following are acknowledged:

Primary Author Jhuma Basak, Consultant


Technical Input Debjyoti Gosh, SAATHII; Harjyot Khosa, India HIV/AIDS Alliance


References • Covey, Stephen R. (1990) The Seven Habits of Highly Effective People: Powerful

Lessons in Personal Change. New York. Free Press.

• Bass, B. and Bass R. (1974) The Bass Handbook of Leadership: Theory, Research, and Managerial Applications. New York. Free Press.

• Woldring,Roelf. (2001) Power In Organizations: A Way of Thinking About What You’ve Got, and How to Use It. Hillsburgh. Workplace Competence International Limited.

• Gonzalez, V.M. and Mark G. (2004) Constant, constant, multi-tasking craziness: managing multiple working spheres. New York. Association for Computing Machinery.

• Kaufmann, D. Kraay A. and Zoida P. (2002) Governance Matters II: Updated Indicators for 2000-01. World Bank Policy Research Working Paper No. 2772. Available from http://papers.ssrn.com/sol3/papers.cfm?abstract_id=297497

• Hirschmann, David. (1999) Development Management versus Third World Bureaucracies: A Brief History of Conflicting Interests. Volume 30. Issue 2.

• Reif, Linda C. (2000) Building Democratic Institutions: The Role of National Human Rights Institutions in Good Governance and Human Rights Protection. Cambridge. Harvard Human Rights Journal.

• Lewin, K. (1935). A dynamic theory of personality. New York. McGraw Hill.

• Prabhu and Rao. (1996) Mind of Mahatma Gandhi, Encyclopedia of Gandhi’s Thoughts, Ahmedabad. Navjeevan Trust.

• Mizruchi, Mark S. (2001) Berle and Means revisited: the governance and power of large U.S. corporations. University of Michigan.

• Conger, J.A. (1992) Learning to Lead’ San Francisco. San Francisco. Jossey-Bass.

• Field Manual (2006), Army Leadership: Confident, Competent, and Agile. p 6‑22. US. Department of Army.

• Lagaan 2001, motion picture, Aamir Khan Productions, India.


About the Leadership and Governance Module

No. A2

Name Leadership and Governance

Pehchan Trainees • Project Directors

• Project Managers/Project Officers

• Administrative and Finance Officers


Training Objectives By the end of the module, the participants will:

• Understand the importance of able leadership and good governance for attaining organisational goals in order to ensure organisational development; and

• Enhance individual leadership qualities in members of the communities they work with so that they can develop the necessary vision to drive the community members for a better life.





Audio-visual Support 1. PowerPoint presentation on ‘Leadership and Governance’.2. Audio-video clip on ‘Mahatama Gandhi’s speech’.3. Audio-video clip on ‘Swami Vivekananda’s speech in

Chicago’.4. Audio-video clip from the movie ‘Lagaan’.

Annexures Annexure 1 on ‘Power and Responsibility’.


Activity Index1


Take-home material

1 Introduction to Leadership

45 minutes N/A Refer to the slides titled ‘A Good Leader Must’ to ‘Walk the Talk’ from the PowerPoint presentation ‘Leadership and Governance’

N/A

2 Styles of Leadership

30 minutes N/A N/A N/A

3 Power versus Responsibility

1 hour 30 minutes (including lunch break)

Personal valuables belonging to participants

N/A Annexure 1 on ‘Power and Responsibility’

4 Leadership Skills: Multi-tasking, Time Management and Decision-making

1 hour N/A Refer to the Audio-video clip on ‘Mahatama Gandhi’s speech’

N/A

5 Introduction to Governance


6 Concept of Good Governance

40 minutes N/A Refer to the slides titled ‘Good Goverance Provides’ from the PowerPoint presentation ‘Leadership and Governance’

PowerPoint presentation ‘Leadership and Governance’

7 Rewards and Punishments

1 hour Chart papers and markers

Refer to the Audio-video clip on ‘Swami Vivekananda’s speech in Chicago’ and the movie ‘Lagaan’

N/A



Activity 1: Introduction to Leadership

Time 45 minutes


• Understand the MTH community’s need for leadership and the qualities of a goodleader;

• Create the vision, mission and goal of the community and the community-based organisation (CBO); and

• Balance the individual’s vision, mission and goals with that of the community and the CBO.

Materials N/A

Audio-visual Support Refer to the slides titled ‘A Good Leader Must’ to ‘Walk the Talk’ from the PowerPoint presentation ‘Leadership and Governance’.


Methodology Ask the participants to share their thoughts and views on the community’s perspective (this refers to the communities they work with, in this case MSM, transgender and hijra) on leadership using the following questions.

• What is your dream for yourself/ life? What is the dream of your community?

• What do you need to do to actualise this dream of your life and your community?

• What do you wish to be the CBO’s vision/dream?

• Does this dream (vision) match the CBO’s vision (as an organisation representing the community)? If yes, then what other ideas do you have to develop this further? If no, then what can be done to match the two visions?

• What are the steps or plans of action to turn this vision into reality?

Probe the participants on their ideas of leadership.

• In which particular areas of your life and work do you require leadership?

• What kind of qualities would a leader need to have in order to provide that specific leadership to you?

• Who is a leader?

Display the slides titled ‘A Good Leader Must’ to ‘Walk the Talk’ from the PowerPoint presentation ‘Leadership and Governance’.

Conclude by discussing that having a personal, organisational and community vision is necessary for community development, and a leader is someone who motivates himself or herself and others to realise these individual, organisational and community visions or dreams into reality.


Background Information

A Few Definitions of Leadership“Leadership is influencing people by providing purpose, direction, and motivation, while operating to accomplish the mission and vision of an organisation, and improve its functioning.” (Department of the Army, 2006)

“Leaders are individuals who establish direction for a working group of individuals who gain commitment form these group of members to this direction and who then motivate these members to achieve the direction’s outcomes.” (Conger, 1992)

“The history of the world is full of men who rose to leadership, by sheer force of self‑confidence, bravery and tenacity.” (Prabhu and Rao, 1966)

Definition of a Vision StatementIt is a future oriented, detailed description of outcomes you want to accomplish. Ideally, it is what you want to establish as a result of your efforts. When working on a vision statement, be as specific as possible: what does it look like, feel like? Who is involved? How? What are they getting from and giving to the organisation/experience?

Definition of a Mission StatementThis should be a statement of why you exist (organisation) or what you want to be (person). This is your purpose. Ideally it should be one sentence, easily repeatable and inspiring.

Definition of a GoalA goal is an intermediary step towards accomplishing your mission and vision. Goals should constitute a stretch measured against time (not something you know you can easily reach). They should be aligned with principles and values. Goals, when accomplished, should bring you closer to your mission and vision. Goals can be further sub‑divided into sub‑goals or objectives.

Note: Some people equate the term ‘vision’ to ‘goal’, and ‘mission’ to ‘objectives’. It is important to understand these concepts and their sequential inter‑relationship rather than dwell too much on terminology. Facilitators should use the terminology in the best possible way they feel would benefit the participants in understanding the concepts.


Activity 2: Styles of Leadership

Time 30 minutes

Learning Outcomes By the end of the activity, the participants will:

• Be able to assess a leader’s style of leadership: how she/he handles people and tasks together?; and

• Create an information database about their community.

Materials N/A



Methodology Divide participants into small groups. Ask each group to select a leader. Brief group leaders that they are to lead the task of collecting HR‑related information from all the members. For instance find out:

• If all the members have ration cards in their name or their families/childrens name? If not, create a list of their requirements;

• If they all have a community health card? If yes, create a list of their expiry dates, etc; and

• If their child is being provided with education? If yes, list the child’s name, age, school and class.

Note: This would help participants understand the process involved in creation of a database or information bank about their community members. It can be explained briefly that Pehchan’s Management Information System (MIS) is also an information bank. An organisation can develop various such databases, depending on the need. These can be useful for preparing community development and planning tools for leaders, as they contain valuable information on the health and development needs of community members. However, such databases need to be developed and used ethically and confidentially. The database should clearly indicate that the desired information has been taken with complete knowledge and consent.

During this process of task completion, tell one member from each group to go up to their leader and seek permission for leave because of some serious issue (for example, either feeling unwell, or some emergency in the family).

Observe how the leader handles this unexpected intervention of the member. Does she/he stop all activity to deal with the said individual? Does she/he grant the person immediate leave or denies it outright? Does she/he designate someone else for this intervention, while she/he continues with the group’s completion of tasks?

After the groups complete their tasks, provide feedback on the styles of leadership and other leadership issues that you observed during the exercise. Conclude the discussion on leadership styles by pointing out that while some persons unconsciously or consciously use a particular style of leadership because it suits their personality and skills, good leaders are flexible and adopt one approach overanother, or even a mixed approach, depending on the needs of the team.


Background Information(Bass and Bass, 1974)

Task-oriented Leaders • Manage/lead by instruction or goal‑setting.

• Make completion of the task mandatory.

• Are more hands‑off with regard to people.

Person-oriented Leaders • Show concern for subordinates.

• Are warm and supportive.

• Are more hands‑off with regard to tasks.

Ideally a leader needs to utilise both these aspects of leadership: it depends on her/his decision‑making capacity, which one to exercise in which particular situation or a mixture of both in a particular situation (a little like using aspects of ‘hard’ as well as ‘soft’ HR).

Concern for People This is the degree to which a leader considers the needs of team members, their interests, and areas of personal development when deciding how best to accomplish a task.

Concern for ProductionThis is the degree to which a leader emphasises concrete objectives, organisational efficiency and high productivity when deciding how best to accomplish a task.


Activity 3: Power versus Responsibility

Time 1 hour 30 minutes (including lunch break)

Learning Outcomes By the end of the activity the participants will:

• Experience and handle both power and responsibility;

• Develop the willingness to take up the role as a leader; and

• Build trust and faith towards their leader.

Materials Personal valuables belonging to the participants.


Take-home Material Annexure 1 on ‘Power and Responsibility’.

Methodology

Pre-lunchBefore breaking for lunch, ask the participants to identify four persons as leaders from their group.

Tell two of the four selected leaders that they would represent the traditional style of leadership (as in the hijra community, for example), while the other two will represent a new style of leadership.

Once the leaders are chosen, tell the participants to deposit their mobile phones, watches and purses under the custody of these four leaders.

These four leaders have to be responsible for protecting the assets of all participants during the lunch break. As part of this exercise, both groups of leaders need to develop a back‑up plan to reimburse participants in the event that the leaders were to lose any of the valuables.

Post-lunchAssist the participants in observing the two different styles of leadership in the exercise and draw attention to the possibility of both of them to co‑exist.

Evaluate the back‑up plan for reimbursement created by the two different sets of leaders. Discuss the feasibility of the plans and share key concepts from the reference material that follows and relate it to the exercise just completed. Point out, or encourage the participants to point out, the situations of ‘trust’, ‘power’ and ‘responsibility’ in the exercise.

Explain that power and responsibility always go hand in hand. There are different forms of power. It is a leader’s responsibility to use power appropriately and ensure best possible results for individual, organisational and community growth.

Note to FacilitatorTraditional Leaders: Focus on ordering the group.

New Leaders: Empower and participate in the group.


Background Information (Woldring, 2001)

We are voted or chosen into positions of responsibility, not of power. It is the responsibility of the leaders to serve, to lead people, and not to have power over people.

What is Power?• Power is the capacity and potential of a person, team, or organisation to

influence others.

• A person’s influence must be accepted by others, in order for change to occur.

Sources of Power• Reward power: Is based on an individuals belief that the other individual has the

ability to grant a reward to him/her.

• Coercive power: It is power based on fear.

• Legitimate power: A person’s structural position within a formal group or organisation, more often than not, plays a very important part in determining his/her access to one or more bases of power. This is known as legitimate power and refers to the power a person receives because of his or her position in the formal organisational hierarchy.

• Expert power: It refers to the influence a person creates as a result of some special skill or knowledge that she/he possesses.

• Referent power: The base for referent power is identification with an individual who has desirable resources or personal traits.

Sources of Power Consequences of Power

Expert Power

Referent Power

Legitimate Power

Reward Power

Coercive Power

Dependence

Compliance

Resistance

Consequences of Power

What is Responsibility’? ‘Response‑ability’ is the ability to choose your response. It is important that the response we choose should be beneficial for our own growth and should be able to protect the trust of the people who depend on us. Responsibility can be defined as assuming accountability (being answerable) for a task, a decision or an action. A person is said to be responsible for something when he or she accepts the consequences of something.


Activity 4: Leadership Skills: Multi-tasking, Time Management and Decision-making

Time 1 hour

Learning Outcomes By the end of this activity the participants will understand the importance of the following attributes in a leader:

• Multi-tasking;

• Time management;

• Decision-making;

• People management;

• Prioritising tasks; and

• Stress management.

Materials N/A

Audio-visual Support Refer to the audio-video clip on ‘Mahatama Gandhi’s speech’.


Methodology Divide the participants into smaller groups and ask each group to select a leader. Ask each group to create a detailed action plan for any one of the following three goals:

• Community awareness on MTH issues;

• Community health awareness; and

• Community children’s education.

Each group’s action plan should:

• Select one of the three goals and state why that goal has been selected as a priority; and

• List the specific process involved in its working i.e its financial plan, promotional material etc. required in order to make the goal a reality, thus reaching the ultimate vision.

While the groups are busy making this action plan, the group leaders have to simultaneously meet a journalist from the media (ask any of the volunteers to play the role of a journalist), and answer all the queries.

Ask someone to play the role of a Project Manager who should call the group leaders asking for an immediate report on the status of work in the group.

Observe how the leader:

• Allocates work to team members;

• Prioritises the most important task;

• Manages time, people as well as situations; and

• Lets get communication affected at times of stress.

At the end of the task, ask for feedback from all participants on the leaders’


performances and share your observations as a facilitator. Relate your observations to the following key leadership skills: (i) Multi‑tasking, (ii) Time management, (iii) Decision‑making, (iv) People management, (v) Prioritising tasks, and (vi) Stress management.

Play the audio file ‘Mahatama Gandhi’s speech’ and ask participants to share what they felt about his words. Are they still relevant today?


Multi-tasking and Time Management(Gonzalez and Mark 2004).

• Multi‑tasking is the capacity to execute several tasks simultaneously and effectively.

• Multi‑tasking requires the capacity to give divided attention to more than one activity. One has to be flexible in mind to stay ready for handling unplanned interruptions in work and to continue both the old and the new work together.

• Effective time management skills can be helpful in such situations.

• Setting the right priority is very important in time management.

• The Time Management Matrix shown below can be made to help decide which task to address first.

Urgent Not Urgent

Imp

ort

ant

No

t Im

po

rtan

t

I• Crises• Pressing problems• Deadline driven

Projects, meetings, preparations

II• Preparations• Presentations• Values clarification• Planning• Relationship building• True recreation• Empowerment

III• Interruptions, some

phone calls• Some mail, some reports,

some meetings• Many proximate pressing

matters• Many popular activities

IV• Trivia• Junk mail• Some phone calls• Time wasters• “Escape” activities


Activity 5: Introduction to Governance

Time 20 minutes


• Receive hands-on learning on governance;

• Learn the practice of fair ethics in working processes and in decision-making;

• Understand importance of transparency; and

• Learn how leadership styles impact the governance of the organisation/team.

Materials N/A



Methodology Divide the participants based on their organsiations. Ask each group to do a role‑play wherein they:

• Select a team leader, a core decision‑making body and a documentation‑keeping body.

• Ask each of the team members to imagine they have contributed 200 rupees to the team leader, creating a collective common fund of that particular group.

• Decide how the collected sum will be utilised:− Fun/pleasure driven activities (such as having tea within the group).− Utility‑driven activities (such as someone in the group may require something such as medicine, rice, etc.).

• The group has to also ensure that five per cent of the total collected contribution would be saved for future use.

• The documentation body has to keep track of the entire process of work, how decisions were taken, differences of opinion voiced as well as prepare a financial statement (along with bills and receipts).

• At the end of the execution of the project, the group has to report/share the project’s working process and financial documentation with the other groups with absolute transparency.

The facilitator should discuss the learning of the participants around governance through this entire exercisein relation to the learning outcomes of the session listed above.



Some Definitions of Governance• Governance simply means the process of decision‑making and the process by

which decisions are implemented. (Berle & Means, 1968)

• Governance is … the traditions and institutions by which authority in a country is exercised for the common good. This includes (i) the process by which those in authority are selected, monitored and replaced, (ii) the capacity of the government to effectively manage its resources and implement sound policies, and (iii) the respect of citizens and the state for the institutions that govern economic and social interactions among them. (Kaufmann, Kraay, Zoido; 2002)

• Governance is the exercise of political, economic and administrative authority to manage a nation’s affairs. It is the complex mechanisms, processes and institutions through which citizens and groups articulate their interests, exercise their legal rights and obligations, and mediate their differences. (Hirschmann, 1999)


Activity 6: What is Good Governance?

Time 40 minutes


• Receive experiential learning on ‘Accountability’ and ‘Responsibility’ towards individuals in the organisation;

• Understand innovative ways to manage crises in their own community and to become a leader;

• Learn to empathise with other individuals of different organisational perspectives/responsibilities/situations for crisis management; and

• Learn how a crisis situation may bring about more solidarity within the group, thus creating organisational cohesiveness and strength.

Materials N/A

Audio-visual Support Refer to the slides titled ‘Good Goverance Provides’ from the PowerPoint presentation ‘Leadership and Governance’.

Take-home Material PowerPoint presentation ‘Leadership and Governance’.

Methodology

Part IIdentify a popular board member from any of the organisations present. Then create a hypothetical situation wherein that particular person has been asked to step down from her/his position due to some misconduct that she/he has committed.

Observe the group’s reaction to this: do they want an explanation of this? Do they accept the situation? Do they want to know what has happened? Do they feel the investigation process has been unfair? Share your observations with the participants.

Part IIAsk the participants to volunteer to play the following roles in the case study provided below.

• A Coordinator

• A Project Manager

• Governing Body Members

Describe the situation to the participants.

• The Project Manager of a CBO was in Delhi (capital of India) for office work.She/he had to take a flight to Chennai (India) and then travel further by road for a meeting called by a CBO. The Project Manager was the reason for the meeting being called. Everybody was informed about the meeting and they had accordingly scheduled to arrive from different interior parts of Chennai. But suddenly the coordinator received a call from the Project Manager saying his/her ticket has not been confirmed because of some confusion and there are no other tickets available in any other flight for his/her travel for the meeting. Now the Coordinator is very worried as all the Governing Body members and other concerned members who have already arrived for the meeting; a considerable amount of money had been spent on organising logistics for this meeting.


Ask the participants, who have volunteered to role‑play, the following questions:

• How should the Coordinator handle this situation? How should she/he handle the Project Manager and the Governing Body members?

• What does the Project Manager have to say to the Coordinator in such a situation; how does the Project Manager plan to explain this situation to the CBO leadership later to pacify the tense situation?

• What do the Governing Body members have to say to the Coordinator and the members of the CBO? Is it somehow possible to retrieve the loss of money, time and face in this entire situation?

Observe the role‑players’ capacity of handling critical situations and in dealing with hierarchies. Ask the other participants for their observations, and ask them how they would have dealt with the situation in any of the roles. Share your observations with them in relation to the learning outcomes of the session listed below and the key concepts of good governance:

• Transparency

• Responsibility

• Accountability

• Participation

• Responsiveness

• Respect for ethical and legal concerns

Background Information(Reif, 2000)

According to the Office of the United Nations High Commissioner for Human Rights, Good Governance Practices for the Protection of Human Rights (HR/PUB/07/4), good governance can be assured when it provides:

“full respect of human rights, the rule of law, effective participation, multi‑actor partnerships, political pluralism, transparent and accountable processes and institutions, an efficient and effective public sector, legitimacy, access to knowledge, information and education, political empowerment of people, equity, sustainability, and attitudes and values that foster responsibility, solidarity and tolerance.”

Key Attributes of Good GovernanceThe concept of good governance has been clarified by the work of the former UN Commission on Human Rights. In its resolution 2000/64, the Commission identified the key attributes of good governance.

• Transparency

• Responsibility

• Accountability

• Participation

• Responsiveness (to the needs of the people)

The links between good governance and fair practices can be cited around four areas: (i) democratic institutions, (ii) service delivery, (iii) rule of law, and (iv) anti‑corruption.

“The measure of a country’s greatness should be based on how well it cares for its most vulnerable populations.”

“Be the change you want to see in the world.”

Mahatma Gandhi


Democratic Institutions Good governance reforms of democratic institutions create avenues for the public to participate in policy‑making either through formal institutions or informal consultations. They also establish mechanisms for the inclusion of multiple social groups in decision‑making processes, especially locally. Finally, they may encourage civil society and local communities to formulate and express their positions on issues of importance to them.

Service Delivery Reform initiatives may include mechanisms of accountability and transparency, culturally sensitive policy tools to ensure that services are accessible and acceptable to all, and paths for public participation in decision‑making.

Rule of LawGood governance initiatives may include advocacy for legal reform, public awareness‑generationon the national and international legal framework and capacity‑building or reform of institutions.

Anti-CorruptionIn fighting corruption, good governance efforts rely on principles such as accountability, transparency and participation to shape anti‑corruption measures. Initiatives may include establishing institutions such as anti‑corruption commissions, creating mechanisms of information sharing, and monitoring governments’ use of public funds.


Activity 7: Guidelines on Rewards and Punishments

Time 1 hour


• Be able to identify the need for organisations to reward and punish certain professional actions; and

• Understand the need for a fair ‘Reward System’ in order to ensure successful governance.

Materials Chart papers and markers.

Audio-visual Support Refer to the audio-video file on ‘Swami Vivekananda’s speech in Chicago’s and from the movie ‘Lagaan’.


Methodology Initiate a discussion on whether there needs to be a proper system of rewards and punishments within a CBO, and if so, why.

Ask the participants to prepare a list of professional activities within the organisation which the community they work with thinks needs to be rewarded.

Point out that it is equally important to chart out a list of behaviours that the community may think needs to be punished.

Once the lists are prepared, display them on a whiteboard or chart paper and ask the participants if they feel there should be a certain body which would work in a neutral fashion to assess/judge these rewards and punishments.

Ask them to then do the following:

• Create parameters for being a member of such a neutral and unbiased committee.

• Decide on a process of electing members to the committee.

• Decide on a process of record keeping of all the decisions taken by the committee for future reference.

Wrap up the day’s activities by screening the following video‑clips, summarising the key concepts discussed and asking for feedback on the day’s learning.

• ‘Swami Vivekananda’s speech in Chicago’

• Scene from movie ‘Lagaan’

Note to FacilitatorDuring the exercise, do not express any value judgments while the participants give their opinions, rather facilitate a free expression of ideas on punishments and rewards.

However, guide the participants to create the reward/punishment system by dividing them into different ‘departments’ such as Financial, HR, Senior Management and Junior Staff.

Give examples of issues around which rewards and punishments maybe given: Punctuality, Absenteeism, Misconduct, Over-achievement etc.

Alert: Rewards and punishments may be thought of on the basis of what a community thinks. But community priorities should keep in mind larger legal and ethical perspectives. Respect for human rights must form the basis of their decisions.


Background Information(Lewin, 1935)

Good governance cannot be ensured without a well‑structured and unbiased ‘Rewards and Punishment’ system.

Concept of Reward and Punishment

Rewards• Positive reinforcement: providing a reward for a desired behaviour.

• Negative reinforcement: removing an unpleasant consequence when the desired behaviour occurs.

Punishment• Applying an undesirable condition to eliminate an undesirable behavior.

Rewards should be decided on the basis of understanding of the needs of members of any group of people (whether a community, organisational team or any other grouping).

Principles of Reward • Rewards should be based on some well‑defined behaviour/performance/

achievement.

• The criteria of getting rewarded should be explicitly communicated to the group members.

• Everyone in the group should have an equal chance to get the reward; no discrimination or personal emotion should affect the reward related decision‑making process.

• Both rewards and punishment should be aligned with the relevant group’s vision and mission.

Principles of Punishment • Well‑defined punishment guidelines should be prepared and communicated to all

the group members.

• Punishments should never be given without prior warning (except for some severe offence).

• Punishment principles should be in line with the law of the country.

• Punishment should be reasonable and in keeping with the gravity of the offence or error.


Annexure 1: Power and Responsibility

Background Information (Woldring, 2001)

We are voted or chosen into positions of responsibility, not of power. It is the responsibility of the leaders to serve, to lead people, and not to have power over people.

What is Power?• Power is the capacity and potential of a person, team, or organisation to

influence others.

• A person’s influence must be accepted by others, in order for change to occur.

Sources of Power• Reward power: Is based on an individuals belief that the other individual has the

ability to grant a reward to him/her.

• Coercive power: It is power based on fear.

• Legitimate power: A person’s structural position within a formal group or organisation, more often than not, plays a very important part in determining his/her access to one or more bases of power. This is known as legitimate power and refers to the power a person receives because of his or her position in the formal organisational hierarchy.

• Expert power: It refers to the influence a person creates as a result of some special skill or knowledge that she/he possesses.

• Referent power: The base for referent power is identification with an individual who has desirable resources or personal traits.

Sources of Power Consequences of Power

Expert Power

Referent Power

Legitimate Power

Reward Power

Coercive Power

Dependence

Compliance

Resistance

Consequences of Power


What is Responsibility? ‘Response‑ability’ is the ability to choose your response. It is important that the response we choose should be beneficial for our own growth and should be able to protect the trust of the people who depend on us. Responsibility can be defined as assuming accountability (being answerable) for a task, a decision or an action. A person is said to be responsible for something when he or she accepts the consequences of something.


Annexure 2: PowerPoint Presentation – Leadership and Governance


Notes








population status.







module

C

module

A

module

C

module

D




module



C2 Family Support

C3 Mental Health





D3 Positive Living





A2 L

eade

rshi

p an

d Go

vern

ance


A3 R

esou

rce

Mob

ilisa

tion

and

Fi

nanc

ial

Man

agem

ent

Facilitator Guide

Resource Mobilisation and

Financial Management

A3

Pehchan 1A3 Facilitator Guide: Resource Mobilisation and Financial Management


About Pehchan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2


Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3


Module Acknowledgements: Resource Mobilisation and Finanacial Management . . . 7

Part 1: About the Resource Mobilisation Module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9


Activity Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Activity 1a: Introduction to Resource Mobilisation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Activity 1b: Definition of Resources and Resource Mobilisation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Activity 1c: Importance of Resource Mobilisation for a CBO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Activity 1d: CBO’s Role in Resource Mobilisation and Challenges to Fund‑raising. . . . . . . . . 15

Activity 1e: Types of Resources and Resource Providers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Activity 1f: Sustainable Techniques and Methods for Resource Mobilisation . . . . . . . . . . . . . . . . . . . . . 20

Activity 1g: Strategic Planning for Resource Mobilisation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

Part 2: About the Financial Management Module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

Module Reference Materials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

Activity Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

Activity 2a: Introduction to Financial Management Module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

Activity 2b: Strengthening Financial Systems – An Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

Activity 2c: Statutory Compliances for CBOs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

Activity 2d: Financial Management Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

Activity 2e: Preparation of Work‑plan and Budget . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37

Activity 2f: Administrative and Finance Officer: Roles and Responsibilities . . . . . . . . . . . . . . . . . . . . . . . . 38

Activity 2g: Understanding Organisational Development Cycle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

Annexure 1a: Case Studies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

Annexure 1b: Case Studies of Successful Resource Mobilisation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

Annexure 1c: PowerPoint Presentation – Resource Mobilisation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

Annexure 2a: Pehchan – Financial Systems Strengthening Guide for CBOs . . . . . . . . . . . . . . . 50

Annexure 2b: Financial Management Reference Material . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51

Annexure 2c: Case Studies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72

Annexure 2d: Organisational Development Components . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73

Annexure 2e: The Organisational Development Cycle. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74

Annexure 2f: PowerPoint Presentation – Financial Management. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75

Pehchan2 A3 Facilitator Guide: Resource Mobilisation and Financial Management

About this ModuleThis module is designed to help training participants: 1) develop an understanding of resource mobilisation; 2) become familiar with resource mobilisation techniques; 3) develop a resource mobilisation strategy for the CBO; 4) develop an understanding about grant management and the basics of bookkeeping and accounting; and 5) review guidelines of strong and stable financial systems. Interactive sessions in this module included games, exercises, group discussion, presentations, case studies, and slide shows. In the Pehchan programme, this module is used to introduce resource mobilisation and financial management principles to CBO staff.

About PehchanWith financial support from the Global Fund, Pehchan is building the capacity of 200 community‑based organisations (CBOs) for men who have sex with men (MSM), transgenders and hijras in 17 states in India to be more effective partners in the government’s HIV prevention programme. By supporting the development of strong CBOs, Pehchan addresses some of the capacity gaps that have often prevented CBOs from receiving government funding for much‑needed HIV programming. Named Pehchan, which in Hindi means ‘identity’, ‘recognition’ or ‘acknowledgement,’ this programme will reach 453,750 MSM, transgenders and hijras by 2015. It is the Global Fund’s largest single‑country grant to date, focused on the HIV response for vulnerable sexual minorities.


Inputs from community consultations helped increase relevance and value of training modules. By engaging MSM, transgender and hijra (MTH) communities in the development process, there has been greater ownership of training and of the overall programme among supported CBOs. Technical experts worked on the development of thematic components for priority areas identified by community representatives. The process also helped fine‑tune the overall training model and scale‑up strategy. Thus, through a consultative, community‑based process, Pehchan developed a training model responsive to the specific needs of the programme and reflecting key priorities and capacity gaps of MSM, transgender and hijra CBOs in India.


PrefaceAs I put pen to paper, a shiver goes down my spine. It is hard to believe that this day has come after almost five long years! For many of us, Pehchan is not merely a programme; it is a way of life. Facing a growing HIV epidemic among men who have sex with men (MSM), transgender, and hijra communities in India, a group of development and health activists began to push for a large‑scale project for these populations that would be responsive to their specific needs and would show this country and the world that these interventions are not only urgently needed but feasible.


At the heart of Pehchan are community systems strengthening. Our approach to capacity building has been engineered to maximise community leadership and expertise. The community drives and energises Pehchan. Our task was to develop 200 strong community‑based organisations (CBOs) in a vast and complex country to partner with state governments and provide services to MSM, transgender and hijra communities to increase the effectiveness of the HIV response for these populations and improve their health and wellbeing. To achieve necessary scale and sustain social change, strong CBOs would require responsive development of human capital.





Once the curriculum was ready to use, trainings‑of‑trainers were organised to develop a cadre of master trainers who would work directly with CBO staff. Working through Pehchan’s four Regional Training Centers, these trainers, mostly members of MSM, transgender and hijra communities, provided further in‑service revisions and suggestions to the modules to make them succinct, clear and user‑friendly. Our consortium partner SAATHII contributed particularly to these efforts, and the current training curriculum reflects their hard work.







General AcknowledgementsThe Pehchan Training Curriculum is the work of many people, including community members, technical experts and programme implementers. When we were not able to find training materials necessary to establish, support and monitor strong community‑based organisations for MSM, transgenders and hijras in India, the Pehchan consortium collectively developeda curriculum designed to address these challenges through a series of community consultations and development workshops. This process drew on the best ideas of the communities and helped develop a responsive curriculum that will help sustain strong CBOs as key element of Pehchan.

We would like to take this opportunity to acknowledge the contributions of those who helped in taking this process forward, including (in alphabetical order): Ajai, Praxis; Usha Andewar, The Humsafar Trust; Sarita Barapanda, IWW‑UK; Jhuma Basak, Consultant; Dr. V. Chakrapani, C‑Sharp; Umesh Chawla, UNDP; Alpana Dange, Consultant; Brinelle D’Sourza, TISS; Firoz, Love Life Society; Prashanth G, Maan AIDS Foundation; Urmi Jadav, The Humsafar Trust; Jeeva, TRA; Harleen Kaur, Manas Foundation; Krishna, Suraksha; Monica Kumar, Manas Foundation; Muthu Kumar, Lotus Sangama; Sameer Kunta, Avahan; Agniva Lahiri, PLUS; Meera Limaya, Consultant; Veronica Magar, REACH; Magdalene, Center for Counselling; Sylvester Merchant, Lakshya; Amrita Nanda, Lawyers’ Collective; Nilanjana, SAFRG; Prabhakar, SIAAP; Priti Prabhughate, ICRW; Nagendra Prasad, Ashodaya Samithi; Revathi, Consultant; Rex, KHPT; Amitava Sarkar, SAATHII; Dr. Maninder Setia, Consultant; Chetan Sharma, SAFRG; Suneeta Singh, Amaltas; Prabhakar Sinha, Heroes Project; Sreeram, Ashodaya Samithi; Suresh, KHPT; Sanjanthi Veul, JHU; and Roy Wadia, Heroes Project.


From the start, the Government of India’s National AIDS Control Organisation has been a key partner of Pehchan. In particular, Madam Aradhana Johri, Additional Secretary, NACO, has provided strong leadership and steady guidance to our work. The team from NACO’s Targeted Intervention (TI) Division has been a constant friend and resource to Pehchan, notably Dr. Neeraj Dhingra, Deputy Director General (TI); Manilal N. Raghvan, Programme Officer (TI); and Mridu, Technical Officer (TI). As the programme has moved from concept to scale‑up, Pehchan has repeatedly benefitted from the encouragement and wisdom of NACO Directors General, past and present, including Madam Sujata Rao, Shri K. Chandramouli, Shri Sayan Chatterjee, and Shri Lov Verma.



India HIV/AIDS Alliance’s Pehchan team has been untiring in its contributions to this curriculum, including Abhina Aher, Jonathan Ripley, Yadvendra (Rahul) Singh, Simran Shaikh, Yashwinder Singh, Rohit Sarkar, Chaitanya Bhatt, Nunthuk Vunghoihkim, Ramesh Tiwari, Sarbeshwar Patnaik, Ankita Bhalla, Dr. Ravi Kanth, Sophia Lonappan, Rajan Mani, Shaleen Rakesh, and James Robertson. A special thank‑you to Sonal Mehta and Harjyot Khosa for their hard work, patience and persistence in bringing this curriculum to life.





Module Acknowledgements: Resource Mobilisation and Finanacial ManagementEach component of the Pehchan Training Curriculum has a number of contributors who have provided specific inputs. For this component, the following are acknowledged:

Primary Author SAFRG, New Delhi


Technical Input Shantanu Pyne, SAATHII; Thomas Joseph, The Humsafar Trust; Chaitanya Bhatt, India HIV/AIDS Alliance


References • Chiam, Vivien. (2011) A Guide to Resource Mobilisation Planning for Partners of the

Telecentre Women: Digital Literacy Campaign. Philippines.Telecentre.org Foundation.

• An Introduction to Resource Mobilisation. (2007). Module 1‑4. Université de Genève. The Resource Alliance.

• Resource Mobilization – A Practical Guide for Research and Community-Based Organizations. (2010) Canada. International Development Research Centre (IDRC).


Part 1Resource Mobilisation


Part 1: About the Resource Mobilisation Module

No. A3

Name Resource Mobilisation and Financial Management


• Project Managers/Project Officers

• Administrative and Finance Officers


Training Objectives By the end of the module, the participants will:

• Develop an understanding on what are the key resources for any oragnisation;

• Understand what is resource mobilisation and articulate its importance;

• Understand the various sustainable techniques and methods for resource mobilisation; and

• Develop an agenda/strategy on resource mobilisation for their organisation.





Audio-visual Support PowerPoint presentation on ‘Training on Resource Mobilisation’

Annexures Annexure 1a on ‘Case Studies’.Annexure 1b on ‘Case Studies of Successful Resource Mobilisation’Annexure 1d on ‘World Bank Document on Resource Mobilisation’ available on digital file


Activity Index1


Take-home material

1a Introduction to Module

30 minutes N/A Refer to the slides titled ‘Introduction to Module’ from the PowerPoint presentation ‘Training on Resource Mobilisation’

N/A

1b Definition of ‘Resources’ and ‘Resource Mobilisation’

45 minutes Annexure 1a on ‘Case Studies’

Refer to the slides titled ‘Definitions of Terms’ from the PowerPoint presentation ‘Training on Resource Mobilisation’

N/A

1c Importance of Resource Mobilisation for a CBO

45 minutes N/A Refer to the slides titled ‘Importance of Resource Mobilisation’ from the PowerPoint presentation ‘Training on Resource Mobilisation’

N/A

1d CBO’s Role in Resource Mobilisation and Challenges of Fund-raising

45 minutes N/A Refer to the slides titled ‘Ways to Mobilise Funds and Resources’ from the PowerPoint presentation ‘Training on Resource Mobilisation’

N/A

1e Types of Resources and Resource Providers


1f Sustainable Techniques and Methods of Resource Mobilisation

1 hour 30 minutes

Annexure 1b on ‘Case Studies of Successful Resource Mobilisation’

Refer to the slides titled ‘Sustainable Techniques of Resource Mobilisation’ from the PowerPoint presentation ‘Training on Resource Mobilisation’

N/A

1g Strategic Planning for Resource Mobilisation

1 hour 30 minutes

N/A Refer to the slides titled ‘Strategic Planning for Resource Mobilisation’ from the PowerPoint presentation ‘Training on Resource Mobilisation’

Annexure 1d ‘World Bank Document on Resource Mobilisation’



Activity 1a: Introduction to Resource Mobilisation

Time 30 minutes

Learning Outcomes By the end of this module, the participants will:

• Be able to articulate the objectives of the training module.

Materials N/A

Audio-visual Support Refer to the slides titled ‘Introduction to Module’ from the PowerPoint presentation ‘Training on Resource Mobilisation’.


Methodology Divide the participants into groups based on their organisation and tell them that they will be playing a game called ‘Resource Collection’. Tell the participants that in three minutes they are to move around the training room and make a list on a sheet of paper the objects available in the training room that they consider as resources for their organisation. Tell them that the group that lists the maximum number of resources will receive a reward in the end.

Once the participants return to their group, ask them to introduce themselves and read out the resources they have listed.

Count the number of resources listed by each group. Declare the group that has the longest list of resources (such as money, watch, books, pens, paper and so on, whatever the participants can think of as a resource) as the winner of the game. Do remember to discount articles such as beads, costume jewellery and other items which have ornamental value and cannot be mobilised as a resource for an organisation.

Ask the participants to share their experiences while playing the game, and why they considered the items they listed as resources. Ask them to answer the following questions:

• What do you think of the game?

• What were your learnings?

• How and where can this learning be used?

• What is the relation between this game and the training?

Relate the experiences of the participants to the topic ‘Resource Mobilisation’, and list the day’s training objectives. Point out that while resource mobilisation is a concern for all non‑profit organisations, the emphasis of the day’s activities will be on how to mobilise resources for NGOs and CBOs.


Activity 1b: Definition of Resources and Resource Mobilisation

Time 45 minutes

Learning Outcomes By the end of the activities, the participants will:

• Understand the meaning of ‘Resources’ and ‘Resource Mobilisation’; and

• Relate this understanding to their own working conditions.

Materials Annexure 1a on ‘Case Studies’.

Audio-visual Support

Refer to the slides titled ‘Definitions of Terms’ from the PowerPoint presentation ‘Training on Resource Mobilisation’.


Methodology Using the PowerPoint presentation explain the definitions of the terms ‘Resource’ and ‘Resource Mobilisation’. Divide the participants into three groups and give each group one of the case studies from Annexure 1a. Each case study has questions that the group should discuss and find answers in 15 minutes

Ask each group to present their case and provide the answers to the questions therein. Encourage other partcipants to ask question to each group based on their findings.

Ask participants to re‑group with members of their own organisation and discuss the three cases, making a list of similarities and dissimilarities of the organisations in the case study with their own organisation. Invite each organisation to share its findings for analysis in the larger group.

Background Information(Chiam, 2011)

What is a Resource?Resource is anything that is essential for attaining the goal of an organisation. Anything that does not contribute to achieving an organisation’s vision and mission cannot be regarded as a ‘Resource’. If any individual is not contributing to the vision and mission of the organisation, they cannot be regarded as a human resource for the organisation.

Human resources in an organisation include its staff, governing body members, volunteers and advisors. The information, skills, and knowledge of these individuals is what constitutes as a resource.

Other important resources for an organisation are money, infrastructure, equipment, materials, books, other learning aids, vehicles, and so on.

An important resource, often not well understood, is the technical support (free or paid) from other agencies as well as from partnership or collaborative arrangements which may or may not include monetary considerations.


What is Resource Mobilisation?Resource mobilisation is a process, which helps in identiying and raising the resources essential for development, implementation and continuation of work in achieving an organisation’s mission. Resource mobilisation means interaction, rapport‑building and expansion of relations (goodwill) with those who may provide the resources; these resources can be in the form of information, skills, knowledge, materials or money.

Resource mobilisation is not limited to fund‑raising. It also means seeking new sources of resource and how it can be optimally, ethically and legally‑used.

Different approaches need to be developed to expand relations with resource providers like government bodies, private sector agencies, international or Indian NGOs, and even CBOs. These approaches usually begin with looking out for a prospective funder, networking (in person during conferences and one‑to‑one meetings) and sharing required information about the organisation’s activities, accomplishments, and administrative and financial systems to convince the funder about the way forward.

These steps may lead to discussing a project or an activity by one’s organisation that also matches the resource‑provider’s agenda, eventually leading to the submission of a detailed project proposal which includes information on implementation, monitoring and reporting mechanisms of the project. If the relationship between the organisation and resource providers is successful, then this can turn into a long‑term relationship.

The essence of resource mobilisation becomes more meaningful when the leadership in an organisation goes beyond implementing only donor’s programme, and envisages a larger and long‑term sustainability of the organisation through planned and systematic resource mobilisation.


Activity 1c: Importance of Resource Mobilisation for a CBO

Time 45 minutes


• Understand the importance of mobilising various resources for their CBO.

Materials N/A

Audio-visual Support Refer to the slides titled ‘Importance of Resource Mobilisation’ from the PowerPoint presentation ‘Training on Resource Mobilisation’.


Methodology Ask the participants why they think resource mobilisation is important for CBOs. List the participants’ responses on a flip‑chart and elaborate on them if needed. After that, discuss the slides titled ‘Importance of Resource Mobilisation’.


Reasons for Requirement of Resources in an Organisation• To start an organisation.

• To continue with its work and achieve the targets.

• To begin or plan for new work.

• To enhance or maintain relationships with the communities served, individual well‑wishers and advisors, government organisations, private and donor agencies, and others.

Importance of Resource Mobilisation as a Process• To build ownership towards one’s organisation.

• To bring together members of the communities served by the organisation, build their capacity and strengthen their communities.

• To build social capital.

• To enrich the organisation with useful resources of various types.

• To advocate for programmes that address the community needs.

• To ensure independence and sustainability of the organisation.

• To enhance the reputation of one’s organisation.


Activity 1d: CBO’s Role in Resource Mobilisation and Challenges to Fund-raising

Time 45 minutes


• Be able to identify the ways in which a CBO can mobilise funds and resources; and

• Understand the challenges in resource mobilisation.

Materials N/A

Audio-visual Support Refer to the slides titled ‘Ways to Mobilise Funds and Resources’ from the PowerPoint presentation ‘Training on Resource Mobilisation’.


Methodology Divide participants into smaller groups and ask them to list the activities that need to be done by a CBO to raise funds and other resources. For each activity, they should also mention a benefit and a challenge.

After they have completed the exercise, ask each group to present their findings. When all the ideas have been shared, discuss the slides ‘Ways to Mobilise Funds and Resource’.

Background Information(The Resource Alliance, 2007)

Organisation’s Role in Resource MobilisationAn organisation must ’promote’ its work and experience to be able to mobilise more resources. This can be done in one or more ways listed below:

• Innovative visiting cards for sharing with key stakeholders.

• Making inquiries and follow‑up through phone calls: telephone is extremely important and often an under‑utilised tool for fund‑raising.

• Writing letters or e‑mails to people you know: writing a good letter or an e‑mail is an art that a fund‑raiser should master. Formal language and presentation is a must in such letters and e‑mails.

• Publishing an annual report: every organisation has to produce an annual report. In some cases it is also a legal requirement. This can be an extremely useful publication as it promotes the organisation and highlights its importance.

• Distribution of brochures, leaflets, appeals: production of effective fund‑raising and publicity literature is one of the most important tasks in fund‑raising. Effective fund‑raising ideas cannot be fruitful if you are using poorly written and designed material.

• Putting up posters, banners and hoardings in strategic locations: using these as resources is one of the most effective ways to get publicity, especially for events and campaigns.


• Using the internet (social networking): there are many innovative ways to raise funds using the internet, including websites, blogs, Facebook, and e‑forums.

• PowerPoint Presentations for formal audiences.

• Newsletter is a good way to keep in touch with your donors, well‑wishers and even beneficiaries. Every time they hear from you, the chances that your work remains in their radar increase.

• Organising a campaign: it is a good way to generate publicity and even funds.

• Media interaction: getting publicity in mass media is important to help drive public awareness of fund‑raising activities. You can use newspapers, magazines, radio and television to get coverage or advertise in media.

• Tapping all available resources: financial and in‑kind contributions from individuals, community members within and outside the country, business houses, national trusts and foundations.

• Involving local communities.

• Getting government support and recognition.

• Regularly updating and communicating with your donor.

Explore More Fund-raising Methods• Events: Such as fund‑raiser parties, cause‑based marathons or runs, ‘Joy of

Giving’ weeks, ‘7 Days‑7 Gifts’ events, etc.

• Donation boxes in shops and homes.

• Collection drives in homes and schools: tickets, coupons.

• Option to donate one’s pay.

• Running income‑generation programs (IGPs) and self‑help groups (SHGs): these help individuals associated with the IGPs and SHGs to raise their personal incomes and thereby contribute more to their NGO/CBO.

• Selling products created by community members (this needs to be clarified with organisation’s auditors).

Challenges to Fund-raising• Public at large and key stakeholders are unaware of social issues and needs and

of the role played by NGOs/CBOs in addressing them.

• Public are skeptical about work of some NGOs/CBOs.

• An organisation’s governing body and leadership may have a non‑committal attitude toward fund‑raising, often stemming from dependence on a single source of income.

• Equipping staff with professional fund‑raising skills.

• Legal barriers: NGOs/CBOs in some cases may not be legally allowed to raise resources through certain methods; for example, through sale of products and services, which may be deemed as a commercial activity, not in keeping with an NGO or CBO’s charitable status.


Activity 1e: Types of Resources and Resource Providers

Time 45 minutes


• Identify different kinds of resources and resource providers; and

• Evaluate the current state of resources in their organisation.

Materials N/A

Audio-visual support N/A


Methodology Ask the participants how many kinds of resources are there, and list their responses on a flip‑chart.Tell the participants to form groups with members of their own organisation and list the resources being used in their organisation. They should categorise their responses under the following heads:

• Physical goods;

• Human resources;

• Money;

• Free services and facilities; and

• Technical cooperation.

Further ask the participants to discuss the following questions:

• From which resource provider their organisation has received resources till date?

• What is the percentage of financial assistance received from these providers?

• Which resources have been tapped maximum and minimum in their organisation?

• What strategies have adopted in order to keep a steady flow of the resources to the organisation?

• Which resource providers need to be targeted in the future to achieve the vision and mission of their organisation?

Background Information(The Resource Alliance, 2007)

Types of Resources‘Resource’ is generally understood as materials, goods or services that help fulfill the organisation’s needs. Materials, money, people and time are resources that are used by community groups, organisations and individuals to fulfill their goals and objectives. Resources are required by all organisation to fulfill its goals.

ExamplesPhysical goods:• Office equipment.• Training material.• Vehicles.• Furniture.• Raw materials.

Human resources:• Senior Management.• Staff.• Volunteers. • Consultants. • Advisors.

Money:• Grants.• Donations.• Membership fee.• Loans.

Free service and facilities:• Office space. • Tools. • Training facilities. • Transportation. • Publications.

Technical cooperation: • Trainings.• Contributions to projects.• Contributions for

organisational development.

• Support from experts. • Scholarships.


It is essential to know the type of resource, its availability, and estimated cost to attain it in order to carry out works as per the desired goals, objectives and activities of the organisation. On the basis of this information, the primary plans of resource‑mobilisation should be established.

The various types of resources can be classified as below.

Money/CashMoney/cash is essential in order to run the existing programs, to pay the cost of goods and services, including salaries, and to carry out new work.

Money/cash can be increased through various means: organisational membership fee, grants received, local funds, donations, and from various other sources such as NGOs, International NGOs,etc.

Technical Assistance/CooperationEvery organisation may not have people with desired skill set for carrying out various types of activities, project and programmes. They may also not have the necessary funds to appoint qualified and experienced employees.

Technical cooperation between organisations occurs when one of them provides the financial support for appointing exprienced employees for a special project, or its employees help‑out for a fixed time‑frame.

Sometimes this arrangement may be pro bono (free of cost). Some organisations provide technical cooperation through training, mentoring and handholding.

Human ResourcesEvery type of organisation requires people/personnel to ensure that it is able to fulfil its set targets. It makes provisions to have the bare essential human resources. Therefore, the organisation might appoint some employees in permanent role, while others may come in when required.

The permanent employees are taken as internal resources of the organisation while employees appointed for a specific time‑period are regarded as external resources. Many organisations also utilise volunteers in order to fulfill its man‑power need.

Physical GoodsThis refers to the physical resources that an organisation is dependent on and therefore must acquire, whether through financial payment or other valid means. Examples of physical goods include office tools, furniture, training tools, raw goods, vehicles and other machines.

Free Services and FacilitiesSome individuals and organisations (often corporate bodies) give physical goods, services and facilities at zero or minimum cost to non‑profit organisations. Provisions for free services in a project or an organisation can also be made through community support.

The resources in kind will differ and change as per the phases of the project in an organisation. For instance, during the preliminary phases, active participation from all its members may be essential for leadership and management. Later, maintenance services will be essential for the infrastructure and equipment involved. The need for human resources also changes as the project progresses.


The organisation should first develop a resource‑mobilisation strategy for these changing needs.

Types of Resource-providers• Government bodies at district, state and national level (ministries, departments,

municipalities)

• United Nations Organisations (UNICEF, ILO, UNAIDS, UNDP, WHO)

• The World Bank

• Bilateral organisations (AUSAID, USAID, DFID, GIZ)

• International non‑governmental organisations (INGOs)

• National NGOs/CBOs, networks,civil society federations and foundations

• International institutions (universities, research organisations)

• International religious institutions (churches, religious boards)

• International volunteer agencies (VSO, Peace Corps)

• Professional groups/associations (bar associations, medical associations)

• Neighbouring friendly countries (embassies, high‑commissions)

• Hospitals and social welfare institutions

• Private companies

• Academies (foreign/domestic), schools, trusts, fellowship or scholarship providers

• Banks (savings and fixed deposits, funding schemes, support for IGPs and SHGs)

• Individuals

Most resource‑providers have their own preferences or mandates for which they provide resources. It is important to have an understanding of this aspect before attempting to access any resources from them. Such information can be obtained from resource‑provider profiles, websites and annual reports. Many donor agencies publish such information in public domain and send out calls for proposals and grants.


Activity 1f: Sustainable Techniques and Methods for Resource Mobilisation

Time 1hour 30 minutes

Learning Outcomes By the end of this activity the participants will:

• Understand various techniques for resource mobilisation; and

• Learn to choose from a range of techniques that suit their organisations needs the best.

Materials Annexure 1b on ‘Case Studies of Successful Resource Mobilisation’

Audio-visual Support Refer to the slides titled ‘Sustainable Techniques of Resource Mobilisation’ from the PowerPoint presentation ‘Training on Resource Mobilisation’.


Methodology Using the slides titled ‘Sustainable Techniques of Resource Moblisation’, discuss the various mechanisms through which CBOs can build their resources. Divide the participants into four groups, giving each group a case from Annexure 1b on ‘Case Studies of Successful Resource Mobilisation’. Ask each group to deliberate on the case study and:

• Identify the techniques used by the organisations to mobilise resources;

• Identify the challenges in resource mobilisation, and how the organisations overcame those challenges;

• Identify whether the technique used was sustainable or not. If sustainable, what are the factors that made it sustainable? If not, then what could the organisation have done differently?; and

• What other techniques the organisationcould have used?

Background Information(IDRC, 2010)

Sustainable Techniques of Resource MobilisationIn order to mobilise resources, organisations have to decide where and how they would be investing their energies. The types and mechanisms of resource mobilisation depend on the nature of required resources. Some techniques are discussed here which may be relevant for NGOs/CBOs.

Building Corporate PartnershipIdentifying types of potential companies which may provide support. This can be done through:

• Personal contacts (ask governing body, staff for references);

• Trade directories, company magazines and business listings;

• Websites, newspapers,television;


• PR agencies(does your organisation fit the corporate image strategy of their client?); and

• Start with companies in your locality or region.

Things to find out about a company:

• The right person to contact.

• The decision‑making process.

• Its social responsibility policy.

• Past involvement with philanthropy.

• Causes supported.

• Its branding and products.

• Its credibility – will an association reflect on your credibility?

• One has to match one’s needs with the company’s priorities and profile.

Payroll Giving

What is ‘payroll giving’?

‘Payroll giving’ is an effective and efficient method used by corporates through which they encourage employees to voluntarily make small but regular donations from their salary to a cause of their choice.

Why payroll giving?

• Provides regular and often general income.

• Life‑long donors tend to continue giving for a long time, unless they change jobs, even then they may continue, even better, they may introduce you to their new company.

• Low cost per donor acquired: by signing on one company, you sign on several individual donors.

• Ability to attract new donors: existing donors will often motivate their peers to give.

• Easy to implement: establish a pattern and run with it every month.

Advantanges of payroll giving

• Builds team‑spirit through a common cause.

• Involves minimum paper work and processing.

• Takes a one‑time decision.

• Creates goodwill with employees, shareholders and the public.

• Provides tax relief.

Simple steps to start payroll giving

• Start in your own organisation: get staff in your own organisation to voluntarily contribute. Then look to establish payroll giving in other organisations.

• Get management support: management creates enthusiasm among employees. The company can even make a matching donation.

• Form a working committee: these are people within the company who will work with you to implement the programmes.

• Establish accounting and auditing procedures: decide with the administration and finance department methods to ensure monthly deductions from salaries and agree what reports and materials you will provide to employees.


• Determine a campaign approach: make a list of things to do and allocate responsibility for every activity, such as distributing fliers, putting‑up posters and making presentations to groups of employees.

• Identify other companies: personal contacts, directories, magazines, websites, media, PR agencies, local, and regional companies.

• Follow‑up: say thank you, send individuals your annual report through the company, encourage employees to visit your work, get your organisation featured in their newsletter.

• Measure and report results: evaluate periodically and discuss ways to improve.

Direct Mail

What is direct mail?

• One person writing to another person about a particular programme/ strategy that both care about. It is an opportunity for both the writer and the potential donor, for it allows both the chance to do something personally to help.

Why direct mail?

• It is personalised and reaches specific and targeted donors.

• Has the potential to produce a measurable response.

• Reaches out to a large number of people (for instance, you can send 100,000 mailers at a time).

• Can be tested repeatedly. One can vary the letter, the timing or the mailing list to test which letter, time or list gets the better response.

• Builds constituency: a fair percentage of donors go on to support the cause in the long‑term.

Disadvantage

• Needs investment but can start small.

The direct mail process

• Identify support agencies: advertisement and market research agencies, mailing list providers, freelance writers and designers, printers, packagers, and mailers.

• Get permission from the nearest post office.

• Identifying mailing lists.

• Put in place response systems.

• Develop and print the direct mailer.

• Timing of the mailer.

• Package and mail.

• Track donations.

• Constant testing.

• Report back to donors.

Face-to-Face Resource MobilisationParticipants should clearly understand the difference between warm visits (to people who know your organisation) and cold calling (to people who don’t know your organisation).


Warm visits

• An organisation may have – as part of its regular resource mobilisation – a process of periodically visiting well‑wishers, donors and other supporters to update them on their organisation’s programmes and funding needs.

• An organisation may run a time‑bound focused campaign for a specific purpose such as construction of its building. Towards this, it may conduct face‑to‑face meetings with potential donors.

Cold visits

• Door‑to‑door collections, donation boxes.

• Cold visits to people’s homes and offices.

• Direct dialogue on the streets.

• Presentations to groups of people such as Rotary Clubs.

Making Your Website Fund-raising Friendly

Include key features like the following:

• Basic information.

• Branding.

• Statement of work, vision and mission.

• Brief information on programmes.

• Contact addresses.

• Other contact details – telephone number, fax, email.

• Organisation registration status.

• Tax exemption details.

Information to build credibility and engage visitors

• Success stories.

• Statement of achievements.

• Statistics about your issue.

• Quotes from people.

• Thanking supporters.

• Annual reports (including financial details).

• Profiles of governing body members.

• Multiple options for visitors to support the organisations: volunteering, donations, skills, in kind contributions, campaign supports.

• Donation amounts and what they will achieve.

Writing Grant Proposals

Important points to remember for a project proposal to be submitted to a donor agency.

• Provide an interesting title and cover page.

• Provide an executive summary.

• Introduce your organisation (who are you, what you do, how you accomplish targets, why you are qualified for a project, etc.).

• State the problem (the need, the scale, any particular reasons).

• State what you plan to do (project goal and objectives, working methods, short‑ and long‑term operational plans, support of local communities, any collaborations, volunteers, handling of key issues through policies and strategies).


• Elaborate on how you will measure the success (expected outcomes, achievements, monitoring progress, evaluating success).

• State what resources and how much of each you need (provide a clear budget, justify all expenditures).

• State how you plan to raise money (sources of funds identified, what percentage you want from the grant maker, how and when).

• Look ahead (how you plan to sustain the work after the grant stops).

• Tell donors why they might be interested (tie your plans to their interests and priorities).

Organising Special EventsThese events are ways of receiving money, which are carried out by organisations relating to the field or community they work with. These occasions are held in order to celebrate, say, a community festival or to mark an important day. The events may or may not be related to the organisation’s programmes. Examples of events related to programmes: rallies, film festivals, seminars. Examples of events not related to programmes: cultural events, exhibitions, fund‑raiser parties and dinners.

Special events are those that create awareness about:

• your cause and your organisation;

• your organisation or community needs; and

• people associated with your organisation who add to your credibility.

Get your ideas together to organise a special event

• Clarify the objective of the event.

• Brainstorm for ideas on types of event and evaluate each idea.

• Get a clear picture of the audiences: age, gender, income.

• Establish a core committee of staff and volunteers.

• Put in place a budget: add internal and external resource costs, calculate expected revenue.

• Reduce the risk involved.

• Put in place a marketing plan.

• Put in place an action plan.

• Decide on the right time – take into account the weather, get enough time to prepare, avoid clash with other events, especially those organised by partners or other friendly agencies.

Special events can include fund-raising events such as:

• Musical/ theatre/cultural shows, where the entrance fee and sponsorships bring income.

• Events planned by other organisations where part of the income is donated to your organisation.

• Events involving the sale of products donated by an artist or a manufacturer (legal implications need to be clarified with the organisation’s auditors on whether an NGO/CBO can sell products or must receive the sale proceeds as ‘donations’ from the artist or manufacturer).

• Events requiring participation by a large number of people and raising resources through participation fee (competitions and festivals).


Other Fundraising Techniques

Self-contributions

The most effective tool of resource mobilisation is self‑contribution. Before collecting resources from other sources, it is a sound practice for every organisation to start some project from self‑contributions. An organisation beginning with self‑contributions can win the trust of other resource providers quickly. So it is appropriate to abandon the tradition of starting any work after receiving resources from others, and begin with self‑contributions!

Internal mobilisation

Organisations in ownership of spare meeting spaces and equipment (photocopiers, telephones, fax machines, projectors and computers) can give them out on rent and make appropriate use of the available resources.

Applying for donations

These are requests for donation or hand‑over of funds or other valuable items from various organisations like cottage industries, trading agencies, private institutions, and individual philanthropists (both national and international).

Membership campaign

Membership campaigns are an important mechanism of resource mobilisation. By increasing its membership, the organisation can expand its relations with membership from people with different capacities, and can mobilise many resources available with the members for the organisation.

Publishing the history of the organisation

Publishing good practices, case studies and achievements which will have an impact on the resource provider. Resource mobilisation is courageous work. No one will provide resources easily. In this connection, it is said that instead of hoping for anyone to give you resources, you need to fully prepare yourself for receiving resources. Rather than thinking of getting resources by asking for it, resources can be received by marketing your organisation’s good practices, work and history.

Expanding relations

There is a saying in the resource mobilisation sector: ‘Resource mobilisation is not only to receive resources but also to receive friends’. Expanding relations is an important mechanism of resource mobilisation. The more an organisation expands its relations the more resources it may mobilise. So, it is said that the organisation with a successful resource mobilisation strategy ’receives resources from friends’.

Personal meetings

If receiving a resource is to receive a friend, then personal meetings play an important role in receiving resources. You have to hold personal meetings with friends and resource providers, invite them to social occasions, and accept their invitations as well. Meeting and building links with influential people often helps.

Formal tea parties and dinners

Personal contact and get‑togethers are an effective mechanism of resource mobilisation. An organisation looking for resources can host special High‑tea (receptions) for local and external resource providers on the occasion of a special event/festival of the local area, or the country. Such occasions will be of a big help in expanding relations and contacts. Resource providers should be felicitated at such functions or local distinguished persons should be called upon to hand small gifts to the resource providers. But if such functions are held frequently, their utility may gradually disappear.


Partnership

Partnership is another mechanism of resource mobilisation. Partnerships help exchange the resources between two or more organisations. Especially if new or small organisations join hands with similar organisations, there will be a possibility of extensive mobilisation of resources at the local and international levels. Without resources, an organisation cannot build its image and without a good image an organisation cannot mobilise resources. As a result, skills and knowledge of resource mobilisation alone is not enough; the main thing essential for a partnership is a meaningful concept.

Technical assistance fee

An organisation can also raise funds by marketing its technical skills and expertise to other organisations, such as becoming a resource person of a training, raising a fee from visitors to your organisation, and raising a fee from individuals or organisations coming to your organisation for research. The organisation can spend such resources as per its wish. Again, clarification may be needed with the organisation’s auditors as to the validity of such a mode of fund‑raising for NGOs/CBOs.

Producing print and audio-visual material

Many NGOs have been carrying out resource mobilisation by developing information, education and communication (IEC) materials as per the requirements of other NGOs and even government bodies. Such organisations publish or produce reports, guidelines, posters, leaflets and audio‑visual material for the benefit of other organisations.

Use of media

The world today is a network of information and communication. For resource mobilisation every organisation should take the support of various forms of media to talk about its achievements, future plans and expansion of relations. In recent times, some of the most successful fund‑raising achievements have been community‑based and utilised social media like Facebook.

For instance, Mumbai‑based filmmakers Anti Clock Films funded their film ‘I Am’ almost entirely from donations raised through word of mouth and publicity on Facebook. Donors were individuals and organisations of all kinds, from different walks of life. Of course, their credibility was high because of past work, but the idea was novel, worth a try and gave them the independence to produce a film without depending on commercial sources.

Other Points to Keep in Mind

Determination of resource providers

There are many resource providers who have their own targets and objectives. It is important for an organisation to understand the interest and needs of the resource providers, and see with whom and where there is a match. Resources should be sought accordingly, and attempts should be made to develop linkages with diverse resource providers.

Details of contributions

Presentation of details of existing contributions and their sources can be effective in mobilising both internal and external resources. Organisations working in a transparent manner with resource providers, beneficiary groups and other stakeholders can quickly win the trust of resource providers.

Mobilisation of local resources

An organisation can attempt to use local resources extensively by involving the beneficiary communities in every phase of the program. This will require some level of micro‑planning at the community level, which can be an effective method to build trust and programme ownership by the communities.


Constitution of a resource mobilisation committee

It may serve an organisation well to constitute a resource mobilisation committee for dedicated and effective resource mobilisation. The committee can have individuals from all fields of the organisation’s functioning – administrative, financial, human resources development, and other technical areas of work.

Programmes should be based on genuine needs of communities

Even if an organisation uses all the mechanisms of resource mobilisation, these will not be effective in the long‑run if its programme/s design/s do not reflect genuine community needs.

Advocacy

Advocacy is an important part of resource mobilisation. A far‑sighted organisation skilled in resource mobilisation raises resources by advocating well with donor agencies and other sources.

List of resource providers

A list or directory of resource providers at the local, regional, national and international levels is an important tool in resource mobilisation.

Enhancement of internal capacity

Internal capacity‑building is necessary for resource mobilisation. As resource mobilisation is a continuous process, the organisation should enhance the capacity of its office bearers in areas like proposal writing, public relations, advocacy, and financial management. There should also be an internal policy and regulations that provide the legal and ethical do’s and don’t’s of resource mobilisation.


Activity 1g: Strategic Planning for Resource Mobilisation


Learning Outcomes By the end of the activity the participants will:

• Learn how to give strategic direction for resource mobilisation; and

• Develop an action plan on resource mobilisation.

Materials N/A

Audio-visual Support Refer to the slides titled ‘Strategic Planning for Resource Mobilisation’ from the PowerPoint presentation ‘Training on Resource Mobilisation’.

Take-home Material Annexure 1d on ‘World Bank Document on Resource Mobilisation’ available in digital file.

Methodology Using the slide titled ‘Strategic Planning for Resource Mobilisation’; describe the first stage i.e steps in planning.

Divide the participants into groups based on the organisation they belong to, and ask them to create a strategic plan for resource mobilisation for their CBO. Once they have developed these plans, ask each group to present their findings, and conduct an interactive discussion on the feasibility of their plans.

Close the day’s proceedings by fielding queries from the participants. If you feel it necessary, conduct a small quiz to ensure that all participants have understood the key points made during the day.

Distribute copies of ‘World Bank Document on Resource Mobilisation’ as take home material to each participant.


Fund-raising/Mobilisation StrategyA strategy is a long‑term plan of action designed to achieve a particular goal. Fund‑raising strategy is a long term plan of action designed to achieve a particular fund‑raising goal.

Steps in fund-raising strategy• Knowing the fund‑raising goal.

• Conducting SWOT analysis of the fund‑raising goal.

• Identifying those who can give:

• government, bilateral, central, state, local bodies; and• institutions, multilateral agencies, funding agencies, foundations, other NGOs,

networks, clubs, corporations.

• Individuals – major donors, group of individuals, small donors.


• Broadly, how can we reach them?

• Government and institutional bodies. —Search request for proposals. —Apply for grant. —Presentations and project visits. —Answer queries. — Implementation. —Reporting.

• Corporations. —Sponsorship. —Cause‑related marketing options.

• Individuals. —Direct mail. —Telephone. —Face to face meetings. —Direct response advertising. —Social media and events.

• Who will raise funds? —Organisational leaders (governing body) and top management. —Other staff. —Fund‑raising team or committee. —Consultants. —Volunteers.

• What are the timelines? For instance if the goal is to raise Rs 15,00,000 in five years!

—Fund‑raising core group: first two months. — Institutional fund‑raising: within first quarter. — Individual fund‑raising: Year 2 beginning. —Large‑scale event mid‑term . . . and so on.

• Why do we need this timeline? —Provides a long‑term blueprint. —Provides a monitoring framework. —Defines roles. — Involves all stakeholders. —A flexible plan that can be revisited.

Proposed strategy for CBOs

Procedures to follow for building a fund‑raising alliance by CBOs.

• Identifying suitable partners with common objectives.

• Signing a Memorandum of Understanding (MoU).

• Registration of the body.

• Contribution of cost by each partner.

• Division of money raised.

• Requirement of human resources.

• Allocation of funds for direct investment in fund‑raising.


Part 2Financial Management


Part 2: About the Financial Management Module

No. A4

Name Financial Management


• Programme Managers / Programme Officers

• Finance Officers


Training Objectives By the end of this module, the participants will:

• Understand the steps of book-keeping and financial management for a CBO;

• Know the statutory compliances to be followed;

• Learn how to prepare a work-plan and a budget; and

• Be able to articulate the roles and responsibilities of the administration and finance personnel.

Total Duration Half-a-day.


Attention: Do not change the names of file or folders, or move files from one folder to another, as some of the files are linked to each other. If you rename files or change their location on your computer, the hyperlinks to these documents in the Facilitator Guide will not work correctly.


Audio-visual Support PowerPoint presentation on ‘Financial Management’.

Annexures Annexure 2a on ‘Pehchan – Financial Systems Strengthening Guide for CBOs’.Annexure 2b on ‘Financial Management Reference Material’.Annexure 2c on ‘Case Studies’.Annexure 2d on ‘Resource Mobilisation and Financial Management’. Annexure 2e on ‘The Organisational Development Cycle’.


Activity Index2

No. Activity Name

Time Material2 Audio-visual Resources

Take-home material

2a Introduction to Module

30 minutes N/A Refer to the slides titled ‘Objectives of the module’ from the PowerPoint presentation ‘Resource Mobilisation and Financial Management’

N/A

2b Strengthening Financial Systems: An Overview

30 minutes N/A Refer to the slides titled ‘Strengthening Financial Systems – An Overview’ from the PowerPoint presentation ‘Resource Mobilisation and Financial Management’

Annexure 2a on ‘Pehchan –Financial SystemsStrengthening Guidefor CBOs’

2c Statutory Compliances for CBOs

30 minutes N/A Refer to the slides titled ‘Statutory Compliances for CBOs’ from the PowerPoint presentation ‘Resource Mobilisation and Financial Management’

N/A

2d Systems of Financial Management

2 hours 30 minutes

N/A Refer to the slides titled ‘Systems of Financial Management’ from the PowerPoint presentation ‘Resource Mobilisation and Financial Management’

Annexure 2b on ‘Financial Management Reference Material’

2e Preparation of Work-plan and Budget

45 minutes Annexure 2c on ‘Case Studies’

NA N/A

2f Roles and Responsibilities of the Administrative and Finance Officer


2g The Organisational Development Cycle

15 minutes Annexure 2d on ‘Resource Mobilisation and Financial Management’ and Annexure 2e on ‘The Organisational Development Cycle’

Refer to the slides titled ‘Organisational Development Cycle’ from the PowerPoint presentation ‘Resource Mobilisation and Financial Management’

Annexure 2d on ‘Resource Mobilisation and Financial Management’ and Annexure 2e on ‘The Organisational Development Cycle’



Activity 2a: Introduction to Financial Management Module

Time 30 minutes


• Be able to articulate the objectives of the training module.

Materials N/A

Audio-visual Support Refer to the slides titled ‘Objectives of the Module’ from the PowerPoint presentation ‘Resource Mobilisation and Financial Management’.


Methodology Tell the participants that this module is a continuation of the Resource Mobilisation module, in which they will be learning how to manage the financial resources they garner for their organisation.

Ask the participants to introduce themselves and their roles and responsibilities in the organisation they represent. It will also be useful to gauge the participants’ knowledge on financial management, and you can do so by either asking them to state their level of knowledge or experience on the subject or by conducting a short informal quiz asking a mix of basic and advanced questions to test their knowledge. However, reassure them that a lack of knowledge of the subject will not be a deterrent to understanding and enjoying the rest of the day’s activities.

Ask the participants what they expect to learn from from this session. Ensure that all participants get a chance to respond and list their responses on a flip‑chart. After all the participants have responded, use the slide ‘Objectives of the module’ from the PowerPoint presentation ‘Financial Management’ to read out what the participants can expect from this session. Match their expectations to these objectives and explain the scope and nature of the day’s training.


Activity 2b: Strengthening Financial Systems – An Overview

Time 30 minutes


• Be able to articulate the steps involved in strengthening Financial Systems in a CBO.

Materials N/A

Audio-visual Support Refer to the slides titled ‘Strengthening Financial Systems-An Overview’ from the PowerPoint presentation ‘Resource Mobilisation and Financial Management’.

Take-home Material Annexure 2a on‘ Pehchan – Financial Systems Strengthening Guide for CBOs’.

Methodology Using the Annexure on ‘Financial Systems Strengthening Guide’, lead the participants through the critical steps that CBOs need to follow to ensure that their financial management systems adhere to standard financial norms and practices. Briefly elaborate on each step, telling the participants that you will be giving more details on these steps later in the module.


Activity 2c: Statutory Compliances for CBOs

Time 30 minutes


• Be able to list the statutory compliances for CBOs and the steps involved in adhering to them.

Materials N/A

Audio-visual Support Refer to the slides titled ‘Statutory Compliances for CBOs’ from the PowerPoint presentation ‘Resource Mobilisation and Financial Management’.


Methodology Write the words ‘Statutory‘ and ‘Compliance’ on a flip‑chart and ask participants to think of adjectives to describe each term. As they respond, write their responses under the appropriate heading.

Explain that ‘statutory’ means ‘of or related to statutes’, or what we normally call laws or regulations. Compliance just means to comply with or adhere to. Therefore ‘statutory compliance’ means that one is following the laws on a given issue.

Using the slides titled ‘Statutory Compliances for CBOs’ give the participants a detailed explanation on the following.

• Annual Returns to Income Tax Department

• Tax Deducted at Source

• Foreign Contribution Regulation Act, 1976


Activity 2d: Financial Management Systems



• Understand the importance of adhering to financial management systems to run their organisations.

Materials N/A

Audio-visual Support Refer to the slides titled ‘Systems of Financial Management’ from the PowerPoint presentation ‘Resource Mobilisation and Financial Management’.

Take-home Material Annexure 2b on ‘Financial Management Reference Material’.

Methodology Discuss the below topics in detail. To ensure that the session does not become a didactic one‑way communication, invite participants to share their knowledge on each of these topics and encourage them to ask questions and clarify doubts. You can distribute copies of Annexure on ‘Financial Management Reference Material’ either before the session begins or at the end.

• Maintaining books of accounts

• Types of accounts

• Registers to be maintained

• Resource mobilisation policies

• Cash transactions, including physical control of cash and its monitoring

• Bank transactions

• General accounting

• Program/work advances

• Bank reconciliation statement

• Salary payment system

• Vehicle log book maintenance

• Hiring vehicle from external agencies

• Expenses reimbursement systems

• Computerised accounting system

• Purchase control (both for fixed assets and general purchases)

• Budget and budgetary control

• Internal control


Activity 2e: Preparation of Work-plan and Budget

Time 45 minutes


• Learn how to prepare a work-plan and budget for an activity.

Materials Annexure 2c on ‘Case Studies’.



Methodology Divide the participants into three groups and give each group a printout of one of the Annexure 2c on ‘Case Studies’. Tell each group to discuss the case study at length, and prepare a work‑plan and budget based on the information provided in the case study.

After 30 minutes, ask each group to present its work‑plan and budget. Allow the participants from other groups to give feedback and ask questions to the presenting group. Support the learning through observations of your own.

After all the groups have presented their material, sum up the discussion to ensure that participants understand the concepts and steps involved in budgetary compliance.


Activity 2f: Administrative and Finance Officer: Roles and Responsibilities

Time 15 minutes


• Understand the specific roles and responsibilities of Administrative and Finance Officer in a CBO.

Materials N/A



Methodology Sum up all the activities discussed above in the module. Explain to the participants that each of the roles discussed in this module are the responsibilities of an Administrative and Finance Officer in a CBO. Participants should be encouraged to brainstorm roles and responsibilities further under the following heads:

• Strengthening Financial Systems.

• Statutory Compliances for CBOs.

• Systems of Financial Management.

• Preparation of Work‑plan and Budget.

Session should be concluded by drawing a consensus among participants, based on the discussion on the above mentioned points.


Activity 2g: Understanding Organisational Development Cycle

Time 15 minutes

Learning Outcomes By the end of the activity, the participants will:

• Name the steps in the Organisational Development Cycle; and

• Relate these steps to their learning from Module A.

Materials Annexure 2d on ‘Resource Mobilisation and Financial Management’. Annexure 2e on ‘The Organisational Development Cycle’.


Refer to the slides titled ‘Organisational Development Cycle’ from the PowerPoint presentation ‘Resource Mobilisation and Financial Management’.

Take-home Material Annexure 2d on ‘Resource Mobilisation and Financial Management’. Annexure 2e on ‘The Organisational Development Cycle’.

Methodology • Ask for 12 volunteers, and randomly, hand each volunteer one of the placards

containing a component of the Organisational Development Cycle.

• Tell the volunteers they have three minutes to order themselves into the sequence they believe is correct for the process of organisational development. They should arrange themselves in such a manner that they face the other participants in the correct order.

• When three minutes are up, or if they have already arranged themselves in a sequence, ask the other participants to comment on the correctness of the sequence. If they suggest changes, ask them why they are suggesting a change. If they feel that the arrangement is correct, ask them to explain why they feel this sequence is logical.

• While debriefing the participants, ask them whether the process of organisational development is strictly linear, or would it be a cyclical process with reviews, revisions and revisiting of the problem statement.

• In this context explain that the ‘strategy’ or ‘strategising’ component of the Organisational Development Cycle is the most crucial component. It takes into account all components that precede it as well as those that follow it, and in fact, is the process that helps operationalise the Organisational Development Cycle. A typical strategy development session for organisational development will assess all the ‘concept oriented’ components that precede it (using SWOT analysis and other tools discussed earlier in Module A training), and then plan for the subsequent components which are all “action oriented”.

• Using the slides titled ‘Organisational Development Cycle’, explain the cyclical process and summarise the key concepts of Module A’s training content.

Note to FacilitatorThe Organisational Development Cycle partially condenses some of the earlier concepts discussed in Module A. For example, instead of ‘vision’, ‘mission’, ‘goals’ and ‘objectives’, it equates ‘vision’ to ‘goals’ and ‘mission’ to ‘objectives’. You can take either approach as long as you are able to explain the essential concepts involved.


Annexure 1a: Case Studies

Case Study A: Jhakaas SangamThe community‑based organisation (CBO) Jhakaas Sangam is a legally registered, 11‑year old trust that works in three districts in Gujarat. The organisation has a 10,000‑strong membership of men who have sex with men (MSM).

The CBO is getting some support from the State AIDS Control Society. As most of the total budget of Jhakaas Sangam is received from a single donor agency, the members of the organisation have not been too concerned about financial sources. Last year, however, the funding agency decided to cut down the budget for the foreseeable future. This has created a big problem for Jhakaas Sangam.

The leadership of the organisation lacks individuals with skills for resource mobilisation. The organisation never thought of the possibility of such a problem. Whenever someone would ask about making the organisation sustainable, they would give a very easy answer, “It will remain sustainable until the donor gives it funds!”

As a result of the decision of the donor agency, a dispute has occurred in the working committee over who should leave and who should continue in Jhakaas Sangam.

Questions1. What are the problems faced by Jhakaas Sangam?

2. Why have the problems arisen?

3. From the resource mobilisation point of view, what could have the organisation done to avoid such problems?

4. What are the similarities between your organisation and Jhakaas Sangam? Make a list.

Case Study B: Hocus Pocus FoundationRajnikant who, until few years back used to teach at a local primary school, is the Chairperson of the Hocus Pocus Foundation. The Hocus Pocus Foundation was founded with health‑ and income‑generation as its mission.

Presently, Rajnikant runs counselling centres, health education centres, HIV service centres for TG and MSM people with the support of a donor agency. Though monthly savings are being generated after formation of self‑help groups (SHGs) for income‑generation, programmes have not been carried out for the skill‑development of women due to lack of the required capital.

The working committee of the Hocus Pocus Foundation has 11 members, but due to lack of skill and knowledge of organisational development and resource mobilisation, Rajnikant has not been able to achieve anything much toward development, other than the HIV health programme granted by the donor agency.


A majority of the SHG members are inactive while some have stopped building savings because they have not been able to use the savings made in their SHG for income‑generation. Rajnikant always pressurises one of the members to write a project proposal and go to meet a donor agency.

Questions1. What are the problems faced by the organisation?

2. What should have Rajnikant done to avoid such problems?

3. What are the similarities between Hocus Pocus Foundation and your organisation? Make a list.

4. From the resource mobilisation perspective, what should Rajnikant now do to improve the organisation?

Case Study C: Maharathi OrganisationMaharathi is a CBO founded in 1998 with the objective to work for the upliftment of the TG community. The CBO has its own structure. The Executive Committee of the CBO is represented by individuals with skilled leadership qualities, as a result of which it has been receiving resources from various sectors. Under its Executive Committee (or Working Committee) is a Sub‑Committee for Resource Mobilisation. The Sub‑Committee works at the local and national level to expand relations with various organisations and collect resources.

The CBO runs programmes in two districts. Local government, private sector and international agencies have been providing financial, technical and other cooperation to the CBO. Starting this year, the CBO is running an adult‑care program and income‑generating programs for the community, in addition to partnering two other big CBOs in four districts.

With the cooperation of local volunteers, it runs a social awakening campaign against prevailing harmful traditions, health issues, HIV issues and takes up cases where legal services may be required. The CBO also runs counselling centres, health‑education centres, and cultural centres with wide participation of local volunteers.

Maharathi has its own policies and regulations and good governance is strong. It has been running programmes as per its target. The CBO’s work has been respected at the national and international levels. Other small organisations take Maharathi as their model.

Questions1. What are the good practices of Maharathi?

2. What are the types of resource providers that Maharathi collects sources from?

3. What is the difference between your organisation and Maharathi?

4. What will you do to make your organisation like Maharathi?

5. On the basis of analysis of Maharathi, what do resource and resource mobilisation mean?


Annexure 1b: Case Studies of Successful Resource Mobilisation

Case I: Sex Workers turn EntrepreneursFor sex workers, fighting social stigma and discrimination is a big challenge. Unlike in the old days when society accepted them as part of the social structure and gave them a respected place, sex workers today are harassed and looked down upon and, more often than not, exploited. Ashodaya Samithi, an organisation of female, male and transgender sex workers in Karnataka, is addressing the issue of social stigma and discrimination towards HIV positive sex workers and sex workers in general by promoting entrepreneurship among them. Its efforts towards this have given shape to an innovative and sustainable project—a community kitchen in Mysore.

Around 150 organised sex workers are today selling thalis or meals at Rs 7 each, at their centre. They sell about 150 meals a day.

What began as an experimental proposition has turned into a business model for them. Their joint effort has won their organisation, Ashodaya, a World Bank grant as well. Development Marketplace (DM) is a competitive grant programme administered by the World Bank and supported by various partners. It identifies and funds innovative, small‑scale development projects with good potential for expansion that can be replicated and which could have development impact.

The sex workers’ organisation has won the grant from among 1,000 competing proposals. The 75 shortlisted finalists from among the 1,000, were invited to Mumbai to set up a stall, exhibit and explain their proposal to a team of jurors and convince them on their proposal. A sex worker and Ashodaya secretary, Bhagyalakshmi did the promotional work. She convinced the jurors on the innovativeness, replication and sustainability of their project and made Ashodaya qualify to receive the World Bank grant of $40,000 in Mumbai from actor and UNICEF envoy Shabana Azmi.

The grant aims are: reducing the social stigma that sex workers face, by undertaking healthcare measures, training speakers and promoting positive living, developing business initiative, and documenting each episode of discrimination and to address them.

Sushena Rezapaul, head of Disha project, which provides technical backing to Ashodaya, told Business Standard, ‘Ashodaya plans to expand the community kitchen project to other districts, encouraged by its success’. As these marginalised women become ‘kitchen managers’, discrimination and stigma will take a backseat.

Ashodaya emerged from a need among Mysore’s sex workers to group themselves into an organisation. Those who came for treatment at the Emanuel Hospital Association (EHA), which is running an HIV prevention project in Mysore and Mandya districts, decided to group into Ashodaya organisation. Besides running the kitchen, Ashodaya, headed by its president Rathnamma, has put up two stalls at the Urban Haath, a handicraft centre in Mysore, where they sell clothes. They plan to promote a community laundry and cater to IT companies, hospitals and major firms, Rezapaul said. Rathnamma acknowledges the increasing awareness towards the inherent capacity of the marginalised and hopes that they will scale greater heights in HIV prevention, care and support through their joint effort.


Case II: Dream-A-Dream Gets a Slice of the EarningsDream‑a‑Dream has joined hands with selected restaurants in Bangalore to create a ‘Dream Table’. From each order given by customers at the ‘dream table’, a portion of the bill goes to Dream‑a‑Dream. This builds an opportunity for corporate social responsibility (CSR) into the hospitality industry.

The objective of Dream‑a‑Dream Bangalore is to promote leadership in children from diverse backgrounds.

Case III: SristisankulaSristisankula is a registered community‑based organisation (CBO), working with men who have sex with men (MSM) in Gadag district of Karnataka. It is part of a state‑level MSM CBO federation called Sarathya. Sarathya presently covers 20 districts of the state and is encouraging MSM communities in remaining districts to form CBOs and be part of the federation. This federation was formed with the support of Karnataka Health Promotion Trust (KHPT); being part of the federation, the CBOs receive knowledge support and information about funding opportunities.

Mr Arif, Secretary of the federation, is also the founder of Sristisankula. In 2002, Mr Arif started working in Gadag district with Samraksha, a partner voluntary organisation of KHPT, towards prevention of HIV and ensured care and medical facilities for those affected. The main objective of Sristisankula is ensuring that MSM, transgender and other sexual minority communities become part of mainstream society.

According to Mr Arif, the National AIDS Control Organisation (NACO) provides direct financial support to MSM CBOs which are more than two years old, under its targeted intervention (TI) programs. Being just a year old, Sristisankula cannot receive support directly from NACO, so it receives financial support from NACO through another CBO Rakshane. Rakshane is a five‑year old CBO which works with female sex workers (FSWs). It approached NACO on behalf of Sristisankula and has received an annual grant of Rs 11 lakh. Next year Sristisankula will approach NACO and has already started building relations with the Joint Director and Programme Director of Karnataka State AIDS Control Society (KSACS).

Mr Arif is also planning to organise events across the district like antakshari competitions, cooking competitions and cultural nights during the year to raise financial support from the local communities. He has approached and presented Sristisankula to local Members of the Legislative Assembly (MLAs) and visiting dignitaries. He also keeps the district administration officials informed of Sristisankula activities. He is hopeful of receiving their individual contributions and later their support under various government schemes. Sristisankula charges Rs. 20 as an annual membership fee from its members for the support it provides.

Sristisankula though just a year‑old, looks for opportunities for support from individuals, government institutions and other grant‑making agencies, whenever and wherever there is an opportunity.

The members of Sristisankula and other CBOs like Aaptamitra and Sanjeevani in Raichur district have started to provide meals to Karnataka State AIDS Control Society (KSACS) training programmes, as part of their income‑generating programme. The profits from


this service are ploughed back into the CBO. Sristisankula is also exploring the possibility of conducting training courses like tailoring for the community.

Case IV: SamartyaSamartya, a six‑month old CBO, is also part of the MSM federation Sarathya. Being part of the federation, Samartya receives technical knowledge of running and maintaining the CBO which includes exploring self‑generated income opportunities.

Samartya is unique in its work in that it links the MSM, transgender and other sexual minorities to various government schemes, such as Aarogyashree (Health Card) and an old age pension scheme.

Being a six‑month old CBO, Samartya hopes to receive support from KSACS next year for its work. In the meantime, it is exploring opportunities with KHPT officials for income‑generating activities for its members. It will be conducting feasibility studies for manufacturing and selling of handicrafts and other products. It is also working with other CBOs that work with women, Dalits and the handicapped. Samartya is also exploring other income‑generating opportunities, such as operating telephone booths.

Samartya approaches and receives individual donations from local MLAs, small businessmen and district administration officials. An annual membership fee of Rs 50 is charged and it constitutes a part of self‑generated income.

The interesting thing about all of these CBOs is that they have received considerable encouragement and support from partner agencies of grant‑making organisations, such as the Bill &Melinda Gates Foundation, NACO and KSACS. These CBOs have received training in how to generate funds locally. It is the partner agencies like Sangama, Samraksha and others that are facing a resource crunch and are finding it difficult to sustain their work.


Annexure 1c: PowerPoint Presentation – Resource Mobilisation


Annexure 2a: Pehchan – Financial Systems Strengthening Guide for CBOs

Generating transactions (through incomes and expenditures)

Basic book-keeping and maintaining the records of incomes and expenditures

Planning and budgeting

Maintaining book of accounts

Registration as a Society/Trust/Non-profit Company

Opening of a bank account

Applications to Income Tax Authorities for:•PermanentAccountNumber(PAN)

•Tax-deductionAccountNumber(TAN)•GettingcharitablestatusunderSections12AAand80GoftheIncomeTaxAct

Auditing of accounts by appointing an external auditor

Preparation of annual report of the organisation

Submission of annual returns to the Registrar of Societies/Registrar of Companies

Submission of annual returns to the Income Tax authorities

Application for FCRA registration (after completion of 3 years) + Opening of separate bank account

Submission of FCRA annual returns

Source: SAATHI


Annexure 2b: Financial Management Reference Material

1. Book-Keeping and Accountancy

1.1 Maintenance of Books of AccountsAccounting is a basic management tool which, if used properly, will enable the organisation’s management and/or any other person, related or unrelated to the organisation, to determine the fair financial status of the organisation.

• The books of account shall be maintained in computerised accounts generally in Tally software.

• The organisation shall maintain separate sets of books of accounts for all grants received (non‑FC/local and foreign contributions).

1.2 Types of AccountingThere are different types of accounting; two important types are the Cash System and the Mercantile System.

• Under the Cash System, an entry is recorded on the basis of the amount being paid or received, whether or not the payment or receipt was due at that point of time.

• Under the Mercantile System (Accrual System), an entry is recorded on the basis of any amount which has become due for payment or receipt, even if the payment or receipt is actually made at a later stage. This system of accounting is generally used by all the organisations since it depicts the actual assets and liabilities of the organisation.

Books of Accounts/Registers to be Maintained1. Petty Cash Book – Manual

2. Cash Book – Tally‑based accounting

3. Bank Book – Tally‑based accounting

4. Different Ledgers – Tally‑based accounting

5. Different Journals – Tally‑based accounting

6. Advance Payment Register – Computerised

7. Fixed Assets Register – Manual/Computerised

8. Stock Register – Manual/Computerised

9. Salary Register – Manual

10. Investment Register – Manual/Computerised

11. Cheque Control Register – Manual

12. Movement Register – Manual

13. Asset Movement Register – Manual/Computerised

14. Donation Register – Manual/Computerised

15. Despatch Register – Manual/Computerised

16. Membership Register – Manual/Computerised


1.3 Resource Mobilisation Policies

Grants

Receipt of a grantThe following processes should be ensured during the receipt of a grant.

• Treatment of grant as FCRA/domestic as per the direction of funder.

• The grant received is for the achievement of the objectives mentioned in the grant agreement.

• The grant received is not of a business nature and satisfies the provisions of Section 2(15) of the Income Tax Act.

Grants and accountingGrants received by the organisation could be of the following types.

• Grants received in support of specified projects or activities mutually agreed upon by the organisation and the donor (restricted grant).

• Grants received which the organisation may freely use for whatever purpose as per its defined objectives (unrestricted grant).

Grants should be recognised as revenues only upon or until the conditions have been substantially met or explicitly waived. A grant with a condition should be accounted for as a liability until the conditions have been substantially met or waived by the donor.

It is also to be noted that revenues received from foreign sources are to be reported to the Ministry of Home Affairs, Government of India, on cash basis as a requirement of FCRA.

Management of a grantThe following processes should be ensured during the tenure of a grant.

• Programme reports must be sent within the intervals fixed under the memorandum of understanding (MoU), signed between the donor and grant recipient.

• The programme reports must match the activity calendar as suggested under the MoU.

• The programme reports should match the financial reports for a particular period. Variances if any should be sorted out prior to sending the same to the funder.

• Over‑spending and under‑spending under various projects, especially the FCRA grants should be properly dealt with.

• Capital and revenue expenses under a particular grant should be properly dealt with.

• Periodic meetings of programme and administration and finance department representatives should be held to keep the expenditures on track as per the budget heads.

Closure of a grantLike the management of a grant, its closure is an essential part of a project. The following processes should be ensured during the closure of a grant.

• Ensure that all the conditions as per the MoU with the funder have been met.

• Ensure that all the fund‑utilisation certificates have been submitted along with the periodic activity reports duly acknowledged by the funder.


• The closure report from the administration and finance department must be in the proper format giving the reconciliation of grant received and utilised, taking into account the interest earned on the said amount.

• The interest earned, if any, should be properly disclosed in the utilisation certificate submitted to the funder and must also be in line with provisions in the MoU.

• Acknowledgement must be received from the funder of ‘NO DUES’, after the submission of final report and total utilisation of funds.

Contribution in KindThis may be in the form of assets or any item that generates revenue. Assets received in kind with an ascertainable value, should be recorded at the value ascertained.

Assets received in kind, the value of which cannot be ascertained, should be valued at a nominal value, say Re. 1/‑, for accounting purposes.

Corpus FundFor a charitable organisation corpus funds are of paramount importance. Normally a corpus fund denotes a permanent fund kept for the basic expenditures needed for administration and survival of the organisation. The corpus fund is generally not allowed to be utilised for the attainment of the organisation’s purposes, but the interest/dividend accrued on such fund can be utilised as well as accumulated.

Corpus funds are generally created out of corpus donations. A donation will be treated as corpus donation only if it is accompanied by a specific written direction of the donor. In the absence of any written direction of the donor, a contribution or grant cannot be transferred to the corpus fund.

• A corpus fund may be created out of own generation, based on a resolution passed by the governing body.

• Corpus fund received should not be treated as income for computation of income for income tax purposes, as it is a receipt that is capital in nature.

• The corpus fund should be suitably invested and should be disclosed separately in the financial statement.

• Interest on the corpus can be utilised as well as accumulated.

Endowment FundAn endowment fund is similar to a corpus fund but it comes with the restriction of certain specific purposes. There may be two types of endowments.

• Perpetual endowments given in perpetuity, and where the fund principal is never spent or repaid.

• Term endowments that are gifts for which the donor has specified a date or event after which the funds may be spent.

When an endowment fund is created out of internal accruals and unconditional voluntary contributions received, it is known as a ‘designated endowment fund’. The board of an organisation may designate certain funds for long‑term activities. The endowment fund so created may be for a fixed period or perpetual in nature.

A designated endowment fund is a discretionary long‑term fund created by the governing body of the organisation. Such funds are bound by the norms and regulations approved by the governing body. Generally such funds are also permanent and not available for the general activities of the organisation. But since the designated fund is created by the organisation itself, therefore there is a legal possibility of revocation of such designated


fund. Another kind of endowment fund is the ‘restricted endowment fund’, which is not available for revocation under any circumstances.

Interest revenue out of an endowment fund is accrued at the end of an accounting year. The fund is usually invested in some securities and such investment is valued at cost price. If the income out of such investment is available for unrestricted purposes, it is recognised in the unrestricted fund. On the other hand, if the income is to be used for some specific purpose, it is transferred to that specific fund.

1.4 Cash TransactionsThe norms for cash transactions are laid down below.

Cash Payments• Cash payments should be made only if supporting documents are obtained to

that effect.

• The Administration and Finance Officer will fill in, on payment voucher(s), the ’project title’ and the ’name of programme’ for which the expenses have been incurred and send the same to Authorised Signatory for approval.

• The Authorised Signatory will give approval on payment voucher(s) and support thereof.

• The Administration and Finance Officer will obtain recipient’s signature on cash payment voucher.

• Where cash payment is more than Rs 5,000/‑, revenue stamp of Re. 1/‑must be affixed and the recipient’s signature should be obtained thereon.

• Cash payment voucher will be entered in Cash Book.

• A serial control number will be given to each payment voucher.

• In case of one‑time payment, ensure that cash payment is kept below Rs 20,000 on a single day to a particular person.3

• Follow authorisation norms in case of cash advances to outside parties and staff/workers.

• Advance payment to staff/workers will be done only on the basis of an authorised plan for programme/plan for travels.4

Cash receipts• No cash will be accepted unless the receipt is authorised as per the authorisation

procedure.

• Receipts will be pre‑numbered at the time of printing.

• The receipt will be printed in duplicate. First copy for donor/party, second copy for accounting and references and records.

• A Receipts Control Register will be maintained to record cash receipts and ready reference.

• A cash receipt voucher will be made for total cash received during the day giving reference of cash receipts and the Receipt Control Register.

• Reference of cash receipt voucher will be given in the Receipt Control Register.

• The Administration and Finance Officer will clearly mention the purpose for which cash has been received.

3 Cash payment of more than Rs 20,000 can be made only when the person does not have any bank operat‑ing in the locality

4 Refer to the section ’Formats for Programme/Travel Plan and Advance Request’


• Cash Book folio will be mentioned on the cash receipt voucher.

• The blank cash receipts will be kept in a safe custody.

Cash book(s)• An organisation should maintain separate cash books for Foreign Currency (FC)

funds as well as local funds.

• The Administration and Finance Officer will clearly mention the programme/expenses head with respective project names in the Cash Book.

• Ensure that a brief narration of the nature of transaction is given in each case.

• The Administration and Finance Officer will mention ledger folio against each cash voucher entered in the Cash Book.

• No alteration can be made in the project name, programme/expenses head and amount;

• If the change is inevitable in the Petty Cash Book, do so by clearly striking it off and writing again.

• The Petty Cash Book(s) will be closed every day, mentioning physical balance of cash available. The concerned staff will mention denomination of cash in the Cash Book itself at the close of the day.

Physical control of cash and monitoring• The organisation’s cash will be kept at a secured place.

• No personal cash will be mixed with organisation cash.

• Physical control of cash will be with the Cashier/Administration and Finance Officer of the organisation.

• In no case, will the cash be moved out of the organisation’s premises without corresponding payment voucher and authorisation.

• Deposit cash on the day immediately following the date of cash receipts in designated bank account.

• Withdrawal of cash will be done only when a proper planning for programme or administrative expenses have been approved by the Authorised Signatories.

• Keep cash at the barest minimum.

• Must insure cash‑in‑safe and cash‑in‑transit to the extent of necessary volume and safety.

• Periodic physical verification (without any notice to Cashier/Administration and Finance Officer), in a proper format meant for this purpose, will be done by each organisation.

• The persons responsible for physical verification will hold this post in rotation.

• Stern action should be taken in case of discrepancies beyond explanation of the Cashier/Administration and Finance Officer and any other party involved.

1.5 Bank Transactions

Bank Payments• Bank payments will mean payment through cheques or direct debits by bank(s)

only.

• No authorisation of cheque payment will be made unless supported by a bank payment voucher.


• In case of any advance payment to staff, Advance Request Form5 will be attached with the voucher for authorisation.

• In case of payment to outside parties, no bank payment voucher will be entertained unless supported by party’s accounts in the books of the organisation.

• Outside party’s accounts in organisation’s books of accounts will be properly reconciled with all the bills raised and payments made till the date before the same is considered for payment.

• Insist on a Statement of Accounts from outside party, if necessary, for account reconciliation.

• The Administration and Finance Officer will ensure that the payments to parties are done only on or after the due dates.

• The Administration and Finance Officer will check availability of funds in the bank from where cheque will be issued.

• The Administration and Finance Officer will ensure, at the time of obtaining authorisation, that the support documents attached to the bank payment voucher are also signed.

• All the cheques issued will be crossed ‘payee’s account only’ unless they are for internal cash withdrawals.

• Complete detail of cheque issued will be mentioned on the payment voucher.

• The Administration and Finance Officer will fill in, on payment voucher(s), the ’project title’ and the ’name of programme’ for which expenses have been incurred.

• The particulars of bank payment voucher will be entered in the Bank Book/Ledger as soon as the cheque is issued.

• The Administration and Finance Officer will obtain recipient’s signature on the payment voucher.

• A serial control number will be given to each payment voucher.

• Where payment is more than Rs 5,000/‑, revenue stamp of Re. 1/‑ must be affixed and recipient’s signature should be obtained thereon.

• The cheque issued will be entered in the Cheque/Draft Issue Control Register6.

• In case, the recipient is an outside party, an official receipt will be requested.

Bank Books/Ledger• Every organisation will maintain separate Bank Books/Ledgers for each project

(for foreign currency or FC funds as well as local funds).

• The Administration and Finance Officer will clearly mention the programme/expenses head with respective project name in the Bank Book/account.

• Brief narration of the nature of transaction will also be given in each case.

• The Bank Book/account will be closed everyday and reflect bank balances.

Maintaining chequebooks/deposit slips• In no case should cheques be kept blank after the signatures of both Authorised

Signatories have been obtained on them.

• Cheque books should be kept in the safe meant for keeping cash.

• Avoid giving post‑dated cheques unless there is absolute necessity, but not without prior approval within organisational level.

5 Refer ‘Formats’ for Advance request

6 Refer ‘Formats’ for Cheque/ Draft Issue Control Register


• Avoid giving bearer cheques.

• Do not leave any blank spaces in cheques between the figures and at the start of the box meant for filling amount in figures. Also, do not leave any spaces when writing amount in figures.

• Strike out the blank spaces after the name and figures in words.

• Preferably, use indelible ink pen for filling cheques.

• In case of cancellation of any cheque, deface the cheque diagonally with a pen and strike off the cheque number.

• If bank payment voucher has been made earlier for the cancelled cheque, prepare a bank receipt voucher and record in Bank Book/account to avoid any confusion in future.

• Mention detail of cheques issued in the cheque counterfoils. This serves as a ready reference and is also useful at the time of preparing Bank Reconciliation.

• Keep all the deposit slips separately and safely till the time bank accounts are reconciled.

1.6 General Accounting

Journal Vouchers• Journal vouchers will be prepared only for the activities not falling in the category

of cash or bank transactions viz. credit purchases, credit sales, depreciation on assets, etc.

• The corresponding effect of these vouchers will be directly taken in the Main Ledger.

• No journal voucher will be accounted for without approval from Authorised Signatory.

• Every journal/adjustment voucher will be required to have adequate supporting documents, unless the same is a transfer entry.

• In case of transfer entry, the previous voucher reference will be given with complete narration.

Maintaining Vouchers• Ensure that all the particulars required in voucher(s) are properly filled.

• Ensure that all the vouchers bear the ’project name’ and ’programme description’.

• All type of vouchers namely, Cash Payments, Cash Receipts, Bank Payments, Bank Receipts and Journals/Adjustments should be separately filed for each project.

• Vouchers should be pre‑numbered and filed numerically.

• Proper binding of the vouchers should be done as and when required, depending on the volume of transactions.

Maintaining Ledgers• Organisations should maintain project‑wise ledgers for both FC and local funds.

• A project‑wise ledger should contain transactions of that project only.

• Ensure that the date and voucher reference is given in case of each transaction.

• Each entry reflected in the ledger should have a brief about the nature of transaction.

• The balancing of the ledger should be done at the close of every month.


1.7 Program/Work Advance

Obtaining/Authorisation of Advance• Program/Work Advances should be given only if the request for the same is

given in the required format.

• On receiving the request for an advance, the Administration and Finance Officer will check for any unutilised advance lying in the person’s name.

• Outstanding advance (if any), in his/her name will be mentioned on the request form.

• The authorised person will ensure that outstanding advance is settled first and then only the request for more advance sis entertained. If it is absolutely necessary to give further advance without settling a previous one, then the reason should be mentioned by the person authorising the advance.

Settlement of Accounts• The Program/Work Advance should be settled immediately after the end of the

program(s). Each organisation should have its own specific timelines to settle advances.

• In no case, however, must the program advance remain unsettled beyond the end of the month; or end of the program(s) whichever is earlier.

• Persons responsible will be required to give complete detail of expenditure on each program/work in the desired format.

• Each expenditure will be supported with adequate bills/receipts/supports/details as the case may be.

• A narrative program report for each program will be prepared and attached to the claim for settlement of program advances.

• Expenses claimed without proper program report/bills/receipts/supporting details should be treated as non‑expenditure and reflected as un‑utilised in the hands of the person who has taken advance.

• For any expenses claimed and paid without authorisation, both the Administration and Finance Officer and the person who has received the expense, are liable to be penalised to the extent of such amount.

• Any amount remaining unutilised at the end of the program/work will be returned to the accounts department for accounting and depositing back.

1.8 Bank Reconciliation StatementsIn normal cases, Bank Book/account maintained by you should match with the bank statements/pass books maintained by the bank on your behalf. There are, however, some cases where both do not match and need reconciliation to arrive at the un‑traced entries at both the end.

Following are examples where your Bank Book and bank statement/passbook may not match.

• Cheques issued by you but not presented by party(ies) in bank for payments.

• Cheques deposited by you but still to be credited by bank.

• Bank charges debited by bank on account of issue of cheques, bank draft clearing charges, commission for TT clearance, etc.

• Some deposits directly done in your bank but not accounted for by the Administration and Finance Officer for lack of information.


It is, therefore, necessary to prepare a Bank Reconciliation Statement on a monthly basis where transactions entered into your Bank Book/account are matched with the bank statements/ passbooks on a periodical basis.

Your organisation will be required to follow these steps.

• Obtain bank statements or get the bank’s passbook updated immediately after the end of the moth.

• Prepare Bank Reconciliation Statement at the end of every month for each bank account you have.

• The reconciliation statement should be filed along with the bank statement for each month.

• Any deviations on the bank’s part should be immediately taken up with the bank and follow‑up done periodically.

• Mistakes/deviations on the organisation’s part should be corrected/adjusted immediately before the next month‑end.

• The Administration and Finance Officer should obtain bank balance confirmation at the end of each accounting year.

1.9 Salary Payment System

Salary Computation• The cut‑off date should be the 25th of each month for the calculation of salary.

• The Administration and Finance Officer will be responsible to obtain authorised statements for salary payments from respective project heads for their field workers/staff for the previous month latest by the third day of the following month.

• The project heads/directors will be responsible to verify the leave records of each staff/worker before number of days is authenticated for salary payments.

• The leave records for office staff should be maintained at organisation’s main office.

• The Administration and Finance Officer should calculate salary computation sheets on the basis of Project Head’s statements for field staff and office leave records for office staff.

• The salary computation sheet should be authorised by the organisation head/project signatory.

• Salary to all the office‑based staff/Project Heads and above would be paid by cheque only.

• Salary to field staff or staff not having bank accounts may be paid in cash, the amount not exceeding Rs 2,000/‑ per month. If anyone with a salary of more than Rs 2,000/‑ needs to be paid salary in cash, a justification note/memo should be prepared.

1.10 Vehicle Log book• All the staff using personal vehicles will also be required to keep and maintain a

‘vehicle log book’.

• The vehicle log book will be updated on a daily basis by the concerned user of the vehicle.

• The Administration and Finance Officer should not entertain any claim for expenses on vehicle use unless the vehicle log book is updated and authorised.


1.11 Hiring Vehicles from External Agencies• Organisations should explore the possibility of hiring vehicles on contract, after

proper analysis of quotations, and to more than one vendor.

• No cash payment should be given to the contractual vendors.

• In case of vehicle‑hiring in the field, prior approval will be required as per authorisation norms.

• Further, all the users will sign on the Travel Claim Form and car hire duty slip for such vehicle hiring.

• The Administration and Finance Officer will check the formalities of prior approval in case of vehicle hiring without any fail before final payment is made to claimant.

1.12 Travel Expenses ReimbursementsRequest for each travel will be done in the suggested format only. Each person will be required to submit claims for reimbursements/adjustments against advance taken only in the Travel/Program Expense Claim Form along with following supporting documents.

• Original tickets of travel by train/bus.

• Boarding pass along with book copy of the air ticket in case of air travels.

• Original bills for stay at hotel/lodge/guest house.

• Receipts for payments made to hotel/lodge/guest house.

• Bills/receipts for use of hired vehicles for local conveyance.

• Bills/cash memo for in‑transit boarding.

1.13 Computerised Accounting systemAn organisation should maintain its accounts in Tally ERP version for the uniformity of the accounts and generation of related reports.

Procedure for Maintaining Accounts in Tally• Organisations must create project‑wise companies for all FC funds, local funds

and non‑grants.

• All manual vouchers will be fed in Tally on a daily basis.

• Accounting entries will be done on a daily basis.

• Backup of accounts from Tally should be taken on daily basis and a back up should be taken on CD/DVD on fortnightly basis.

• Tally accounts should be protected with passwords and the passwords should not be shared with others. Only the Administration and Finance Officer, the organisation’s head and any other key administration and finance staff should know the password.

1.14 Purchases Control

Capital Purchases• No capital item should be allowed to be purchased if the same has not been

budgeted beforehand.

• Subject to the budget (whether under a particular project or from Indian funds), a capital Item justification will be prepared by the organisation and submitted to its Purchase Committee.


• The committee should ask for at least three quotations from the open market for rate and quality comparison. A Vendor Analysis Chart will be prepared by the committee for approval.

• After receiving approval from the committee, the organisation will place a Purchase Order giving full description to the designated vendor.

• The user of the capital item should ensure that the item purchased is properly installed as per the user manual supplied with the asset;

• The Administration and Finance Officer should ensure that all the costs till the time of installation of the capital item have been accounted for and capitalised.

• The Administration and Finance Officer should also ensure that the item so purchased is duly recorded in the Fixed Assets Register giving description of assets, its location and user.

• The assets received as donation/kind should be valued at Re. 1/‑ for proper accounting.

• No depreciation will be charged on such donated assets.

• The Administration and Finance Officer will also ensure that the asset is comprehensively insured for adequate value (market value).

Fixed Assets Register• Organisation will maintain fixed assets in the prescribed Fixed Assets Register7.

• Separate sheet will be used for each asset.

• Every asset/sheet will be given a control/code number in following manner.

Name of organisation

↓

Name of donor

↓

Name of asset

↓

Location of asset

↓

Financial year of purchase

↓

Control number

• The Asset Register will be updated for each purchase and sales/disposal.

• In case of relocation of assets, a copy of corresponding fixed asset sheet of the assets will also move along to be incorporated in the recipient’s Fixed Assets Register.

7 Refer to the section ’Fixed Assets Register’


Physical verification of assets1. Physical verification of assets should be done at least once a year.

2. Organisation should form a special team for physical verification of assets.

3. Any discrepancy in assets as compared to the assets register will be immediately reported to the organisation’s governing body.

Depreciation on assets• Depreciation on assets will be provided on Written Down Value Method (WDV) as

per the rates prescribed under the Income Tax Act.

• The assets depreciated fully will be kept in the books with the value of Re. 1/‑.

2. Budgeting and Budgetary Control

2.1 Purpose of Budgeting and Budgetary Control ProceduresThe purpose of the budgeting and budgetary control procedure is to accomplish the following.

• Prepare annual and project wise operational budgets.

• To record budget item‑wise daily income and expenditure by the grant recipient.

• To record budget item‑wise cumulative expenditure to date.

• To compare and monitor cumulative expenditure by budget item, to the original or revised budget allocations.

These procedures of budget control should satisfy the requirements of the donors funding the project.

Information from the budget book can be used in the budget‑monitoring sheet for reporting and also for assisting in controlling expenditure. Ideally, the budget book should be maintained on a computer spreadsheet. This makes it easier to update and amend it. However, the budget book may be maintained and updated manually. Each budget line should be on a separate page.

2.2 Budget and Expenditure ProceduresPrincipal activities that should be performed.

• Prepare annual work‑plan and budget.

• Prepare operational budget.

• Record the original or revised budget for the financial year concerned.

• Post daily expenditure to the budget book.

• Record cumulative expenditure and monitor remaining budget.

• Obtain donor approval in advance for revisions of budget.


3. Internal ControlAn Internal Control and Monitoring Mechanism is very essential for an organisation. It is essential for the organisation to have proper controls in place so that money or funds cannot be misused and to prevent corruption in the organisation. Some aspects of Internal Control and Monitoring Mechanism are as follows.

• Keeping cash in a safe place.

• Making sure that all expenditure is properly authorised.

• Following the budget.

• Monitoring how much money has been spent on what every month.

• Employing qualified finance staff.

• Conducting internal audits on monthly or quarterly basis.

• Having a statutory audit every year.

• Carrying out bank reconciliation every month, which means checking that the amount of cash you have in the bank, is the same as the amount that your Bank Book tells you that you ought to have.

Proper Internal Control and Monitoring proves that the amounts recorded in the books of accounts and the reports based on it are accurate.

4. Legal Compliances

4.1 Income Tax ActEvery non‑profit organisation having exemption under the Income Tax Act, 1961, must file an annual return on or before 30th September of the calendar year for the fiscal year of March of each year along with the audited financial statements.

Annual Returns to the Income Tax Department:The following documents will be filed along with the returns of income.

• Form 10B

• ITR ‑ V

• Memo of Taxable (Summary of Income and Expenditure Account)

• Balance Sheet – Schedules

• Receipts and Payments – Notes

• Income and Expenditure – Notes

• List of Trustees

• Copy of Section 80G IT Certificate

• Copy of Section 12AA IT Certificate

• Copy of PAN

• Activity Report

• Disclosure of Key Financial Policies


Tax Deducted At Source (TDS)• Organisation should comply with the provisions of Income Tax Act, 1961 while

making payment to a person/company whose payment is subject deduction of tax.

• In simple terms, TDS is the tax getting deducted from the person receiving the amount (Employee/Deductee) by the person (Organisation) paying such amount (Employer/Deductor). This is applicable for certain types of payments, as applicable under the Income Tax Act.

• In the process of TDS, deduction of tax is effected at the source when income arises or accrues. Hence where any specified type of income arises or accrues to any one, the Income Tax Act enjoins on the payer (Organisation) of such income to deduct a stipulated percentage of such income by way of Income Tax and pay only the balance amount to the recipient of such income.

• The tax so deducted at source by the payer has to be deposited in the government treasury to the credit of the Central Government by 7th of the succeeding month. The tax so deducted from the income of the recipient is deemed to be payment of Income Tax by the recipient at the time of his assessment.

• Income from several sources is subjected to tax deduction at source viz. salary, interest, dividend, interest on securities, winnings from lottery, horse races, commission and brokerage, rent, fee for professional and technical services, payments to non‑residents, etc. It is always considered as an Advance Tax which is paid to the government.

• Prior to making any payment, an organisation needs to ensure that the payee has a valid PAN, or else the tax will be deducted at 20 per cent.

4.2 Foreign Contribution Regulation Act, 1976This is an important legislation which can have far reaching repercussions on an organisation if the provisions are not strictly adhered to. This Act requires the organisation to maintain only one bank account specified in the Certificate of Registration for receipt of funds. However, multiple bank accounts can be opened for utilisation of foreign contributions.

4.3 Reporting to Ministry of Home Affairs through Annual Report in Form FC-6 (Earlier FC-3)The Annual Report in the Form prescribed by the government, viz. Form FC‑6 will be prepared for the fiscal year ending on 31st March of every year and will be filed with the Ministry of Home Affairs on or before 31st December after the end of the fiscal year.

The Annual Report stated above will contain the following.

• The Audited Receipts and Payments Account.

• Form FC‑6 prescribed by the government signed by the Chief Functionary and certified by the Auditor.

• Audited Balance Sheet.


5. Roles and Responsibilities of Administration and Finance Officer

Roles and Responsibilities Reporting Requirements

d. Maintain cashbook, ledgers and other documents as defined in various sections of the Finance Manual.

e. Obtain adequate vouchers as defined in the manual in various sections.

f. Do not consider claims for expenses or adjustments based on unauthorised documents.

g. Ensure proper use of telephone and other equipment of the organisation.

h. Maintain a Fixed Asset register as per guidance in the manual.

i. Maintain stocks records as per the guidance in the manual.

j. Liaison with Project Head and organisational Secretary on various issues.

k. Keep an eye on budget utilisation and management in case of any deviation.

l. Prepare various documents as required.m. Maintain staff records as per the guidelines.n. Coordinate with programme staff about

requirements of support for proper accounting;o. Prepare Monthly Information Reports(MIR).

a. Monthly reports by 5th of the following month for the Project Head and Management Committee members of the organisation as mentioned below.• Monthly Trial Balance. • Project-wise monthly Receipts and Payments

Account, and Income and Expenditure Account.

• Utilisation of funds for both FC and Indian funds.

• Finance MIR in the suggested format.

b. Annual Reports by the end of 31st May for each financial year for the Project Head and Secretary of the organisation as mentioned below. • Project-wise annual utilisation of funds.• Project-wise Balance Sheet for FC and local

funds.• Detail of project-wise unspent grant

balances. • Consolidated Receipts and Payments.• Accounts and Income and Expenditure

Account for both FC and Local funds.

c. Any other report as and when required by other project or organisational personnel.


6. Formats

6.1 Program/Travel Plan & Advance Request

ORGANISATION’S NAME

ADDRESS

Program/Travel Plan & Advance RequestName/Designation: Location:

Project Title: Program/Detail:

Travel Plan for the Period: from -------- to ---------.

Date Place(s) to be Visited Mode of Travel Brief Description of Activity

Advance Required

Total Advance Required (in words): Rs

Outstanding Advance (if any): Rs

Prepared by Program Approved by

Advance Approved for Rs--------

----------

Paid Rs--------------------

Vide

Voucher No. -------------------

Dtd.

---------------

Accountant


6.2 Travel Program Expenses Claim


ADDRESS

Travel/Program Expenses ClaimName/Designation: Location:

Project Title: Program/Detail:

Part A: Travel Expenses

Date Place(s) Visited

From To

Mode of

Travel

Fares Boarding & Lodging

Local Conveyance

Other Expenses

Total (A)

Total Travel Expenses (in words) (A):

continued overleaf


6.2 Travel Program Expenses Claim (continued)

Part B: Program Expenses

Date Place/Area of Work

Activity/Program Amount (Rs) Program Report Ref.

Prepared by: Advance taken(Vr. No.__________/ dtd__________)

Less Total of Part A & B:(J V No.__________/ dtd__________)

Payable/Recoverable(Vr. No.__________/ dtd.__________)

Paid/Recovered Rs --------------------Vide Voucher No. -------------------dtd.---------------

Travel and Program Expenses Approved by

Accountant C.E.O. President/Secretary/Treasurer


6.3 Cheque/Draft/P.O. Issue Control Register


ADDRESS

Cheque/Draft/P.O. Issue Control RegisterS. No. Cheque/Draft/P.O.

No.Date Amount

(Rs)Party/Receiver Bank Signature

Total Travel Expenses (in words) (A):


6.4 Fixed Assets Register (Asset Leaf)


ADDRESS

Fixed Assets Register (Asset Leaf)Name of Asset Category of Asset Vendor/Party

Vendor Bill/Challan No./Date: Project Ref.

Date of Installation/Capitalization: Location:

JV Reference/Date: User/User Dept.

Detail of Costs For Accounts Dept.

Nature of Cost Voucher Ref./Date

Qty. Amount (Rs)

Basic price Rate of Depreciation:

Insurance

Installation Year Opening WDV

Dep. Closing WDV

Any other incidental Charges

1.

2.

3.

Total


6.5 Fixed Assets Register (Control Sheet)


ADDRESS

Fixed Assets Register (Control Sheet)Category of Asset: Location:

User/User Dept. Pages: from ____________ to ____________

1 2 3 4 5 6 7 8 9 10

Year Gross Block

Additions During Year

Sales/ Adjustments

Total (2+3-4)

Op. Dep.

Dep. For the Year

Total Dep. (6+7)

Closing WDV (5-8)

Opening WDV (2-6)


Annexure 2c: Case Studies

Case Study – 1ABC Society is a community‑based organisation working on HIV, gender, sexuality and SRH issues in West Bengal. As part of its awareness‑generation programs, it is planning a day‑long film show followed by discussions on gender and sexuality issues on a weekend. Please prepare a work‑plan and a budget for the said event.

Case Study – 2PQR Trust is a CBO working with men who have sex with men (MSM)/ transgender (TG)/ Hijra (MTH) populations in Odisha. As part of a World AIDS Day campaign, it is planning a month‑long awareness campaigns in different districts of Odisha. A local funding agency has asked PQR Trust to submit a detailed work‑plan and budget for the same. The maximum grant support limit is Rs 3,00,000/‑. Please prepare a detailed work‑plan and budget for PQR Trust.

Case Study – 3MNP Society works with TG/Hijra populations in Manipur, and is planning to run an income‑generation programme (IGP) for its beneficiary groups. Please prepare a work‑plan and budget to initiate an IGP by MNP Society so that it can apply to funding bodies for grant support.


Community Mobilisation

Short-term Vision

Activities

Strategising

Budgeting

Monitoring & Evaluation

ProblemScenario

Long-term Vision

Mission Statement

Policies

Resource Mobilisation

Activity Plan

Annexure 2d: Organisational Development Components


Annexure 2e: The Organisational Development Cycle

Mission Statement / Objectives

Short Term Vision / Goal

Long Term Vision / Goal

Community Mobilisation

Problem Scenario

Monitoring and Evaluation

Activity Plan

Budgeting

Resource mobilisation

Strategising Activities

Policies

The Organisational Development Cycle


Annexure 2f: PowerPoint Presentation – Financial Management


Notes






Image © Prashant Panjiar for India HIV/AIDS Alliance


population status.







module

C

module

A

module

C

module

D




module



C2 Family Support

C3 Mental Health





D3 Positive Living






B B

asic

s of

HIV

Pre

vent

ion

and

Ou

trea

ch P

lann

ing

(Pre

-TI)

Facilitator Guide

Basics of HIV Prevention and

Outreach Planning (Pre-TI)

B

Pehchan 1B Facilitor Guide: Basics of HIV Prevention and Outreach Planning (Pre-TI)


About Pehchan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2


Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3


Module Acknowledgments: Basics of HIV Prevention and Outreach Planning (Pre-TI) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

About the Basics of HIV Prevention and Outreach Planning (Pre-TI) Module. . . . . . . . . . . . . . . . . 9


Activity Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Activity 1: Basics of HIV and STI Prevention, Care, Support and Treatment . . . . . . . . . . . . . . . . . . . . . . . 11

Activity 2: Programming Outreach and Preventions: The Pehchan Approach . . . . . . . . . . . . . . . . . . . 15

Activity 3: Community Building and Communication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Activity 4: Referrals and Linkages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

Activity 5: Drop-in Centre (DIC) Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

Activity 6: Condom Promotion and Negotiation Skills . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

Activity 7: Overview of NACP III . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

Annexure 1: Points for Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37

Annexure 2: PowerPoint Presentation – Basics of HIV Prevention and Outreach Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

Pehchan2 B Facilitor Guide: Basics of HIV Prevention and Outreach Planning (Pre-TI)

About this ModuleThis module was designed to help training participants: 1) learn basic facts about HIV/AIDS and STIs; 2) understand the roles and responsibilities of outreach workers and peer educators; and 3) appreciate the value of needs assessments, implementation planning, behaviour change communication, linkages and referrals, Drop-in-Centre management, condom promotion, and negotiation skills. In the Pehchan programme, this module orients participants on India’s National AIDS Control Programme and its Targeted Intervention prevention strategy and is used specifically with CBO Programme Managers, Programme Officers, Counsellors, and Outreach Workers.





Module Acknowledgments: Basics of HIV Prevention and Outreach Planning (Pre-TI)Each component of the Pehchan Training Curriculum has a number of contributors who have provided specific inputs. For this component, the following are acknowledged:

Primary Authors Meera Limaya and Muthu Kumar, Consultants; and Yashwinder Singh and Chaitanya Bhatt, India HIV/AIDS Alliance


Technical Input Olga Aaron, SIAAP; Souvik Ghosh, Sudip Chakraborty, Anupam Hazra and Debjyoti Ghosh, SAATHII


References • Targeted Intervention under NACP III, Operational Guidelines. (2007) Volume I. Core

High Risk Groups. National AIDS Control Organisation. Ministry of Health & Family Welfare. Government of India. Available from http://www.nacoonline.org/NACO/

• Country Progress Report India. (2010) United Nations General Assembly Special Session (UNGASS).

• Antiretroviral therapy for HIV infection in adults and adolescents: Recommendations for a public health approach. (2010 revision). Department of HIV/AIDS. World Health Organization.

• Revised Guidelines for HIV Counselling, Testing, and Referral. (2001) Technical Expert Panel Review of CDC. Atlanta. Available from http://www.cdc.gov/MMWr/preview/mmwrhtml/rr5019a1.htm

• Guidelines on HIV testing. (2007). National AIDS Control Organisation. Ministry of Health & Family Welfare. Government of India.

• Targeting HIV Prevention, 2009, Animation, Boehringer, C., Sohn, A.G and Ko, Ingelheim, Germany.

http://www.cdc.gov/MMWr/preview/mmwrhtml/rr5019a1.htm

http://www.cdc.gov/MMWr/preview/mmwrhtml/rr5019a1.htm


About the Basics of HIV Prevention and Outreach Planning (Pre-TI) Module

No. B

Name Basics of HIV Prevention and Outreach Planning

Pehchan Trainees • Project Officer

• Counsellor

• Outreach Workers

• Administrative and Finance Officer

Pehchan CBO Type Pre-TI

Training Objectives By the end of the training, the participants will:

• Gain a basic understanding on HIV, AIDS and STIs and their prevention, care, support and treatment;

• Learn about basics of behaviour change communication (BCC), peer education, outreach work; and

• Learn the basics of Drop-in Centre (DIC) management, linkages and referrals, and crisis management.

Total Duration Two days. A day’s training typically covers 8 hours.




Audio-visual Support 1. PowerPoint presentation on ‘Basics of HIV Prevention and Outreach Planning’.

2. Audio-video clip on ‘Targeting HIV Prevention’.

Annexures 1. Annexure 1 on ‘Points for Discussion’.


Activity Index1

No. Activity Name Time Material1 Audio-visual Resources Take-home material

1 Basics of HIV and STI Prevention, Care, Support and Treatment

2 hours N/A Refer to the slides titled ‘HIV/AIDS and Modes of Transmission’, to ‘Positive Prevention’ from the PowerPoint presentation ‘Basics of HIV Prevention and Outreach Planning’

Audio-video clip on ‘Targeting HIV Prevention’

N/A

2 Programming Outreach and Preventions: The Pehchan Approach

3 hours Annexure 1 on ‘Points for Discussion’

Chart papers and markers

Refer to the slides titled ‘Roles and Responsibilities of ORWs and PEs’ to ‘Condom Availability and Accessibility’ from the PowerPoint presentation ‘Basics of HIV Prevention and Outreach Planning’

N/A

3 Community Building and Communication

2 hour 30 minutes

Chart paper, sketch pens, markers

Refer to the slides titled ‘Behaviour Change Communication’ to ‘Dialogue-based Inter-personal Communication’ from the PowerPoint presentation ‘Basics of HIV Prevention and Outreach Planning’

N/A

4 Referral and Linkages

2 hours N/A Refer to the slides titled ‘Referrals and Linkages’ from the PowerPoint presentation ‘Basics of HIV Prevention and Outreach Planning’

N/A

5 Drop-in-Centre Management

2 hours N/A Refer to the slides titled ‘Drop-in Centre Management’ from the PowerPoint presentation ‘Basics of HIV Prevention and Outreach Planning’

N/A

6 Condom Promotion and Negotiation Skills

2 hours N/A Refer to the slides titled ‘Condom Promotion and Negotiation’ from the PowerPoint presentation ‘Basics of HIV Prevention and Outreach Planning’

N/A

7 Overview of NACP III

2 hours N/A Refer to the slides titled ‘HIV/AIDS Overview & Update on NACP III Interventions’ from the PowerPoint presentation ‘Basics of HIV Prevention and Outreach Planning’



Activity 1: Basics of HIV and STI Prevention, Care, Support and Treatment

Time 2 hours

Learning Outcomes By the end of this activity, the participants will be able to articulate, using simple language, the following:

• Basic concepts of HIV/AIDS;

• Methods of HIV prevention;

• Common symptoms of STIs; and

• The link between STIs and HIV.

Materials N/A

Audio-visual Support 1. Refer to the slides titled ‘HIV/AIDS and Modes of Transmission’, to ‘Positive Prevention’ from the PowerPoint presentation from the PowerPoint presentation ‘Basics of HIV Prevention and Outreach Planning’.

2. Audio-video clip on ‘Targeting HIV Prevention’.


Methodology

Part I: HIV/AIDS and Modes of TransmissionUsing the PowerPoint presentation ‘HIV/AIDS and Modes of Transmission’ ask the participants about the differences between acquiring the human immnuo-deficiency virus (HIV) and acquired immuno-deficiency syndrome (AIDS) and what these terms are all about. Screen the movie ‘Targeting HIV Replication’ to the participants. Before screening, brief the participants that this movie will give them an idea of how HIV replicates within the human system and how the body tries to battle the HIV virus with the aid of Antiretroviral Drugs. After that, using the slides titled ‘Basics of HIV/AIDS and Link between HIV and AIDS’, clarify to the participants the difference between the two terms.

Using the slide titled ‘Symptoms of HIV/AIDS’ briefly discuss the manifestations of HIV and AIDS.

Tell participants that the HIV infection has different stages: ask them what they know about these stages. After allowing a discussion for five minutes, use the slides titled ‘Stages of HIV Infection’ to talk about the different stages. Briefly mention the role of CD4 cells as ‘protectors of immunity’.

While discussing the fourth stage, start an interactive discussion on Opportunistic Infections (OIs). After a few minutes of interaction, display and elaborate on the information in the slide titled ‘Opportunistic Infections’.

Note to FacilitatorTry to familiarise yourself with local terminology and use them as far as possible.

Do not use technical jargon. Use simple and local language; it will help the participants understand the subject better.


Proceed to the slide titled ‘How is HIV transmitted’.

• Ask participants what they think are the main modes of transmission and note them down on a flip-chart.

• Match what you have written down with the pictures that are shown in the presentation.

• Conduct an interactive session on the best ways to protect oneself from any STI transmission, including HIV.

Part II: Sexually Transmitted InfectionsStart the session by asking the participants what they understand by ‘Sexually Transmitted Infections’ or STIs (‘Guptrog’ in Hindi). List down key responses related to STIs.

Using the slide titled ‘Sexually Transmitted Infections’, explain that:

• STIs are infections that are mainly passed from one person to another during vaginal, anal or oral sex;

• There are about 25 different STIs with different symptoms;

• The term STI is often preferred to the term sexually transmitted disease (STD) because there are a few STDs, such as chlamydia, that can infect a person without causing any obvious disease or symptoms (asymptomatic STI);

• STIs are commonly transmitted through vaginal, anal and oral sexual intercourse or other (non-penetrative) sexual contact. But some STIs like syphilis and hepatitis B may also be transmitted non-sexually through infected blood transfusion or by using infected needles and syringes, or from mother to child; and

• HIV is also a type of STI, but has many unique characteristics that set it apart from other STIs, particularly with regard to its symptoms and impact on health.

Ask the participants what they perceive to be common STI symptoms. Take down their responses on a white board and discuss the following:

• How STI symptoms can vary: they may range from genital soreness and ulceration, unusual lumps, itching, pain when urinating, and/or an unusual discharge from the genitals – in both males and females, and also how symptoms among females maybe more complicated.

• How these symptoms help in diagnosis using syndromic management protocols in the resource-constrained settings of India (as a substitute for expensive laboratory test-based diagnoses).

• Common STIs among men who have sex with men (MSM), male-to-female transgendered persons (TGs) and hijras (all grouped together as MTH), are syphilis, gonorrhoea, hepatitis B. Ask the participants to add to the list.

Discuss the following:

• Most STIs are completely curable (except hepatitis B and C).

• Why STIs must be treated as early as possible because they cause complications, including increased risk for HIV transmission.

• Why it is important to go to a qualified doctor for early and complete treatment as soon as one suspects symptoms suggestive of STI or possibility of having been exposed to an STI. Point out the importance of going to the doctor and that too frequently (e.g., every three months) for check-ups.

Note to FacilitatorIf one of the partners in a sexual relationship is infected by an STI, then both need to undergo a check-up, as per doctors’ advice, to avoid transmission and re-infection.

This should be done even if the sexual partner does not have any symptoms of STI. Thus it is imperative to point out the importance of getting the client’s sexual partners checked for STIs and treated for the same, if necessary (including their female sexual partners).


Bring to attention the necessity for the MTH clients to take the full dose/course of the treatment medicine to prevent complications and re-infection and why it is important to avoid sexual activity till the STI is cured, or at least use condoms wherever it is not possible to abstain from sexual activity.

Discuss the complications of untreated STIs:

• They can cause serious illness;

• Chance of contracting HIV is enhanced (ulcerative STIs);

• Some STIs can be passed from infected mother to foetus during pregnancy; and

• Long-standing STIs like gonorrhoea can cause blocks in the urinary tract.

Briefly summarise STI prevention measures: condom and lubricant usage for penetrative sex; non-penetrative sex and abstinence if visible sores and ulcers are present; and vaccination for hepatitis B as per the doctor’s advice.

Questions on vaccination for HIV may be anticipated and participants should be informed that research on vaccines is underway with no conclusive results are there so far.

Ask participants why they think STIs are within the ambit of Pehchan Programme. After they give their opinion, corroborate their statements (or refute if necessary) by mentioning that the prevalence of STIs amongst female sex workers (FSWs)/MSM/TG/Hijra/Injecting drug users (IDUs) is high, and the factors responsible for the high rate of STIs include low literacy levels, social taboos, stigma and low level of knowledge and information about STIs, which is where the project steps in.

Part III: Avoiding HIV and STI

Tests for HIV and Pre- and Post-test Counselling for HIV TestingDisplay the slide titled ‘How to avoid HIV and STI Transmission’ at the start of the discussion. Write the answers on the whiteboard and then brainstorm with the participants about methods of avoidance other than those stated earlier either on the list or in the presentation.

Ask participants to make a note of all the methods which come up during this session. Also, remind them that this shall be further elaborated during the session on ‘Positive Prevention’. Also clarify ways in which HIV is NOT transmitted. Use the slide titled ‘You cannot get HIV from’.

Ask participants what they know about the various types of HIV testing. After about five minutes of interaction, use the slide titled ‘Tests for HIV’ to discuss the different types of HIV detection tests used in India.

Ask participants about the importance of counselling in HIV testing. Use the slides from ‘Goals of Pre and post Counselling’ till ‘Post Test Counselling for a Positive Test Result’ to elaborate on the different issues covered in pre- and post-test counselling.

Ask the participants if they are aware of the treatments available to persons infected with HIV (people living with HIV or PLHIV). Using the slide ‘What are antiretroviral drugs?’ explain what Antiretroviral Therapy (ART) is and tell them that ART starts only with a CD4 count of ≤350 cells/mm (this is current Indian standard, every country can have different standards) (WHO, 2010).

Continue on the next slide, ‘How ART works in the body’. If possible, summarise briefly the information provided in the film screened at the start of the module. Discuss the issues mentioned in the slide notes at some length.


Part IV: Positive Prevention Using the slides titled ‘Positive Prevention’ open the session by asking the participants to define what they understand by Positive Prevention. After about 10-15 minutes of discussion, explain how the National AIDS Control Programme (NACP) looks on HIV prevention as a core component, and what the goals and objectives are of prevention.

After explaining these goals, discuss the different types of behaviours which are considered to be high-risk. Then ask the participants who they think prevention programmes target.

Explain the basis of carrying out positive prevention programs and the understanding of susceptibility and risk. Explain to participants why understanding the basic facts of HIV and STI transmission is a key to positive prevention, and discuss at what levels interventions can be carried out.

In this segment, explain the idea of self-discipline. Have an open discussion with the group as to why an individual needs to take control of oneself and one’s conduct; for positive prevention.

Note to FacilitatorIt is up to the facilitator to use a slide show while speaking about positive prevention.

If you think the group is more interactive, then you can cover all the basic aspects through group discussions, and fill in the gaps that appear in the discussion with the slides.


Activity 2: Programming Outreach and Preventions: The Pehchan Approach

Time 3 hours


• Be able to list the roles and responsibilities of Outreach Workers (ORWs) and Peer Educators (PEs);

• Be able to explain the importance of conducting needs-assessment in the project, and the process involved in conducting a needs assessment;

• Understand the need for and importance of using different tools to plan outreach, and receive hands-on training on using specific tools;

• Understand how outreach activities are implemented at the field level; and

• Be able to prepare the first draft of hotspot maps.


Audio-visual Support Refer to the slides titled ‘Roles and Responsibilities of ORWs and PEs’ to ‘Condom Availability and Accessibility’ from the PowerPoint presentation ‘Basics of HIV Prevention and Outreach Planning’.

Take-home Material Hotspot maps created by the participants.

Methodology

Part I: Roles and Responsibilities of ORWs and PEsDivide the participants into groups of six or seven participants each, and give each group chart papers and markers. Ask them to draw a line down the middle of the chart paper, dividing the paper into two columns. The first column should be titled Peer Educators (PE) and the second Outreach Workers (ORW).

Ask the groups to list the roles and responsibilities of each. Provide 10 minutes for this task. Ensure that the group has equal numbers of both ORWs and PEs in order to facilitate mutual learning. To save time, only one or two groups may be allowed to present their points.

Randomly select a group to present, and encourage other participants to provide feedback and add points from their lists (if not included). Display all the points on a chart paper so that they can be referred back to by the participants later on.

Using the slides titled ‘Roles and Responsibilities of ORWs and PEs’, explain the role of a PE – who is a PE is, why a PE’s role is important, especially when it comes to the programme and what are the duties of a PE. Explain the role of an ORW, and his/her importance in this project as well as his/her duties.

Wrap up this session by saying that the entire project depends on how well the PEs and ORWs do their jobs, and how well they coordinate with each other.


Part II: Needs-assessment StudyStart this session by dividing the participants in three groups. Tell the groups to deliberate on the following questions for ten minutes, listing their responses on a chart paper:

• Group 1: How do you think one can assess needs of the community?

• Group 2: What do you think are the needs of the community?

• Group 3: Who will be your key informants? How will you gather information from them?

Invite each group to present their responses to the larger group. Orient the participants on:

• What a needs-assessment is;

• Why needs-assessment is important for programmes like Pehchan;

• Who can conduct a needs-assessment;

• How it is conducted; and

• What are the various terminologies connected with it, such as ‘stakeholders’, ‘key informants’, ‘focus group discussions’ (FGDs) and ‘in-depth interviews’.

Point out to the participants that needs-assessment:

• Generates quantitative information as well as qualitative data;

• Involves establishing contact with MTH community members (it can help the programme to meet up to 50% of the estimated population in a given location on a one-to-one or group basis);

• Meeting the community helps in generating interest and curiosity about the Programme; and

• Helps in mobilising the community and in the process helps in understanding the community and its needs better.

Ask the participants to brainstorm on the process of conducting a needs-assessment exercise: how is data collected as a part of the needs-assessment exercise? Note their responses on a flip-chart and discuss the process adopted in an assessment. Explain to the group through the slides titled ‘Needs- assessment and Advanced Needs-assessment’ that data will be gathered from the field in three ways (in Pehchan Programme):

• From FGDs with the community (10-12 members in each FGD);

• In-depth interviews with 8-10 stakeholders and key informants, who are senior members in the community and who can give the required information on the overall community scenario; and

• Around 50-60 interviews with the MTH community members.

Explain that this exercise in Pehchan shall be carried out by external consultants. Also mention that the information gathered will be analysed and used for developing strategies and making decision and that this exercise provides first-hand information about the community: the lifestyle of its members, its vulnerability factors and risk-behaviours prevalent, its culture and many more community-related details.

In this context, mention the various themes which are included in needs-assessment of new CBOs in Pehchan [those implementing the Pre-targeted intervention (TI) package], and existing CBOs (those implementing the TI Plus package).

Explain how consultant support shall be given at various stages. Explain the steps that are needed for completing quarterly reports of the needs assessment.


Part III: Planning and ImplementationStart with a game. Ask one of the participants to stretch both arms as far as possible and then describe it as the ‘outreach’ of a person. Ask each participant to do the same, with all of the participants standing in a circle and touching each other with the tips of their fingers. At this point, explain how important it is to ‘reach out’ to the last person in the community and form a ‘protective circle’ around all the community members and provide them the benefits of an HIV intervention or other health projects.

Using the slides titled ‘Planning and Implementation’ discuss how:

• Outreach, broadly is an activity with an overall objective of raising awareness on HIV/AIDS and STIs, commodity distribution (condoms and lubricants) and promoting health-seeking behaviour; and

• It is important to study and understand the situation and work plan accordingly for an effective outreach programme as outreach is the backbone of any HIV intervention, particularly HIV prevention programmes (like the NACP-III, HIV TI programmes or Pehchan Pre-TI package).

Discuss with the participants that outreach is a systematic approach of delivering STI/HIV prevention services to high-risk groups (HRG) and that it includes:

• Contacting HRG (MTH) community members and building rapport with them; and

• Providing them information and services/material (condoms and lubricants) to prevent the spread of STI/HIV, and linking MTH community members to health and other services.

Explain the following:

• The objective of outreach planning is to enable outreach activities to reach 80-100 per cent of the available MTH population on a regular basis, in order to achieve maximum coverage and impact on HIV prevention;

• Outreach planning led by PEs is a process that empowers them and helps increase the ownership of the programme by the community and peers;

• How outreach planning as a process uses various tools to facilitate individual-level planning and follow-up of service uptake, based on individual risk and vulnerability profiles of HRG community members; and

• Benefits of outreach planning include:• Avoidance of duplication and diffusion of efforts and responsibility;• Clear demarcation of outreach sites (or hotspots) for better accountability of

an individual PE;• Individual tracking of HRG members reached;• Help in planning outreach at the hotspots; and • Generating data for use in making decision.

Introduce a group activity regarding Outreach Area Mapping in the following manner:

• Divide the participants in three to four groups, and give them chart papers and markers. Also provide them with bindis or post-it notes in various colours.

• Ask each group to prepare a map for the area where they work. The map should include all the important roads and important places like schools, banks, hospitals, some shops, bars, and parks.

• After they finish drawing a map of their area, ask them to mark where the MTH community members are located and make note of how many are located at each hotspot. For instance, if it is a cruising site for MSM, like a public urinal, then make note of how many MSM cruise the place at any given time or how many are regular visitors to that site.


• While the participants work on the numbers, ask them to provide the timings when these MTH community members are found in that area.

• After the maps are prepared, explain that the map outlines the area of jurisdiction for each PE in the project area, and that hotspot mapping is one of the tools that can be used during their work in the area.

Explain the availability of various tools for outreach planning.

Using the slides titled ‘Hotspot Analysis Tool’ explain:

• How this tool helps:• To compile information in an urban situation; and• Also to undertake a needs-assessment related to each hotspot in this project

area to facilitate planning;• Why it is important to repeat the tool every six months as ground realities may

change from time to time;

• How spot-specific information should be available to develop a plan for the spot, such as volume of MTH clients, typology, age groups, time of operation of the spot and frequency of operation; and

• Remind the participants of the following, to be kept in mind at all times when planning outreach:• Volume of clients: planning should ensure that the hotspots with higher client

load need to be reached as a priority.• Typology: planning should be specific to each type of client (MSM/TG/Hijras). • All solicitation and service points need to be reached. ORW/PEs can directly

reach the points or reach these through other community members. The ORWs need to advocate with concerned stakeholders there, such as person in-charge of a public urinal, guard of a park, local shopkeeper etc., so that a supportive environment for outreach is developed.

• Age: MTH needs differ with respect to age, therefore planning needs to address this.

• Time/day of operation: understanding the busy hours and days of operation will help plan outreach with respect to those times. Example: certain days in a month when more sexual activities or sex work takes place in a hotspot or more MTH people come to a particular spot such as a market during specific hours of a day. Outreach needs to be strengthened in those hours or on those days.

• Evenings and nights may be busy at certain spots and hence the project needs to ensure the outreach is planned during those times of the day.

Introduce a group activity at this point. Divide the participants into smaller groups. Encourage the group to practice the Hotspot Analysis Tool in the group. The participants may use the flip-charts and marker pens for this purpose.

Call upon the group to make presentation to the remaining audience. Encourage a discussion on the following questions.

• What was the process followed by the group?

• What is the outcome of the exercise?

• How do you think this exercise will help in planning?

• What are the common mistakes made while using this tool?

• What are the consequences of such mistakes?

Note to FacilitatorDefine volume for the participants.

High volume: more than 10 clients/week

Medium volume: 5-9 clients/week

Low volume: 4 or less clients/week


Use the slides titled ‘Contact Mapping’.

• Describe it as a tool to map contacts with MTH community members in each hotspot and to plan the outreach accordingly so that duplication of contacts can be avoided by the PEs.

• As a tool it needs to be used every six months to ensure all new MTH members at any given hotspot can be reached.

• Ask the participants to draw a map of a town or other working area and mark all the locations (including landmarks) and hotspots in the map and do the following:• Write the number of MTH in each spot. • Assign an easily recognisable label (like alphabets A, B, C or numbers 1, 2,3)

to each ORW and PE. • Use colour codes to mark the MTH members who are associated with a

particular ORW and PE. For example, assign colour to all the first PE’s MTH contacts in each hotspot. Repeat this activity for all PEs.

• For each hotspot, list the names of contacts based on PE and ORW. Provide outreach site-wise/ hotspot-wise line listing.

• The contacts which appear as common across the lists should be given a separate colour code.

Discuss the following:

• Which are the hotspots that have limited contacts?

• Where is outreach not happening? How do we increase outreach?

• Who are the contacts in each hotspot?

• Who is the project not reaching to?

Remind the participants that:

• This tool is for monitoring the work done by each PE at each hotspot;

• Contacts may not be mutually exclusive – the same community member may be counted twice by more than one PE; and

• Both geographic and social networks of PEs can play an important role in planning outreach.

Describe ‘Contact Mapping’ as a way to help participants understand who the contacts are after mapping them in each hotspot. To explain this better, carry out a group exercise in the following manner:

• Ask the original groups to get together and look at their map again.

• Ask each group to select three hotspots on the map that have the maximum number of contacts.

• Give the groups 30 minutes and ask them to list names of the contacts in each of the hotspots.

• Ask each group to answer the following questions and record their answers:

• Which of the contacts does each ORW know very well? • What are the numbers and identities of the contacts that are known by more

than one ORW?


After 30 minutes, ask each of the groups to present their group work. Again encourage the PEs to make the presentations. Ask participants what they learned and how it will help them in planning outreach. Conclude this part of the session by informing the group that:

• Both geographic networks and social networks of peers play an important role in planning outreach to the MTH community; and

• Mobility is a critical factor among MTH and hence the need to use the tool every six months as described in these group exercises.

Remind the participants that it is important to know:

• The number of contacts in each hotspot and whether we can increase that number in order to maximise the benefits to as many MTH members as possible;

• The contacts which may be missing from the list;

• That ORWs and PEs have contacts in more than one hotspot; and

• That peers have their own social networks, certain MTH members who they are friends with and have influence over.

Using the PowerPoint slides titled ‘Participatory Site Load Mapping’; explain to the participants that this tool is meant to:

• Help programme implementers understand the gap between estimates of MTH populations, the number of unique contacts and the number of regular contacts by studying the MTH load in a day, a week and a month in different outreach sites or hotspots;

• Give information on potential regular contacts: the potential number of MTH people the team based at the SSR level can contact in a month;

• Help understand the turnover of MTH people at a given outreach site in a day, a week and a month and compare the same with the number of unique contacts and the number of regular contacts at these sites; and

• In order to make the participants understand better, discuss with them that in order to reach out to MTH people it is important to know where and how many are available on a given day, a week and a month.

Divide the participants based on the organisation they belong to, and ask them to draw a map of the SSR’s working area, clearly depicting the sites at which MTH people pick up/solicit their clients/sex partners.

Ask the participants to colour-code outreach sites based on MTH sub-typology. Check that the participants have marked all the outreach sites based on MTH sub-typology. Once all the sites are marked, ask the participants to write down beside the site the number of MTH people who are always available on a normal day.

Next ask the participants to write the number of MTH people available at these outreach sites in a week. Check with the participants if there are any specific days in a week when the number of MTH people peaks and ask reasons for the same.

Once the above exercise is done, ask participants to mark the number of MTH people available in these outreach sites on a monthly basis and also ask if there are specific days in a month when the turnover is high and the reasons for the same. Then ask the participants to add the daily, weekly and monthly turnover in all the sites and draw up a picture of MTH turnover for their SSR.

Now again ask the participants to compare these figures with their estimate, unique contact figures and regular contact figures for these outreach sites and analyse in the following way:

Note to FacilitatorParticipatory Site-Load Mapping is a visual exercise conducted by ORWs, PEs and volunteers.

This exercise requires a thorough understanding of the geography of the area that the CBO is located in.


• Is the total number of MTH people available in these sites more or less than the unique contact and regular contact number? Why?

• Is weekly and monthly high turnover linked with any specific typology of MTH people or sex work?

• Are there specific sites where number of unique contact and regular contact is less than monthly turnover? Why?

• Which are the sites and typology of MTH that need focused outreach in the SSR? Who (in the outreach team) is responsible for these specific sites? What should they do to improve outreach to ensure higher contacts?

Using the slides titled ‘Opportunity Gap Analysis’ define ‘Opportunity Gaps’ as obstacles that impede an individual/community from moving from one level to the next in the behaviour change processes. After that, describe how it is important for the programme to analyse site-wise opportunity gaps in outreach. Explain the guidelines for this purpose as described below.

• Various outreach processes (contacts, registrations, condoms) take place in the field. However during these processes, there are dropouts and that is what is called ‘Opportunity Gaps’.

• Analysis should be done for the outreach sites, where HIV prevention programme are implemented.

• Make note of the status of each indicator in an opportunity-gap analysis framework.

• For each indicator, identify the gap and reasons for those gaps, making a note of the next steps to address the gap.

Gaps may be due to either internal or external factors.

• Internal factors: where project has direct control, as in work of ORWs and PEs.

• External factors: not under the project’s control; like the high mobility of MTH people on a daily basis.

Other indicators that can be included are: number of community members that have

• Faced crises;

• Received support from the project for these crises; and

• Received entitlements and have had their non-HIV needs addressed.

Activities Status Opportunity gaps

Reasons What should we do?

Internal External

Estimate

Contacts

Registration

Regular contacts

STI treatment

Follow-up

Regular check-ups

ICTC* referrals

*Government-run Integrated Counselling and Testing Centres


After the brief, encourage the group to complete the task-tool. The participants can use the flip-charts and marker pens for the same. After completing the task-tool, encourage one of the groups to present their work to the larger group. Encourage a discussion on the following topics.

• What was the process followed by the group?

• What was the outcome of the exercise?

• How did/can the exercise help in planning outreach?

• What were the common mistakes made while completing the task-tool?

• What consequences could these mistakes have?

Using the slides titled ‘Peer Maps’ explain how it is important to understand and analyse the outreach done by PEs with MTH community members. Then present the guidelines to map the peers as described below:

• PEs should map the hotspots in town or other working area, and meet their community members in these hotspots.

• PEs should map MTH populations that they are accountable for, depicting high, medium and low volumes in these hotspots using different colour codes.

The PEs are to indicate the following:

• Number of times each of them met clients that they are working with in the last month; and

• How many condoms were distributed to each of the clients contacted?

Let the participants analyse the map in the manner given below:

• In the previous month did the PE meet with all the MTH clients he/she is working with? If not, why?

• Based on the volume of sexual activity, including sex work, was there any difference in the kind of outreach done by the PE? Did he/she meet with high-volume MTH clients more often than low-volume MTH clients?

• Were the condoms distributed on the basis of volume of sexual activity? Were enough condoms distributed to cover all sexual acts of MTH clients? Was there a shortfall? How is this shortfall in condom distribution being filled? Is it through condom outlets?

Conclude the session by saying that it is important to understand the need of each of the clients that a PE is accountable for planning regular contacts and condom distribution accordingly. This will ensure that the condoms are available to MTH members whenever they are in need, and at the same time will avoid dumping of condoms where no need exists.

Using the slides titled ‘Condom Availability and Accessibility’, describe the tool which (i) helps in mapping condom-availability points and (ii) helps to understand if they are easily accessible to MTH clients.

Begin by discussing with the participants the importance of condoms to prevent HIV. Discuss that in condom programming the first priority is to make condoms accessible and available. Remind them how condom availability is a key component under the Pre-TI activities of Pehchan.

Ask the participants to work in groups and draw a map of their town or other working area or use an existing map. Ask them to mark all the places where MTH individuals solicit sexual partners or clients for sex work (hotspots). Also ask participants where sexual activity normally takes place.


Mark all these places on the map using bindis of two different colours: one to indicate sites where solicitation takes place and the other to indicate sites where the actual sexual act takes place. Then ask the participants to check when a site is active (for soliciting and sex work) and at what time of the day. Mark with colours depicting the site as active either only in the day or at night or both times.

Next ask the participants to mark the condom depots in the map symbolically to indicate whether the depots are functional during the day or at night or round the clock. Once the map is complete ask the following questions:

• Are there condoms depots in all the sites where soliciting or sex work takes place? If not, what are the reasons? Do the sites, e.g. Hijra dera-based sites which do not have depots, prefer direct distribution?

• Do all the sites that are active during the day or night or round the clock have condom depots that are open at the same time as the sites are active?

• Are condom depots accessible to the MTH clients?

Conclude by stating the importance of access to condoms at the right time and place. Ask participants to draw up a plan to fill the gaps in condom accessibility and availability, if any.


Activity 3: Community Building and Communication



• Understand the Behaviour Change Communication concept and how it is useful for developing positive behaviours;

• Promote and sustain individual, community and societal behaviour change among MTH members; and

• Understand dialogue-based inter-personal communication (IPC).

Materials Annexure 1 on ‘Points for Discussion’ Chart paper, sketch pens, markers.

Audio-visual Support Refer to the slides titled ‘Behaviour Change Communication’ to ‘Dialogue-based Inter-personal Communication’ from the PowerPoint presentation ‘Basics of HIV Prevention and Outreach Planning’.


Methodology

Part I: Behaviour Change Communication (BCC)Using the slide titled ‘Behaviour Change Communication’; tell the participants that BCC is an interactive process with communities to impart tailored messages. It uses approaches that adopt a variety of communication channels to develop a positive change in behaviour. BCC helps promote and sustain individual, community and societal behaviour change and maintain appropriate behaviours. Explain how:

• Providing correct information to relevant populations is a key strategy in all HIV interventions.

• It is important for HRGs like MTH people to have correct information on general and sexual health-related subjects to reduce the vulnerability to STI/HIV infection.

• The information can be imparted through peers (PEs) to MTH community members.

Divide the participants into three to four small groups. Provide each participant in a group with Annexure 1 on ‘Points for Discussion’. Let each group memorise the ‘Points for Discussion’ and practice the same within the group. After the participants have discussed the annexure within their groups, ask them to enact a mock session on how they will talk to a community member on a particular subject.

Generate a discussion on the topics that are important for the PEs to talk about in the field with community members. Identify the topics and encourage the participants to list them.


Part II: Dialogue-based Inter-personal Communication (IPC)Use the slide titled ‘Dialogue-based Inter-personal Communication’, to emphasise the importance of communication, especially ‘communicating right’, and discuss:

• How IPC moves beyond messages, and through face-to-face interaction, dialogue and critical reflection helps vulnerable and high-risk behaviour populations to identify barriers to STI/HIV risk reduction, analyse the barriers, and plan ways to address them;

• How IPC can be used as a key Pre-TI component, that is, to talk about outreach, drop-in centres (DICs), ICTC referrals, advocacy initiatives and CBO formation; and

• That IPC comprises the following components:• Content: this can be on STI or HIV/AIDS.• Methods: processes used to stimulate dialogue. In this session participants

will learn about two methods.• Facilitation skills: PEs needs to ensure that they encourage dialogue and

discussion on key issues rather than just providing messages. Thus IPC is an important tool for initiating dialogue.

• Values and attitudes: PEs need to have an appropriate attitude while working with MTH clients and should be non-judgmental and un-biased.

Tell participants that they will now learn about two IPC tools that can be used during outreach work: ‘Body Mapping’ and ‘Why Is It So?’ Brief the participants on the objectives and processes for the first tool ‘Body Mapping’. Remind them of the purpose of this exercise, which is to:

• Enable HRG members to explore STI/HIV vulnerability factors relating to one’s body; and

• Understand more about non-penetrative sexual activities.

Body Mapping: Ask for a volunteer in each group to lie on the ground and have someone trace the outline of his/her body on the ground or on a chart paper. Ask participants to treat the outline as a naked body and to draw in the details. Now ask participants to brainstorm on the following questions:

• What are the erogenous spots in the body?

• What are the ports of entry of HIV virus?

• How does the HIV virus enter the body? What makes it easier for the virus to enter the body? (Clear any misconceptions).

• What options are there for safer sex, particularly non-penetrative sex?

Relate this discussion to the participants’ knowledge about erogenous spots and explain that there are a vast number of options for safer sex which do not allow STI or HIV infections to spread. Conclude the session by asking the group to reflect on the following:

• What are the advantages of this tool?

• What are the difficulties that you are likely to face while conducting such a session with MTH clients?

• What is their learning’s from this session?

‘Why Is It So?’ Brief the participants on the objectives and processes for the second tool. Remind the participants that the purpose behind this tool is to help HRG members understand why risk behaviours occur and what can be done to reduce them.


Encourage the group to start a dialogue by naming the different kinds of behaviours that put people at risk of HIV/STI infection. Correct any misconceptions. Pick any one risk behaviour and ask them to draw a symbol of this risk behaviour in the centre of a flip-chart inside a circle.

Ask, ’Why is it so?’ and ask them to draw and/or write the reasons for the risk behaviour in question, inside blurbs connected to the circle. Keep asking ‘Why is it so?’ adding further reasons in connecting blurbs until the participants are exhausted with reasons.

Now ask the participants what the diagram says about the following:

• What are the most important reasons (vulnerability factors) for the risk behaviour in question?

• What are the ways that HRG members already try and reduce the risk behaviour?

• What would further help them avoid the risk behaviour represented in the diagram?

• If time permits, practice this tool with more risk behaviours identified by the participants.


Activity 4: Referrals and Linkages

Time 2 hours


• Understand the necessity and importance of linkages with government agencies and NGOs;

• Understand the different terminologies like referral, accompanied referral, referral slips, linkages, etc.; and

• Understand the relevance of a contacts database.

Materials N/A

Audio-visual Support Refer to the slides titled ‘Referrals and Linkages’ from the PowerPoint presentation ‘Basics of HIV Prevention and Outreach Planning’.


Methodology Divide the participants into three to four groups and ask each group to discuss amongst themselves and collate information about:

• The needs of the community they work with;

• The services available in their working area, with contact details and services provided; and

• The service providers (individuals) with their contact details, timings for services, special services provided.

Through the slides titled ‘Referrals and Linkages’ introduce participants to the following terms:

• Referrals: services that are not available with you, but are demanded by the community. In order to provide these services, you must take help from other government agencies or NGOs. For e.g. for HIV testing, clients are referred to government ICTCs.

• Accompanied referrals: referrals in which ORW/PE accompany the client to the various services. This helps to improve the relationship and trust between the client and the ORW/PE.

• Referral slips: a small slip which is required when the client is referred to another facility or service. The slip has details such as name of the client, age, sex, and reason for the referral. The slip is issued to the client, who has to produce it at the service referred to. Usually the service provider, after noting details of services provided to the client, keeps one copy of the referral slip for reference and returns the other to the client. The copy with the client helps in follow-up by the ORW/PE, and the one with the service provider helps you confirm if the client did visit the service provider and received the services needed.

• Linkage: To provide services that the community needs, which are not currently met by the programme, through a chain of other established facilities that provide those services. This may mean locating your agency close to or in the same premises as another key service (for example, establishing a DIC close to a health clinic). It could also mean facilitating the provision of different but related services from the same service provider (example: the government ICTCs, which


provide not only HIV counselling and testing services, but also information on STIs and prevention of parent-to-child transmission of HIV). Such linkages help in saving time and money for the clients, who can benefit from availability of different services close to each other or under the same roof.

Sum up by emphasising the need to establish linkages and networking because they:

• Help in linking CBO’s services to the needs and demands of the community being served;

• Assist a CBO to network with other support groups and CBOs of the same community (at district, state, regional, national and international levels), key NGOs and even self-help groups (SHGs);

• Connect you to rights-based organisations engaged in the development field;

• Connect you with professional institutions and legal-aid organisations;

• Help engage with other civil rights movements in the country;

• Connect you with health services closely linked to HIV, such as:• TB referrals to DOTS centres;• ICTC linkages;• STI clinics;• Treatment for opportunistic infections or OIs; and • ART centres

• Connect you with other key health and emergency services such as:• Reproductive health services for female sexual partners of MTH clients; and• Psycho-social support and counselling for dealing with issues around gender

and sexual identity, violence, trauma, family support and information on legal rights

• Connect you with government bodies/departments and civil society agencies for MTH community development and overall well-being. Linkages could include the following:• Vocational training/income-generation programmes, SHGs;• Social support services for nutrition, education, banking, insurance and

acquiring citizenship identity documents like passports, PAN cards, BPL cards and Aadhar cards; and

• Legal support services like NGOs providing legal-aid and government-run State and District Legal Services Authorities that provide free legal aid to those in need.

Make the participants sit in the organisations they come from and ask them to prepare points on how to establish a crisis intervention team in their area or organisation. Ask them to ponder the following questions.

• What should be the objectives of crisis intervention?

• What should be the constitution of the team?

• What is the rationale behind the interventions thought of by your team?

• How will you make the services accessible and available to the community when they are in need?

• How will you document different aspects of these processes?

Point out that they could start by mapping all the resources in their area which they feel can make for a good resource in crisis response. Explain that:

• Addressing any crisis at hand should involve concrete, easy-to-implement, effective crisis management techniques, in combination with local advocacy programmes.


• Creating an enabling environment for effective MTH prevention programmes will build self-esteem, which in turn will help MTH focus more on their physical and mental health and well-being, specifically in relation to STIs and HIV.

• Crisis management responses rely on creating Community Action Groups to assist victims in seeking medical care and legal recourse and to train community-friendly lawyers, beat-level police, and SSR staff to provide support for filing first information reports (FIRs).

• On the whiteboard/chart paper draw three concentric circles. The smallest and innermost circle represents the primary support circle of crisis management consisting of the immediate resources (the Counsellor, and those ORWs and PEs who are in the immediate vicinity of the client). The second circle or middle circle represents second-line support consisting of the Project Manager, the Administrative and Finance Officer, the ORW and PEs not in the immediate vicinity of the client. The third and outer circle, represents tertiary support, i.e. referrals and linkages to be built-up with services in order for the client to receive help from the right quarters.

On the basis of the above, ask the group whether they have any new strategies to address and/or prevent any kind of crisis.


Activity 5: Drop-in Centre (DIC) Management

Time 2 hours


• Understand the importance of a DIC in Pre-TI interventions for MTH community members under Pehchan Programme.

Materials N/A

Audio-visual Support Refer to the slides titled ‘Drop-in Centre Management’ from the PowerPoint presentation ‘Basics of HIV Prevention and Outreach Planning’.


Methodology Using the PowerPoint slides titled ‘Drop-in Centre Management’, describe how:

• DICs act as ‘safe spaces’ critical in the early phase of delivery of health services linked to HIV or even other health and development services, especially for street-based populations;

• A DIC is vital, given the limited interaction that can be possible between the outreach staff of a CBO and MTH community members at places like streets and parks;

• At DICs, MTH people can interact with each other, rest, seek advice, share information, approach someone in case of a crisis, or pick up condoms;

• DICs can serve as centres for some popular activities like self-defence classes, literacy classes, and other skill-building activities;

• DICs serve as centres for HIV-related and other counselling and/or for STI services. DICs also facilitate ICTC referrals;

• DICs can also provide referrals to satellite services such as TB treatment, de-addiction, legal aid, crisis response, social welfare schemes and services; and

• A DIC should ideally be located close to where MTH community members live or operate, or can access easily with minimal travel.

Emphasise that the location and functioning of the DIC should be dictated by availability and the preference of the MTH community members. Explain how it is important for:

• The DIC to be located within easy access to MTH community members;

• The CBO running the DIC to have information about the services available in the surrounding areas, and extensive social mapping of the area should be done to identify community resources to which the DIC can make referrals to; and

• The CBO to keep in mind the ’Three A’s’:• Availability (menu of services under one roof);• Accessibility (in terms of location and timings); and• Affordability (cost to reach the DIC).

Explain how the DIC infrastructure should have:

• Sufficient space, that is, at least three or four rooms, one large one for group meetings, while the others can be for services such as counselling;

• Clean, well-ventilated spaces;


• A toilet;

• Running water/soap;

• Basic furniture; and

• If possible, a TV and some light recreational reading materials.

List the services that can be provided by the DIC.

• Outreach services where ORWs and PEs reach out to MTH community members in their own environment, on a daily basis, to build rapport and refer them back to the DIC.

• IEC dissemination where continued education is provided through leaflets/pamphlets/games/demonstrations/group discussions on STI/HIV issues.

• Psychosocial support where the counsellor is made available to address issues on behavioural change and issues around HIV-testing.

• Condom programming to promote correct use of condoms and lubricants, and access to free condoms and lubricants.

• ICTC, OI treatment, ART, STI treatment, TB treatment and other health, legal and social support referrals.

Tell the participants about commonly asked questions by MTH community members about a DIC, and how they should answer these questions:

• Will anyone take our photographs in the DIC?

State that confidentiality about the individual and his/her gender and sexuality will be strictly maintained and no one will take photographs without an MTH individual’s consent.

• Will we get loans/money for visiting the DIC or attending meetings at the DIC?

Explain that a DIC provides a safe space to discuss and address health and other rights-based issues of the community, for counselling and as a place to celebrate community events. No money will be provided for visiting a DIC but community members should be assured that they will be respected and treated in a nice manner and be told that they will enjoy the community gatherings and events.

• What are the services I will get when I come to the DIC?

List the services usually provided by a DIC such as health-related services, counselling services, a safe space for community members to interact, and community events.

• What else we will get from a DIC?

Say that there are possibilities of a cultural team being formed in future where people with dance, theatre, make-up and singing skills can be provided an opportunity to showcase their talents. They could practice in the DIC, enhancing their skills and give performances during community events.

• If I bring my partner, can I do dhandha (sex work) in the DIC?

Use this as an opportunity to talk about the rules and regulations of a DIC. You could answer in two ways: (i) ‘Sex is not allowed in a DIC and there are also some other regulations which you will understand when you come to the DIC.’; or, (ii) simply say that ‘You will get the answer once you visit the DIC’. This is because sometimes simply saying ‘No’ might hurt the person who has questioned.


Activity 6: Condom Promotion and Negotiation Skills

Time 2 hours


• Understand the importance of condom-usage; and

• Know the myths and misconceptions about condom-usage.

Materials N/A

Audio-visual Support Refer to the slides titled ‘Condom Promotion and Negotiation’ in the PowerPoint presentation from the PowerPoint presentation ‘Basics of HIV Prevention and Outreach Planning’.


Methodology Using the slides titled ‘Condom Promotion and Negotiation’ introduce the participants to the learning objectives of this session on Condom Promotion and Negotiation Skills. Ask the participants what they already know about condoms. Allow and encourage all the trainees to participate in the discussion. Emphasise the following points during the discussion:

• While putting on the condom if one realises that the side is wrong, one should not use the same condom by changing the side. As it has already touched the body, some body fluids might be attached to it and it could carry the risk of infection. In such cases, one should use another condom.

• In oral sex, the chances of HIV infection are low. However, the use of a condom is still essential as oral sex can lead to STIs.

• Using a condom is a skill, and one should develop comfort in putting it on.

• Condoms should be kept in a cool and a dry place away from sunlight and water.

• There is no need to use extra lubricant as condoms are already lubricated, but if required, say for anal sex, one can use water-based lubricants like KY Jelly (not oil).

• There are various types of condoms, such as flavoured (chocolate/strawberry) and textured (dotted/ribbed). These can enhance sexual pleasure.

• The government and various companies manufacture condoms. Government condoms are available free of cost for distribution. They are also of the same quality (quality checked at equally reputed laboratories).

• Some condoms are also socially marketed. These are cheaper than those available at market cost.

• Condoms provide dual protection from infections and from unwanted pregnancy.

• Female condoms are also available in the market but they are still very expensive. But some HIV intervention projects provide them through social marketing.

Discuss some of the common myths and misconceptions about condoms, such as:

• Using condom during sex is irritating.

• Condoms reduce sexual pleasure.

• Condoms are sticky and oily.


• Erection fails before slipping the condom on to the penis.

• Double condoms provide better protection.

• Use of condom implies lack of emotional feeling or love for the partner.

• Condom is a barrier of ‘mistrust’ between two partners.

Address these myths by clarifying that:

• Condoms are soft and lubricated and proper use of condom does not cause irritation;

• Two condoms should not be put on at a time because the chance of both tearing increases;

• Condoms need not create any barrier of feelings, loss of erection or mistrust. Rather, using a condom shows that you care for yourself and your sexual partner. Learning how to use a condom properly and with comfort will prevent loss of erection and any negative feelings. It is important for you to talk about these issues with your sexual partner. Not using condoms is an option only if both you and your sexual partner are in a sexually monogamous relationship, know for sure that you do not have any STI or HIV, and are able to maintain this status in future;

• The process of wearing a condom is also pleasurable and can add to the sexual pleasure; and

• Using a condom allows enjoyment of sexual pleasure without any tension or apprehension about getting infected by an STI or HIV.

Call upon the participants to handle a condom available during the session. Ask them to blow it, put it on the hand, and fill it up with some water. While doing so, explain that the condom is long and wide enough to accommodate an erect penis without the risk of rupturing (demonstrate by filling it with water or blowing it into a big size).

Next, call upon any two participants to do a male condom demonstration. The other participants need to observe the demonstration carefully.

After the demonstration, ask the participants if it was done correctly. If yes, appreciate the efforts of the volunteers. If not, ask the other participants to give suggestions for improvement. Quickly summarise the main steps in condom-usage, including the use of water-based lubricants.

With two participants, enact a role play in the following manner:

Dilnaar is a kothi who likes going to a truck stop to have sex. He meets a handsome truck driver, Jassi, who takes an instant liking to him. They decide to have sex with each other, but in bed, Jassi refuses to use a condom. Dilnaar refuses to have sex till Jassi uses a condom.

At this stage, ask the participants what Dilnaar should do to encourage Jassi to use a condom.

• Should he talk about Jassi being safe from anything Dilnaar has?

• Should he talk about hygiene?

• Should he try and take an emotional angle, and tell Jassi that if he really likes him, he ought to wear a condom?

After taking the opinions of the participants, let the actors demonstrate what they feel would be the best way to negotiate condom-usage in this situation. Allow brief discussion on the role play and the issue of condom negotiation. Remind the participants that no two situations are the same – various ruses might need to be used in order to ensure condom usage.


Activity 7: Overview of NACP III

Time 2 hours


• Learn about NACP III and India’s response to the HIV/AIDS challenge; and

• Understand the concept of Targeted Intervention.

Materials N/A

Audio-visual Support Refer to the slides titled ‘HIV/AIDS Overview & Update on NACP III Interventions’ from the PowerPoint presentation ‘Basics of HIV Prevention and Outreach Planning’.


Methodology

Part I: Overview of NACP III Tell the participants that the session is intended to introduce the participants to India’s response to the HIV/AIDS challenge and the rationale for starting the National AIDS Control Programme (NACP).

Using the slides ‘HIV/AIDS Overview & Update on NACP III Interventions’, explain the following:

• In 1992, the Government of India launched the first National AIDS Control Programme (NACP I, 1992-1999) with the objective of slowing down the spread of HIV infections so as to reduce morbidity, mortality and impact of the HIV epidemic in the country.

• To strengthen the management capacity for oversight and better implementation of the NACP, an autonomous National AIDS Control Organisation (NACO) was set up.

• The main objective of NACP I (1992-1999) was to develop facilities to provide treatment for STIs in district hospitals and medical colleges, expand the network of blood banks, initiate an HIV surveillance system, and set up SACS/DACS in all states and in some districts of the country.

• NACP II (1999-2006) was launched in 1999 with the focus shifting from raising awareness to changing behaviour, decentralisation of programme implementation at the state-level and greater involvement of NGOs. NACP II, among other things, launched the strategy ‘Greater Involvement of People Living with HIV/AIDS’ (GIPA). It also marked the launch of the National Rural Health Mission (NRHM) and the provision of ART.

• NACP II paved way for NACP III which aimed at halting and reversing the epidemic in India over a five year period (2007-2012). NACP III aimed to achieve its goal through:

• Saturation of coverage of HRGs with STI/HIV TI programmes (TIs) and a scaled-up intervention for the general population;

• Provision of greater care, support and treatment to a larger number of PLHIV;• Addressing human rights and ethical issues, with a focus on fundamental

rights of PLHIV and their active involvement;

Note to FacilitatorPlease explain that the Pre-TI package of Project Pehchan is a precursor to a TI project. Depending on the success of Project Pehchan and NACO/SACS annual plans, a Pre-TI CBO may be implementable in one to two years time.

Also, describe how:

• though NACP III is coming to an end soon; and

• NACP III is still relevant to the project despite NACP IV coming into force by the end of this year (2012).


• Strengthening the capacity (e.g. infrastructure, human resources) in prevention, care, support and treatment at the district, state and national levels; and

• Strengthening the nationwide Strategic Information Management System (SIMS) to help track the HIV epidemic.

Current HIV/AIDS Scenario in India• There were an estimated 23.9 lakh PLHIV by the end of 2009, with an estimated

adult HIV prevalence of 0.32 per cent.

• Nearly 87 per cent of HIV infections occur through the heterosexual route of transmission.

• While the overall HIV prevalence in India is low, there is a concentrated epidemic, contributed by a very high prevalence among HRGs, with the highest among IDUs followed by MTH people, FSWs and STI clinic attendees respectively.

• A few states, and a few districts in those states, saw more impact of the epidemic. A few states, where HIV prevalence is particularly high either in general or in specific districts and among specific populations, are Andhra Pradesh, Delhi, Gujarat, Karnataka, Maharashtra, Manipur, Tamil Nadu, and West Bengal.

• Some gains have been made during NACP III in tackling the HIV epidemic, particularly in reducing HIV prevalence among pregnant women (antenatal clients or ANCs) and prevention of parent-to-child transmission in some states. But these gains are yet to be replicated on a larger scale, particularly among MTH populations.

Part II: What is a Targeted Intervention (TI)?Introduce the concept of TI to the participants by explaining how:

• The primary drivers of the HIV epidemic in India are unprotected paid sex/commercial female sex work, unprotected sex between men, and people those inject drugs;

• TIs are a resource-effective (value for money) way to implement HIV prevention and care programmes in resource-poor settings like India;

• TIs are a cost-effective method aimed at offering HIV prevention and care services to high-risk populations (FSWs, MTH, and IDUs) by providing them with the information, means and skills they need to minimise HIV transmission and to deal better with its impact; and

• A TI-approach recognises that people who are at risk of HIV infection are often marginalised from the broader community and are stigmatised and discriminated.

Components of a TI• BCC which involves understanding and assessment of individual and group

practices/behaviours which can pose risk of HIV infection.

• Access to STI services: improving access to STI services as STIs (both symptomatic and asymptomatic) increase the risk of HIV transmission.

• Provision of commodities to ensure safer practices like condoms, water-based lubricants and fresh syringes and needles (in exchange of used ones).

• Enabling environment that focuses on reducing stigma and discrimination and creation of an environment that helps in accessing information, services and commodities by the HRGs.


• Community organising and ownership building by engaging CBOs in program-management through developing their capacity and ownership.

• Linkages to HIV care, support and treatment programmes, including PLHIV networks, ICTCs, ART centres, Community Care Centres, DOTS centres for TB treatment, detoxification centres and other harm-reduction initiatives.

Part III: Brainstorming and SummarisingEncourage a discussion and gather feedback from participants on the topics covered in this session. This activity is an opportunity to reinforce the importance of a TI and of working with populations most at risk for HIV, like MTH community members. Brainstorming will also help in identifying the possible challenges and bottlenecks perceived by the participants during the course of their work.

Engage the participants in an exchange of ideas about the topics and also enable them to question the facilitator, which provides the latter with an opportunity to review the session. At this point the facilitator should encourage the participants to seek answers to questions such as:

• Why was NACO instituted?

• What do you understand by the term ’concentrated epidemic’ and ‘HRG’, and how are they important for our response to the HIV epidemic? and

• What do you think was the rationale for NACP and for TI in particular?

Finally, conclude the discussion by summarising key points discussed throughout this module.

Pehchan 37B Basics of HIV Prevention and Outreach Planning (Pre-TI)

Annexure 1: Points for Discussion

Sexually-Transmitted Infection (STI)

Prevention• Most STIs occur due to unprotected sex.

• STIs can be prevented if we ensure that we use condoms during each sexual act.

Signs and SymptomsMost common systems are:

• Discharge from the genitals – pus like discharge, whether foul smelling or not.

• Pain in groin.

• Soreness in the genitals.

• Itching.

• Burning sensation while passing urine.

Treatment• Most STIs are curable.

• Refer to the doctor for further care and treatment.

• Complete the drug treatment.

• Use condoms during every sexual relation.

Importance of Partner Treatment• If a sexual partner has STI, then both you and the partner should take treatment

to avoid re-infection.

Referrals• Whenever a potential client is identified with symptoms suggestive of STI, provide

all the information and knowledge about STI.

• Refer to the doctor for further treatment.

• Regular follow-up at the clinic is important after the initial visit.

HIV/AIDS• How does HIV spread?

• How does HIV not spread? (Kissing, touching, sharing utensils etc.)

• What are the ways of preventing HIV transmission? (Use of sterile needle, condoms etc.)


Testing for HIV

Preparing for HIV testing(CDC, 2001)

Even if a client declines to undergo HIV testing, counsellors must ensure that the following information is provided to all people visiting the testing center:

• Information, benefits and consequences of HIV testing.

• Risks for transmission and prevention of HIV.

• The importance of getting an HIV test.

• Meaning of the test

• Obtaining further information or, HIV prevention counselling.

• Orienting about other referral services.

There are two types of tests(NACO, 2007)

• ELISA: Enzyme-linked immunosorbent assay (ELISA) is the most commonly performed screening test at blood banks and tertiary care sites testing large number of specimens in a day. It is easy to perform, adaptable to large number of samples, is sensitive and specific and cost effective.

• Rapid Testing: Rapid tests are in vitro qualitative tests for the detection of antibodies to HIV type 1 and 2 in human serum, plasma whole blood saliva and urine. Currently HIV testing in India is performed on serum/ whole blood, and plasma. This is because the HIV testing on urine and saliva samples has not been evaluated and validated in India.

ART• ART stands for Anti Retroviral Therapy.

• This is a treatment given to HIV positive people, and it restricts the replication of virus in the body.

• These medicines are taken regularly and lifelong, under a doctor’s advice.

• These medicines are available free of cost at all government hospitals.


Annexure 2: PowerPoint Presentation – Basics of HIV Prevention and Outreach Planning


Notes








population status.








module

C

module

A

module

C

module

D




module



C2 Family Support

C3 Mental Health





D3 Positive Living





C1 I

dent

ity, G

ende

r an

d Se

xual

ity

Facilitator Guide

Identity, Gender and Sexuality

C1

Pehchan 1C1 Facilitator Guide: Identity, Gender and Sexuality


About Pehchan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2


Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3


Module Acknowledgments: Identity, Gender and Sexuality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

About the Identity, Gender and Sexuality Module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9


Activity Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Activity 1: Introduction to Identity, Gender and Sexuality Module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Activity 2: Introduction to Identity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Activity 3: Sex, Sexuality and Gender Terminology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Activity 4: Understanding Gender and Sexual Identity Formation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Activity 5: Stigma, Discrimination and Homophobia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

Activity 6: Psychological Issues Related to Identity, Gender and Sexuality . . . . . . . . . . . . . . . . . . . . . . . . . . 28

Activity 7: Wrap-up . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

Annexure 1: Notes on Identity, Gender and Sexuality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

Pehchan2 C1 Facilitator Guide: Identity, Gender and Sexuality

About this ModuleThis module is designed to help training participants: 1) gain a broad understanding of language and concepts relating to identity, gender and sexuality; 2) understand differences in gender, sex and sexuality; and 3) become familiar with the experience of stigma and discrimination in the lives of men who have sex with men (MSM), transgenders and hijras. In the Pehchan programme, this module is used to introduce principles of identity, gender and sexuality to CBO Programme Managers, Programme Officers, Counsellors, and Outreach Workers.





Module Acknowledgments: Identity, Gender and SexualityEach component of the Pehchan Training Curriculum has a number of contributors who have provided specific inputs. For this component, the following are acknowledged:

Primary Author Dr. Maninder Singh Setia, Consultant


Technical Input Vaibhav Sarai, Consultant; Olga Aaron, SIAAP; and Debjyoti Ghosh, SAATHII


References • Erikson, E.A. (1968) Identity: Youth and Crisis. London. Faber and Faber.

• Mead, G.H. (1934) Mind, Self and Society. Chicago. University of Chicago Press.

• Deaux, K. (2000) Encyclopedia of Psychology. Volume 4.Northamptonshire.Oxford University Press.

• Boyce, Paul. (2007) Conceiving Kothis: Men Who Have Sex with Men in India and the Cultural Subject of HIV Prevention. Pg 175-203. Medical Anthropology.

• Palmer, N.R., and Stuckey B.G. (2008) Premature ejaculation: a clinical update. Sydney. Medical Journal of Australia.

• Dovidio, J.F., Major. B., and J. Crocker (2000) Stigma: Introduction and Overview. New York: Guilford Press.

• Goffman, E. (1963) Notes on the Management of Spoiled Identity. New York. Simon & Schuster.

• Troiden, R.R. (1989) The formation of homosexual identities. Journal of Homosexuality.

• Rowland David L., and Peggy Rose. (2008) ‘Understanding & treating premature ejaculation’, in The Nurse Practitioner. Westwille. Purdue University.

• Kantor M. (1998) Homophobia: Description, Development, and Dynamics of Gay Bashing. Westport. Praeger.

• MSM Circle. Humsafar Trust. Available at www.humsafar.org.

• Training Module: Identity, Sexual and Gender Case Series. Short-film. 2011. Selling Dreams Productions and Karnam Consultancy, for India HIV/AIDS Alliance.


About the Identity, Gender and Sexuality Module

No. C1

Name Identity, Gender and Sexuality

Pehchan Trainees • Project Officers

• Counsellors

• Outreach Workers



• Gain a broad understanding of terms such as ‘identity’, ‘sexuality’ and ‘gender’ and how they are related to issues of stigma and discrimination;

• Develop an understanding of different types of sexual identities;

• Understand the limitations and challenges in defining ‘identity’;

• Develop an understanding of stigma and discrimination from an MTH perspective; and

• Be able to develop strategies to deal with stigma and discrimination.





Audio-visual Support Short-film titled ‘Identity, Gender and Sexuality Case Series’.

Annexures Annexure 1 titled ‘Notes on Identity, Gender and Sexuality’.


Activity Index1


Take-home material

1 Introduction to Identity, Gender and Sexuality Module

10 minutes N/A Short-film: ‘Identity, Gender and Sexuality Case Series’

N/A

2 Introduction to Identity


3 Sex, Sexuality and Gender Terminology

1 hour N/A N/A N/A

4 Understanding Gender and Sexual Identity Formation

1 hour 30 minutes

N/A N/A N/A

5 Stigma, Discrimination and Homophobia

1 hour 30 minutes

N/A N/A N/A

6 Psycho-social Issues


7 Wrap-up 30 minutes N/A N/A Annexure 1 on ‘Notes on Identity, Gender and Sexuality’



Activity 1: Introduction to Identity, Gender and Sexuality Module

Time 10 minutes


• Be able to articulate the objectives of this training module.

Materials N/A

Audio-visual Support Short-film titled ‘Identity, Gender and Sexuality Case Series’.


Methodology Welcome the participants and then screen the short-film titled ‘Identity, Gender and Sexuality Case Series’. After the film ends, initiate an interactive discussion to set the tone for the rest of the day. You could ask some of the following questions (add any questions of your own) to set the ball rolling:

• How do we define ourselves? Why are these definitions important to us?

• How do we talk about our sexual desire?

• Why do we sometimes keep our desires a secret? Why are we scared to disclose them?

• Why does disclosure sometimes result in violence of different kinds, such as emotional/social/economical/political?

List keywords from the participants’ responses on the board, circling those that you feel will be relevant to discussions that will happen later in the day.

Wrap-up the activity by introducing participants to the objectives of this training module, and relate the objectives to the earlier discussion. Explain that the day’s training will cover the following topics:

• What is identity and how is it formed?

• The various sexual identities and gender-related identities that people adopt.

• How certain sexual and gender identities are linked to stigma and discrimination.

• Strategies to deal with stigma and discrimination.


Activity 2: Introduction to Identity

Time 40 minutes

Learning Outcomes By the end of this activity, participants will:

• Be able to define the term ‘Identity’ and understand some of its characteristics.

Materials Few sheets of paper and pen.



Methodology Ask for (or select randomly) two volunteers for this exercise and give each of them a sheet of paper and a pen. Tell each volunteer to imagine that s/he is meeting a stranger who asks the question, ‘Who are you?’ Each volunteer should write at least ten words (or phrases) that best describe his/her identity.

After five minutes, ask them to read through the list, rearranging the words (or phrases) in a descending order, with the word that they feel best describes their identity coming at the top and the one that is less fitting than the first coming after, and so on.

Ask two other participants to come forward and read the lists made by the first two volunteers’ to the rest of the group. Write the lists down on a flip-chart and discuss with the group why the volunteers have chosen those words to describe themselves.

Ask the rest of the participants the following questions and list their responses on a flip-chart:

• How many of you would: • Describe yourselves in the way the volunteers described themselves?• Have had descriptions similar to those of the volunteers?• Matched all the 10 descriptions listed on the chart paper?

• What words have you used to describe yourself that were not included in the list?

Initiate a discussion on the concept of identity based on the responses elicited during the above exercise. Explain how through the examples provided by some of the participants one could understand that:

• There are multiple forms of identity, based on race, religion, ethnicity, nationality, sex, sexual orientation, gender, occupation, personal relation, etc.;

• One person can have more than one of these different identities. Also, a person may consider one identity to be more important than another; and

• Identities may change with time or place, and it is important to know that identity is situational and temporal.• Multiple identities can evoke different responses from the same person to a

question, depending on what identity the person has adopted when she/he is asked the question. For instance, a man can have several roles, such as that of a son, lover, husband, worker, and so on. Depending on what role he is playing, his answer to the same question might vary from role to role. Also, when two people playing a similar role are asked the same question, they might very similar answers. For example, a corporate executive and a home-maker at a parent-teacher meeting may both respond to a question in a similar manner, i.e. in the capacity of a parent.


• A man who is comfortable identifying himself as a homosexual in a group of similar friends may not declare his sexual identity at his workplace, where his identity as a productive employee may be more important. This shows that identity is situational and has an impact on a person’s day-to-day life.

• It is important to understand that identity is a matter of choice and presentation. For instance, if a person wears a women’s attire, it might be because he wants to portray himself as a woman. However, a person in a man’s attire might present himself as a woman in all other respects, and consider himself to be transgender (TG); it is the person’s choice to represent herself/himself the way she/he wants.

Using the whiteboard, explain any one of the popular definitions of the term ‘identity’ as described below. (Select only one definition to avoid confusing the participants. Use the one that you feel will best help you set the tone for the rest of the day’s discussions).

• The quality or condition of being the same in substance, composition, nature, properties, or in particular qualities under consideration, or absolute or essential sameness or oneness. (The Oxford Dictionary, 2010)

• Identity is the internal process by which one defines and integrates various aspects of self. It may be related to time in one’s life. (Erikson, 1968)

• [Identity is a] place an individual holds in the society and the various roles played. For example, the same person can be a manager at the workplace, a father at home, a son at his parents’ home. (Mead, 1934)

• For example, people may identify themselves as belonging to a particular organisation/club/city/country, etc. (Deaux, 2000)

Summarise the key learnings of the session that outreach workers (ORWs), counsellors and advocacy officers need to be sensitive to when working with MSM, transgenders, and hijras (MTH):

• Identity is not always constant; it might change with factors such as time, roles, social milieu, geographic location, and phase in life.

• Identity is a matter of choice. Sometimes, however, it may be forced and the person then internalises it over a period of time.

• While dealing with outreach clients, try to understand more about their identity: how they would like to identify themselves? Even if they seem to be MSM, there may other identities that they would want to be identified with.

• Identities are often exclusive; moreover, each individual may have multiple identities. An interaction of these identities may lead to complex life situations. This should be borne in mind while counselling individuals.

• Do not try to impose your identity on an individual while dealing with him/her in the field.

• Recognise that although there is one main identity assumed by a person at any given point, it may clash with other roles and responsibilities of the person.

• Understanding a person’s predominant identity will help ORW to understand various issues related to that individual in the field. For example, an individual may be more concerned about his relationship with his parents rather than his sexuality, or he may be more concerned about his work status rather than safe sex practices.


Activity 3: Sex, Sexuality and Gender Terminology

Time 1 hour


• Know how sex, sexuality and gender create identities and how these identities often overlap and contradict each other; and

• Identify local and regional variations of sexual and gender identities and learn how labeling these identities can be limiting and can complicate the definition of ‘identity’.

Materials N/A



Methodology

Part I: Sexuality and Sexual Orientation Begin by asking the participants the following: what you understand by sex? Or, what is sex?

After the participants answer, follow it by describing it as ‘an individual’s anatomical or biological characteristics that help in classifying people (male, female, transgender, intersex, etc.)’.

Introduce the term ‘sexuality’. Explain that:

• It is a broader term than sex and includes components such as anatomy, identity and behavior.

• The expression of sexuality is also influenced by one’s sexual orientation and sexual desires.

• It also includes other components such as the gender identity that society assigns or thrusts upon us by expecting males to act masculine, and females to act feminine.

• Sexuality also includes the social roles that one finds oneself playing; this may refer to one’s familial obligations, parental obligations, or desire to be a parent.

Note to FacilitatorFirst, present the terms relating to sex, sexuality and sexual orientation. Keep in mind that some of these terms will have more relevance meaning for some participants than others. Then explain the terms ‘gender’ and ‘gender identity’.

Then, introduce the terms that qualify or surround the various sexual and gender identity terminologies. Emphasise that a person can have more than one gender and/or sexual identity, and they might seem to contradict each other. For example, a person can be a hijra, a transgender person or an MSM and might also be married to a woman and have children.

This is a limitation of identity categories; no single identity can completely encompass one’s entire history, desire, or life.

It is important for the participants to realise that since identities can be fluid, they can change over a person’s lifetime and, because there are several other influences (such as familial, economic, and social), a person might be forced to accept certain identities as well.

These limitations of identity make our work more complex because we need to avoid fixed assumptions about any identity.


Sexual orientation, as mentioned above, is one of the expressions for the term ‘sexuality’. It includes romantic or erotic affection/attraction towards another person. It could be towards a person of the opposite sex or gender, the same sex or gender, or to both sexes or more than one gender.

Sexual Orientation: Homosexuality, Heterosexuality, and Bisexuality• When people express love, affection, and eroticism towards others of the same

(biological) sex. Such individuals are referred to as homosexuals. There are both male homosexuals and female homosexuals. Male and female homosexuals are described by different terms to indicate their homosexuality (e.g. ‘gay’ for males and ‘lesbian’ for females).

• When people express love, affection, and eroticism towards the opposite sex. Such individuals are referred to as heterosexuals.

• When people express love, affection, and eroticism towards both sexes, such individuals are referred to as bisexuals. They may also have a steady partner of either sex.

Part II: Gender Explore the different aspects of ‘Gender’. Describe the term as below:

• Gender is an individual’s social/ legal/personal status. We use terms such as man/woman and masculine/feminine to describe these aspects.

• Gender identity is the sense of being a man or a woman or someone in between. It may not necessarily be the same as the biological sex. Gender identity is the fundamental sense of belonging to one sex.

• When gender identity is expressed externally in the social sphere, it becomes a ‘gender expression’.

• Gender roles are shared expectations that apply to individuals on the basis of their socially identified sex. A person’s gender role also signifies the way in which she/he behaves or appears in the social space. This may vary in different cultural settings. This perception is according to the expectations of the society in that particular setting.

Part III: Gender and Sexual Identities This section will introduce the participants to some sexual and gender identities.

Men who have sex with men (MSM)Referred to as MSM, this is an umbrella term to include all men who have sex with other men irrespective of their sexual identity. This definition is based on behaviour.

This term was coined by public health professionals in the 1990s to understand transmission of HIV and other sexually transmitted infections (STIs) among men who have sex with men, regardless of identity.

So it is important to understand that a man who self-identifies as gay or bisexual may not only be sexually active with men, and a man who self-identifies as heterosexual or ‘straight’ may be sexually active with men and/or transgenders as well as women. ‘MSM’ is sometimes used as an identity category for homosexual or gay men, even though it was developed as a term to describe behaviour.

To summarise, the term ‘MSM’ is used to describe men who have sex with other men regardless of how they identify themselves. Though the term ‘gay’ is often used in to describe such men, ‘gay’ is more seen as reflecting a social or cultural identity. In certain areas of India, such as in Manipur, terms such as ‘B-MSM’ and ‘A-MSM’ are used

Note to FacilitatorPlease note that the terms given in this activity are just starting points for discussion.

Ask participants to create their own list with terms from the region/state they belong to and ask them the differences between each term so that they realise the limitations of thinking of an identity in a fixed, concrete way.


(signifying receptive and penetrative sexual partners, respectively). Some kothis (see below) or gay-identified men may also identify themselves as MSM.

TransgenderSometimes shortened to ‘TG’, the word ‘transgender’ is used to describe those who transgress social gender norms. It is often used as an umbrella term to mean those who defy binary gender constructions and those who break or blur culturally prevalent or stereotypical gender roles.

TG persons often live, for all or part of their lives, in a gender role opposite to the one they were assigned at birth. In contemporary usage, TG has become an umbrella term used to describe a wide range of identities and experiences, including but not limited to pre-operative, post-operative and non-operative transsexual people, and male or female cross-dressers (sometimes referred to as ‘transvestites’, ‘drag queens’ or ‘drag king’). A male-to-female TG is referred to as ‘a transgender woman’ and a female-to-male TG is referred to as ‘a transgender man’.

TranssexualThese are people whose gender identity is that of the opposite biological sex. There are male-to-female and female-to-male transsexuals. A transsexual may or may not have had sex reassignment surgery and thus could be ‘pre-operative’ transsexual, ‘post-operative’ transsexual and ‘non-operative’ transsexual. (A male-to-female transsexual person is referred to as ‘a transsexual woman’ and a female-to-male transsexual person is referred to as ‘a transsexual man’).

IntersexThe term ‘intersex’ refers to individuals who possess variations in sex characteristics including chromosomes, gonads, and/or ambiguous genitals that do not allow them to be distinctly identified as female/male sex binary.

KothiTraditionally, in India, a kothi is defined as a male who displays feminine characteristics, such as physical mannerisms. Kothis are often considered receptive in anal/oral intercourse with men; however, kothis may also penetrate other men and are often referred to as dhoru kothis. In addition, kothis may get married to women and may be behaviourally bisexual. These married effeminate men are sometimes referred to as pav-bata-wali-kothis.

Kothis are a heterogeneous group and a single definition or identity does not describe the heterogeneity in this group. The meanings attached to kothi-identity vary according to region, language, age-group, socio-economic status, educational status, degree of involvement in the kothi community, and even from one kothi-identified person to another.

For example, in Manipur, as mentioned above, the term used for them is ‘B-MSM’ or the receptive (not penetrative) partner. Men identified as kothis may often have varying degrees of feminine mannerisms/behaviour. Some may cross-dress in specific situations such as parties/dances or for a sexual partner. They may not otherwise publicly cross-dress and also may not let their birth families know that they cross-dress. It has been argued that the kothi-identified men may want to differentiate themselves from hijras. Further, they may not want to place themselves under the hijra or TG umbrella.

GayThe term ‘gay’ is typically used to describe people attracted people of the same sex, often in the context of a social, cultural or political identity. In India, this term often reveals a person’s social class, education, or media exposure. Some self-identified kothis may also identify themselves as gay due to their association with organisations working with HIV prevention.


Panthi/Ghadiya/GiriyaThese are terms used by kothis to describe ‘masculine’-looking men who are usually considered to be ‘real men’ who penetrate. These men may not self-identify themselves as anything other than heterosexual, although there are some who know the term kothis use to describe them and may call themselves panthis.

Some kothis have steady panthis who are referred to as partners, boyfriends or mard (meaning a macho man in Hindi). These are also referred to as ‘A-MSM’ in Manipur. Though they are usually the penetrative partners, they may get penetrated in certain situations.

A panthi may not identify with the kothi culture and may consider himself a heterosexual who ‘just has sex with other men’. Kothis may not encourage panthis to have some sort of homosexual identity. Though apparently reflecting the ‘top’/‘bottom’ dichotomy seen in western gay culture, kothi and panthi identities are not exactly congruent since a gay-identified man may call himself a ‘top’, a ‘bottom’, or ‘versatile’ based on his sexual behaviour.

Double-DeckerThis term is used in India for individuals who get penetrated as well as penetrate. They might not be effeminate, and some kothis call themselves double-deckers if they have ever been a penetrative partner in the past. Often this term is used as a label rather than a self-claimed identity.

Bisexual This term describes men (i) who are behaviourally bisexual but may not have any identity associated with their bisexuality; or (ii) who self-identify as bisexual men. Specific sexual behavior, such as penetrative or penetrated, does not necessarily form a part of this identity. For example, if a man is bisexual it means that he has sex with men and women. However, it may not be instantly clear as to what sort of sexual role he plays while having sex with other men.

Men who are vulnerable due to their occupation/professionThis group includes multiple categories of men who may be ‘situational’ homosexuals or engage in sex for economic reasons. In India, this group includes maalish-waalas or masseurs, vocational groups like male film extras, room boys, beer-parlour boys, or truck cleaner boys. These may be temporary situations that may change with passage of time.

Hijras/Kinnars Hijras is derived from Urdu and suggests the idea of ‘leaving one’s tribe’. Hijras have a distinct socio-cultural identity. They are different from male-to-female TGs. They are biological males who have feminine gender identity, wear women’s attire and play a feminine gender role, but they are also part of a unique history and sub-culture on the Indian subcontinent.

There are two categories of hijras. These categories are named to indicate what they signify. Akwa hijras are ones who are not castrated and therefore may also have penetrative sex with men or women. Nirwan hijras are ones who are ritually castrated. Sometimes, they may also undergo a surgical procedure for emasculation or removal of the penis.

Many of them do not live with their biological families. Hijra communities are organised into seven major clans, called gharanas, and each gharana is owned by a key person called a Nayak, a senior hijra. Under each nayak are many gurus (masters or teachers), and under each guru there are many chelas (disciples).


A person can be a chela of a particular guru and also be a guru for some other persons (i.e. have their own chelas). In India, the term kinnar is used to describe hijras and is seen as a more respectable and formal term. A number of terms are used across the country. In Tamil Nadu, the equivalent term is thirunangai (respected women), aravanni. In Punjabi the term khusra is used. In Gujarati, they are called Vyandhal.

In South India, male devotees in female clothing are known as jogappa. Hindu temple hijras are often referred to as jogtas. The term ‘eunuch’ was once commonly used to describe hijras in English, now experts have sought to include them under the umbrella term of trangenders.

Overall, male-to-female transgenders and hijras are a separate group socially, culturally, and behaviourally from MSM. Thus, HIV prevention programmes and activities should be specific for this group, and they should not be grouped together with the other MSM sub-populations.

The preceding is by no means an exhaustive list of all identities. Each local area may use multiple other names or have other groups that could be added to this list. Also, identity categories are fluid, and there can be movements across these various groups.

You can show a diagram developed by the Humsafar Trust (CBO in India) called the MSM circle which captures many of the different identities described above and reflecting the context of Mumbai where Humsafar is based. Use only if you think that it is necessary and will help clarify these issues and not confuse the participants.

Single migrant worker

Male sex worker, Malishwala, Gym Boys, Hotel Boys and Boys at Dancing Bars

Truckers, Taxiwalas, etc.

KothiGay identified

Panthi

Behaviourally bisexual

Bisexual

Bhand / Mausi / Khada-Koti

Nirvan Hijra

Jogtas

Hijra construct

Film Extras

Akwa Hijra

MSM Circle


Activity 4: Understanding Gender and Sexual Identity Formation



• Understand the formation of sexual and gender identity; and

• Understand the challenges that people face in coming to terms with their identity, especially when the identity does not clearly align with societal norms.

Materials N/A



Methodology

Part I Read out the following case study to the participants.

Case StudyPummy is in his early thirties. He grew up in a small town where his father worked as a construction labourer. He is the only son and is also the youngest one in the family; he has five sisters. Pummy had a relatively happy childhood with lot of affection from his parents and sisters.

‘As I was the youngest and the only son I was pampered a lot,’ says Pummi. ‘My parents and all my sisters loved me a lot. I never did any household work. Literally, I was a spoilt kid. When I was a child, sometimes my sisters would dress me up as a girl. I liked it a lot. I used to admire myself standing in front of the mirror. Due to the nature of his work, my father would mostly be away from the home. My mother was a very dominating women and a strict disciplinarian. But she was very lenient with me and also she never scolded my sisters for dressing me up as a girl. As I grew up, my sisters stopped dressing me as a girl. I found it very odd. When I requested them to do so, they either ignored me or scolded me for being effeminate. After all, I was a grown up boy.’

Pummy got married at the young age of 19. He had already had a couple of sexual relationships with other men by then. As these relationships were clandestine, they never became a matter of concern for Pummy, who always thought that once he was married to a woman he would assume a normal married life. He was very happy to get married. However, he did not understand the meaning and importance of getting married.

By the time he was 23, Pummy was a father of two children – a girl and a boy. As his father was not keeping well, Pummy shifted to Delhi with his family to look for a job.

Pummy says, ‘I came to Delhi. I simply loved the energy of the city but at the same time its vastness scared me. Soon I got a job as a salesman. I was living happily with my family. Sometimes when I was alone at home I used to wear my wife’s clothes. Once I had to catch a bus from ISBT (the Inter-state Bus Terminus


in Delhi). When I reached there it was late in the evening. I was waiting for the bus when I noticed a group of effeminate boys chatting with each other very happily. I wanted to approach them but was very nervous. I took the bus and came back home. I could not sleep the whole night.’

Pummy started going to ISBT daily after that. For months, he just went there to sit in a tea stall and observe the group. Then one day he gathered the courage and approached the group. He introduced himself as ‘Raman’ as he was still scared to reveal his true name. ‘He is a kothi,’ said one guy. ‘Her real name must be Ramona,’ said another guy. Everyone laughed. Pummy was confused. He did not understand the word kothi. Pummy excused himself and came back home.

Using the case study as a backdrop, lead the discussion on identity, acceptance, and disclosure.

Ask the participants how and when they heard the words hijra (if they are hijras), kothis (if they are kothis), TGs (if they are TGs), and gay (if they are gay).

Ask whether the participants felt any confusion, shame and guilt when they realised they were a hijra or a gay or a kothi or a TG. For example, it is very common for sexual minorities to say, ‘we often wondered why God made us like this’. This is an expression of the emotional difficulties that people face due to their identities.

Ask the participants what they think are the difficulties that Pummy will face. Remind them that Pummy is married now. What sort of confusion will he face? What can he do now? Will he feel confused, alone and isolated because of his desires?

At this stage, provide them with relevant, additional information.

Given below is some additional information on the various stages of identity formation (homosexual). (Troiden, 1989)

Stage 1 The first stage is sensitisation, usually occurring before puberty. Here the individual might believe that s/he is heterosexual, and it is only in some respects (such as mannerisms, choice of clothes, or sexual preferences, etc.) that she/he is ‘different’ from other people of her/his own sex.

Stage 2The next stage is that of identity confusion. This may occur during the adolescent period when these young people start experiencing homosexual desires and feelings. Inadequate knowledge about sexuality, and experiencing desires and feelings which are new to them, may lead to identity confusion and turmoil.

Note to FacilitatorThere are several models of identity formation. While it is not advisable to present these to participants, reading about them will give you a broad base of perspectives to base your session on.

Cass proposed the Sexual Identity Formation Model which comprises the following stages (Palmer and Stuckey, 2008):

• Pre-stage: the individual has a heterosexual identity.

• Identity confusion: questioning same-sex gender affinity.

• Identity comparison: there is some sort of acceptance about the new identity but there may still be some confusion.

• Identity tolerance: there may be a gradual acceptance of self-identity.

• Identity acceptance: they start accepting their identity and start staying with others who have the same identity.

• Identity pride: start valuing their new found identity and may be less receptive to heterosexuals.

• Identity synthesis: gradually the individual starts accepting the whole identity and comes to term with the heterosexuals as well.

There are various other models as well, such as the Inclusive Model (awareness, exploration, deepening, commitment, internalisation, and synthesis). (Rowland and Rose, 2008)


Stage 3The third stage is that of identity assumption when the individual starts accepting the homosexual identity and informs others as such. This is a variable process and may occur at different ages; this may involve the process of ‘coming out’. They might not be comfortable with their identity and might still be feeling isolated, alone and depressed, but at that point of time they know their identity.

Stage 4 The last stage is that of commitment. Here the individual is comfortable with the homosexual identity and lives life accordingly.

Remind participants that these models are all theoretical and are not definitive, i.e. a person can undergo doubts several times before she/he is sure of her/his identity. It can be a long process for a person to become comfortable with his/her identity in a stable way.

Summarise the key learnings of the session which ORWs, counsellors and Advocacy Officers need to be sensitive to when working with persons of the MTH community.

• Sexual identity, gender identity, and behaviour are complex.

• Identity and behaviours are fluid and are a matter of individual choice. All individuals with the same identity may not necessarily have the same behaviour.

• Individuals may self-identify the way they want to; however, they should practice safe sex practices irrespective of their identities.

• Remember that nearly all who are born as biological males and have now taken different identities are vulnerable to HIV and other STIs; for example, a panthi, giriya, may be masculine looking but that does not mean that the person is not vulnerable.

• Use the appropriate gender term as self-identified by the individuals while addressing them.

• Advocacy Officers need to know that: • Their work in the field relies on their understanding various identity groups

existing in the immediate community, their specific behaviour practices, and to ensure responsiveness of ORW messages and expectations of specific groups.

• They must try to assess any possible uneasiness with messages given to various groups.

• They should act as a medium to bring these issues to the notice of the counsellor.

• They must try to figure out any identity politics on-site and adapt the prevention messages to be responsive to the local context.

Note to FacilitatorRemind the participants that although some or most of these western models may not necessarily apply in the Indian context, they nevertheless serve as a good basis to understand some of the concepts behind the process of ‘disclosure’ and ‘coming out’. (You should decide whether the various ‘models’ can be shared with the participants depending on your assessment of their interest and capability.)

Some of the models on gender identities and identity formation are useful to understand the process of ‘disclosure’ and ‘coming out’.

It has been argued that bisexuals may experience continued uncertainty; it may be more difficult for them to find role models than gay/lesbians/

TG people. There may also be difficulties in managing attractions and relationships.

For TGs, the issue of disclosure may be experienced differently than it would be by gay/lesbian/bisexual individuals, especially in Indian society where there is a social presence of TG people. If a TG moves around in female attire, this is on its own a ‘disclosure’ of gender expression to society. Some may decide to retain external male genitalia, whereas others may decide to undergo a sex reassignment surgery. Thus, there are various levels of comfort and disclosure, and it should not be seen as an ‘all or none’ phenomenon. It is often a spectrum and at various stages of life individuals are at different points on the spectrum.


Activity 5: Stigma, Discrimination and Homophobia



• Understand the concepts of homophobia and transphobia;

• Understand how identities that counter societal norms can engender stigma and discrimination; and

• Be able to articulate strategies for dealing with stigma and discrimination.

Materials N/A



Methodology

Part I: Introducing ‘Stigma’Start this session with a game. The idea behind the game (described below) is to demonstrate the stereotypical notions people have about the behaviour of people labelled with sexual and gender identities outside the mainstream.

Divide the participants into five groups and name the groups Mr. India (Men), Ms. India (Women), Mr. TG India, Ms. TG India, and Ms. Hijra India.

Ask all the groups to stand on one side of the room. Play some lively music and ask one or two members of each group (one member at a time) to walk their way to the other end of the room (or a designated area). Tell them that as they walk across their room, they should behave in a manner that they think is representative of their group (mannerisms of men if they are from group Mr. India Men and so on).

Ask the participants whether the representatives portrayed their roles properly.

If participants voice an opinion, for instance, that Mr. India Men was not manly enough, point out that our concept of an ideal male is a result of social conditioning. Also point out that when we or others are not able to live up to such ‘ideal’ standards created by social conditioning, it leads to both self and social stigmatisation.

Continue with the discussion on stigma in which you describe stigma as the process by which individuals with devalued physical attributes, behavioural patterns, or medical conditions experience prejudice, discrimination, stereotyping, and exclusion (Dovidio, Major J and Crocker, 2000). In simple words, stigma is the severe disapproval of a person on the grounds of characteristics that distinguish them from other members of a society.

Stigmatised individuals experience or anticipate negative reactions due to the existing social norms or due to their own awareness of how they violate social norms (Goffman, 1963). We find multilayered, and different types of, stigma in lesbian/gay/bisexual and TG settings. For example, there may be stigma because of their sexuality and sexual orientation, their expression in society, and their sexual behaviours and infections associated with it. If someone has HIV, then there is an additional stigma of the HIV infection.


(Note: Remind participants that some of these types will be discussed later during the training).

After defining stigma and describing its various types, move on to explaining ‘homophobia’. Start by defining homophobia as the fear and hatred of homosexuality (The Oxford Dictionary, 2010).

Part II

Dealing with Stigma and Discrimination Divide the participants in two groups. Give one case study (given below) to each of the group and ask the groups to study present a synopsis of their case study to rest of the participants along with the answers for the below questions. Use the below mentioned points to debrief the participants on both the case studies.

Pointers for debriefing Case Studies:

Ask participants the following questions:

• Where in the story does the character face stigma?

• Is there any self-stigmatisation?

• Does the stigma experienced by the protagonist result in any discrimination?

• What sort of challenges – psychological, social or other – does the protagonist face because of stigma and discrimination?

Brainstorm as to what the counsellors, ORWS and peer educators (PEs) can do to strategise and counter stigmatisation and discrimination. Once all the responses are elicited and discussed, proceed to explaining the following:

• Types of homophobia;

• Internalised homophobia/transphobia;

• Heterophobia; and

• Internalised stigma of all forms for homosexuals/transsexuals/TGs.

Initiate a discussion on issues of transphobia, prejudged notions, medical issues, and gender violence. Explain that transphobia can manifest in the following ways:

• Prejudices about the roles and place of TGs in society.

• Using pronouns not confirming to the gender expression.

• Forcing them to choose male or female in forms that need to be filled.

• Medical admissions in male wards.

• Heckling on streets.

• Unnecessary and unfounded fear of TGs on streets.

• Gender violence in extreme cases.

• People not being comfortable with the fact that they were born as men and live as women.

• Discouraging them from sex reassignment procedures.

Summarise the key learnings of the session for the participants:

• Homophobia and transphobia are shown by members of the general population and in a few instances by a few lesbian/gay/bisexual/TG community members. One has to deal with issues of homophobia at various levels – personal, social, political, communal, religious, and legal. Often, addressing these issues with support from the MTH community, along with the support from sensitive non-community members, helps in dealing with homophobia at various levels.


• Addressing ‘internalised homophobia’ and stigma is essential for success of any program that works for the MTH community. If an ORW or a PE sees that any of their clients are confused or depressed because of internal and external homophobia/transphobia, then they should strongly encourage or convince the clients to come to the drop-in centre (DIC) and speak to the counsellor. During sessions, counsellors should first address internalised homophobia before dealing with external homophobia. Before addressing cases of homophobia, the counsellor needs to be clear about the source and level of homophobia the client is experiencing – whether it is personal, social, political, and so on – and assist the client in devising appropriate strategies.

• Excessive labelling of homophobia or heterophobia is not very helpful. One has to be careful in labelling any wrong doing or injustice as homophobia.

Advocacy Officers need to:

• Understand the issues of structural homophobia (example: in medical settings, legal settings, etc.); and

• Sensitise individuals in these structural settings in order to address homophobia at these levels.

Case Study 1Anshul studies in a college in Mumbai. He travels everyday in train with a group of friends from college and has also made friends with others he has met in the train. He meets with the non-college friends outside of college campus once in a while and is good friends with them too.

Anshul has always felt attracted to boys in his class and college. Though he does not know any other men who have similar yearnings, he is aware of the term ‘homosexual’ and ‘gay’ and has read about it in some newspaper articles. He has tried to find other people like him but has not been successful so far.

Sidhaant is one of his friends and Anshul really likes him, but he is not sure if Sidhaant is gay or not. So he tries to take it easy and does not approach Sidhaant with anything. Nevertheless they are very good friends and meet often in a tea shop close to their house/ They love tea and call these meetings their ‘masala time.’ Anshul values the friendship and decides not to pursue his feelings any further with Sidhaant.

One day, when Anshul and other guys were travelling back from college in the train, they meet Sidhaant. It is a very busy time of the day and the train is crowded. Suddenly one well-dressed and groomed young man accuses Anshul of making physical contact in an inappropriate way and shouts at him for ‘behaving like a homosexual.’ Anshul is stunned and does not how to react to the outburst. His friends tell him not to worry and forget about the incident. The moment passes and they all get down at their respective stations.

However, Anshul is bothered by this incident. He worries that he has some problem that others do not have. He wonders why the passenger yelled only at him. Did he figure that Anshul was gay? Do others know about him? Do they talk about him behind his back? He is not sure about these answers but wonders if there is something wrong with the way he talks or walks or holds books or the way he dresses; he somehow concludes that there is something ‘wrong’ with him.

He decides to discuss this with Sidhaant. He hopes that Sidhaant will understand him. So they meet for one of their ‘masala times.’ He reminds Sidhaant about the incident and tells him that because of the whole episode he was depressed


and could not focus. He adds that ‘Sidhaant, I want to let you know that I do like men. I mean, I always fantasise about them.’ On hearing this, Sidhaant responds nicely and says it is OK, he understands it. Anshul is happy that he was able to talk with someone and feels good about it.

However, Anshul notices after this conversation that Sidhaant’s attitude towards him has changed. They have not had a ‘masala time’ in about four weeks. Nor does he see him that often. Anshul has a feeling that because of the disclosure about his sexual orientation, Sidhaant ignores him and hardly responds to his calls. Once when they spoke, Sidhaant was indifferent on the phone and said that he had been busy with work and studies.

Case Study 2 Sushant is a high school (10th grade) student. He goes to school regularly, is studious, and always scores well in all exams. Often on the way to the school, he and his friends see a group of hijras at the traffic signal, clapping loudly and asking for money from all the car and rickshaw passengers who stop at that signal. Once in a while they also see some people making fun of them, jeering at them, making rude gestures, or heckling them.

Sushant sees this one day and tells his friends that it is not nice to behave that way. ‘Let them live as they want to,’ he says.

Friend 1: What are you saying! Do you think this is normal, dressing up like a woman and all that? I don’t like this, and I don’t think what they are doing is right.

Friend 2: I agree with him. This is not normal. Why don’t you and I behave like them? They just want to create a nuisance in society.

Sushant: I don’t think so. I think they are born that way. I think they are called hermaphrodites. I don’t think they have ‘proper’ male or female organs.

Friend 1: How do you know all this?

Sushant: I read it in a book. It was some sort of a medical magazine. They did talk about this group of men called transgenders. You know, interestingly, some are men and want to become women!

Friend 2: Really? They are there just to harass normal people. When we were small, we were asked to stay away from them as they were notorious for abducting young boys and making them look and behave like them. I was always very afraid of them.

Friend 1: What else did the magazine write about them?

Sushant: They had interviewed some doctor who dealt with people like these, and many of them frequented his clinic for sex-change operations.

Friend 2: So does he do these operations?

Sushant: No yaar, he said he discourages people from getting it done. He says that it is not the right thing to do, and this behaviour can be rectified by hormones and other therapies.

Friend 1: See I told you, this is not right.

Sushant: But then there was this other doctor who said that it is fine as long as they take proper precautions and medications.

Friend 2: I don’t know. I don’t agree with you that it is alright to be a transgender.


Background Information(Kantor, 1998)

Types of Homophobia • Medical

• Religious

• Socio-cultural

• Criminal

• Political

• Biological

MedicalHomosexuality has been, for many years, considered a mental illness that could be treated or even cured. Though the perception has changed significantly over the years, there are physicians who still believe that homosexuality is not ‘normal’. They use different forms of therapies (aversion therapy, psychotherapy, hormonal therapy) which they claim can cure the condition.

Another commonly presented argument is that gay men waste ‘nature’s gift,’ the opportunity to procreate. Some also believe that anus is not suited to penetrative sex. Another point often made is that anal sex often leads to sexually transmitted infections, including HIV.

Counter arguments are: heterosexual sex is also not always for procreation and many times sex between a man and a woman is recreational; anal sex is pleasurable, and the use of lubricants can facilitate anal sex just as they are often used in case of inadequate lubrication during vaginal sex; peno-vaginal sex also can transmit infections and diseases, including HIV.

ReligiousMany religions call homosexuality a sin, an act against the ‘wish of God.’ Some believe that HIV/AIDS is the result of that ‘sin.’ Issues of religion and homosexuality are sensitive and have to be dealt with carefully. For those who would like to maintain both religious as well as sexual identities and feel that they may be going against their religion, it helps to introduce them to groups and religious scholars who are known for their soft and sympathetic stand on homosexuality.

Socio-culturalSociety accepts heterosexuality as the norm. Individuals grow up seeing heterosexual couples (male and female) and accept it as the model for sexual and emotional relationships. This becomes part of the conditioning that most people go through in their early years.

Family expectations and societal expectation about our individual roles also play a significant part in shaping attitudes. For example, most men in India are expected to get married to a woman by a particular age and anything that goes against this norm is not seen as acceptable. As a result, many gay men in the country get married under pressure from their families.

http://www.questia.com/searchglobal?q=author!Martin Kantor!AllWords


CriminalSexual relationships between consenting adults of the same sex have long been the target of both social and legal sanctions. Though such relationships are increasingly gaining social acceptance as society is gradually becoming more tolerant, certain jurisdictions have retained statutory prohibitions on homosexuality despite advocacy and criticism from groups and individuals who believe that the laws are obsolete and should be removed.

The arguments opposing decriminalisation revolve around concerns about ‘negative’ aspects of homosexuality, STDs, and paedophilia and claim that decriminalisation will result in increased frequency of homosexuality and will destroy the sanctity of the ‘family.’

People favouring decriminalisation counter by arguing that sexual orientation develops due to multiple factors, including genetics, and it is unlikely that an increase in the incidence of homosexuality will occur as a consequence of decriminalisation. Anti-sodomy laws compel many gay men and women to conceal their sexuality and marry for appearance’s sake. Decriminalisation may actually help to remove some of the stigma and have a positive influence on relationships between homosexuals and their families, thereby promoting greater acceptance of homosexuals by their families.

What is Internalised Homophobia ?This is defined as a negative feeling towards oneself because of homosexuality. However, the term has given way to the term ‘internalised stigma’ as many believe that negative attitudes are not the same as having fear or phobia. Many see this phenomenon as an inevitable consequence for children who are exposed to heterosexist norms. Research has shown that most gay men and lesbians adopt negative attitudes towards (their) homosexuality early in their developmental histories.

These negative attitudes result in repression of one’s own homosexual desires and encourage a clash between a person’s religious or social beliefs and his sexual and emotional desires. This could result in clinical depression, denial and suicidal thoughts. Such a situation may cause extreme repression of homosexual desires.

In addition to internalised stigma, some gay men may also disapprove of other MSM who do not confirm to their identity or social structure. For example, a gay-identified man may have issues identifying himself with ‘kothi’ men.

What is TransphobiaTransphobia refers to a range of negative attitudes and feelings towards transsexualism, transgenderism, and transsexual or transgender people.

Transphobia can manifest as physical violence, verbal abuse, social marginalization and neglect. Many TG people also experience homophobia from people who associate their gender identity with homosexuality.


Activity 6: Psychological Issues Related to Identity, Gender and Sexuality

Time 45 minutes


• Know the various psychological issues that can arise in connection with one’s identity, gender, and sexuality; and

• Be able to identify the situations where a person has to be referred to specialist care.

Materials N/A


Take Home Material N/A

Methodology Use a question and answer format to discuss the various psycho-social issues faced by the members of MTH community. Use the discussion that ensues to allow participants to discuss and share experiences from the field.

Is homosexuality normal? Am I the only one?Medically, homosexuality is no longer considered a disease or abnormality. Globally, various surveys have provided information on the prevalence of same-sex sexual behaviours across cultures and communities.

Though various theories were proposed to explain homosexuality (genetic, hormonal, and psychoanalytic, etc) and ‘treat’ it medically, it is now widely accepted that homosexuality is not a disease.

What about Transsexualism? The term ‘transsexualism’ refers to individuals who have a cross-gender desire and identification. They are not comfortable in the sex of their birth and may like to identify themselves with the opposite gender. This is differentiated from ‘transvestitism,’ which is the practice of cross-dressing or wearing clothing traditionally associated with the opposite sex or gender.

When transsexualism causes distress in an individual, it can be diagnosed under ‘Gender Identity Disorder (GID).’ GID can be caused by genetic factors and prenatal exposure to hormones, as well as other psychological and behavioral reasons. It is generally required that the treating physician figures out whether: (i) the GID is temporary (sub-clinical), frequent/periodic, or constant; and (ii) the benefits to the individual from medical and surgical therapies.

Such a person might consider medical and surgical options for sex reassignment procedures. Hormonal therapy include medical castration (suppression of indigenous hormones) and later the addition of hormones of the opposite sex. Surgical procedures include removal of testes and scrotum, removal of penis, vaginal space creation (vaginoplasty), urethra creation, creation of clitoris, labia, and vulva. Other procedures may include breast augmentation and voice box surgeries. For women, the surgeries may include removal of ovaries and uterus and creation of the penis and scrotum.


What about penis size? Do I have a small one? Generally speaking, many men may come to the counselor or other project staff with concerns about penis size. They may say that they have a small penis and would like to enhance its length. Some authors have shown that homosexual men may place particular importance on size. This may be associated with greater self-esteem. It may also play role in sexual positioning.

However, it is often found that though they may be within the average range, many men often underestimate the size of their penis relative to other men and think that they are undersized. Further, size typically does not impact function. Educating the individual about penis size is important; staff should try to tell them, unless it is really very small (which can happen with some medical conditions), most fall within a normal range.

An important issue for HIV prevention is the role of penis size in condom use. There may be condom slippage, condom tightness, and poor use of condoms due to penis size. Thus, a range of condom sizes may be required for optimal HIV prevention.

Myths about ‘semen loss’ and ‘masturbation’ Many individuals are concerned about semen loss. It is often referred to as ‘Dhat Syndrome’ (the word ‘Dhat’ referring to semen). There are wrongly-held beliefs that a lot of blood is required to create one drop of semen, and therefore, with the loss of semen men may lose vigour. This may also be accompanied by other symptoms such as pain, tiredness, mental health issues, and excessive worries. There are other fears about masturbation, such that it is bad or abnormal, will lead to sexual weakness in future, may alter the penis permanently, and cause mental problems. On the contrary, masturbation is safe, pleasurable and healthy.

It is important to assert that semen is a body fluid and is produced normally by body without causing damage. Semen ejaculated by masturbation or by a sexual act with another person is replaced as needed. A third route is that of nocturnal emissions. Semen is sometimes ejaculated during sleep, referred to as ‘wet dreams’. One should not worry too much about these – the semen will be replenished soon.

Premature ejaculation It is defined as persistent or recurrent ejaculation with minimal stimulation before, or on, or shortly after penetration and before the person wishes it. (The American Psychiatric Association, 2000) Premature ejaculation simply means early ejaculation, when a male is unable to control or delay ejaculation. It can cause distress for both the person and his partner and can be treated often with the help of a physician.

Erectile dysfunction This is the inability to achieve or maintain an erection sufficient for sexual performance. It can occur due to various reasons: ageing, anxiety, stress, relationship issues, depression, obesity, smoking, cardiovascular problems, and hormonal problems, to name a few. There are multiple therapies available, and treatment will include detailed history-taking, psychological and psychiatric evaluation, and therapies, including lifestyle changes as well as cognitive, behavioural, medical, and surgical interventions. Any treatment needs to be undertaken under the guidance of a physician. If erectile problems impede daily functioning, an individual may also require mental health counseling.


Activity 7: Wrap-up

Time 30 minutes

Learning Outcomes The participants will summarise:

• The various concepts they have learnt throughout the training session.

Materials N/A


Take-home Material Annexure 1 on ‘Notes on Identity, Gender and Sexuality’.

Conduct a quiz to check participants’ learning. Divide participants into various groups. Ask a question to one group and allow other groups to judge whether the answer was correct or not. Some questions that could be asked are:

• What are some of the characteristics of identity? (Remind them that identities are fluid and can change over time).

• What are the various things that ORWs, counsellors, and Advocacy Officers should remember about the concept of identity?

• What is sex?

• What is gender?

• What is sexual orientation?

• What is sexual identity and gender identity?

• What are the four steps towards identity formation?

• What are the points that ORWs, counsellors and Advocacy Officers should remember when dealing with identity formation?

• What is stigma?

• When does it result in discrimination?

• What is homophobia (the various models of homophobia)?

• What is transphobia?

• What is internalised homophobia and transphobia?

• What should ORWs, PEs and counselors remember when they find their clients suffering from and dealing with stigma and discrimination?

End the day’s training emphasising that there is diversity in our identities, sexualities, sexual identities, gender identities, and orientations, and that this diversity needs to be celebrated and encouraged and not stigmatised.


Annexure 1: Notes on Identity, Gender and Sexuality

For Outreach Workers and Counsellors1. Identity is never constant; it changes with factors such as time, roles, social milieu,

geographic location, and phase in life to name a few.

2. Identity is a matter of choice. Sometimes, however, it may be ‘forced’ and the person then internalises over a period of time.

3. While dealing with outreach clients try to understand more about their identity—how they would like to identify themselves. Even if they seem to be MSM, there may be other identities that they would want to be identified with.

4. Identity is often not linear; each individual may have multiple identities. An interaction of these identities may lead to complex life situations, and this should be borne in mind.

5. Recognise that although there is one main identity assumed by a person at any given point, it may clash with other roles and responsibilities of the person. Understanding the predominant identity will help ORWs to understand various issues related to the individual on the field; for example a man may be more concerned about being a son than about his sexuality, or he may be more concerned about his work status rather than safe sex practices. These issues will help you address the main concerns of these individuals.

6. Identity and behaviours are fluid and are a matter of individual choice. Do not try to impose your identity on the individual while dealing with them in the field.

7. All individuals with the same identity may not necessarily display the same behaviour.

8. Individuals may self-identify the way they want to; however, they should practice safe sex practices irrespective of their identities.

9. Remember that nearly all who are born as a biological male and have now taken different identities are vulnerable to HIV and other STIs; for example, a panthi, giriya, may be masculine looking and muscular; however that does not mean that the person is not vulnerable.

For Advocacy Officers1. The role of the Advocacy Officer is to understand the work of ORWs, and the

problems they face while dealing with subjects on site.

2. The role is to mediate and facilitate, between the counsellors and outreach subjects, negotiation skills related to understanding one’s identity, the interactions with different identities, and the most pressing issues related to it. (By this we mean that even though the NGO might be working on issues such as HIV and STI prevention for MTH, if the MSM has a child who is facing discrimination then the NGO has to realise that the pressing issue for the person is the child’s welfare and education, because the person is also a father. The Advocacy Officer will have to explore the possibilities of crisis management regarding that issue.



Notes








population status.








module

C

module

A

module

C

module

D




module



C2 Family Support

C3 Mental Health





D3 Positive Living





C1 I

dent

ity, G

ende

r an

d Se

xual

ity

C2 F

amily

Sup

port

Facilitator Guide

Family Support

C2

Pehchan 1C2 Facilitator Guide: Family Support


About Pehchan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2


Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3


Module Acknowledgments: Family Support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

About the Family Support Module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9


Activity Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Activity 1: Exploring the Term ‘Family’ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Activity 2: Understanding Basic Family Dynamics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Activity 3: Introduction to Disclosure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Activity 4: Consequences of Disclosure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Activity 5: Planning for Disclosure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Activity 6: Impact of Disclosure on Families . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

Activity 7: Basics of Family Counselling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Activity 8: Wrap-up . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

Annexure 1: Frequently Asked Questions by Family Members When Their Children Come Out . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

Annexure 2: PowerPoint Presentation – Family Support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

Pehchan2 C2 Facilitator Guide: Family Support

About this ModuleThis module is designed to help training participants: 1) develop a common understanding of the term ‘family’ from the perspective of men who have sex with men (MSM), transgenders and hijras (MTH); 2) identify different constructs of ‘family’ present in MTH communities; 3) explore the importance of ‘family’ in a person’s life; and 4) understand issues faced by MTH community members with regard to their families. In the Pehchan programme, this module is used to introduce principles of family support to CBO Outreach Workers and Counsellors.





Module Acknowledgments: Family SupportEach component of the Pehchan Training Curriculum has a number of contributors who have provided specific inputs. For this component, the following are acknowledged:

Primary Author Priti Prabhughate, ICRW


Technical Input Vaibhav Sarai, Consultant; Olga Aaron, SIAAP; and Debjyoti Ghosh, SAATHII


References • Sears J.T.,and Williams W.L. (1997) ‘Effective Coming Out: Self-Disclosure Strategies

to Reduce Sexual Identity’ in Overcoming Heterosexism and Homophobia. New York. Columbia University Press.

• Frequently Asked Questions: Parents, families and friends of lesbians and gays. (2012). PFLAG. Washington, DC. Available from http://community.pflag.org/Page.aspx?pid=290

• FAQ for friends and family of LGBT people. (2003). Orinam. Chennai. Available from: http://orinam.net/parentsfaqenglish/


About the Family Support Module

No. C2

Name Family Support

Pehchan Trainees • Project Managers

• Counsellors

• Outreach Workers (ORW)

Pehchan CBO Type TI Plus

Training Objectives By the end of this module, the participants will be able to:

• Develop an understanding on the social constructs of a family and how they apply to MTH community members;

• Support members of the MTH community in dealing with the issue of disclosing their sexual orientation to their families (biological/marital); and

• Identify the psycho-social issues that MTH community members and their families face due to disclosure of their sexual orientation/gender identity and identify strategies to address them.





Audio-visual Support PowerPoint presentation ‘Family Support’.

Annexures Annexure 1 on ‘Frequently Asked Questions by Family Members When their Children Come Out’.

Note to Facilitator‘Family Support’ is a topic that involves situations that are difficult to generalise as they vary based on the context and individuals involved. Encourage participants to learn from their own and others’ experiences and ideas. However, as a result, the sessions may become unstructured. Therefore, at the end of every session summarise the key learnings and then continue to the next one.

At the end of the day, use the wrap-up activity to ensure that the training objectives have been met.


Activity Index1


Take-home material

1 Exploring the Term ‘Family’

50 min Chart paper, crayons

Refer to the slides titled ‘Introduction to Module’ from the PowerPoint presentation ‘Family Support’

N/A

2 Understanding Basic Family Dynamics

50 min N/A Refer to the slides titled ‘Onnie’s family to Onnie’s family-hierarchy’ from the PowerPoint presentation ‘Family Support’

N/A

3 Introduction to Disclosure

45 min N/A Refer to the slides titled ‘Onnie’s social circle’ from the PowerPoint presentation ‘Family Support’

N/A

4 Consequences of Disclosure

50 min N/A N/A N/A

5 Planning for Disclosure

50 min N/A Refer to the slides titled ‘Who should I tell first?’ from the PowerPoint presentation ‘Family Support’

N/A

6 Impact of Disclosure on Families

40 min N/A Refer to the slides titled ‘Reactions to disclosure’ from the PowerPoint presentation ‘Family Support’

Annexure 1 titled ‘Frequently asked questions by family members when their children come out’

Printouts of the Powerpoint slide titled ‘Reactions to disclosure’

7 Basics of Family Counselling

1 hour N/A N/A N/A

8 Wrap-up 45 min N/A N/A N/A



Activity 1: Exploring the Term ‘Family’

Time 50 minutes


• Distinguish between family as a social institution and other forms of family that go beyond the traditional constructs of kinship and blood-relations;

• Articulate the value of families in the lives of MTH community members; and

• Identify different types of family structures that apply to MTH community members and the overlap among these structures.

Materials Chart papers, crayons

Audio-visual Support Refer to the slides titled ‘Introduction to Module’ from the PowerPoint presentation ‘Family Support’.


Methodology Give each participant a chart paper and crayons and ask them to spend the next 20 minutes drawing their ‘family’. Encourage the participants to draw whatever comes to their mind when the term family is used.

Ask them to draw without consulting fellow participants. If necessary, they can move out of the training hall or spread out in such a manner that they do not infringe on each other’s privacy.

After 20 minutes, invite the participants to sit in a circle, share their drawings, and describe what they have represented in the picture. Through the discussion, explore:

• Various constructs of families and the hierarchical relationships in them;

• Reasons why biological families are not necessarily families of choice;

• Implications of forming/adopting families of one’s own choice, especially by members of MTH community;

• The role of family in shaping one’s own sense of social identity;

• Whether an individual can be a part of more than one ‘family’; and

• Issues faced by MTH in their biological families as well as in families of their choice.

Explain to the participants that this module is called ‘Family Support’ and tell them to voice their expectations from this module. List their responses on the board. Introduce them to the objectives of the module by either writing them on the board or displaying the PowerPoint slides titled ‘Introduction to Module’ from the PowerPoint presentation ‘Family Support’. Map their expectations with the objectives of the module and tell them which of their expectations would be met in the day’s training. It is also important to explain why some expectations are beyond the scope of this module.

Note to FacilitatorThis exercise is designed to explore the term ‘family’ in all its manifestations— whether nuclear or joint, biological or adopted (including transgender and hijra family constructs), parental, single or marital, and to explore the importance of familial support in the MTH community.


Note: Consider the following while leading the discussion on families:

• The term ‘family’ is most commonly associated with the notion of biological family, consisting of siblings, parents and relatives.

• The term ‘family of choice’ refers to a family of selected members who come together because of their sexuality and sexual orientation or other reasons. From an MTH community’s perspective, the term ‘family’ may also include the larger lesbian/gay/bisexual/transgender family.

• Explain how MTH families may differ with regard to: • Support they get;• Members who constitute the family;• Expectations of the family from its members; and• Rights and responsibilities of the members.

• Transgender and hijra families of choice have more formal structures than MSM families of choice, such as:• Gharanas and jamaats of a hijra ‘family’ that have various layers of hierarchy.• The gharana system runs as a parallel social structure within Indian society

and many such gharanas/jamaats/deras exist in India.• Gharanas represent a closely-knit family system, which is often the single

major source of social support for its members and in which the members (chelas) depend on gurus for their subsistence.

• The gurus in a gharana have a role in deciding the responsibilities of their chelas, the allocation of financial resources, assigning household chores, and so on.


Activity 2: Understanding Basic Family Dynamics

Time 50 minutes


• Understand the basic family dynamics in terms of hierarchy and power, intimacy and distance, and patterns of communication;

• Understand the concept of family support; and

• Understand other forms of support circles.

Materials N/A

Audio-visual Support Refer to the slides titled ‘Onnie’s family to Onnie’s family-hierarchy’ from the PowerPoint presentation ‘Family Support’.


Methodology Read out the following case study to the participants. The case study is made up of three segments. After completing each segment, add circle(s) representing each character in the case study (as described and shown below) on a whiteboard (or on a blank PowerPoint slide).

Segment 1Aniruddha (21) is an Outreach Worker (ORW) with a community-based organisation (CBO) in Burdwan, West Bengal. Educated and working with transgender/hijra communities for the last two years, he goes to home in his village on weekends. At work, Aniruddha is known as Anita, who likes cross-dressing and has had several partners, both male and female. At home, Aniruddha is called Onnie; his family is unaware of the irony of his nickname being so similar to his ‘feminine’ name. His family thinks he works as a travelling salesman.

(Pause the reading and draw a circle that represents Onnie in the centre of the paper, as shown in the diagram to the right)

Segment 2 Onnie’s home is in Nutangram village and his family is comprised of his mother, father, his 17-year old younger sister, and 15-year-old younger brother.

His father is an aging farmer and mother is a home-maker. Onnie sends home money every month, some of which goes to support his brother in school. Onnie and his sister are very close, and Onnie has promised to take care of all the expenses for her wedding, especially since their father has no savings.

(Pause the reading, and add circles that represent Onnie’s parents and siblings around the circle ‘Onnie’)

Sister

Brother

Father

Mother

Uncle

Onnie


Segment 3Onnie’s uncle, his father’s eldest brother, looks after the family farm. Onnie’s father has no say in family matters and lives at his brother’s mercy. The uncle sexually abused Onnie as a child, and the abuse stopped only when Onnie became a teenager. He has paid for Onnie’s education. The uncle is now putting pressure on him to get married to the only daughter of a wealthy mill-owner. The uncle has decided to leave his fortune to Onnie on the condition that Onnie gets married and produces a male heir as he does not have a family of his own.

(Draw a circle representing Onnie’s uncle on the paper)

Part I: Family Dynamics Use the slide titled ‘Onnie’s family’ from the PowerPoint presentation ‘Family Support’ to discuss the family’s dynamics. In the slide containing circles representing Onnie’s family members, resize and re-position the circles appropriately as you go through the following points. (To do so, you will need to open the PowerPoint presentation in normal mode, not in slideshow mode).

Discuss the family hierarchy in the case study and accordingly move the circles around to illustrate the hierarchies (refer to the slides titled ‘Onnie’s family-hierarchy’ from the PowerPoint presentation ‘Family Support’) for one possible interpretation.

Discuss the power equations in the family based one economic power, social power, and emotional hold. The size of the area of the circle can be used to signify relative power. For instance, in the adjacent diagram, the uncle is represented by the biggest circle, with Onnie coming second, representing the economic power wielded by him over the members of the family. Brainstorm about decision-making scenarios in Onnie’s family.

Identify the family members Onnie is close to. Use the distance between circles in the diagram as a measure of emotional bonding between Onnie and other family members. Ask participants to discuss issues of independence and dependence, both material and non-material, in Onnie’s family.

Using arrows draw the communications channels between the family members. Draw heavy lines to represent frequent and healthy communication and draw light lines, or broken lines, to represent troubled or difficult communication channels. Encourage a discussion around the following questions:

• Do you think Onnie’s mother could talk directly to the uncle about family matters?

• Who do you think Onnie’s sister would go to if she needed support?

• Do you think the family would ever sit together to discuss family issues?

SisterBrother

FatherMother

Uncle

Onnie

SisterBrother

FatherMother

Uncle

Onnie


Part II: Family SupportUsing Onnie’s case study, discuss the needs and expectations that family members have of each other and how these can make or break family relationships. Explore the material and non-material needs and the expectations that arise both in biological as well as in families of choice.

Divide the participants into small groups of four or five and provide them with chart papers and markers. Display the slides titled ‘Onnie’s family expectation’ from the PowerPoint presentation ‘Family Support’ and ask each group to list the possible material and non-material needs and expectations that each member of the family may have of Onnie.

After they have done so, ask participants to list possible material and non-material needs and expectations that Onnie may have from each of the family members. Ask them to share their findings in the larger group, writing down key words from their responses in the diagram on the whiteboard.

Discuss Onnie’s support needs and ask the participants what they think the family members can do for him. Similarly, discuss the family’s support needs, and ask the participants what they think Onnie can do for the family. Discuss how Onnie’s family members, either as individuals or as a group, can act both as a source of support as well as distress.

Part III: Other Sources of SupportDraw large circles around the smaller ones in the scenarios depicted above, and describe how family is one of many support mechanisms (social circles) that an individual is a part of. With the participants working in the same groups, ask them to identify and draw other social circles that Onnie may have or has had in the past. Ask the group to present their findings, ensuring that the following key social circles are covered:

• Family;

• Neighbours;

• Relatives;

• Colleagues at work;

• School/college;

• Friends; and

• Community (friends from community).

Discuss how each social circle may be a source of support or distress to Onnie.

Explore how families can:•Offerprotectionfrom

stress, both financial and psycho-social;

•Beasourceofsustenance;

•Providesupportintimesofcrises;

•Helpwithresourcessuchas money, property, food, etc.; and

•Providememberswithasense of social identity.

Note to FacilitatorIf time permits, manipulate the size/location of the circles in the diagram to also discuss how there could be an overlap, for instance, a family member acting as a friend or a work colleague as part of the friends circle.

Explain how circles that have more influence (‘power’) over Onnie can prove to be the greatest source of support.


Activity 3: Introduction to Disclosure

Time 45 minutes


• Understand the pressures that a person may endure when disclosing his/her sexual orientation or gender identity.

Materials N/A

Audio-visual Support Refer to the slides titled ‘Onnie’s social circle’ from the PowerPoint presentation ‘Family Support’.


Methodology Tell the participants that Onnie goes to the counsellor’s office and tells the counsellor that he is in a dilemma: he cannot continue to keep his sexual identity/gender orientation a secret any longer.

Refer to the slides titled ‘Onnie’s social circle’ from the PowerPoint presentation ‘Family Support’ and ask the participants to discuss the following:

Why do you think Onnie feels the need to ‘come out’? Discuss all possible internal and external pressures that may be compelling him.

• How important do you think it is for an MTH individual to accept one’s own sexual/gender identity before disclosing to others?

• Given that Onnie had already started cross-dressing in public, why do you think it was easier for him to ‘come out’ in a public space rather than to his family?

• Do you think Onnie would have disclosed (or not disclosed) under the following circumstances:• If he was not a cross-dresser?• If he did not live with his family?• If he lived in Delhi or Mumbai, instead of a small town like Burdwan or

Gorapkhpur?• What if he were born into an American? Or Iranian family?

Ask the participants to consider the following:

• What if Onnie’s dilemmas about disclosure were not about sexual identity but about HIV status?

• What if Onnie had recently found that he was infected with HIV?

• What would be the possible internal and external pressures that could be compelling him to reveal his HIV status?

Remind the participants about Onnie’s family’s expectations about his marriage and discuss the following:

• How the issue of disclosure or ‘coming out’ is very pertinent in the context of an Indian family, as most young adults live with their biological family and share common family resources.

• How it is relevant in a society where there is an emphasis on marriage and procreation, where the expected gender roles for men are strongly embedded and where inheritance is closely linked to procreation.

Note to FacilitatorIt is critical for participants to understand that disclosure is only a choice, and it is normal for an individual to choose NOT to disclose their sexual choices, gender orientation or HIV status to others.

To disclose or not to do so is an individual’s choice, and the role of the counsellor should be to facilitate the client’s decision-making process.


• How it is common to expect men to carry the burden of maintaining the family lineage, which often results in members of the MTH groups being put under pressure to marry and/or, if they are already married, lead double lives.

• How in some cases, disclosure is accidental, where families or significant others may find out about a person’s sexual orientation, and that individual may be ostracised or worse.

• How disclosure for transgenders and hijras may be different from that of lesbian/gay/bisexual individuals, especially in the Indian society where there is a social presence of transgenders.

Sum up the discussion by ensuring that the participants understand that disclosure varies for each individual. It is normal for some individuals to not disclose or inform others. Disclosure may mean different things to different people. For some, it is about talking of one’s sexuality, sexual preferences, and gender in a public space or platform like the media or work place. For others, disclosure is a private matter, in which one comes out to people close to them.

A transgender person makes a ‘disclosure’ of gender expression to society when she decides to move around in attire of the gender opposite to their birth gender. Some transgenders may only cross-dress when in certain parts of their cities or towns when with other transgenders and dress as per their birth genders when in or near areas where their biological families live.

Disclosure may be made at early or later stages of life; it depends on when the person feels comfortable about disclosing. Some lesbian/gay/bisexual/transgender people disclosing their sexuality, sexual preference, and gender at a relatively younger age. For others, disclosure is made at later stages of life.

Disclosure also depends on the types of support one is likely to get, which can be in the form of social support, legal, or financial support, to name a few.

Disclosure is situational and depends not only on the place where the individual lives but also on the social circle she/he moves in. For example, a person may be more comfortable moving in lesbian/gay/bisexual/transgender groups or may have partners in a geographical location where she/he is not known, e.g. in cities other than their place of residence or work. Gradually, as they become comfortable with themselves and their sexuality, they may start moving in lesbian/gay/bisexual/transgender circles in their home town as well. However, some people live their entire lives without disclosing their identity to others or by only disclosing it very selectively.


Activity 4: Consequences of Disclosure

Time 50 minutes


• Articulate the consequences of disclosing a person’s HIV status or identity/gender/sexuality;

• Evaluate the pros and cons of disclosure; and

• Articulate the importance of counselling and the role of a counsellor in disclosure.

Materials N/A



Methodology

Part I: Understanding the Consequences of Disclosure Divide the participants into three groups and ask them to list their answers to the following questions:

• Ask the first group: ‘What does Onnie hope to gain by disclosing to his family?’

• Ask the second group: ‘What does Onnie fear he may lose by disclosing to his family?’

• Ask the third group: ‘What changes in life may Onnie have to make regardless of his family’s reactions to disclosure?’

Ask the participants to review Onnie and his family’s needs and expectations of each other while doing the exercise.

Draw three columns on the whiteboard. Label them ‘Gains’, ‘Losses’, and ‘Life changes regardless of family’s reactions’. As participants from each group share their responses, write them down under the respective columns.

Some responses that you may expect:

• Gains: Better mental health, self-confidence, increased support from family, friends, colleagues, decreased pressure to marry, less pressure/ridicule at work, greater freedom, and better sense of security;

• Losses: Loss of existing social support, loss of job opportunities/financial losses, increased pressure to marry, possible exposure to conversion treatments, and loss of inheritance; and

• Life changes regardless of family’s reactions: Relocating to new locations, looking for new jobs/opportunities, and replacing family support with other social circles or families.

Ask participants to consider whether the gains outweigh the losses. If they find it difficult to come to a conclusion, ask them to assign scores to each item on the list, giving a positive score for each gain and a negative score for each loss.

Note to FacilitatorConsequences of disclosure will depend on how close-knit the family is: whether the member is an important or sole bread-winner; whether she/he is financially dependent; and whether she/he is the only child.

Remind the participants that though other circles may seem appropriate and less stressful for disclosure than families, they also pose problems. For example:

• A transgender may find the members of a social circle that she/he is ‘coming out’ to are either not effeminate enough or too effeminate for his/her liking;

• Somebody who identifies himself as gay and wants to disclose may not be comfortable with the kothi culture he discovers in the social circle in which he comes out; or

• Disclosure in a heterosexual group of friends may risk alienation or even loss of friends, as many of them may not understand issues related to sexuality and gender.


Ask them to similarly score the items in the ‘Life changes regardless of family’s reactions’, telling them to decide for themselves whether to give an item a positive or negative score. Remind them that the scores are subjective and could differ depending on the perspective of the person scoring. Ask them to imagine that they were in Onnie’s situation: would they like to change the scores?

Remind them that the impact of the inevitable life changes that would occur – regardless of the other consequences and whether these would get positive or negative scores – would depend on a number of factors, including Onnie’s outlook towards life, availability of support and other factors.

Discuss whether the consequences of disclosure to other social groups would be similar to that of disclosing to the family. Point out to participants that disclosing in one social circle may have consequences both positive and negative in other spheres of life as well. For instance, disclosure may cause strained relationships within Onnie’s family that may affect his ability to concentrate at work, which could have an impact on his productivity. On the other hand, a positive response from his family may encourage Onnie to further his prospects by making him more willing to take on new and challenging projects in his workplace or seeking a better job.

Discuss which situation in more difficult: coming out to the family or coming out in the workplace. Discuss whether the consequences of disclosure of HIV status would be similar to the consequences of disclosing sexual orientation or gender identity. Discuss the positive and negative consequences of disclosure on the care, support and treatment services s/he receives if the person is living with HIV.

Additional Topics for DiscussionExplore the ‘what if’ scenarios, such as:

• What if Onnie were the only child in the family? (Tip: Explain how it may be more difficult for an MTH person who wants to disclose if he or she is the only child in a family as parental and familial expectations may be more intense than in families with more than one child).

• What if Onnie were the only male child in the family? (Tip: Explain how it is more difficult for an MTH person who wants to disclose if he is the only male child as he faces parental expectations of marriage and procreation).

• What if Onnie were a student and not earning any money? (Tip: Explain the importance of financial stability in influencing one’s decision to disclose because financial dependence on the family may delay one’s decision).

• How does the social status of the family affect disclosure? (Tip: Ask participants to discuss how their family’s social status would have affected their decision to disclose as it may affect the reputation of the family and why there may be pressure on the MTH person to hold back or postpone the decision to disclose).

• Ask the participants if they have faced situations in the past when someone (including parents, brother, sister, etc.) has stood up for a person and risked familial and social censure. For example, ask them if their parents supported an out-of-caste, an inter-religious or a love marriage in the family that does not fit the norms of the larger family.

• How does access to other social support systems (MSM/transgender groups, and community organisations) affect the process of disclosure? (Tip: Explain how it is sometimes important for MTH individuals to ensure that social support systems are at hand at the time of disclosure. The support could come from a willing friend or MSM/TG groups who can stand up for their fellow MTH community members).


• Are the dilemmas different depending on whether the person disclosing is an MSM, a transgender or a hijra? If so, what could be the differences?

• What are the considerations for transgender persons who want to disclose? (Tip: Explain why it is important for transgender persons to decide if and when to come out to their biological family members and also how and when to discuss sexual reassignment surgery, if they are considering this option.

Part II: Role of the Counsellor Ask participants what they think should be the role of a counsellor or an ORW in the process of disclosure. Reiterate that the decision to disclose is purely an individual’s choice and that counsellors and ORWs cannot rush or influence the person’s decision.

Ask two volunteers to enact a small role-play in which one of them plays the role of a counsellor and the other that of a client who has come to the counsellor for reassurance and is seeking help on disclosure. Ask the person playing the role of the client to act anxious about disclosure, as described below:

• ‘I am so confused; should I tell my family or not?’

• ‘I am so afraid; tell me if everything will be alright?’

• ‘What would you do if you were in this position?’

• ‘How do you think my father will react?’

During the role-play, ensure that the counsellor makes supportive, reflective statements that encourage the client to examine his/her situation but do not give false assurances or evaluations and do not make any judgments of the client.2

2 The participants will undergo Mental Health in Module D3, wherein they will learn about the interviewing skills necessary for counselling.

Note to FacilitatorThe Role of the Counsellor

• Help the person assess whether he has come to terms with his sexual identity and feels that he can deal with the consequences of his decision to disclose or not.

• Help individuals evaluate their situation and make informed decisions, and provide a safe space for dialogue in which all facets of disclosure and non-disclosure can be thoroughly examined. This includes helping them examine whether the anticipated consequences, positive or negative, are realistic or not.

• Help individuals prepare for the reactions they may face, and prepare them to deal with these reactions in an affirmative, non-confrontational manner. Counsellors could even role-play with the clients to practice their responses to anticipated reactions from their families.


Activity 5: Planning for Disclosure

Time 50 minutes


• Understand the steps in the process of deciding who to disclose to, how and when; and

• Identify various forms of support that are available at the time of disclosure.

Materials N/A

Audio-visual Support Refer to the slides titled ‘Who should I tell first?’ from the PowerPoint presentation ‘Family Support’.


Methodology

Part I: Deciding Who, How, and When to Disclose? Ask the participants to assume that Onnie has decided to disclose to his family and ask what they think are the factors that will minimise Onnie’s and his family’s distress:

• What should Onnie disclose–his sexual orientation or his gender identity, or both?

• Would it be better for Onnie to tell the whole family in a single sitting or one by one?

• When would be the best time to do so?

• What should Onnie say?

Using the slides titled ‘Who should I tell first’ from the PowerPoint presentation ‘Family Support’ ask the participants to place Onnie’s family in appropriate quadrants of the matrix, based on the level of ease and the degree of importance that coming out to these people would mean to Onnie.

For example, it would be important but very difficult to disclose to his uncle, while coming out to his brother would be relatively easy but not as important. Coming out to his sister would be easy and important, as she could be an ally when disclosing to his parents.

Apply the above mentioned scenarios (who to disclose to, how and when) for Onnie’s other social circles.

Note to FacilitatorThe person disclosing should ask themselves the following:

• Have I decided who first to disclose to, and when and where?

• Have I decided how to start the conversation?

• Have I thought about how they may react and how I should respond?

• What if someone turns violent? Do I have a place to turn to for safety?

• Am I prepared for the worst case scenario? What if my family throws me out? Do I have a place to stay?

• Have I got at least one friend who can support me in the process and protect/shelter me?

• Have I got enough information to provide my family with answers to their questions on homosexuality?


Part II: Planning for SupportDivide the participants into four groups and ask each group to work on the following questions:

• What kind of support would Onnie need in the period before the actual disclosure (pre-disclosure)?

• What kind of support would Onnie need when he discloses to his family?

• What kind of support would Onnie need in the long-term if he gets very little or no support from his family?

Ask the groups to share their findings, listing their responses on the whiteboard. Ensure that their responses cover the need for emotional, financial and physical support. Ask participants to discuss the following:

• Where can Onnie look for alternate support and how should he go about acquiring this support? Use the diagram of various social circles to brainstorm about the kind of support these social circles can offer: • Family: shelter, emotional security, financial support, and looking after health

needs;• Colleagues: emotional and moral support; • Friends: emotional and financial support; and• Community support: shelter, economic, moral and emotional support.

Note to FacilitatorWhile it is difficult to define ‘support’, the term has profound implications on the physical and emotional well-being of an individual, especially for members of MTH communities who may be facing stigma at various levels. Having people and especially family-support is crucial.

This session explores the meaning of support and discusses how CBOs and CBO staff can think of innovative means of expanding support systems to members of MTH, as well as their families and friends. You should aim at covering the following issues:

• Understanding the importance and benefits of support;

• Assessing various forms of support available to MTH individuals; and

• Creating new avenues of support for sexual minority?


Activity 6: Impact of Disclosure on Families

Time 40 minutes


• Understand how families cope with disclosure;

• Articulate the different stages of coping with the disclosure to the family; and

• Understand the need for supporting the family through disclosure.

Materials N/A

Audio-visual Support Refer to the slides from those titled ‘Reactions to disclosure’ to ‘Coping Cycle’ from the PowerPoint presentation ‘Family Support’.

Take-home Material Annexure 1 titled ‘Frequently asked questions by family members when their children come out’.

Printouts of the Powerpoint slide titled ‘Reactions to disclosure’.

Methodology

Part I: How will the family react to disclosure? With the help of thought-bubbles provided in the printouts of PowerPoint slides titled ‘Reactions to disclosure’, ask the participants what, they think are the different kinds of reactions that Onnie can expect from his family after disclosure, both individually and collectively. Alternately, consider small role-plays in which participants can act as family members who react to Onnie’s disclosure.

Refer to the family’s expectations of Onnie (elicited in a previous activity) and map each family member’s reactions to what she/he could lose by Onnie’s disclosure. Display the slides titled ‘Coping Cycle’.

Link some of the family’s reactions to the coping framework. Explain that this is a broad framework, and different families react differently when an MTH person chooses to disclose to them. Explain how these reactions change over a period of time and how family members go through various stages of coping with the news before they are able to accept their family member’s sexual orientation.

Stages of Coping

Denial Discuss possible denial reactions that can come from a family. Explain how family members can deny that people of alternate sexuality or gender exist and how denial can come in the form of avoidance of any conversation or dialogue around issues of sexuality, sexual orientation or gender.

AngerExplain how some family members may express anger that could be attributed to many reasons, ranging from homophobia or transphobia to fears hurting the reputation of their family to a sudden feeling of loss.

Note to FacilitatorDuring this session, participants need to consider Onnie’s disclosure from his family’s perspective.

It is important that the trainees empathise with the family members as well, not just with Onnie.


Violence Remind the participants how anger sometimes could also escalate to a crisis situation, resulting in physical violence. (Inform participants that issues of violence and abuse will be dealt in Module D2 which is on Trauma and Violence).

Bargaining Describe how some families in an attempt to reconcile with their family member’s sexual orientation may suggest strategies to keep ‘everyone happy.’ For example, parents could propose that their son marry a girl (to keep their honour intact) and continue to see his male partners in a clandestine fashion (to keep the son happy).

Despair Describe how despair is a common reaction that manifests differently in families. Explain how it manifests at a physical level (as unexplained aches and pains, headaches, feeling sick repetitively, and loss of appetite) and at a psychological level (as sadness and anxiety).

Acceptance Reiterate how acceptance of one’s sexual orientation by their family members is a gradual process. Explain how:

• The pace of the process of acceptance is different for different families; and

• Acceptance does not necessarily follow a linear pattern.

Review Onnie’s family’s reactions as elicited during the role-play, and ask participants to examine how these fit into the ‘Coping Cycle’. Discuss ‘marriage’ as a strategy often used by families to diffuse the fallout of disclosure. Read out the following scenario:

Imagine that at some point in the future, Onnie discloses to his mother, who seemed to accept this calmly. However, she passes many marriage proposals his way to coax him to get married. Onnie refuses to meet the girls and is confronted by his father about it and for his decision to not get married. The confrontation results in an altercation between Onnie and his father.

In the course of the altercation, Onnie’s mother tells his father about Onnie’s sexual orientation. This infuriates Onnie’s father and confirms his fears; in the past, his father had suspected that ‘something was wrong with Onnie’ when he came across condoms and reading material on sex and condoms in Onnie’s office bag. Onnie’s father blames the CBO for having a ‘bad’ influence on him. Onnie’s mother tries to pacify his father by saying that this is just a phase in their son’s life and that he will grow out of these habits once he is married.

When Onnie breaks down, his mother pacifies him by saying that he could meet men secretly until he gets married and assures him that she will find him a suitable bride.

Pose the following questions to initiate a discussion:

• Is Onnie’s mother in denial?

• Is she trying to strike a bargain?

• How should Onnie respond to his mother?


Part II: Support for the Family Start the session by eliciting answers to the following questions:

• Do you think Onnie’s family needs support?

• What impact could Onnie’s disclosure have on his family?

• What resources do CBOs have or can create to support families?

• What do you think are the options to support Onnie’s family, both within the programme and otherwise?

Initiate a small brainstorming exercise in which the group makes a list of possible interventions for family members. Ensure that the following points are covered during the session:

• Value of family support groups for parents, facilitated by counsellors;

• Maintaining a record of families who know about their child’s sexual orientation and have coped well, and who can help other families with children who have recently disclosed;

• Development of specific IEC materials for families;

• Importance of home visits to ensure that families, especially parents, are coping well; and

• Importance of helping MTH individuals communicate with parents in the post-disclosure period and help parents deal with societal and familial censure and other pressures they may be facing.

Distribute copies of ‘Frequently asked questions by family members when their children come out’ to each participant.

Note to FacilitatorDiscuss why it is important to support families of MTH individuals who have decided to disclose. Explain:

• How a family faces multiple dilemmas and questions when confronted with the situation of a family member with alternate sexuality. Describe how family member/s feel isolated and suddenly burdened with the idea of carrying a ‘secret’ with them that needs to be concealed from their extended family;

• How parents of MTH individuals have to think of ways and means of dealing with stigma from others, if their child reveals her/his sexual orientation publicly. At an individual level, many parents may begin isolating themselves from family functions, such as weddings and

family gatherings, as they may fear facing other relatives who do not know about their child. Commonly, mothers face questions about why their child is not married or continually turns down marriage proposals and as a result gradually withdraw from social settings to avoid difficult questions;

• How there is a sense of isolation felt by the parents that has psychological and physical consequences; they feel pressure to keep a secret and at the same time have to deal with a new image of their son/daughter; and

• How support provided to the family during such times will ensure greater acceptance of their child and will help them feel less isolated.


Activity 7: Basics of Family Counselling

Time 1 hour


• Understand the key elements of family counselling in the context of a family member’s disclosure of sexual orientation or gender identity.

Materials N/A



Methodology Note: Although ORWs and peer educators are trained on family counselling, it is advisable that family counselling is conducted only by a trained counsellor. Introduce the concept of family counselling by briefly explaining how it is a special kind of group counselling, which involves counselling more than one family member in a joint session. The focus of the session is on modifying the interplay of various factors within the family system. Thus, it enhances the functioning of the family as a unit and/or functioning of its individual members.

An important goal of family counselling is to help a family cope with a member’s sexual orientation vis-à-vis their expectations from the individual, to discuss issues of stigma that the family could anticipate, and to help them cope with their own emotions.

Develop various scenarios by asking participants to brainstorm on when, where and why they (as staff of the CBO working with the MTH community) may have to intervene with a family post-disclosure and with which family member. Select a post-disclosure scenario and discuss the following issues:

• How is family counselling different from individual counselling?

• What should be the goal of counselling Onnie’s family?

• Is the goal of counselling the family in best interest of Onnie?

• What should the counsellor know about family dynamics in order to help Onnie?

• How can the counsellor address the concerns of each member of the family without compromising Onnie’s wellbeing?

• What should the counsellor do/say if a fight breaks out between family members?

• How should the counsellor react if the family makes him/her an object of their distress?

• What should a counsellor do if Onnie has been subjected to physical abuse by his family?

Ask participants to consider the following scenarios from the point of view of counselling. Ask them what a counsellor should do if the family says any/all of the following:

• I know this is an illness he’s got. If he gets married, everything will be alright.

• Please tell me my son will be cured, right?

• What will the neighbours say to this public shame my son has brought upon us?

• People like you (counsellor, ORW, etc.) and your organisation are responsible for

Key Messages

• Families go through various emotions when they find out about a loved one’s sexual orientation.

• Families need space to be heard.

• Being patient is important.

• Families take time to accept the sexual orientation of their family member

• The goal of counselling is to facilitate dialogue between an MTH individual and her/his family and to clarify misconceptions regarding homosexuality.

• Gently help family members re-adjust/re-negotiate their expectations of a member from the MTH community.

Note to FacilitatorRemind participants that they need to follow the principles of group counselling (as discussed in Module C3 on Mental Health) when dealing with families.


this.

• You please leave my house; I will not talk to you.

• I am not feeling too well. I am having pain in my chest, and I cannot deal with this anymore.

• I feel so depressed, can you help me?

• I refuse to call him Anita; he will remain Onnie to me, forever!

Through small role-plays, explore scenarios where the counsellor offers support to family members and encourages them to be supportive of Onnie. Ensure that the counsellor’s responses are supportive and reflective, and not evaluative, interpretative or confrontational.

Do’s and Don’ts of Counselling

Do Do not

• Set certain ground rules: no violence and verbal or physical abuse during counselling.

• Schedule enough time. Very often, family members need to ventilate their emotions. Give them enough time and safe space to express themselves.

• Maintain confidentiality: do not accidentally disclose your client to other family members who may not be aware of the client’s sexual orientation.

• Do not take sides with one or more of the family members or the client. Rather, be a facilitator of a dialogue between family members and your client.

• Do not get into an argument with family members of the client during counselling.

How to conduct a family sessionCounsellors should do the following:

• Observe the family’s dynamics:• How the family communicates with each other: find out who makes most

decisions, who follows (or does not follow) the decisions, and what happens when one member does not follow decisions;

• Different emotions, patterns of dominance and submission, roles played by family members and communication styles. Also, observe whether these patterns are rigid or relatively flexible;

• Try to recognise who is the submissive or dominant person in the family and who is the most valued person in the family; and

• Try to understand patterns of relationships within the family, such as who supports whom, who is perceived as being rigid, and who is the peacemaker in the family. Understanding relationship patterns is important while dealing with issues around disclosure. For example, very often a family member who could be sympathetic to your client may be outside of the immediate family circle, such as a cousin or an aunt.

• Counsellors may make occasional comments or remarks intended to help family members become more conscious of patterns or structures that had previously been taken for granted, but refrain from sounding judgmental;


• Use a problem-solving approach when dealing with families:

• Understand expectations of family members, especially from your client, and gauge how these expectations can be negotiated. (For example, a father insisting that his gay son can see other ‘friends,’ but cannot attend parties or be seen around with his friends);

• Ask the family to recall situations where the family faced a crisis or an unusual situation and how the family reacted to this situation; and

• Explore ways in which family members can be supportive. (For example, by not depriving the MTH person of the family his/her rights of inheritance);

• Be empathetic with family members. It is not easy for families to accept their children as having a sexual or gender identity different from the one they expected them to have. Give examples of families who have gone through similar experiences and share the process;

• Be ready to deal with the reactions to disclosure as mentioned above (shock, denial, anger, bargaining, blaming, despair, etc.) and give space to family members to normalise these reactions as being natural consequences upon receiving unexpected (in most cases negative) news. Sometimes negative reactions can even be directed towards the counsellors;

• Counsellors need to be well-prepared with reading materials, handouts and other resources to share with family members;

• Most often one session may not be enough, so make sure you follow-up with the family and make yourself accessible to family members; and

• Last, but most important, congratulate the family members for making an effort to seek more information.


Activity 8: Wrap-up

Time 45 minutes


• Be able to apply the decision-making processes discussed in the earlier sessions to other scenarios of disclosure, such as disclosing to female partners, disclosing in the workplace, disclosing HIV status, etc.

Materials N/A



Methodology Summarise the decision-making process learnt so far and point out that the steps given below are applicable to all social groups:

• Exploring consequences;

• Evaluating consequences;

• Deciding who to disclose to, how and when;

• Preparing for consequences of disclosure; and

• Assessing and accessing post-disclosure support.

Divide the participants into three groups and ask them to discuss Onnie’s disclosure to other social groups:

Group 1: Disclosure to workplace colleagues (assuming Onnie was not working in the CBO);

Group 2: Disclosure to heterosexual friends (make this a local club where Onnie is the carrom champion); and

Group 3: Disclosure in a public space.

During the exercise, ensure that the groups are following the decision-making process discussed in earlier activities. Ask each group to select a spokesperson to play the role of Onnie. S/he can then share their observations with the larger group.

The spokesperson should address the audience in the first person, as in ‘I, Onnie, wanted to tell my office... I thought about the consequences… The positives were...’ and so on. Allow the other participants to make observations and provide feedback, and at the end of each presentation, ask the presenter how s/he felt about Onnie’s decision.


Annexure 1: Frequently Asked Questions by Family Members When Their Children Come OutSource: www.orinam.net, www.pflag.com

1. How are sexual orientation and gender identity determined? (OR) Is it my fault that my son/daughter is gay? (Or) Did I fail as a parent?

It is never anyone’s ‘fault’ if they or their loved one grow up to be lesbian/gay/bisexual/TG (LGBT). Please don’t feel guilty, it is certainly not your fault.

No one knows exactly how sexual orientation and gender identity are determined. However, experts agree that it is a complicated matter of genetics, biology, psychological and social factors. For most people, sexual orientation and gender identity are shaped at any early age. While research has not determined a cause, homosexuality and gender variance are not the result of any one factor like parenting or past experiences.

2. Is there something wrong with being gay, lesbian, bisexual or TG?

No. There have been people in all cultures and times throughout human history who have identified themselves as LGBT. Homosexuality is not an illness or a disorder, a fact that is agreed upon by both the American Psychological Association and the American Psychiatric Association. Homosexuality was removed from the Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association in 1973. World Health Organization (WHO) removed it in 1981. Being transgender or gender variant is not a disorder either, although Gender Identity Dysphoria (GID) is still listed in the DSM of the American Psychiatric Association. Being LGBT is as much a human variation as being left-handed – a person’s sexual orientation and gender identity are just another piece of who they are. There is nothing wrong with being LGBT – in fact, there’s a lot to celebrate.

3. Can gay people change their sexual orientation or gender identity?

No, and efforts to do so aren’t just unnecessary they’re damaging.

Religious and secular organizations do sponsor campaigns and studies claiming that LGBT people can change their sexual orientation or gender identity because there is something wrong. We believe that it is our anti-LGBT attitudes, laws and policies that need to change, not our LGBT loved ones.

These studies and campaigns suggesting that LGBT people can change are based on ideological biases and not peer-reviewed solid science. No studies show proven long-term changes in gay or TG people, and many reported changes are based solely on behaviour and not a person’s actual self-identity. The American Psychological Association has stated that scientific evidence shows that reparative therapy (therapy which claims to change LGBT people) does not work and that it can do more harm than good.

4. How does someone know they are gay, lesbian, bisexual or transgender?

Some people say that they have ‘felt different’ or knew they were attracted to people of the same sex from the time they were very young. Some TG people talk about feeling from an early age that their gender identity did not match parental and social expectations. Others do not figure out their sexual orientation or gender identity until they are adolescents or adults. Often it can take a while for people to put a label to their feelings, or people’s feelings may change over time.

http://www.orinam.net

http://www.pflag.com


Understanding our sexuality and gender can be a lifelong process, and people shouldn’t worry about labelling themselves right away. However, with positive images of LGBT people more readily available, it is becoming easier for people to identify their feelings and come out at earlier ages. People don’t have to be sexually active to know their sexual orientation – feelings and emotions are as much a part of one’s identity. The short answer is that you’ll know when you know.

5. If one could perceive their sexual orientation/identity at a young age, why did not my son/daughter talk about it to me?

There could be several (and unique) factors/reasons why a child may not discuss his/her sexual attraction/orientation with his/her parents. A critical factor might be the relationship a parents and a child share; in some families it’s very open; in some it’s strict and disciplinarian in nature. In addition to that, there is a general trend among Indian parents to not talk about sex, let alone sexual orientation, with their children. Active avoidance of such an important topic might make the children uncomfortable in discussing this with their parents.

For example imagine if you have a son who is attracted towards a girl. Do you think you would feel uncomfortable if he would like to discuss about it with you? If your answer is yes, then you can then imagine how much harder it would be for your son to talk about his attraction to another boy rather than to a girl.

6. Should I talk to a loved one about his or her sexual orientation or gender identity before the person talks to me?

It’s seldom appropriate to ask a person, ‘Are you gay?’ Your perception of another person’s sexual orientation (gay or straight) or gender identity (male or female) is not necessarily what it appears.

No one can know for sure unless the person has actually declared that they are gay, straight, bisexual, or transgender. We recommend creating a safe space by showing your support of LGBT issues on a non-personal level. For example, take an interest in openly discussing and learning about challenges, struggles and issues faced by LGBT people. Learn about LGBT communities and culture. Come out as an ally, regardless of whether your friend or loved one is LGBT.

7. Did my son/daughter become gay/lesbian because he/she travelled or moved abroad (eg. USA, Britain, Europe, Australia)?

One’s sexual orientation is not dependant on one’s visit or stay abroad. The American Association of Pediatrics (and other leading science/health professional organizations) opine that sexual orientation is probably not determined by any one factor, but by a combination of genetic, hormonal, and environmental influences right as a foetus in the womb of the mother; definitely not due to traveling abroad. (http://aappolicy.aappublications.org/cgi/reprint/pediatrics;113/6/1827.pdf)

Hence this notion that your son/daughter became gay because of going abroad does not have any rational scientific reasoning. The reasons why they could have ‘come-out’ to you after going abroad could be several, like the following:

1. Your son/daughter might have attained the emotional maturity to share their deepest feelings only then.

2. Due to their education and professional exposure they might have gained the self-confidence to talk about it.


3. Modern democracies (like USA, Australia, Europe) have a strong record in human rights where sexual minorities have obtained social and legal recognition, including marriage rights, adoption rights, etc. This could have given your son/daughter the hope and dignity to be themselves.

In summary, there could be several reasons. Irrespective of the reason, you should feel happy and proud that your son/daughter is more confident and is trying to stand up for himself or herself. You should feel proud that you gave the necessary ethical values/lessons while they were growing up, to be confident and honest about themselves.

8. How do same-sex partners have physical intimacy? How is this possible? It’s very disgusting to think about it!

Same-sex partners have physical intimacy in many ways. We suggest that you talk about it to an LGBT friendly counsellor/doctor who might be able to point you in the right direction (e.g. websites, brochures etc.).

Some pointers for you:

-There is nothing to feel embarrassed/disgusted about this. This feeling of disgust is usually borne out of lack of knowledge.

- Have you ever wondered how your heterosexual son/daughter/family members have physical intimacy in their marriages? Just like them, your gay son/daughter sometimes could find these questions very private and intimate. However you could cautiously choose to ask appropriate questions on these topics to your gay son/daughter.

-When your gay son/daughter is in love with his/her partner, their relationship is not merely physical. Just like your love for your husband/wife is multi-dimensional encompassing emotional, spiritual, financial and physical intimacy, so would your gay son/daughter have the same kind of intimacy with his/her partner. Never equate their intimacy with their partners as only lust, as it can be very hurtful and judgmental for them.

9. If my son/daughter marries, will that change his/her sexual orientation?

Marriage, which usually in Indian culture is overtly attributed to solve problems, will not work in this context. Several gay men/women have are routinely pressurised by their families and the general society to marry the person of opposite sex. There have also been cases where misled parents have paid huge monies to Swamis/black magicians to ‘change’ their gay son/daughter.

Your gay son/daughter marrying a person of the opposite sex will cause severe emotional trauma to not only the ‘married’ couple but their extended families. These couples due to their emotional and physical incompatibility will be emotionally broken leading to unwanted divorces. Lately several courts in India have compensated divorcing women (who have been duped to marry gay men) with several lakhs of rupees.

If you ever feel pressurised due to society’s compulsion ask yourself, would you let one of your heterosexual daughters marry a known gay man and throw her life into disarray? The more gay men/women are allowed to be themselves (and choose their own partners), the fewer the unwanted divorces and lesser the emotional trauma suffered by everyone in the family.


10. I am able to accept my son/daughter. But how do I deal with relatives and the general society?

Just because your son/daughter ‘came-out’ to you, it does not imply that they are going to go on to rooftops to declare their sexual orientation. Please take time to sit down and talk in detail about this to your child. Chalk up a plan and decide whom you both are comfortable to be ‘out’. You can always take the help of an LGBT friendly counsellor who can help both you and your child in this direction.

One of the simple and easy ways to respond to relatives when confronted about your child’s marriage you could state: ‘He/she is currently not interested in marriage and as a parent I think he/she is mature enough to tell me when he/she is ready.’

There is one important emotional pointer to be understood about your gay son/daughter. Your son/daughter could have had years and years (sometimes decades) of pent up frustration for having to hide who they truly are and that could have caused them even irreparable emotional trauma. Some of them hence might decide that they don’t have to go through the same kind of pain and decide that they would rather be ‘out’ to everyone. Even though it might be a huge task for you, you should try to support and empathise with your child’s feelings and wishes.

With human rights and equality being the hallmark for democracies like India, you might be pleasantly surprised that there is lot of awareness of who gay people are. Recently in June 2009, Delhi High Court declared that discrimination based on sexual orientation is illegal and unconstitutional. Such legal, political and media support has improved our society’s understanding of LGBT people and it is growing more tolerant.

11. I would like my son/daughter to have a marriage, family and children. I am apprehensive who might take care of him/her in their old age.

Your wishes and apprehension are valid concern for many parents. Why do you want your children to be married? Your response would usually be that you would like to see your children happy with all comforts as you might know. You could claim that it is your way of attaining happiness which you think would work for them too. But have you ever wondered or asked your children if they would also derive the same satisfaction and fulfillment in life by ‘marrying’?

Not everyone gets married, nor everyone who gets married has kids, nor all parents who have kids end up having kids who take care of them in old age. These are eternal truths of our humankind. There is another truth too: gay/transgender people do get married with their loved ones, adopt and raise kids and have a fulfilling retirement life. However this usually happens in liberal democratic societies (e.g. US, Europe, etc.) and it is unfortunate that it does not happen often in India.

Countries around the globe like Spain, South Africa, Canada, Belgium, Norway, etc., provide legal and social structures for gay marriage, adoption, immigration, pension benefits, and other family-raising incentives. Huge strides have been made for the equality and dignity of LGBT families across the world, including India. As any social taboo takes years to be removed (e.g., untouchability, women’s inequality) and rectified, so does it take time to remove misunderstandings of who LGBT’s are.

Do not despair, Indian society is growing more tolerant and understanding in this modern era. Please support and embrace your gay son/daughter just like thousands of other Indian parents have done in their struggle for equality.


Annexure 2: PowerPoint Presentation – Family Support


Notes








population status.








module

C

module

A

module

C

module

D




module



C2 Family Support

C3 Mental Health





D3 Positive Living





C2 F

amily

Sup

port

C3 M

enta

l Hea

lth

Facilitator Guide

Mental Health

C3

Pehchan 1C3 Facilitator Guide: Mental Health


About Pehchan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2


Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3


Module Acknowledgments: Mental Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

About the Mental Health Module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Module Reference Materials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Activity Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Activity 1: Understanding Mental Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Activity 2: Identifying Mental Health Problems and Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Activity 3: Mental Health and the MTH Community . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Activity 4: Introduction to Counselling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

Activity 5: Counselling Skills: Building a Foundation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

Activity 6: Counselling Skills: Listening to the Client’s Story . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

Activity 7: Counselling Skills: Helping Clients Explore their Stories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

Activity 8: Counselling Skills: Helping Client Explore Options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

Activity 9: Counselling Skills: Helping Clients Make a Plan, Reviewing, and Terminating . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

Activity 10: Dealing with the Risk of Harm to Self or Others. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

Activity 11: Wrap-up. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

Annexure 1: Ramesh’s Story . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

Annexure 2: Definitions of Health and Mental Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46

Annexure 3: Mental Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48

Annexure 4: Difference Between Poor Mental Health and Mental Disorders . . . . . . . . . . . . . . . 57

Annexure 5: Mental Health: What’s Normal, What’s Not . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61

Annexure 6: The Changing Status of Homosexuality vis-à-vis Mental Health . . . . . . . . . . . . . 65

Annexure 7: Counselling Cards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67

Annexure 8: Model of Counselling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68

Annexure 9: Building a Foundation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71

Annexure 10: Listening to the Client’s Story . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73

Annexure 11: Helping the Client Explore Their Story . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76

Annexure 12: Helping the Client Explore Option and Self-help Strategies for Successful Coping . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82

Annexure 13: Help Your Client Make a Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84

Annexure 14: Dealing with Suicide and Self-harm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86

Annexure 15: PowerPoint Presentation – Mental Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87

Pehchan2 C3 Facilitator Guide: Mental Health

About this ModuleThis module is designed to help training participants: 1) become familiar with basic concepts of counselling; 2) develop skills to form a support relationship with a programme client within an ethical framework; 3) increase awareness of common mental health concerns among men who have sex with men (MSM), transgenders and hijras; 4) build capacity to assess and provide basic psychosocial support; and 5) promote positive mental health. In the Pehchan programme, this module is used to introduce principles of family support to CBO Outreach Workers and Counsellors. This module is designed to help CBOs’ Counsellors and Outreach Workers to introduce the concept of Mental Health and the importance of psychosocial support.





Module Acknowledgments: Mental HealthEach component of the Pehchan Training Curriculum has a number of contributors who have provided specific inputs. For this component, the following are acknowledged:

Primary Author Monika Kumar, Manas Foundation


Technical Input Vahista Dastoor, C4D Consultant, Debjyoti Ghosh, SAATHII and Harjyot Khosa, India HIV/AIDS Alliance


References • Social determinants approaches to public health: From concept to practice. (2011)

Department of Ethics, Equity, Trade, and Human Rights Health (ETH).World Health Organization. Geneva.

• Mental health and development: Targeting people with mental health conditions as a vulnerable group. (2010). World Health Organization. Geneva.

• The ICD-10: Classification of Mental and Behavioural Disorders Clinical descriptions and diagnostic guidelines. (1993) World Health Organization. Geneva.

• What is Mental Ill Health? (2010) Mental Health Ireland. Dublin. Available on http://www.mentalhealthireland.ie/information/what-is-mental-ill-health.html

• An Introduction to Mental Health: A Faciltator’s Manual for Training Community Health Workers in India. (2009) The Nossal Institute for Global Health. University of Melbourne. Victoria.

• Basic Counselling Skills Participant Manual (Community Counsellor Training Kit). (2006) LifeLine/ChildLine. Namibia.

• It’s time for reform: Trans Health Issues in the International Classifications of Diseases: A report on the GATE Experts Meeting. (2011). Global Action for Trans Equality. The Hague.

• Mental health: What’s normal and what’s not. (2011). Mayo Foundation for Medical Education and Research. Arizona. Available on www.mayoclinic.com/health/mental-health/MH00042/

• Kustner, C.R. et al. (2011) Counselling theory and practice in South Africa: Participants’ manual. Anova Health Institute. Johannesburg.

• Peterson, C. (1995) Psychology of Abnormality. Saunders (W.B.) Co Ltd. Philadelphia.

• Hooker, E. (2003) Being gay is just as healthy as being straight. American Psychological Association. Washington DC.

• Hooker, E. (1957) The adjustment of the male overt homosexual. Journal of Projective Techniques. New York.

• Rosenhan, D.L. and Seligman, M.E.P. (1989) Abnormal Psychology. Second edition. W.W. Norton. New York.


• Gorrindo, T. (2010) Supporting Gay Youth as a Way to Prevent Suicide. American Psychiatric Association.

• Maslow, A. H. (1954) Motivation and personality. Harper and Row. New York.

• Jahoda, M. (1958) Current concepts of positive mental health. Basic Books Inc. Publishers. New York.


About the Mental Health Module

No. C3

Name Mental Health


• Counsellors

• Outreach Workers (ORWs)



• Understand the basic concepts of mental health and be able to recognise symptoms of mental disorders;

• Be able to articulate common mental health concerns in the MTH community and be able to respond appropriately to people experiencing symptoms of mental disorders; and

• Understand the basic concepts of counselling and the role of Pehchan personnel in helping persons with psycho-social problems.

Total Duration One and a half days. A day’s training typically covers 8 hours.





Audio-visual Support PowerPoint presentation ‘Mental Health’’.

Annexures Annexure 1: ‘Ramesh’s Story’. Annexure 2: ‘Definitions of Health and Mental Health’.Annexure 3: ‘Mental Disorders’.Annexure 4: ‘Difference between Poor Mental Health and Mental Disorders’.Annexure 5: ‘Mental Health: What’s Normal, What’s Not’.Annexure 6: ‘The Changing Status of Homosexuality vis-à-vis Mental Health’. Annexure 7: ‘Counselling Cards’.Annexure 8: ‘Model of Counselling’.Annexure 9: ‘Building a Foundation’.Annexure 10: ‘Listening to the Client’s Story’.Annexure 11: ‘Helping Clients Explore Their Story’.Annexure 12: ‘Helping Clients Explore Options and Self-help Strategies for Successful Coping’.Annexure 13: ‘Helping Clients Make a Plan’.Annexure 14: ‘Dealing with Suicide and Self-harm’.


Activity Index1

No. Activity Name


Take-home material

1 Understanding Mental Health

1 hour 30 minutes

Chart paper, markers

N/A Annexure 1: ‘Ramesh’s Story’ Annexure 2: ‘Definitions of Health and Mental Health’

2 Identifying Mental Health Problems and Disorders

1 hour 30 minutes

Refer to the slides titled ‘Signs and Symptoms of Poor Mental Health to Some Common and Severe Disorders’ from the PowerPoint Presentation ‘Mental Health’

Annexure 3: ‘Mental Disorders’Annexure 4: ‘Difference between Poor Mental Health and Mental Disorders’Annexure 5: ‘Mental Health: What’s Normal, What’s Not’

3 Mental Health and the MTH Community

1 hour Chart paper, markers

N/A Annexure 6: ‘Changing Status of Homosexuality vis-à-vis Mental Health’

4 Introduction to Counselling

45 minutes N/A N/A Annexure 7: ‘Counselling Cards’Annexure 8: ‘Model of Counselling’

5 Counselling Skills: Building a Foundation

1 hour N/A N/A Annexure 9: ‘Building a Foundation’

6 Counselling Skills: Listening to the Client’s Story

1 hour N/A N/A Annexure 10: ‘Listening to the Client’s Story’

7 Counselling Skills: Helping Clients Explore their Stories

1 hour N/A N/A Annexure 11 on ‘Helping Clients Explore their Story’

8 Counselling Skills: Helping Clients Explore Options

1 hour N/A N/A Annexure 12 on ‘Helping Clients Explore Options and Self-help Strategies for Successful Coping’



9 Counselling Skills: Helping Clients Make a Plan, Reviewing, and Terminating

1 hour N/A N/A Annexure 13: ‘Helping Clients Make a Plan’

10 Dealing with the Risk of Harm to Self or Others

30 minutes N/A N/A Annexure 14: ‘Dealing with Suicide and Self-harm’

11 Wrap-up 30 minutes N/A N/A N/A


Activity 1: Understanding Mental Health



• Define ‘mental health’ and understand its relation to overall health.



Take-home Material Annexure 1 on ‘Ramesh’s Story’.Annexure 2 on ‘Definitions of Health and Mental Health’.

Methodology Write the words ‘mental health’ on the whiteboard/flip-chart and gauge participants’ knowledge levels by asking the following questions:

• What is mental health?

• How do you identify a person who has poor mental health?

Divide participants into five groups and give them a chart paper and marker. Ask each group to divide their chart paper into three columns, ‘physical’, ‘mental’ and ‘social/relationships’.

Read aloud the first section from Annexure 1 on ‘Ramesh’s Story’. Ask the participants to trace the significant events of Ramesh’s life and comment on the impact such events may have had on Ramesh physically, mentally and socially.

Help identify some of the events to give cue to the participants, such as Ramesh’s wet dream, his mother scolding him, falling in love with Raj, self-education on sexuality, falling in love with Aziz, being beaten by Aziz’s brother, marriage, going to the city, meeting Piyal, meeting up with Piyal’s friends, and getting syphilis. Give them about 30 minutes to do this activity.

Read out the remaining section of the case study, and ask the participants to fill up the columns with their responses. Now draw four columns on the whiteboard/flip-chart with the following titles for the columns: events, physical, mental and social. Ask each group to share their inputs and write the keywords from their responses on the whiteboard/flip-chart.

Using the participant responses on the whiteboard/flip-chart, ask the participants to consider looking at each column vertically, wherein one can observe the ups and downs in his physical, mental, and social life and relationships.

Now study the table horizontally, one can see that positive states of being, whether they be physical, mental or social/relationships, seem to occur at the same time as the negative states seem to occur. Ask the participants why they think this is so. Spend some time on allowing them to come to the conclusion that the physical, mental and social/relational aspects of a human being cannot be segregated as easily as has been done in the lists in the columns as each aspect is closely integrated with the other, and a negative effect in one can have a domino effect on the other aspects. Give examples.

• Losing one’s job could isolate one from others (social/relationship aspect), could make one feel helpless and depressed (mental), and could lead to a loss of appetite (physical) and subsequently, make one feel weak.

• On the other hand, getting a much-wanted job could raise one’s spirits (mental),


put one in touch with others (social/relationship) and because of the elated feeling of well-being, it can improve one’s appetite.

At this juncture, explain the concept of health as the (World Health Organization, 2003) has defined it: ‘a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity’. While physical and mental well-being should be clear to the participants, spend some time discussing the concept of social well-being, which essentially refers to how people experience their connections with others and the strength of those relationships. Social well-being also includes connections with family members, friends, neighbourhood, community, and workplace.

Using some of the responses from the whiteboard/flip-chart, ask the participants to identify the sequence of impact on the three aspects of Ramesh’s being – physical, mental and social/relationships. They should be able to make the conclusions that follow.

• In some cases, a clear-cut sequence of events can be identified.

• In other cases, the sequence of causality may not be so clear.

• In some cases, an adverse event caused mental disturbance, which resulted in negative reactions being manifested in his physical and social self.

• In others, an adverse event caused Ramesh to develop positive coping skills which had an impact on his physical, mental and social well-being.

Ask the participants that if each of them were to be in Ramesh’s position, would the impact on their physical, mental and social well being be identical? If yes, ask why they think it would be. If not, then ask why not? It is important that the participants reach the conclusions that follow.

• While events may negatively impact health, health is dependent on many other factors, such as genetics, income, social status, education, literacy, etc.

• More importantly, each person is a unique human being and is a product of a unique physiology, state of mind, life experiences and learnings, both good and bad. People live through the most adverse of life circumstances and yet can lead healthy, happy lives.

Ask participants to consider Ramesh’s case and answer how would they conclude whether a person is mentally healthy or not. Allow them to brainstorm for a while, listing their responses on the whiteboard/flip-chart. If you feel it is necessary, ask them to work in their groups to develop a definition of mental health.

After they have shared their responses, read out the World Health Organization definition (2003) of mental health: ‘a state of well-being in which the individual realises his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community’.

Discuss the different sections of the definition in relation to Ramesh’s case.

• Does Ramesh realise his own abilities?

• Can Ramesh cope with the normal stresses of life?

• Does Ramesh work productively and fruitfully?

• Is Ramesh able to make a contribution to his community?

Draw the participant’s attention to the fact that for every person mental health is not an absolute state but has its ups and downs. This can clearly be seen in Ramesh’s story.


Background Information (World Health Organization, 2011)

The Determinants of HealthMany factors combined together affect the health of individuals and communities. Circumstances and environment determine the health of a person. To a large extent, factors such as where we live, the state of our environment, genetics, our income, education level, and our relationships with friends and family all have considerable impact on our health; whereas the more commonly considered factors, such as access and use of healthcare services, often have less of an impact.

Determinants of health include:

• Social and economic environment;

• Physical environment; and

• Person’s individual characteristics and behaviours.

The context of people’s lives determines their health. Individuals are unlikely to be able to directly control many of the determinants of their health. These determinants – things that make people healthy or not – include the above factors, and many others, which are available in detail in Annexure 2 on ‘Definitions of Health and Mental Health’.


Activity 2: Identifying Mental Health Problems and Disorders


Learning Outcomes By the end of this activity, participants will be able to:

• Identify the signs and symptoms of poor mental health; and

• Understand the distinction between the terms ‘normal’ and ‘abnormal’ in the context of mental health.

Materials Chart paper and markers.

Audio-visual Support Refer to the slides titled ‘Signs and Symptoms of Poor Mental Health in Some Common and Severe Disorders’ from the PowerPoint Presentation ‘Mental Health’.

Take-home Material Annexure 3: ‘Mental Disorders’.Annexure 4: ‘Difference between Poor Mental Health and Mental Disorders’.Annexure 5: ‘Mental Health: What’s Normal, What’s Not’.

Methodology

Part I: Signs and Symptoms of Poor Mental HealthAsk the participants how they would recognise a person with poor mental health. After allowing them to brainstorm for a while, use the PowerPoint slides titled ‘Signs and Symptoms of Poor Mental Health’ to discuss the following:

• Different physical and mental reactions in a person that may occur due to poor mental health – use the pictures on the slides to discuss whether Ramesh could have manifested similar reactions; and if so, during which phase of life he would exhibited the same.

• The terms ‘signs’ and ‘symptoms’ and the difference between subjective indication of disease and objective evidence.

After the discussion, explain to the participants what is meant by a ‘sign’: an indication of the existence of something; any objective evidence of a disease that is perceptible to a physician, as opposed to the subjective sensations.’ Explain that a ‘symptom’ is subjective evidence of disease or of a person’s condition; it is the evidence as perceived by the person, indicative of some bodily or mental state.

Further, ask participants to think of the following questions in relation to the PowerPoint presentation used in the module:

• What could cause a sign/symptom?

• What could the person be thinking at this time?

• What could the person be feeling at this time?

• What was the person doing or what he or she may have done after experiencing the distress? (Behaviour)

Form the participants into smaller groups, giving each group chart paper and a marker. Ask them to divide the chart paper into four columns, labelling the columns ‘events’, ‘thoughts’, ‘feelings’ and ‘actions’, and ask the participants to write down what they think Ramesh would have thought, felt and did at the time of the various events in his life.


Ask the participants to share their responses and write them down on a flip-chart. Once you have sufficient responses, stick the flip-chart in a prominent place on the wall for ready reference during later activities. Conclude the session by pointing that:

• All persons are unique, and that a person’s facial expressions, outer appearance and behaviour are only indicative of what the person is really thinking and feeling. Responsible professionals, helpers and caregivers must explore, through counselling and other means, what the person is actually thinking or feeling and should not intervene on the basis of external behaviour and appearance only.

Part II: Brief Overview of Mental DisordersDiscuss the difference between poor mental health (or mental ill-health) and mental illness (or mental disorders).

Using the Power Point slides titled ‘Some Common and Severe Disorders’ introduce participants to some mental disorders and also to the two major classification reference guides of mental disorders: the Internal Classification of Diseases (ICD) and the Diagnostic and Statistical Manual (DSM).

Background Information(University of Melbourne, 2009)

Mental ill-health This term refers to the kind of general mental health problems we can all experience in certain stressful circumstances; for example, work pressures can cause us to experience poor concentration, mood swings and sleep disturbance. Such problems are usually of temporary nature, are relative to the demands a particular situation makes on us, and are generally responded to with support and reassurance.

Mental disorders (or mental illness) These can be defined as the experiencing of severe and distressing psychological symptoms to the extent that normal functioning is seriously impaired.

Some form of professional medical help is usually needed for recovery/management of both poor mental health and mental disorders. This help may take the form of counselling or psychotherapy, drug treatment, and/or lifestyle change.


Classification of Mental Disorders

Severe Mental DisordersPeople with severe mental disorders usually experience a mixture of physical, emotional, mental and behavioural symptoms, as well as imagined symptoms.

Severe mental disorders are rare and usually involve noticeable behavioural problems and the expression of strange or unusual ideas, often called psychosis. Psychosis is sometimes described as ‘losing touch with reality’.

People with severe mental disorders are more easily identified as having a mental health problem than those with common mental disorders, because they seem more obviously different from others in the way they think and behave. Most people in psychiatric hospitals suffer from severe mental disorders. Refer to Annexure 3 on ‘Mental Disorders’.

Part III: Determining What is Normal and What is Abnormal Ask the participants to list factors that they believe affect mental health. Write their responses on a flip-chart in three separate columns under the following heads:

• Social and economic environment

• Physical environment

• Individual characteristics and behaviours

It is important to discuss that while genetics and an individual’s physical and mental make-up plays a role in mental disorders, external factors too have a significant role to play, and labelling people who have poor mental health or have mental disorders as people who ‘should pull themselves together’, who are weak-minded, weak-willed, crazy, abnormal, etc. is irresponsible.

Discuss the dangers of labelling people as ‘normal’ or ‘abnormal’. While there are a numerous pitfalls in using the labels ‘normal’ and ‘abnormal’, from the mental health/mental disorders point of view, it becomes necessary to distinguish between these to understand whether a person’s mental state has deviated from what is considered a state of ideal mental health.

In this context, you can again remind participants of the WHO definition of ideal mental health as being: ‘a state of well-being in which the individual realises his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community’.

Mental Disorders

Common Mental Disorders

Severe Mental Disorders

Depression Anxiety Excess Use of Alchol

Psychotic Episode Schizophrenia Bipolar

Disorder

Generalised Anxiety Panic Disorder OCDPhobias


Introduce participants to the criteria of ‘Failure to Function Adequately’ (see box), which they can use as a ‘checklist’ to determine whether a person’s mental state has deviated from the norm. Using this set of criteria, behaviour of an individual may be defined as abnormal if it harms the individual or other people. Use Ramesh’s case study to elaborate on each of the above criteria.

• Was Ramesh in distress when he realised that he was unable to have sex with his wife without thinking about Aziz?

• Was his behaviour irrational and unconventional when he started showing uncontrolled sexual behaviour in the city?

Discuss the grey areas in the criteria titled ‘Observer discomfort’ and ‘Violation of moral standards’: Who are the observers and who set the moral standards?

Remind participants of the various factors that affect mental health, that what may be considered ‘normal’ in one society may be considered ‘abnormal’ in another, and that the concept of norms also changes over time. Evolving norms related to homosexuality are a case in point; this is discussed in more depth in the following activity.

Also point out that, as professionals, when one speaks of a person who is in poor mental health, it is the thoughts, feelings and behaviour that are evaluated as normal or abnormal, not the person. When one speaks of the person as abnormal, it amounts to stigmatising the person. For more information on this, please refer to Annexure 5 on ‘Mental Health: What’s Normal, What’s Not’.

Criteria for Failure to Function Adequately

• Distress: the person is upset or depressed.

• Maladaptive behaviour: behaviour that prevents someone from coping with everyday situations.

• Irrationality: belief or behaviour not connected with reality.

• Unpredictability: reacting to a situation in a way that could not be predicted or reasonably expected.

• Unconventional behaviour or statistically rare behaviour.

• Observer discomfort: behaviour that makes other people feel uncomfortable.

• Violation of moral standards: breaking laws, taboos, etc.

Strengths of this Technique

• It provides a practical checklist.

• It takes into account the social/cultural context.

Weaknesses of this Technique

• Sometimes it is normal to be distressed (e.g. grieving).

• Some people may be abnormal (e.g. a psychopath) and yet show no signs of distress.

• Some of the criteria are subjective; who judges what is ‘unpredictable’?

(Rosenhan & Seligman, 1989)


Activity 3: Mental Health and the MTH Community

Time 1 hour


• Understand the historical background of homosexuality vis-à-vis mental health;

• Identify the common mental health issues faced by the MTH community and understand the role that stigma plays in determining mental health; and

• Identify the scope of mental health interventions in Pehchan and understand their roles in the same.

Materials N/A


Take-home Material Annexure 6: ‘Changing Status of Homosexuality vis-à-vis Mental Health’.

Methodology Discuss how homosexuality has been considered a mental illness and give the timeline of events of the last forty years that have changed that perception (as mentioned below). Point out the impact of activism in changing norms of society and medical establishment.

Refer to the decriminalisation of Section 377 of the Indian Penal Code as another normative change – this time in the legal establishment – and the implications of the change in legal status on the mental health of those who were previously affected by the law.

Discuss how despite legalising homosexuality, social acceptance remains poor, leading to stigma (both external and self-stigma) and discrimination. Point out that there is a popular but unfounded perception that homosexual people have more mental health problems. However, stigma is a major cause of mental health problems in lesbian/gay/transgender (TG) people, not homosexuality. Also point out about the double marginalisation faced by the community: people with mental illnesses are also socially stigmatised in a number of countries, including India, and MTH people with mental illnesses are therefore doubly marginalised.

Ask the participants to share their experiences with mental health problems in the MTH community. Ensure that the terms they use and their articulation of these problems are not vague but reflect the learnings of the day’s activities.

Using Ramesh’s case study, ask the participants the following questions:

• Can we link the instances of homophobia in Ramesh’s life with his later high-risk behaviour?

• When Ramesh went to the city and met his new friends, was his social life actually growing? Or was he merely experiencing freedom for the first time, which he expressed sexually?

• In his experience of freedom, was he displaying responsible behaviour?

• What roles does Ramesh’s family expectations play in his overall mental state, especially in his high-risk behaviour?


• When Ramesh started having sex with Piyal and his friends without any protection, he felt very happy and did not experience any distress. Would you call that healthy behaviour?

• Do you think Ramesh was driven into this lifestyle because of his sexual orientation?

• What role did non-acceptance of Ramesh’s sexual orientation by his family play in his life? Would his life have been different had he been accepted the way he was?

Help participants identify the factors that play a detrimental role in the mental health of the community in general and explore whether there are differences in mental health issues among the three identities: MSM, transgender and hijra.

Briefly discuss the role of Pehchan programme and its component of internal capacity building of MSM, transgender and hijra communities to help them deal better with stigma and discrimination that affects their physical and mental health.

Discuss the role and scope of Pehchan personnel in dealing with the mental health issues of the MTH community. Use Ramesh’s case study an example to identify when and how Pehchan personnel could have intervened to help Ramesh.

• What do you think should have been done to Ramesh by the hospital/doctor/medical advisor at the following stages:

• When he was first taken to the hospital after being a victim of a violent homophobic attack by Aziz’s brother?

• When he was diagnosed with syphilis? • When he, along with his wife, was diagnosed with HIV?

• What could the personnel of Pehchan programme have done had they been linked with the various medical service providers Ramesh interacted with in the course of his life?


Activity 4: Introduction to Counselling

Time 45 minutes

Learning Outcomes By the end of the activity, the participants will be able to:

• Define the term counselling and understand the difference between counselling and other helping relationships;

• Articulate the physical, temporal, and relational boundaries of a counselling relationship; and

• Be able to articulate the steps in counselling.

Materials N/A


Take-home Material Annexure 7: ‘Counselling Cards’.Annexure 8: ‘Model of Counselling’.

Methodology

Part I: Introduction to Counselling Ask the participants what they think counselling is and write key responses on a flip-chart. Tell the group that when people experience difficulties in their lives, they sometimes turn to another person for help. This could be a trusted friend, a family member or a religious leader. They could also meet with a person who has been trained to effectively help them. In simple terms, a counsellor is trained to listen and respond to people in emotional distress and to empower them to deal with their difficulties.

Ask the participants to think about a time when they sought help from someone when they were in a difficult problem and felt supported. Ask them to think about the experience and what were their feelings and the state of mind:

• Before they approached the person?

• During their interaction/s with the person?

• After speaking to the person?

Ask a few participants to talk about their experiences of being helped. Encourage them to focus their feedback on the questions asked above and on the feelings generated, not on the problem. Participants may have difficulty in articulating a range of feelings; encourage them by prompting but do not put words in their mouths. List key words from their responses on a flip-chart under the three columns titled ‘Before’, ‘During’ and ‘After’.

Probe whether the helpers gave them advice and solutions, or heard them out and allowed them to find their own solutions. Link their feedback to the process of counselling and discuss the pros and cons of giving advice as opposed to allowing a person find their own solution.

Describe counselling as a process based on a relationship that is built on empathy, acceptance, and trust. Within this relationship, the counsellor focuses on the client’s feelings, thoughts and actions, and then empowers clients to:

• Cope with their lives;

• Explore options;

• Make their own decisions; and

• Take responsibility for those decisions.

Note to FacilitatorIt is not the intention of this module to help individuals in becoming counsellors, nor does the manual purport to teach counselling skills. The activities and the exercises herein are designed to develop an awareness of counselling and its therapeutic intent, and participants should understand that after undergoing training in this module, they are not qualified to refer to themselves as counsellors. They are, however, to be encouraged to pay close attention to the skills of counselling, as developing these skills will enhance their overall communication in their work and personal lives.

\\192.168.0.5\e\Data Server\Users\hkhosa\AppData\Local\Temp\wz2814\D5 - Mental Health\B5_ Annexures\B5_Annex0x_HowToRespond.docx


Part II: Understanding the Framework of Counselling Summarise the discussions by telling participants that the main aim of counselling is to create an emotionally safe space and an accepting, caring relationship in which the client can explore, discover and clarify ways of living a more satisfying and resourceful life.

Introduce the concept of boundaries in counselling by conducting an interactive discussion on the possible disadvantages of having a close personal relationship (e.g. friend, family member) with someone seeking help. You could also discuss the power dynamics between a person seeking help and a helper, and how important it is to ensure that the relationship remains one of equality.

Explain how the following help in creating a ‘safe space’ necessary for counselling:

• The physical frame (location and arrangement of counselling setting).

• The time frame (length and number of sessions).

• The ethical frame (respecting the dignity, individuality and rights of the counselee)

• The counselling frame (being in the client’s frame of mind, creating a safe space, limited self-disclosure and physical contact, permission for taking notes or tape recording, only if necessary).

Part III: Overview of Counselling ProcessAsk for five volunteers and hand each volunteer one of the placards containing the elements of the Model of Counselling (Refer to Annexure 7 on ‘Counselling Cards’). Tell the volunteers they have two minutes to stand in a sequence they believe is correct for the process of counselling. They should arrange themselves in such a manner that they face the other participants in the correct order.

When two minutes are up, or if they have already arranged themselves in a sequence, ask the other participants to comment on the correctness of the sequence. If they suggest changes, ask them why they are suggesting a change. If they feel that the arrangement is correct, ask them to explain why they feel this sequence is logical.

Once volunteers are in the correct sequence, ask participants why the ‘Help Client Make a Plan’ is not a rectangle like the other placards. Then re-arrange the placards vertically so that it looks like a house, where the ‘Help Client Make a Plan’ placard becomes the roof of the house. Point out that the ‘Build a Foundation’ placard is right at the bottom, just like the foundation of a house. If possible, stick these placards in this manner in a prominent place so that participants can refer to this during the following sessions.

Use the following scenario from Ramesh’s story:

‘For many months, Aziz and I kept on catching up with each other in the afternoons before I went off home. No one used to be there at his place – his elder brother was in college, his father at work, and his mother passed away. One day, his brother came back early and, unknown to us, was watching us undress each other. He suddenly burst in with a cricket bat and started beating me mercilessly. I must have passed out, for the next thing I remember I was in a hospital with my anxious parents staring at me.’

Ask the participants to imagine that the doctor treating Ramesh refers him for counselling. Assuming Ramesh has come for counselling; hypothesize what each of the elements in the Model of Counselling would entail. Allow participants to guess what might be happening at each stage and clarify their responses wherever necessary.

Tell participants that this is only a model – there are variations to the approach; however, keeping this in mind will help them give direction in their counselling process. Also remind them that a client does not show improvement in a neat, linear manner and will often progress, regress and even digress. The counsellor needs to be prepared for this to

What is a Framework? In preparing for counselling, certain arrangements need to be in place. We use the word framework in counselling to describe the place and time where counselling happens as well as the emotional space the counsellor creates so clients feel free to share their concerns. A framework can be defined as a structure that holds things in place. Without considering these frameworks, counselling might ‘fall apart’.

(Kustner, 2011)


happen and move at the pace of the client. Moreover, it is to be noted that these steps could be achieved with some clients in one or two sessions, and for others, this process may take many sessions.

End the session leaving participants with the following visual imagery: remind them of the counselling framework and its four frames and ask them to visualise the Counselling Model as a house with the counselling framework around it like a protective fence.

Emphasise that:

• Throughout the counselling process, the responsibility for growth and change remains with the client; and

• Essentially, counselling is about helping others to help themselves, and helping them grow in a way they choose.


A Model of Counselling(Kustner, 2011)

Principles of the Model‘Building the house’ means building the counselling relationship to help the client deal with his/her problems. As the counselling process moves forward, a trustful working relationship is built between the counsellor and the client.

Clients have different needs with regard to counselling. Some clients just need help in telling their story in order to help them to continue with the ‘house building’ on their own. The client is responsible for building his/her house and counselling can end at any stage in the ‘house building’ process. The counsellor is only a facilitator of the process.

Other Aims of Counselling

• Reducing tension

• Resolving conflict

• Increasing understanding

• Increasing self-acceptance

• Exploring problem-solving options

• Improving interpersonal relationships

• Providing information, when appropriate

BUILD A FOUNDATION Self-preparation, preparation of context and contracting

LISTEN TO CLIENT’S STORY Listening, Soler Map, 3 R’s

HELP CLIENT TELL STORY Reflecting feelings, empathy, paraphrase

HELP CLIENT EXPLORE OPTIONS Summarising, questioning, immediacy

HELP CLIENT MAKE A PLAN Problem-solving, solution-focused

RE

VI

EW

IN

G

CLIENT’S EXTERNAL SUPPORT

Based on Egan’s Helping Model


Listening to and exploring the client’s story helps to build trust and understanding, which then allows the client and the counsellor to move into exploring solutions and making a plan. Reviewing the counselling process is done by summarising and is helpful to re-focus the client and counsellor on what has been achieved in the counselling process. The client’s family, friends and community resources are included in this helping process.

‘Building the house’ is also a collaborative effort of the client, the counsellor and external support structures, and follows a flexible process.

The Counselling Framework(Kustner, 2011)

Physical FrameThe counselling room should be comfortable, quiet and private. Even if you do not have access to a proper counselling office, consider the following while setting up the space:

• Positioning of chairs;

• Minimal wall decorations;

• Box of tissues handy;

• Culture-friendly ornaments; and

• Small, visible clock.

Other physical contexts: Counselling can take place in other contexts (e.g. a hospital room, under a tree, a waiting room, a formal counselling space, a police station, a clinic), and sometimes counsellors have to be creative in finding ways to ensure privacy and facilitate communication.

TimeframeSessions should ideally last 45-50 minutes as shorter sessions may provide too little time to explore, and longer sessions can tire the client and the counsellor. (In trauma cases, sessions may take longer than 50 minutes). How often the client should come (frequency) and how many sessions are allocated (duration) depends on the needs of the client and availability of the counsellor. This is discussed in the initial session. Sessions should be regular (usually weekly) and consistent.

In some cases, the counsellor may only have one or two sessions with the client and will have to do his/her best within these limitations. (There is research suggesting that just unburdening in a first session can help individuals/families to move forward.)

Ethical Framework . • Respect the dignity, individuality and rights of the counselee.

• Respect the autonomy of the counselee.

• Take informed consent.

• Provide confidentiality, including confidentiality of records.

• Avoid doing any harm.

Note to FacilitatorTaking notes or tape recording the counselling session is helpful, but may have a negative impact in counselling. Be aware of the client’s response to this and explain your intention. Ask the client’s permission before you do this.

Touch: Facilitating or Harming the Process of Counselling?

It is also useful to think about appropriate use of touch. In some cultures it is acceptable and even desirable to convey empathy and understanding through a pat on the shoulder, a warm handclasp or even a hug. In others there may be strict limitations on touching, especially cross-gender touching. It may be useful to discuss:

• What are the norms around touch in the specific setting?

• How comfortable are you as a counsellor with touch?

In general a new counsellor should completely avoid touching clients, apart from handshakes, to create a proper professional distance.


Counselling Relationship FrameAs counsellors, one must maintain physical, emotional and social boundaries when dealing with clients.

As counsellors, one should not touch their clients, reveal personal details, give advice or pass judgements, and engage in multiple relationships with the clients. It is not appropriate to be a friend and a counsellor to a client at the same time.

As a counsellor one should not get emotionally attached to the clients, share their own problems, make false promises, get angry, or cry in front of clients.

These are avoided so as to maintain clear relationship as one of ethical counselling and not everyday socialising.

This framework makes the client feel safe and comfortable to explore his/her problem, and it protects the counsellor from getting emotionally involved.


Activity 5: Counselling Skills: Building a Foundation

Time 1 hour

Learning Outcomes By the end of this activity, the participants will understand:

• What constitutes a counselling relationship and the skills needed to build the relationship; and

• The concepts of ‘empathy’, ‘trust’, ‘non-directive’, and ‘here and now’ and their role in facilitating counselling.

Materials N/A


Take-home Material Annexure 9 on ‘Building a Foundation’.

Methodology

Part I: Understanding ‘Building a Foundation’ Refer to the base of the model of counselling ‘Building a Foundation’ and ask participants what they think this would constitute. After eliciting their responses, conclude that building the foundation constitutes:

• Self-preparation: being aware of how one is feeling before the session and putting aside one’s own thoughts and feelings to focus completely on the client.

• Preparation of context: preparing the physical space in which counselling is to take place and mentally preparing oneself to act within the framework of counselling.

• Welcoming and contracting: point out how important first impressions are, and how important it is for the client to feel comfortable and safe when s/he comes into the counselling space. Establishing the boundaries of the counselling relationship also gives the counselee a clear idea of what s/he can expect and what is expected of her/him.

Part II: Skills-building Ask for two volunteers, one to act as Ramesh and the other as the counsellor. Ask them to do a small role-play where Ramesh visits a counsellor for the first time. In this role-play, Ramesh has a minimal role to play; the focus is on the counsellor and how s/he demonstrates foundation building skills. Stop the role-play when the counsellor finishes establishing the boundaries of the relationship.

Ask Ramesh how comfortable or uncomfortable he felt with the counsellor and why he felt that way. Ask the other participants to give feedback on the counsellor’s role-play. Ensure that the feedback is given in a constructive manner. Remind participants to think of themselves as counsellors when giving feedback – they should be empathic, non-judgemental, non-directive, and responsive to the needs of the role-player. Encourage more participants to play the role of the counsellor.

Building a Foundation

‘Building the Foundation’ includes the entire range of concepts discussed in counselling framework and establishing these in the counselling session.

In the first session with a client, most of the elements of the framework are established through the welcoming and contracting process. These are often revisited during subsequent sessions.

Other elements are present through all sessions.


Part III: Pillars of CounsellingStart the next session with visual imagery: tell the participants to close their eyes and visualise the ‘House’ model of counselling again, but this time in 3-D. They should visualise the house as a 3-D rectangle, with four pillars at the four corners, reaching from the floor to the ceiling. These four pillars are named:

• Empathy

• Trust

• Non-directive

• Here and now

Brainstorm with the participants about the concept behind each of these pillars. Discuss the concept of ‘empathy’ as opposed to ‘sympathy’. Discuss why being non-judgemental is one of the most important facilitators in counselling.

Discuss the concept of non-directive; remind participants that the goal of counselling is to restore/awaken the client’s own resources, and being directive would be akin to taking away choice from the client.

Discuss the concept of being in the ‘here and now’: the counselee brings up problems that affect him or her in the current session and the counsellor responds accordingly. Events reported by the client are not as important as the thoughts and feelings (and events) being reported in the current session.

Tell participants that apart from these four pillars or principles of counselling, there are a number of others, for more information refer them to Annexure 9.


Activity 6: Counselling Skills: Listening to the Client’s Story

Time 1 hour


• Understand what is meant by listening and attending skills.

Materials N/A


Take-home Material Annexure 10: ‘Listening to the Client’s Story’.

Methodology

Part I: Introduction to Listening and Attending. Tell participants that listening and attending are the two skills required to help clients tell their story, and practicing the principles of SOLER MAP (see the adjacent box) will help them in listening and attending.

Skill-builder: SOLERAsk for two volunteers to play the role of Ramesh and a counsellor and allow them to get comfortable in their chairs. Ask Ramesh to start talking about a problem scenario, and ask the group to observe the counsellor.

Now ask the participants to point out whether the posture of the counsellor was appropriate and to explain the reason behind their opinion. After some discussion, introduce the concept of SOLER and allow various participants to practice it.

Elaborate on the concept of listening, and ensure that participants understand that listening is more than just hearing; it includes the following:

• Listening with your ears to the words being said and hearing what people are saying;

• Noticing the way people look when they’re talking (non-verbal);

• Grasping the meaning behind people’s words; and

• Observing your reactions to what you hear, so you can respond in a non-judgemental and empathic way.

Skill-builder: Responding Using the Principles of MAPResponding is a key element in listening – it conveys to the speaker that the other person has heard. Facilitate small role plays in which the counsellor responds with minimal encouragers such as ‘mmm’, ‘uh’ ‘huh’, and ‘I see’ that could be accompanied by nods of the head.

Ask the participants to conduct a role-play in which the counsellor keeps interrupting Ramesh, and discuss how interrupting or saying things before Ramesh does cannot be called effective listening.

SOLER MAPSit squarely, facing the other person

Open, non-defensive body posture

Lean slightly toward the client

Eye contact

Be Relaxed and comfortable

Minimal encouragers

Attentive silence

Presentation

For more details refer to Annexure 10 on ‘Listening to the Client’s Story’.


Part II: Silence in the Counselling Space: What Does it Mean?Discuss silence in the counselling space: what does it mean when a client is silent, and how can a counsellor use silence effectively. Highlight the use of silences in allowing the client space to collect his/her thoughts and regain composure, especially when clients are crying or thinking.

Being silent in an interaction is often uncomfortable and avoided. People are tempted to fill the gap in a conversation. However, in counselling, sitting with a person in silence often communicates a deep, empathic understanding.

Clients are encouraged to explore feelings in counselling, and often crying, shouting or looking away are ways in which these feelings are expressed. The counsellor should respect and allow for free expression of feelings by giving the client space and by appropriately reflecting his/her feelings.

Through practice, a counsellor will learn the difference between ‘stuck silence’ and ‘reflective silence’. If you are unsure about the silence, it is OK to ask the person to clarify. Otherwise, respect the silence and stay with it.


Listening to the Client’s Story(Kustner, 2011)

ListeningListening is integral to building trust in the counselling relationship, and it gives the client space to open up. It also prepares the client and counsellor to reach a level where it is emotionally safe in the relationship to help the client explore options and make a plan. We listen for and observe:

• Our own feelings – self-awareness;

• The client’s experiences – what happened to them (content);

• The client’s behaviour – what they did or did not do (non-verbal);

• The client’s feelings – that arise in relation to their experiences and behaviour; and

• The client’s mood, appearance, and speech patterns.

AttendingAttending means being physically, intellectually and emotionally ‘present’ in a counselling session.

These skills indicate to the client that the counsellor is listening, is aware and is ready to interact. They show in a non-verbal way that the counsellor is attentive and available.

For more details on these skills refer to Annexure 10 on ‘Listening to the Client’s Story’.


Activity 7: Counselling Skills: Helping Clients Explore their StoriesTime 1 hour


• Understand the importance of helping clients explore their stories; and

• Demonstrate the skills of reflection, paraphrasing, clarifying, and summarising.

Materials N/A


Take-home Material Annexure 11: ‘Helping the Client Explore their Story’.

Methodology

Part I: Why ‘Explore’ the Client’s StoryAsk the participant’s why exploring the client’s story is necessary – can a counsellor not just listen to the problem and give a solution?

Elicit their responses, and remind them that counselling is a process of empowerment, not solution-giving by the counsellor. In exploring their own stories, counselees begin to untangle the various threads of their own lives, explore their own strengths, weaknesses, and options. More importantly, having someone listen empathetically and non-judgmentally to one’s thoughts and feelings is a critical part of the healing process.

Draw the following processes on a flip-chart, briefly elaborating on each step, and on how exploring the client’s story plays a critical role in the cycle of moving towards resolution and healing.

Also point out that exploring does not mean only focusing on ‘problems’, but also means focusing on ‘solutions’. It is a process in which:

• The counsellor asks what the client wants to change and how;

• Opens the space for possibilities – looks at exceptions and resources;

• Most importantly, assumes that the client is competent, resilient and resourceful; and

• Gives preference to the client’s voice and expertise and builds on the clients ideas.

Problems seem harder to solve

Unresolved problems

Feel stuck, can’t do anything about it

Low self-esteem ‘I’m useless’

Low mood

Identify problem

Unresolved problems

Explore the problem

Identify goalsThink of solutions and supports

Taking steps towards solutions

Feeling better

Source: Basic Counselling Skills Participant Manual (Community Counsellor Training Kit)

Left: Problem Cycle. Right: Problem Treatment Cycle


Part II: Skill-building in Reflection, Paraphrasing, Clarifying and Summarising The nervousness of a novice counsellor is usually generated by the thought ‘What do I say to the client’. Assure the participants that the main skill of the counsellor is listening and responding to what the client says, and this responding essentially mirrors what the client is saying.

• Point out that if they mirror the client’s responses, they will not fall into the trap of responding in a judgemental manner.

• Skilful use of reflection is the key to conveying empathy; by mirroring what the client says (or, as in advanced skills, does not say), the client feels understood by the counsellor.

• Introduce the skill of reflection, and get participants to reflect on content and feeling. Ensure that participants are not parroting the client’s statement, but go beyond to correctly reflect thinking, feeling and process.

• Also introduce participants to the idea of paraphrasing and clarifying process. Now ask the participants to do small role-plays demonstrating the skill of paraphrasing and clarifying.

• Explain the concept of summarising and facilitate role-plays in which participant can practice the skills of summarising.

Part III: Skill-building in QuestioningDiscuss the techniques of exploring through questioning, and point out that:

• Almost every novice counsellor tends to overuse questions. Caution participants of the drawbacks of this.

• Before asking a question, remind participants to ask themselves, ’What is the need for me to ask this question?’ Questions should serve a purpose and help the client to think about the problem in a different way.

• Probing is a way of getting a more accurate understanding of the client and their problem. It must be used sparingly and must not be used to satisfy the counsellor’s curiosity.

Introduce participants to open-ended and close-ended questions and to the importance of open ended questioning in facilitating the process of counselling.


Helping the Client Explore Their Story(Kustner 2011)

Reflection When somebody takes the time to tell us their story, it is important that we respond in a way which respects what they have said and shows them we have grasped what they are trying to say. Reflecting skills are those skills which allow the counsellor to respond directly to what a client has said to take the conversation further in a useful direction. They also show that the counsellor has been listening or, if the response misses the mark, gives permission to the client to put the counsellor back on track.

It is always important to begin a response with a qualifier such as, ‘It seems to me …’ or ‘It appears that …’ and to use a tone of voice which conveys tentativeness. This is not because the counsellor wishes to appear uncertain but to show respect for the client’s right to be the final judge of the ‘truth’ of their words, thoughts and feelings.

Note to FacilitatorRemind participants of the exercise in which they were segregated and worked on ‘what Ramesh thought, felt and did’.

Ask them to relate the skill of recognising what a client may be thinking and feeling, or how a client may have behaved (or behaves during the counselling session) with the skills of reflecting and paraphrasing.


ParaphrasingA paraphrase is a brief, tentative, statement which reflects the essence of what the person has just said. A good paraphrase:

• Captures the essence of what the person said. It leaves out the details;

• Conveys the same meaning, but uses different words;

• Is brief. Your paraphrase should be shorter than what the person just said;

• Is clear and concise. Your paraphrase should help clarify things, not confuse them; and

• Is tentative. We want the client to feel comfortable with disagreeing with or correcting the paraphrase.

ClarifyingClarifying is a way of getting more information from the client by asking them to make clearer what they have just said. As noted above, the simple act of paraphrasing what the client has said may bring clarity because in their response to the paraphrase they will automatically expand on their words and ideas.

Sometimes, however, you are not sure what they mean by something and it is necessary to ask a question and probe. Probing is a real art and is an advanced skill which gets better with practice. Clarifying is a form of gentle probing because it does not introduce anything into the counselling which is not already there – that is, it starts from what the client has already said.

Exploring Through QuestioningIn any communication with a client in which the ultimate aim is to understand the client, convey information, and promote emotional wellness, the counsellor will have to go beyond reflecting what has been heard to explore what is not clear and to deepen understanding on both sides. The counsellor should use exploring skills after the initial phases of the encounter have been completed (meeting, contracting, and hearing the initial concerns, facts and feelings).

SummarisingSummaries are essentially a series of paraphrases of issues from a client. A summary provides order and focus and sorts out relevant material to explore in an encounter. Good summaries act as natural ‘stopping and reflecting’ points in a conversation and can also be used to start sessions and bring them to a close. To effectively summarise, the counsellor has to really listen and attend to what the client is saying and how they are saying it.

For more details on these skills, refer to Annexure 11 on ‘Helping Client Explore their Story’.


Activity 8: Counselling Skills: Helping Client Explore Options

Time 1 hour


• Explore options and understand self-help strategies.

Materials N/A


Take-home Material Annexure 12: ‘Helping the Client Explore Option and Self-help Strategies for Successful Coping’.

Methodology

Part I: Why explore options? Remind participants that the goal of counselling is to empower the client, and point out that, in the problem treatment cycle, the client moves from exploring their problems towards finding solutions.

Point out that in exploring solutions, the client needs to discover their own inner resources and coping skills. Introduce the concept of examining one’s own strengths and weaknesses by conducting an interactive discussion using Ramesh’s life as a case to explore his possible strengths and weaknesses, and their implications in moving towards a solution.

Ask participants what kind of external support could be used by the client to bolster his/her quest for empowerment. While clients need to look at their inner resources, a part of the exploratory process is also looking at the allies (drawn from family, friends and community) and the emotional and practical sustenance that the client can draw from them. However, stress that external support should not become a prop for the clients; otherwise, they neglect developing their inner resources, and depend only on external support.

Discuss the following options which counsellors can encourage clients to explore:

• Self-help treatments and coping strategies (Refer to Annexure 12 on Helping the Client Explore Option and Self-help Strategies for Successful Coping);

• Professional counselling, psychiatric and general health practitioners;

• Other service providers. (Remind the participants that they will be discussing referrals in the D4 module on Friendly Services); and

• Drawing support from family, friends, and community.

Skill-builder 1: Encourage Self-help TreatmentsRefer to the earlier sessions on Mental Health Disorders, and ask participants which disorders could respond to self-help. Explore their answers through role-plays.

Discuss the kind of self-help treatments and self-care methods that can be recommended for common mental disorders. If you have the time, lead the participants through a guided relaxation exercise. Tell them that it is a practical tool they can use in counselling clients, and that clients can also practice relaxation exercises when alone.

Note to FacilitatorThe participants must understand that they are not trained in mental health, and therefore there are restrictions to the kind of assistance they can provide.

Yet, in a helping capacity, as front-line personnel of Pehchan, they have the scope of providing ‘mental health first-aid’ as it were to persons who need psychological help and support.

Tell them that while they are not trained in diagnosis of mental health disorders, they can help recognise these disorders.

While they may not be able to correctly distinguish between depression and bipolar illness, or between generalised anxiety and panic, they can train themselves to observe whether a person is in poor mental health, and be in a position to suggest measures to deal with it, as well as appropriately refer a person to a competent service provider.


Skill-builder 2: Giving Reassurance and InformationDiscuss with examples the difference between giving reassurance and giving false hope. Ask participants why giving false hope or false reassurances are detrimental to the helping process, and facilitate role-plays in which realistic reassurance is demonstrated.

Discuss the importance of giving correct information and facilitate role-plays which demonstrate how a counsellor/helper should respond if s/he does not have correct or complete information.

Skill-builder 3: Giving Information about Psychiatric TreatmentAlthough prescribing drugs and other forms of treatment are strictly beyond the scope of the helper, participants need to be aware of there are different types of drugs that are used to treat mental health disorders. Elaborate that only a certified psychiatric can prescribe it, while taking care of issues of drug compliance, side-effects etc.

Describe the importance of consulting a professional psychiatrist before taking any medication, and facilitate role-plays in which helpers deal with clients’ reservations about taking drugs.

Skill-builder 4: Encourage the Person to Get Appropriate Professional HelpTell participants that as responsible helpers they need to know the limitations of their helping skills and that referring clients to the appropriate referral services is a part of their skill-set. Discuss the various services that persons with mental health problems may need, and facilitate some role-plays in which the helper directs Ramesh to an appropriate service provider.

Discuss or demonstrate how a person reluctant to see another service provider, say, a psychiatrist, can be encouraged to do so (through reassurance and information giving).


Activity 9: Counselling Skills: Helping Clients Make a Plan, Reviewing, and Terminating

Time 1 hour


• Be able to demonstrate the skills of problem-solving and planning and understand the process of assessing and reviewing change.

Materials N/A


Take-home Material Annexure 13: ‘Helping Clients Make a Plan’.

Methodology

Part I: Problem-solving and PlanningAsk participants how Ramesh, or any other client, should choose amongst a number of available options. Discuss the role of information in problem-solving – what kind of information would Ramesh need in order to decide on a particular course of action?

Using Ramesh’s case, conduct an interactive discussion on the pros and cons for him to select a particular course of action – for instance, moving to the city.

Discuss the role of the counsellor in providing information to the client, and conduct an interactive discussion on the kind of information-giving that would be appropriate within the ambit of Pehchan programme. The counsellor should have information on the following:

• HIV/AIDS and sexually transmitted infections (STIs)

• Identity, gender and sexuality

• Referral services available

• Legal and human rights

• How to report human rights violations

• Community support services.

Part II: Understanding, Assessing and Reviewing ChangeAsk participants about what they think will change for a client as she/he moves towards empowerment/healing/resolution.

• Is it the external circumstances that change?

• Or does the client change? If the latter, then what changes in the client?

Remind participants of the exercise where they categorised happenings in Ramesh’s life into thoughts, feelings and behaviour, and point out that through counselling, it is possible for the client to bring about changes in his own thoughts, feelings and behaviour to be able to cope better with external circumstances.


Drawing the following stick-figures in a sequence on a flip-chart, discuss the slow and difficult process of behaviour change.

Ask participants how a counsellor can support a client in putting a choice into action and evaluate the results.

Discuss the cyclical nature of counselling, in which both the client and counsellor assess progress towards the client’s goals, and continually re-explore experiences, options and solutions, and take steps towards the client’s goals.

Background Information(Kustner, 2011)

Problem-solving: The ‘Traffic Light Model: Stop, Think, Do’The traffic-light problem-solving model is a useful way to approach problematic situations. Sometimes people rush into ‘solving’ problems without thinking of the pros and cons of their actions. This model encourages people to stop, think and then act, thereby they make informed and well thought-out decisions in solving their problems.

Process of Change

Pre- contemplation

Contemplation

Determination / Preparation

Action

Maintenance

Relapse / Recycle

No: Denial

Maybe: Ambivalence

Yes, Let’s Get Motivated

Doing it: Go Living It Start Over: Ugh!!

0-3 Months 3-6 Months Over 6 months

Source: Basic Counselling Skills Participant Manual (Community Counsellor Training Kit)

STOP

THINK

DO


STOP

Define the ProblemThis is the most important step in the problem-solving model, and often requires the most time in counselling. This step involves gathering information and clarifying. It also involves breaking what seems to be a huge problem into its various parts or sub-problems (sometimes called partialising).

THINK

Explore All OptionsThis step involves exploring all possible options to solve the problem (or, to start with, just one part of the problem, perhaps something that is reasonably achievable). Encourage the client to brainstorm as many solutions as they can to their problem, even if they seem silly. Continue until all ideas are exhausted. It is important that you as a counsellor do not have a preconceived idea on what the solution should be.

Look at alternatives and consider the consequences of each idea generated from the above brainstorm. Ask clients to look at the pros and cons of each solution. Usually the best solution is the one with the more advantages than disadvantages.

DO

Select an Option, Make a Plan, and Take ActionEncourage the client to select the most effective option, based on whether or not it is practical, appropriate, and realistic. Be patient and gently support the client to make their choice.

Develop a PlanAsk the client to think about how they can put their choice into action. Ask questions such as who, what, when, and how to make the plan as specific, achievable, and realistic as possible so that it can be implemented within a time-frame. It is sometimes helpful if the client writes their plan down.

Take ActionAcknowledge that this step is usually the most difficult for people. To help build the client’s confidence, it can be helpful to start with an action where the client has a relatively good chance of succeeding. Using role-play to ‘practise’ what the client will do and say and to anticipate possible reactions can also be helpful. Reassure the client that you will explore the outcome in the next session.

EvaluateThis is an important opportunity to see what worked, what did not work and why. Reassure clients that if they do not succeed, to try and try again till they succeed!


Activity 10: Dealing with the Risk of Harm to Self or OthersTime 30 minutes

Learning Outcomes By the end of this activity, the participants will learn how to deal with:

• The possibility of harm to self or others; and

• The issue of confidentiality in such cases.

Materials N/A


Take-home Material Annexure 14 on ‘Dealing with Suicide and Self-harm’.

Methodology Read out the following case scenario:

‘I went back to the city, wracked with guilt and shame. I started neglecting my work, stopped interacting with my so-called friends, and started drinking heavily. I used to cry myself to sleep every night. It was entirely my fault – I am nothing short of a murderer, I thought – and one day, I realised that I had no right to live. So I decided I would throw myself off a moving train. That would end everything. No one needed to know who I was and where to send my body, for I no longer have any home or any family’.

Ask the participants to imagine that at this stage, on the train, a peer educator from their CBO bumps into him. What do you think the peer educator can do? Was there any other stage in his entire life that someone could have approached him with help? Brainstorm whether a timely intervention earlier in Ramesh’s life could have helped Ramesh lead a healthier and a more satisfying life.

Ask whether a counsellor or any helper should directly refer to suicide, such as asking ‘Do you sometimes feel that life is not worth living?’ Conclude the discussion by elaborating that counsellor needs to be sensitive towards the client while addressing the issues of suicide. Ask them to refer to the following steps while addressing self-harm and suicidal thoughts:

• Risk-assessment involving intent and planning (where, how, when) and history of previous attempt.

• Making a contract.

• Exploration of confidentiality – exclusion.

• Ensuring security – suicide watch, hospitalisation.

• Attending to any emergency.

• Working at close intervals with client to ensure that client moves away from suicidal ideation towards hope.

When the client fears violence2 from someone, ask the client to: • Avoid negotiating with the abuser.

• Make security arrangements.

• Be assured that it is not the client’s fault.

• Have courage to take charge of his/her life and not feel like a victim.

2 Violence is discussed in detail in Module D4: Trauma & Violence

Note to FacilitatorIf you believe the person is at risk of harming him/herself, then:

• Don’t leave the person alone;

• Seek immediate help from someone who knows about mental disorders;

• Try to remove the person from access to the means of taking their own life; and

• Try to stop the person from using alcohol or drugs.


If the client is threatening/behaving violently to others:

• Warn about breaking confidentiality.

• Assess risk, and if necessary, warn the potential victim (if possible); if necessary, escalate the warning and report to police or other restraining authorities.

Basic Elements in Helping(University of Melbourne, 2009)

Assess the Risk of Suicide or Harm to Self or Others People with mental disorders sometimes feel so overwhelmed and helpless about their lives, as they perceive their future to be hopeless. Engage the person in conversation about how they are feeling and let them describe why they are feeling this way. Ask the person if they are having thoughts of suicide. If they are, find out if they have a plan for suicide. This is not a bad question to ask someone who is mentally unwell. It is important to find out if he/she is having these thoughts in order to refer him/her for help.

Encourage the Person to Get Appropriate Professional HelpYou can encourage the person to consult with a doctor who knows about mental disorders, and who is able to prescribe medication, if necessary. Then you can follow up by giving ongoing support to the person and their family. If the person is very unwell, i.e. you think they are suicidal or psychotic, and he/she is refusing to take any help from a doctor, encourage the family to consult with the doctor so that they can explain the situation and get professional support.

For more details, refer to Annexure 14 on ‘Dealing with Suicide and Self-harm’


Activity 11: Wrap-upTime 30 minutes


• Review the module’s learnings.

Materials N/A



Methodology Ask the participants to:

• Review the definition of mental health and summarise how the counselling process helps in mental health;

• Explain why counselling is different from other forms of helping;

• Outline the aims of counselling and the role of Pehchan personnel in the mental health of the MTH community;

• Warn against diagnosing mental disorders and labelling people as mentally ill, or mentally disturbed, as doing so is beyond their purview; and

• Describe the scope of Pehchan front-line workers and their scope.

Remind the participants that learning counselling is a lengthy process – however, to aid them in their daily work, the annexures provided in previous sessions should be read thoroughly and kept handy at all times by all members of the CBO.


Annexure 1: Ramesh’s Story

Section IHi, I am Ramesh – and this is my story.

I was born in a village. I lived with my parents and my elder brother. Everyone thought I was a blessing from God, for I was born over 10 years after my brother.

I was a child when I first saw anyone having sex. It was my elder brother and the neighbour’s daughter. He was 16 and I was five. At first I thought he was beating her – she kept on moaning and crying out loudly. My brother, luckily, never caught me looking. It took me about six more years to start understanding what was going on.

Yet, while I started understanding what was going on, I did not understand what my brother found attractive in that girl – or any girl for that matter.

In a year’s time, the movie ‘Qayamat se Qayamat tak’ came to our village cinema. I adored Amir Khan. He was so good looking! At the time, I did not realise what I was feeling – till one morning I woke up to a wet stain in my shorts after a night filled with songs from the film and Amir Khan – and the stain was definitely not urine.

I rushed to my mother to tell her, thinking I had got some kind of disease. All she told me was that I must have had ‘dirty thoughts’ in my head for something like this to happen, and that if it kept on happening then she would tell my father. I was afraid of my father. I decided that I would only concentrate on my studies, and keep thoughts of Amir Khan out of my head. From that day on till the time I finished school, I never came second in class. I avoided my friends in case they realised that I must have had ‘dirty thoughts’. I could not tell them that Amir Khan was really cute, could I?

Yet, as hard I would try, I kept on getting wet dreams. I never touched myself down there, thinking that it was a perversion – after all, my mother had told me to keep dirty thoughts at bay. Touching yourself is dirty, isn’t it?

The year I was about to finish school, I met Raj. He and I became best friends – we even taught each other. I taught him maths, and he taught me history. However, that did not last long – for one day, over a history lesson, his hand touched me, and then started our love-making. We were no longer friends, we were lovers. Yet, every time we would make love, when I went home, I would cry in shame and disgust at myself for feeling such feelings for another boy – my mother could not be wrong!

We finished school, and Raj and I had to part ways, for he got admitted to a different college in a different state. We promised to remain in touch, but seldom did. The last I heard, he got married and even had two children.

I moved on, got admitted into college with a full scholarship, thanks to my academic track record. I started reading more and learning more about sex, sexuality and gender – and I realised I was not heterosexual – beyond that I could not articulate at that point. As I realised, my mother was wrong – about the ‘dirty thoughts’, about my wet dreams, about everything! I burned with anger at having let myself be misled by her–of having had years of guilt about touching myself sexually, about touching Raj sexually. Yet I realised that at that point I could have done nothing. I started channelising my anger at the college gym – I ran for miles at times just to get her words out of my head. Once or twice, I even got drunk, but my body revolted so badly, I decided never to do it again.


In my class, there was a boy, Aziz. His skin was like snow, his lips were cherry red, and he used to spend hours staring at me. I felt a familiar stir inside me, and decided to befriend him. We became really good friends over a short period of time. We used to go to the college gym together, sometimes even go running together. He seemed to get the fact that I was trying to get my mother’s words out of my head – even though I had not told him anything. Aziz went out of his way to introduce me to all his friends and family members as his best friend, without whom he felt incomplete.

One day, while at his place to exchange notes, Aziz playfully came and sat on my lap and said that that was the way my girlfriend must be sitting on my lap. Then suddenly, our eyes locked, and we let our emotions take over. From then on, there was no looking back – my mother’s words were driven out from my mind and for the first time I felt love for myself.

For many months, Aziz and I kept on catching up with each other in the afternoons before I went off home. No one used to be there at his place – his elder brother was in college, his father at work, and his mother no more.

Yet one day, his brother came back early, and unknown to us, was watching us undress each other. He suddenly burst in with a cricket bat, and started beating me mercilessly. I must have passed out, for the next thing I remember I was in a hospital with my anxious parents staring at me.

Aziz’s brother had told my father about the situation he had found the both of us in. My father decided that enough was enough, a good girl would settle everything. And thus, I was married to a shy young girl from a village.

In the beginning everything was fine – the festivities kept everyone occupied. I was very happy with all the attention that I was getting, but this happiness was short-lived. Everytime I would try to have sex with my wife, Aziz’s face would float into my mind. There were times when I would suddenly stop everything, and rush out of the room, to my wife’s utmost amazement.

I decided that I would move to the city in search of a job and stay away from my wife as much as possible.

My parents were very happy that at least one of their sons was going to live in the city. Little did they realise why.

I reached the city, and put up with my relatives there. In about a week’s time, I got a job as a newspaper sales agent. I would have to go from door-to-door selling newspaper subscriptions.

One day, on such a round, I met Piyal. When Piyal opened the door the first time, he was standing there in his underwear. He invited me in, and excused himself and went to put on some clothes. He came back and sat next to me while I explained the details of the subscription.

Piyal readily agreed to buy one, and asked for my phone number for further details. I was very flattered – till then no one in the big city had asked for my number.

In a couple of days, Piyal called me and asked me to go over to his place because he wanted to talk about further subscriptions. I went over in a great hurry, and saw him seated there with a couple of others.

He asked me to sit down, and we started chatting. He offered everyone drinks – but I refused. I started getting a little impatient – what about my subscriptions? His friends immediately took out the money and told me to sign them on – but they had a condition: I would have to get intimate with them.


I knew it from the moment I saw Piyal for the first time – yet why didn’t I stop myself? I went ahead and started making out with everyone. I don’t remember whether there were any condoms or not, but I experienced anal sex for the first time there.

Over a period of time, my visits to Piyal’s place started growing. Everytime I would go there, we would have sex – either with him, or with his friends. My world was growing at a fast pace. I seldom thought about my wife sitting at home – I was finally being able to live my life the way I wanted to – I was doing well at work, thanks to Piyal and his friends helping me out, and they became my support group – even though all we did was meet up for sex.

However, one day, I went down with a very high fever. When I went to the doctor, I was told that I had syphilis. I had ignored the slight sore patch near my penis – and apparently that had been the first sign of it. I started having sleepless nights, thinking of everything else that might have happened to me. These bouts of insomnia kept on even after I recovered. I could barely concentrate at work and I felt afraid to have sex again.

I went and met Piyal and told him about it – he said that these things happen, and it is no big deal. I felt reassured. That evening was a celebration at his place for my recovery, and I met all my other friends at the party – and once again, I was back to my normal way of things.

Section IIOne day, after a lot of cajoling by my mother, I had to go visit my parents. When back in the village, I saw that my wife was under tremendous pressure to have a child. I did what I considered to be my duty, much to my chagrin.

After I went back to the city, in a month I got the news that my wife was pregnant. I felt relieved. At least now I would not be required to have sex with her. I felt sorry for her at times – after all she had nothing to do with this situation.

Over the next few months, her visits to the doctors became very frequent. I thought that there would be nothing to worry about – after all a child born in the village is far healthier than one born in the city!

One day she called me up and told me that her delivery date was in a week’s time, and that she wanted me to be there. I took leave and went off to my village. The child was delivered. It was a boy, but a very ill boy. My wife was also extremely unwell. The doctors did multiple tests, and then asked me to give blood for a test too.

In a few hours, I was told that we were both HIV positive and that they would start the necessary treatment on the child.

My entire world came crashing down. I knew why it had happened – why hadn’t I listened to myself?

That evening I went to a local bar, and drank till I fell down unconscious. Later when I came around, I saw myself lying outside my parents’ home’s door. Someone must have dragged me there and left me there.

I entered, and saw that everyone was looking at me in a very cold way. I thought, the doctor must have told them. But I ignored them and rushed off inside to wash my face and lie down. I felt helpless and I did not know what to do. Then in the morning I realised why they were so silent the previous night – the child had died, and so had my wife.


Suddenly everything in my world changed. After I completed the funeral rites, my father called me to his room, and told me that I must leave the village forever, for he knew and nearly the entire village knew that my wife had died of HIV complications. I felt lost and trapped. I had a job in the city, yes, but I had no one there! Just the few friends with whom I would meet up to have sex! I had no family!

I knew that none of my relatives would speak with me if my father told them not to – and that is exactly what happened.

Wracked with guilt and shame, I went back to the city. I started neglecting my work, stopped interacting with my so-called friends and started drinking heavily. I used to cry myself to sleep every night. It was all my fault – I am nothing short of a murderer, I thought – and one day, I realised that I had no right to live. So I decided – I would throw myself off a moving train on the way back from work. That would end everything. No one would know who I am, where to send my body, for I no longer had any home or any family.


Annexure 2: Definitions of Health and Mental HealthSource: World Health Organization

The World Health Organization (WHO) defined health in its broader sense in 1946 as, ’a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity’.

The World Health Organization defines mental health as ‘a state of well-being in which the individual realises his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community’.

The Determinants of HealthMany factors combine together to affect the health of individuals and communities. Whether people are healthy or not, is determined by their circumstances and environment. To a large extent, factors such as where we live, the state of our environment, genetics, our income and education level, and our relationships with friends and family all have considerable impacts on health, whereas the more commonly considered factors such as access and use of healthcare services often have less of an impact.

The determinants of health include:

• Social and economic environment;

• Physical environment; and

• Person’s individual characteristics and behaviour.

The context of people’s lives determines their health, and so blaming individuals for having poor health or crediting them for good health is inappropriate. Individuals are unlikely to be able to directly control many of the determinants of health. These determinants – or things that make people healthy or not – include the above factors, and many others:

• Income and social status. Higher income and social status are linked to better health. The greater the gap between the rich and poor, the greater the differences in health.

• Education. Low education levels are linked with poor health, more stress and lower self-confidence.

• Physical environment. Safe water and clean air, healthy workplaces, safe houses, communities and roads all contribute to good health.

• Employment and working conditions. People in employment are healthier, particularly those who have more control over their working conditions

• Social support networks. Greater support from families, friends and communities is linked to better health.

• Culture. Customs and traditions, and the beliefs of the family and community all affect health.

• Genetics. Inheritance plays a part in determining lifespan, healthiness and the likelihood of developing certain illnesses.

• Personal behaviour and coping skills. Balanced eating, keeping active, how we deal with life’s stresses and challenges all affect health. Coping skills also include smoking and drinking which may help one cope, but have a negative effect on


mental and physical health in the long run.

• Health services. Access and use of services that prevent and treat disease influences health.

• Gender. Due to gender differences individuals suffer from different types of diseases at different ages.


Annexure 3: Mental Disorders

1. Symptoms of Mental Disorders

Physical Feeling Thinking Behaviour Imagining

Tiredness Sadness Excessive worry Crying False beliefs

Aches & pains Anxiety Self blame and criticism

Social withdrawal Hearing voices

Weight loss Guilt Unable to make decisions

Talking to him/herself

Seeing things not there

Pounding heart Helplessness Poor concentration Aggression Smelling things not there

Sleep disturbance Loss of emotion Thoughts of death and suicide

Poor personal hygiene

Tasting things not there

Stomach ache Mood swings Rapid thinking Avoidance behaviour

Feeling things not there

Feeling short of breath

Hoplessness Poor judgement Rapid speaking

Loss of appetite Low self-estieem Not making sense to others

Muscle tension Excessive fear Attempting suicide

Lack of energy Loss of motivation Irritability

2. What You Can Do For a Person Who Needs Help

Source: University of Melbourne, 2009

2.1 Assess the Risk of Suicide or Harm to Self or Others . People with mental disorders sometimes feel so helpless about their life that future seems hopeless to them. Engage the person in conversation about how they are feeling and let them describe why they are feeling this way.

Ask the person if they are having thoughts of self-harm or suicide. If they are, find out if they have a plan for suicide. This is not a bad question to ask someone who is mentally unwell. It is important to find out if she/he is having these thoughts in order to refer her/him for help.

2.2 Listen without JudgmentListen to what the person describes without being critical or thinking they are weak. Don’t give advice such as ‘just cheer up’ or ‘pull yourself together’. Avoid getting into an argument with the person.

Note to Facilitator If you believe the person is at risk of harming herself/himself then:




• Try to stop the person from using alcohol or drugs.


2.3 Give Reassurance and InformationProvide hope to the person. Tell the person that she/he has an illness that can be treated, and it doesn’t mean that she/he is a bad person. Let she/he know that you want to help.

2.4 Encourage the Person to get Appropriate Professional HelpYou can encourage the person to consult a doctor who knows about mental disorders, and who is able to prescribe medication if necessary. Then you can follow-up by giving ongoing support to the person and her/his family. If the person is very unwell, i.e. you think they are suicidal or psychotic, and she/he is refusing to get any help from a doctor, encourage the family to consult the doctor so that they can explain the situation and get professional support.

2.5 Encourage Self-help TreatmentsSuggest actions that the person can perform herself/himself to help relieve the symptoms of mental disorder such as:

• Getting enough sleep;

• Eating a healthy diet;

• Regular exercise;

• Relaxation and breathing exercises, e.g. yoga;

• Avoiding alcohol; and

• Joining support groups for women, men or youth.

3. How You Can Respond to a Person With Unexplained Physical Complaints

3.1 Assess the Risk of Harm to Self or Others Make sure that the person is not suffering from any physical illness. If you have doubts that the symptoms may be caused by a physical illness, refer the person to a doctor.

3.2 Listen without JudgmentSpend some time talking with the person to find out the type of complaints she/he has. It is helpful to use general questions – such as, ‘have you been worried about anything lately?’ – to find out if the person is having problems that may be contributing to physical illness.

3.3 Give Reassurance and Information Stress and worry often contribute to unexplained physical illness. If the person is able to reduce these two, it will help improve the physical condition.

3.4 Encourage the Person to Get Appropriate Help Explain that emotional stress often leads to physical illness, which in turn can make condition worse. Treatment is needed to help the underlying problem and not just the symptoms, for example stress caused by money problems may contribute to headaches and body aches, and finding a solution to the money problems will help treat the same. Vitamins and pain killers will not help unless there is evidence of malnutrition or a painful physical illness.


3.5 Encourage Self-help Treatments Relaxation exercises such as slow breathing may help the person manage stress and worry. Encourage the person to involve herself/himself in interesting and pleasurable activities or to join support groups. Follow up with the person regularly and refer to the local doctor if further treatment for mental or physical disorders is required.

4. How You Can Respond to a Person Experiencing Excess Worry and Panic

4.1 Assess the Risk of Harm to Self or OthersIf you are unsure if the person is having a panic attack or a life-threatening condition such as a heart attack or asthma attack call for a doctor immediately. If possible move the person to a quiet, safe place. Stay with the person until she/he has recovered.

4.2 Listen without JudgmentStay calm yourself and help the person relax by encouraging slow breathing to match your own breathing (Elaborate that they need to breathe in for three seconds through your nose and pause for three seconds before breathing out for three seconds then repeat).

4.3 Give Reassurance and InformationExplain that the attack will soon stop and she/he will feel better. Reassure the person that their symptoms are not a sign of serious physical illness. Explain that worry and fear are triggering the symptoms.

4.4 Encourage Self-help TreatmentsExplain that if the person can stop worrying, it will help break the cycle of worry which then leads to panic which is a precursor for further worry. Teach a relaxation technique that can be used at times of stress (see below).

Relaxation techniques are helpful for controlling stress and worry. Many people with stress often breathe shallowly. The following technique introduces a better way of breathing that can be used when feeling anxious, and can help the person to feel calmer.

Find a comfortable position either lying flat on your back or sitting comfortably in a chair.

• Place your hands on your stomach.

• Breathe as you normally would and notice whether your hands on your stomach rise or your chest rises as you breathe.

• To breath properly your stomach should rise (as this expands your diaphragm).

• Begin by slowly breathing in through your nose for five counts. Watch your hands to help you see if your stomach is rising when you breathe in.

• Gently hold your breath and count till five. When learning you may only be able to count to three but after practice you can increase to five.

• Slowly breathe out through your mouth for a count of five while gently pushing down on your stomach.

• Repeat this process for three to five minutes.

Change ThinkingSuggest ways to change thinking and attitudes that contribute to worry, for example:

• ‘Something is wrong with me, I must be a weak person’ can be replaced with ‘I feel this way because I worry too much, these feelings are temporary’;

• ‘I hope they don’t ask me a question, I won’t know what to say.’ Replace with: ‘Whatever I say will be OK, I am not being judged. Others are not being judged, so why should I be?’

TipsThis relaxation exercise can be practiced first thing in the morning and/or just before going to sleep at night.

Remind people not to get annoyed if they cannot do this exercise correctly straight away. It takes practice to feel comfortable.

Remind people not to breathe too quickly when doing this exercise.


5. How You Can Respond to a Person Feeling Unusually Sad or Thinking About Suicide

5.1 Assess the Risk of Suicide and Harm to Self or OthersAsk the person if she/he has thoughts of ending her/his life. If the person is thinking so, it is important to seek professional help as soon as possible.

5.2 Listen without JudgmentTreat the person with respect and dignity. Don’t be critical of the person or belittle her/his feelings. Do not interrupt if the person is speaking more slowly and less clearly than usual. Remain patient even if the person is more repetitive than usual. Encourage the person to talk to you since ‘a problem shared is a problem halved’. Talking about feelings usually makes things better. Let the person know you are concerned about her/him and would like to help. It is more important to be ‘genuinely caring’ than to say all the ‘right things’. Supporting a person who is feeling unusually sad and hopeless requires patience, persistence and encouragement, and takes genuine kindness and attention. Offer some practical assistance with tasks that may seem overwhelming for the person such as fetching water or cleaning the house. Give reassurance and information that:

• They are not alone in facing their problems;

• They are not to blame for feeling sad and hopeless;

• They are not weak or a failure because have these feelings; and

• With time and treatment they will feel better.

If a person has thoughts of suicide you can help them identify reasons to continue living, such as being with friends and family.

5.3 Encourage the Person to Get Appropriate Help If the person is very depressed she/he should be seen by a doctor who understands about mental disorders and will be able to diagnose the problem and offer treatment and care. If the person has been feeling sad and hopeless for weeks and it is affecting their functioning in daily life, the doctor may prescribe anti-depressant medication. A doctor may decide to refer the person to a specialist for further counselling.

5.4 Encourage Self-help Treatments• Help the person to think positively about their situation.

• Help the person to identify their negative thoughts and how they make them feel. For example: ‘I will always feel miserable, nothing will change in my life’.

• Suggest some positive ways of looking at the same situation. For example: ‘These feelings are temporary, I feel this way because I am not well, talking to the health worker, taking my medicine and trying to solve my problems will make me feel better’. Encourage the person to frequently challenge negative thoughts in this way.

• Involve the family.

• If there is conflict or violence in the family you may need to think of alternative support networks such as women’s groups, friends or a religious leader.

• Families often need help to understand the person’s problems and manage their own stress related to the situation.

• Families also need help to understand the importance of not being too critical or over protective of the depressed person.


If a person is thinking of committing suicide:

• Remove access to all dangerous items such as knives and poison;

• Ensure the person is not left alone—enlist help from family and friends to keep the person company if necessary;

• Seek professional help as soon as possible;

• If the person is consuming alcohol, try to stop him/her from consuming anymore;

• Listen non-judgmentally, do not give advice or contradict the person;

• Let the person know that you and others care about him/her;

• Let the person know that even though the situation seems hopeless at present, things are likely to improve—feeling bad is only temporary; and

• If the person has already harmed him/herself e.g. swallowed poison, emergency medical treatment is required.

6. How You Can Respond to a Person Who is Tired all the Time

6.1 Assess the Risk of Harm to Self or Others Make sure the person is not suffering from any physical illness by referring them to see a doctor.

6. 2 Listen without JudgmentRecognise that chronic tiredness is a symptom of a problem rather than laziness. It is important to identify the possible reasons why a person feels tired. Once the problem is identified it will be possible to work out a solution to help overcome feelings of being tired.

6.3 Give Reassurance and InformationIf having poor sleep is the problem, refer to the handout on ‘How you can respond to a person with a sleeping problem’.

Encourage the person to gradually increase activity levels.

Regular contact with friends and relatives can help. There is no specific medication that by itself will cure tiredness; taking tonics or vitamins is not helpful for people who do not have anaemia or malnutrition.

6.4 Encourage the Person to get Appropriate HelpRefer the person to a doctor if you suspect tiredness is due to a physical illness. Refer the person to a doctor if she/he might be depressed.

6.5 Encourage Self-help TreatmentsLifestyle changes can help a person to regain and maintain mental balance without having to resort to medications or a therapy.


7. How You Can Respond to a Person Who is Hearing Voices, Suspicious of Others or Expressing Unusual Beliefs

7.1 Assess the Risk of Suicide and Harm to Self or Others• Try to determine if there is any risk of self-harm or any threat of harm to others.

• A person who is hearing voices may be frightened and suspicious and needs to be approached in a very unthreatening way.

• If the person is suicidal, respond as outlined in the handout on ‘How you can respond to a person who is feeling unusually sad or thinking about suicide’.

• If the person threatens violence to others try to restore calm and safety – this is covered in the hand-out on ‘How you can respond to a person who is threatening violence’.

7.2 Listen without Judgment• Speak calmly, clearly and in short sentences.

• Introduce yourself and let her/him know that you want to help.

• Don’t be critical of the person.

• Avoid confrontation and arguments.

• Don’t tell her/him that there are no voices or that her/his beliefs are wrong.

• Don’t pretend that you can hear the voices or agree with false beliefs.

• Give reassurance and information.

• Try to talk to the person when she/he is calm and thinking clearly.

• Be honest and try to win the person’s trust.

• Do not make promises you cannot keep and do not lie to the person.

• Explain to the person and her/his family that hearing voices is a symptom of a mental disorder (or a problem in the brain) and treatment is available.

7.3 Encourage the Person to Get Appropriate HelpEncourage the person to see a doctor to be assessed for antipsychotic medication, which is usually the best treatment for this disorder.

7.4 Encourage Self-help Treatments• Visit the person regularly once she/he has started to recover.

• Assist the person to reintegrate into the social life of the community and into employment or other family duties.

8. How You Can Respond to a Person Who is Engaging in Harmful Use of Alcohol

8.1 Assess the Risk of Suicide or Harm to Self or OthersUrgent medical help may be required if the person is suffering from:

• Intoxication or overdose of alcohol;

• Severe withdrawal reaction; and

• Serious infection or injuries from alcohol use.


8.2 Listen without JudgmentDo not be critical of the person, as stopping alcohol use is not easy for those who are dependent.

8.3 Give Reassurance and Information• Harmful use of alcohol is a common problem.

• Often other problems such as depression or anxiety underlie an alcohol problem and there are effective treatments for the underlying problems.

• There are three stages to overcoming an alcohol problem.• Admitting there is a problem.• Stopping or reducing the harmful use of alcohol.• Remaining sober.

• Provide the person with information of the harm caused by using too much alcohol.

8.4 Encourage Self-help Treatments• Refer the person to a community support-group that helps people who drink too

much alcohol, e.g. Alcoholics Anonymous, or facilitate the formation of similar support groups.

• Advise:

• Have two or three days a week free from alcohol; and• Eat before you have your first drink.

9. How You Can Respond to a Person Who is Threatening Violence

9.1 The best way to help is by starting to restore calm and safety.• Do not get involved physically to stop violence.

• Never put yourself at risk; if you are frightened, seek outside assistance immediately.

• Remove any weapons, or items which could be used as weapons, from the immediate environment.

• Stay calm and keep the atmosphere as non-threatening as possible; talk quietly, firmly and simply, avoid making any abrupt movements.

• Do not raise your voice or talk too quickly.

• Do not threaten the person, as this will increase their fear and may trigger an aggressive reaction.

• Give the person enough space so that they don’t feel trapped.

• Try to get the person to sit down; it is best if you are both seated side by side rather than facing each other.

• Do not ask a lot of questions as these can cause the person to become defensive, agitated or angry.

• If the person’s behaviour appears to be getting out of control, you must remove yourself from the situation and immediately call for other people to help.


10. How You Can Respond to a Person Who is a Victim of Domestic Violence

10.1 Assess the Risk of Suicide or Harm to Self or OthersUrgent psychological or psychiatric help may be required if the person is suffering from trauma due to domestic violence.

10.2 Listen without Judgment and Do Not be Critical of the PersonFighting against domestic violence is often not easy given Indian social circumstances and considering the fact that most victims of domestic violence are marginalised people – women, children, people belonging to sexual minorities.

10.3 Give Reassurance and InformationAlso, encourage the person to get appropriate help from the police, local clubs and lawyers if necessary.

10.4 Encourage Self-help Treatments Refer the person to a community support-group or legal-aid societies where he/she can get advice on how to deal with different types of domestic violence from a legal standpoint.

11. How You Can Respond to a Person Who is in a Crisis Situation1. Assess the situation and the risk.

2. Involve the family and friends of the client in managing the crisis if the family of the client is approachable.

3. Support the client on three levels.

• The primary level – where the support shall be given by the peer educators, associated field workers and other officers of your community-based organisation (CBO) closest to the client.

• The secondary level – where all other officers of your CBO shall step in as and when required.

• The referral level – where friendly services associated with your CBO shall be mobilised to deal with the crisis as and when necessary – local police station, local politicians, local clubs, lawyers, doctors, etc.

4. Follow up with the client to see whether the crisis has been managed effectively or not.

5. If the crisis still continues, continue giving support and look for alternative solutions depending on the situation – remember the client needs to be kept out of harm’s way.


12. How You Can Respond to a Person Who is Experiencing Stress

12.1 Assess the Risk of Harm to Self or Others Make sure that the person is not suffering from any physical illness, if you have any concern that the symptoms may be caused by a physical illness, refer the person to a doctor.

12.2 Listen without JudgmentSpend some time talking with the person to find out the type of complaints. It is helpful to use general questions such as ‘have you been worried about anything lately?’, to find out if the person is having problems that may be contributing to their symptoms, which might be varying in nature – from sleeplessness to acute body aches.

12.3 Give Reassurance and Information Stress and worry often contribute to unexplained physical symptoms and if the person is able to reduce stress and worry this will help improve the physical symptoms.

12.4 Encourage the Person to Get Appropriate HelpExplain that emotional stress often leads to physical symptoms, which in turn can make emotional stress worse. Treatment is needed to help the underlying problem and not just the symptoms, for example stress caused by money problems may contribute to headaches and body aches, finding a solution to the money problems will help treat the headaches and body aches. Vitamins and pain killers will not help unless there is evidence of malnutrition or a painful physical illness.

12.5 Encourage Self-help TreatmentsRelaxation exercises such as slow breathing may help the person manage stress and worry. Encourage the person to become involved in interesting and pleasurable activities or to join support groups. It has been seen that building a hobby often channelises stress and turns it into creative energy.

Review the person regularly and refer to the local doctor if further treatment for mental or physical disorders is required.


Annexure 4: Difference Between Poor Mental Health and Mental DisordersSource: Mental Health Ireland, 2010

Poor mental health (or mental ill health) refers to the kind of general mental health problems we can all experience in certain stressful circumstances; for example, work pressures can cause us to experience poor concentration, mood swings and sleep disturbance.

Such problems are usually of temporary nature, are relative to the demands a particular situation, and generally respond to support and reassurance.

All of us suffer from mental health problems at times, and such temporary problems do not necessarily lead to mental illness. However, being mentally unhealthy limits our potential as human beings and may lead to more serious problems.

Mental disorders (or mental illness) can be defined as the experiencing of severe and distressing psychological symptoms to the extent that normal functioning is seriously impaired.

Some form of professional medical help is usually needed for recovery/management of both poor mental health and mental disorders. This help may take the form of counselling or psychotherapy, drug treatment and/or lifestyle change.

Mental Disorders

Common Mental Disorders

Severe Mental Disorders

Depression Anxiety Excess Use of Alchol

Psychotic Dpisde Schizophrenia Bipolar

Disorder

Generalised Anxiety Panic Disorder OCDPhobias


Classification of Mental DisordersSource: University of Melbourne, 2009

Severe Mental DisordersPeople with Severe Mental Disorders usually experience a mixture of physical, emotional, thought and behavioural symptoms, as well as imagining symptoms.

Severe Mental Disorders are rare and usually involve noticeable behavioural problems and the expression of strange or unusual ideas, often called psychosis. Psychosis is sometimes described as ‘losing touch with reality’.

People with Severe Mental Disorders are more easily identified as having a mental health problem than those with Common Mental Disorders, because they seem more obviously different from others in the way they think and behave. Most people in psychiatric hospitals suffer from Severe Mental Disorders.

The main types of Severe Mental Disorders are as given below.

Psychotic Episode

The person displays severe behavioural problems and expresses strange or unusual ideas. It is caused by a combination of factors including genetics, brain chemistry, stress and other factors such as the use of drugs or intense depression.

Psychotic episodes usually start suddenly and do not last for a long time.

A psychotic episode may eventually become a more serious psychotic illness such as schizophrenia, or it may only occur once in a person’s lifetime.

Schizophrenia

Mainly affects young people before 30 years of age. Both men and women are affected equally by schizophrenia, and symptoms may develop rapidly over several weeks or more slowly over several months. Many people mistakenly believe that schizophrenia is the same as split-personality but this is not correct.

Symptoms of schizophrenia include:

• False beliefs e.g. thinking others are trying to harm her/him, or believing that her/his mind is being controlled by others.

• False perceptions–seeing, smelling or tasting things that are not there, and most commonly hearing voices that are not there.

• Strange behaviours e.g. talking to herself/himself.

• Poor concentration and inability to think clearly.

• Lack of motivation to do things.

• Inappropriate emotions e.g. laughing at something sad.

• Loss of social skills and social withdrawal.

• Restlessness, walking up and down.

• Poor personal hygiene.

• Saying things that do not make sense to others.

• Aggression.


Bipolar Disorder

The person experiences extreme mood swings between low mood (depression), high mood (mania) and normal mood. The symptoms of the depressed stage of the illness are much the same as depression (described later), and the symptoms of the manic stage of the illness include:

• A very happy mood.

• Unrealistic plans or ideas.

• Inappropriate sexual behavior.

• Spending a lot of money.

• Not sleeping.

• Irritability.

• Rapid talking.

• Unable to be still and relax.

• Beliefs that she/he is special or superhuman.

• Limited understanding that she/he is behaving in an unusual way.

• Both men and women can be affected, usually in early adulthood.

Common Mental DisordersPeople with Common Mental Disorders usually experience physical, emotional, thinking and behaviour symptoms, but not imagining symptoms. Some people may get treatment for physical problems associated with their illness (like poor sleep or appetite), but neglect the cause of these physical problems such as underlying depression or anxiety. People with Common Mental Disorders are often not treated because it is more difficult for family members and health workers to recognise that they are suffering from a mental disorder.

The main Common Mental Disorders are:

Depression

Unusually sad mood that does not go away. Depression is a mental disorder when the symptoms last for at least two weeks and they affect the person’s ability to carry out her/ his work or have satisfying personal relationships. Everyone can feel sad when bad things happen, occasional sadness is not depression.

Events that contribute to the development of an unusually sad mood include:

• Distressing events that the person cannot do anything to control like the death of a loved one or the breakdown of a relationship.

• Stressful events such as ongoing family conflict.

• Chronic medical conditions like diabetes or stroke.

• Sometimes women can become depressed after they give birth.

The symptoms of depression include unusually sad mood, and all or some of the following.

• Loss of interest and enjoyment in activities.

• Tiredness and lack of energy.

• Loss of self-confidence.

• Feelings of hopelessness and helplessness.

• Wishing they were dead.

• Difficulties in concentrating.

• Sleeping problems.

• Loss of interest in food and loss of weight.

• Experiencing a range of physical complaints that have no apparent medical cause e.g. weakness, aches and pains.

• Not every person who is depressed has all these symptoms, and the severity of depression is different for different people.


Anxiety

Excessive fear, nervousness and worry (anxiety) is a mental disorder that is more severe and long lasting than everyday worries. It interferes with a person’s ability to carry out his/ her work or have satisfying personal relationships.

There are many types of anxiety disorders ranging from mild uneasiness to panic attacks.

Generalised Anxiety Disorder – when the person worries excessively about things, and experiences multiple physical and psychological symptoms that occur nearly every day for at least six months.

Panic Disorder – when the person experiences a sudden and severe anxiety attack. They feel intense fear or terror that is inappropriate for the setting. The symptoms are often physical and include dizziness, shaking, sweating, feeling of choking, rapid breathing, and rapid heartbeat.

Phobias – when a person feels very scared in particular situations e.g. when in closed spaces, crowded places like markets, or near lizards etc. The person generally avoids the fearful situation.

Obsessive-Compulsive Disorder (OCD) – a condition where the person has repeated thoughts (obsessions) or does things repeatedly (compulsions) and is unable to stop the behaviour or the thoughts e.g. hand washing to the point where the skin is damaged.

Symptoms include unrealistic or excessive fear and worry, and one or all of the following.

• Irritability.

• Worrying a lot about things

• Feeling that something terrible is going to happen.

• Feeling scared (butterflies in the stomach).

• Avoiding certain situations e.g. social events.

• Disturbed sleep.

• Muscle tension.

• Restlessness.

• Physical symptoms like rapid heartbeat, dizziness and trembling.

Excessive Use of Alcohol and Other Drugs (Substance Abuse)

This is one of the most common mental disorders.

Using alcohol or drugs does not mean that a person has a mental disorder, but it does become a disorder when the alcohol or drug use harms the person’s physical, mental or social health. Excessive use can result in.

• Dependence on alcohol or drugs, which makes it difficult for people to stop using the alcohol or drugs;

• Problems at work, school or home or legal problems due to use of alcohol or drugs; and

• Damage to physical or mental health secondary to the use of alcohol or drugs.

People with alcohol and drug problems often have other underlying mental health problems and use alcohol or drugs as a type of self medication for feelings of excessive worry or sadness.


Annexure 5: Mental Health: What’s Normal, What’s NotSource: Mayo Foundation for Medical Education and Research, 2011

What is the difference between mental health and mental illness? Sometimes the answer seems clear. For instance, a person who hears voices in his or her head could have schizophrenia. A person who goes on a frenzied shopping spree or starts an ambitious project, such as remodelling the bathroom, without any plans might be having a manic episode caused by bipolar disorder.

In some cases, however, the distinction between mental health and mental illness is not so obvious. If you are afraid of giving a speech in public, does it mean you have a mental health condition or a run-of-the-mill case of nerves? If you feel sad and discouraged, do you have the blues, or is it full-fledged depression?

It is often difficult to distinguish normal mental health from mental illness because there is no easy test to show if something is wrong. Mental health conditions are diagnosed and treated based on signs and symptoms as well as on how much the condition affects your daily life.

Mental health conditions are identified by looking for signs and symptoms that affect our behaviour, feelings and thinking.

BehaviourFor instance, obsessive hand-washing is a sign of a mental health condition, as is not following daily self-care routines such as bathing, brushing one’s teeth and hair, or changing clothes regularly. Drinking too much alcohol might be the sign of a mental health condition.

FeelingsSometimes a mental health condition is characterized by a deep or ongoing sadness, euphoria or anger.

ThinkingFor instance, delusions, such as thinking that the television is controlling your mind, or thoughts of suicide, might be symptoms of a mental health condition.

Abnormality: What Is It?

While on the face of it, ‘abnormality’ sounds like an easy thing to define, there are many different techniques used by psychologists to classify behaviour, or mental health, as ‘abnormal’. All of these have their strengths and weaknesses; there is no one ‘right’ way to define abnormality. Some of the most common ways are given below.


Statistical AbnormalityIn some cases it is possible to gather data in a numeric form and derive a mean average value. We can then say that the majority of values which are nearest to the mean are ‘normal’, and the minority of values farthest from the mean are ‘abnormal’. For example, if the average height of a set of people is five foot eight, with most values falling in the range four feet to six foot six, then a height of less than three foot or more than eight foot would probably be considered ‘abnormal’.

One problem with the statistical approach is that the decision of where to start the ‘abnormal’ classification is arbitrary. Typically, abnormal values are considered to be anything with a standard deviation of greater than two. Applying this measure to values of IQ, which have a bell-curve distribution around a mean of 100, values of lower than 70 or greater than 130 are classified as ‘abnormal’.

An important consideration of statistically ‘abnormal’ values is that ‘abnormal’ doesn’t necessarily mean undesirable. For example, someone with an IQ of 131 is statistically abnormal, but may well be regarded as gifted.

Another problem with this method is that behaviour which is undesirable may be statistically frequent. For example, depression is regarded as undesirable, yet it is not uncommon enough to be classified as abnormal in the statistical sense.

Deviation from Social NormA social norm is an unwritten rule which governs behaviour in a given social context (see Conformity). Using this definition, behaviour which breaks these rules is regarded as abnormal.

Strengths of this technique• It takes into account the social dimension, which is important because the same

behaviour that might be considered ‘abnormal’ in one context could be ‘normal’ in another. For example, wandering around naked in the town centre is not normal but wandering around naked on a naturist beach is.

• It takes cultural relativism (the way that social norms change over time and between cultures) into account.

• It tries to avoid ethnocentrism, which is the tendency to regard one’s own culture as ‘normal’ and consequently see different cultures as ‘abnormal’.

Problems With this Technique• It is difficult to define what a ‘cultural context’ is because cultures have sub-

cultures within them. One way to overcome this is to use laws as a reference point, e.g. if a society has a law against murder, then that is considered a ‘social norm’. However, evidence shows that many, if not most, people will admit to breaking the law, and so by this measure, they are all ‘abnormal’.

• It does not provide an objective definition of abnormality.

• It makes non-conformity undesirable. For example, suffragettes might have been labelled ‘abnormal’ even though they achieved positive things (by current standards).

• It can lead to discrimination/abuse of ‘non-conformists’: for example, labelling people as mentally ill if they do not go along with the prevailing political system.

Szasz argued that ‘mental illness’ is a label that is used to justify forcing treatment on people. For example, drugs are prescribed to people to make them behave more like ‘normal’ people do.

http://www.nickoh.com/emacs_files/psychology/24-Oct-2002.htm


Deviation from Ideal Mental HealthIn this context, ‘normal’ can be taken to mean ‘mentally healthy’, while ‘abnormal’ describes an undesirable state which is somehow deficient from ‘mental health’. This approach therefore attempts to describe the characteristics that constitute ‘ideal’ mental health.

This approach is characteristic of humanistic psychologists such as Maslow, who defined his hierarchy of needs (e.g. physiological, safety, love, esteem, self-fulfilment, etc.) as a means of assessing where an individual was on their path to self-actualisation, which he regarded as the ideal state. However, a problem with this approach is that very few people would be considered ‘normal’ by this measure, because few people achieve self-actualisation as Maslow defines it.

In a slightly different approach, Jahoda defined six criteria by which mental health could be measured:

• Attitudes of an individual toward his/ own self;

• Growth, development, or self-actualization;

• Personality integration;

• Autonomy;

• Perception of reality; and

• Environmental mastery.

According to this approach, the more of these criteria are satisfied, the healthier the individual is.

An advantage of this type of approach is that it does provide areas to target when treating depression, and it focuses on a positive approach to the problems. On the other hand, like Maslow’s criteria, very few people are likely to achieve all six of Jahoda’s objectives, and it is also hard to measure the extent to which an individual misses these criteria. Another criticism of Jahoda is that some of the criteria might be seen to be ethnocentric: for example, autonomy is seen in some cultures as an undesirable trait.

Failure to Function AdequatelyUsing this set of criteria, behaviour is defined as abnormal if it hurts the person or other people. Rosenhan & Seligman, 1989 listed seven criteria.

• Distress: the person is upset or depressed.

• Maladaptive behaviour: behaviour that prevents someone from coping with everyday situations.

• Irrationality: belief or behaviour not connected with reality.

• Unpredictability: reacting to a situation in a way that could not be predicted or reasonably expected.

• Unconventional behaviour or statistically rare behaviour.

• Observer discomfort: behaviour that makes other people feel uncomfortable.

• Violation of moral standards: breaking laws, taboos, etc.


Strengths of this Technique• It provides a practical checklist.

• It takes into account the social/cultural context.

• It takes into account statistical influence.

Weaknesses of this Technique• Sometimes it is normal to be distressed (e.g. grieving).

• Some people may be abnormal (e.g. a psychopath) and yet show no signs of distress.

• Some of the criteria are subjective; who judges what is ‘unpredictable’?


Annexure 6: The Changing Status of Homosexuality vis-à-vis Mental Health

Source: Hooker, 1957

Evelyn Hooker’s pioneering research debunked the popular myth that homosexuals are inherently less mentally healthy than heterosexuals, leading to significant changes in how psychology views and treats people who are gay.

FindingsIn the 1950’s, Dr. Evelyn Hooker studied 30 homosexual males and 30 heterosexual males recruited through community organizations. The two groups were matched for age, IQ, and education. None of the men were in therapy at the time of the study. Dr. Hooker administered three projective tests, which measure people’s patterns of thoughts, attitudes, and emotions – the Rorschach, in which people describe what they see in abstract ink blots, the Thematic Apperception Test [TAT] and the Make-A-Picture-Story [MAPS] Test, in which people tell stories about different pictures.

Unaware of each subject’s sexual orientation, two independent Rorschach experts evaluated the men’s overall adjustment using a 5-point scale. They classified two-thirds of the heterosexuals and two-thirds of the homosexuals in the three highest categories of adjustment. When asked to identify which Rorschach protocols were obtained from homosexuals, the experts could not distinguish respondents’ sexual orientation at a level better than chance.

A third expert used the TAT and MAPS protocols to evaluate the psychological adjustment of the men. As with the Rorschach responses, the adjustment ratings of the homosexual and heterosexuals did not differ significantly. Based on these findings, Dr. Hooker tentatively suggested that homosexuals were as psychologically normal as heterosexuals.

SignificanceHooker’s work was the first to empirically test the assumption that gay men were mentally unhealthy and maladjusted. The fact that no differences were found between gay and straight participants sparked more research in this area and began to dismantle the myth that homosexual men and women are inherently unhealthy.

Practical ApplicationIn conjunction with other empirical results, this work led the American Psychiatric Association to remove homosexuality from the Diagnostic and Statistical Manual (DSM) in 1973 (it had been listed as a sociopathic personality disorder).

In 1975, the American Psychological Association publicly supported this move, stating that ‘homosexuality per se implies no impairment in judgment, reliability or general social and vocational capabilities… (and mental health professionals should) take the lead in removing the stigma of mental illness long associated with homosexual orientation.’

Although prejudice and stigma still exist in society, this research has helped millions of gay men and women gain acceptance in the mental health community.


Timeline of Events(Adapted from American Psychological Association)

Significant Events 1973 - American Psychiatric Association removes homosexuality from list of mental disorders in its Diagnostic and Statistical Manual (DSM).

1975 - American Psychological Association follows suit.

1981 - World Health Organization removes homosexuality from list of mental disorders in its International Classification of Disorders (ICD).

2001 - Chinese Psychiatric Association delists homosexuality as a mental disorder.

2008 - Indian Council of Medical Research considers allowing LGBT people (same-sex couples) to become parents through artificial reproductive techniques, but this is still under debate. Proposed changes in adoption laws may debar this provision.

Transgender phenomenon (in medical jargon Gender Identity Disorder [GID]), is still classified as a mental disorder in the DSM IV and ICD. But even this is set to change. The new version of the DSM is likely to replace it with the term ’gender dysphoria’, no longer call it a disorder, but a condition in which some persons may need psycho-social and medical support.

The change in the ICD is still being debated. Trans-activists the world around don’t just want a simplistic change by delisting GID, but also want that many hidden sub-clauses or sections in the ICD be addressed. In fact, simply delisting GID may remove some of the health benefits that transpersons do receive because they have a ‘disorder’. They don’t want to lose those relevant benefits till an alternate arrangement assures them of that.


Annexure 7: Counselling Cards

Build a foundation

Help client explore story

Listen to a client’s story

Help client explore options

Help client make a plan


Annexure 8: Model of CounsellingSource: Kustner, 2011

Principles of the Model

‘Building the house’ means building counselling relationship, in helping the client deal with her/his problems. As the counselling process moves forward, a trusting working relationship is built between counsellor and client.

Clients have different needs with regard to counselling. Some clients just need help to tell their story, in order to help them to continue with the ‘house building’ on their own. The client is responsible for building her/his house and counselling can end at any stage in the ‘house building’ process. Counsellor is the facilitator for the process. Listening to, and exploring the client’s story helps to build trust and understanding, which then allows the client and counsellor to move into exploring solutions and making a plan. Reviewing the counselling process is done by using the summarising skill, and is helpful to re-focus the client and counsellor on what has been achieved in the counselling process. The client’s family, friends and community resources are included in this helping process.

‘Building the house’ is also a collaborative effort, between the client, counsellor and external support structures, which follows the following flexible process.

Building a Foundation Preparation for counselling is important in building a solid foundation for effective counselling to take place. Firstly, the counsellor prepares her/himself through self-awareness and diversity. The counsellor ensures that she/he is aware of the basic principles of counselling–being respectful, real and responsive.

For preparation of counselling context or environment is also important. A safe, quiet and comfortable place is prepared. Setting up the initial agreement (contract) also forms the groundwork of a successful counseling relationship.

Client’s External Support

BUILD A FOUNDATION

LISTEN TO CLIENT’S STORY

HELP CLIENT TELL STORY

HELP CLIENT EXPLORE OPTIONS

HELP CLIENT MAKE A PLAN

RE

VI

EW

IN

G




Annexure 8: Model of CounsellingSource: Kustner, 2011

Principles of the Model

‘Building the house’ means building counselling relationship, in helping the client deal with her/his problems. As the counselling process moves forward, a trusting working relationship is built between counsellor and client.

Clients have different needs with regard to counselling. Some clients just need help to tell their story, in order to help them to continue with the ‘house building’ on their own. The client is responsible for building her/his house and counselling can end at any stage in the ‘house building’ process. Counsellor is the facilitator for the process. Listening to, and exploring the client’s story helps to build trust and understanding, which then allows the client and counsellor to move into exploring solutions and making a plan. Reviewing the counselling process is done by using the summarising skill, and is helpful to re-focus the client and counsellor on what has been achieved in the counselling process. The client’s family, friends and community resources are included in this helping process.

‘Building the house’ is also a collaborative effort, between the client, counsellor and external support structures, which follows the following flexible process.

Building a Foundation Preparation for counselling is important in building a solid foundation for effective counselling to take place. Firstly, the counsellor prepares her/himself through self-awareness and diversity. The counsellor ensures that she/he is aware of the basic principles of counselling–being respectful, real and responsive.

For preparation of counselling context or environment is also important. A safe, quiet and comfortable place is prepared. Setting up the initial agreement (contract) also forms the groundwork of a successful counseling relationship.


Listen to Client’s StoryListening is integral in building trust in the counselling relationship and gives the client space to open up. It also prepares the client and the counsellor to reach a level where it is emotionally safe in the relationship to help the client explore options and make a plan. We listen for and observe the following:

• Our own feelings – self-awareness.

• The client’s experiences – what happened to them (content).

• The client’s behaviour – what they did or didn’t do (non-verbal).

• The client’s feelings – that arise in relation to their experiences and behaviour.

• The client’s mood, appearance and speech patterns.

We show the client we are listening to them by monitoring our own non-verbal behaviour in counselling. We use the SOLER MAP technique – sit squarely, facing the client at a comfortable angle and distance; have an open posture; lean towards the client when suitable; make appropriate eye contact; be relaxed and use minimal encouragers and attentive silences and assess the client’s presentation.

Help Client Explore StoryBesides listening to the client, we can help them explore their story, by accurately reflecting their feelings and content. By doing this, we show the client that we are willing to understand their world as they experience it. This also helps to build trust and encourages self-reflection.

In helping the client explore their story, we attempt to gain a deeper understanding of their experience. We also do this to help the client make sense of her/his world by focusing their thoughts and exploring and identifying themes.

Help Client Explore Options

The goal of counselling is to empower the client, and through the problem treatment cycle the client moves from exploring problems to finding solutions. In exploring solutions, the client needs to discover their own inner resources and coping skills, as well as look at external sources of support such as:

• Self-help treatments and coping strategies;


• Other service providers. (Remind the participants that they will be discussing referrals in the module on Friendly Services); and

• Drawing support from family, friends and community.

Help Client Make a PlanMany novice counsellors (and even some senior counsellors) think that this part of the counselling process is the most important. However, as we have seen, the most important part of counselling is building the counselling relationship between client and counsellor and ensuring that the client feels heard in terms of her/his feelings and experiences.

In problem solving, the counsellor is merely a guide, leaving the responsibility for decision-making to the client. As ethical counsellors we respect our client’s dignity in making their own choices.

Client’s External Support Structure

Client’s external support structure, such as family, friends, religious leaders and community members, should also be acknowledged in the counselling process. Clients should be encouraged to use their support systems in helping them with their problems.

Problems usually occur in interaction with others and therefore the effective counsellor does not just focus on the individual, but rather on the individual within a social system.


As counsellors, we guide clients by helping them look at various options or solutions to their problems. We also assist clients to make a plan, by helping them weigh up the pros and cons of the options. Solution-focused questions may also assist clients in thinking about their problems differently.

ReviewingEnding counselling (after the first session or at termination) involves reviewing where the counselling relationship has reached, and acknowledging the different goals that have been realised as a result of the counselling relationship.

Reviewing gives both counsellor and client a sense of closure. When reviewing, it is important to deal with the client’s feelings of ending counselling.

Important Note for Pehchan Staff

Participating in this training module does not mean that you have become a counsellor. You must be clear about the fact that you are not trained in mental health, and therefore there are restrictions to the kind of assistance you can provide.

Yet, in a helping capacity, as frontline personnel of Pehchan, you have the scope of providing ‘mental health first-aid’ as it were, to persons who need psychological help and support.

While you are not trained in diagnosing mental health disorders, you can help recognise these disorders in a person.

While you may not be able to correctly distinguish between depression and bipolar illness, or between generalised anxiety and panic, you can train yourself to observe whether a person is in poor mental health, and be in a position to suggest measures to improve her/his health, as well as appropriately refer the person to a competent service provider.


Annexure 9: Building a Foundation Source: Kustner, 2011

Initial ContactA person comes for counselling in one of the two ways: another organisation or person usually refers them, or they make a decision to seek counselling on their own. It takes a lot of courage for clients to come for counselling, and some are more eager than others to start the process.

When a person phones or asks to see a counsellor, it is important that the counsellor or telephone receptionist maintains ethical behaviour, as well as an empathic attitude, to give the client the impression that it is an emotionally safe place. The person’s problem is not usually discussed when the person phones or asks for an appointment. If the person starts discussing their problem, it is useful to reflect the client’s feeling and reassure them that you will discuss it in your session e.g. ‘It sounds like you are keen to talk now. Could we talk more about this on Thursday?’

An appropriate time and location is agreed upon by both parties, as well as any fees and procedures for cancelling the session. This initial contact forms the first part of the counselling contract.


BUILD A FOUNDATION





RE

VI

EW

IN

G




Getting StartedWhen the person arrives for counselling, greet them respectfully and introduce yourself. Remember that you are in the role of counsellor, and the person is likely to see you as an authority, or provider of help. It is important to let the person feel comfortable, without losing your role as counsellor. Being over-friendly or ‘prim and proper’ usually does not create a favourable beginning for counselling.

Once you are both seated, the counsellor usually begins by asking the person for a few personal details – name, age, address and contact number. Some counsellors prefer their clients to fill in a client detail form.

Initial AgreementsBefore discussing the client’s reason for coming for counselling, it is helpful to reassure the client that confidentiality will be maintained. Briefly explain the limits of confidentiality as well. Some counsellors, have an informed consent form that explains the ethical duties of the counsellor and what the client can expect from counselling.

‘Before we start, I just want to reassure you that everything we discuss here today will be kept confidential. The only time I might have to tell someone about our sessions is if I feel you may do harm to yourself or others, but I will always let you know if I do.’

At this stage, it is also suitable to briefly discuss and negotiate the duration of counselling, frequency and length of sessions, as well as any fees or counselling administrative procedures. In this initial agreement, it also useful to explain the roles of the client and counsellor, and what the client expects from the counselling relationship. In India, where counselling is not well understood, it would also be helpful to discuss what the client understands counselling to be; whether they have been for counselling before, and what their experience of counselling was.

Note all aspects of this initial agreement or contract are not necessarily explored in full, in the first session – it is usually re-negotiated, clarified and refined throughout the counselling process. It should be flexible and realistic.

How to BeginAn open-ended question is usually helpful to get the counselling session started: ‘What brings you here today?’, or a non-verbal gesture, such a nod of the head.

Statements such as, ’How can I help you?’ may set the context that you are going to be ‘the helper’ and that the client is not able to help himself. This is not necessarily wrong but be aware of the impact of your words. Give the client time to respond, and empathically reflect on any non-verbal behaviour you may observe e.g. ‘It seems like it’s difficult for you to talk about it’.


Annexure 10: Listening to the Client’s StorySource: Kustner, 2011

ListeningListening is integral in building trust in the counselling relationship and gives the client space to open up. It also prepares the client and counsellor to reach a level where it is emotionally safe in the relationship to help the client explore options and make a plan. We listen for and observe.

• Our own feelings – self-awareness;

• The client’s experiences – what happened to them (content);

• The client’s behaviour – what they did or didn’t do (non-verbal);

• The client’s feelings – that arise in relation to their experiences and behaviour; and

• The client’s mood, appearance and speech patterns.

We show the client we are listening to them by monitoring our own non-verbal behaviour in counselling.

AttendingAttending means being physically, intellectually and emotionally ‘present’ in a counselling session. These skills indicate to the client that the counsellor is listening, is aware and is ready to interact. They show in a non-verbal way that the counsellor is attentive and available. The acronym SOLER MAP is often used to summarise basic skills.


BUILD A FOUNDATION





RE

VI

EW

IN

G




• S – stands for sitting squarely: this means facing the client so that they can see the counsellor and communicate openly. Sometimes a more ‘conversational’ sitting style is used where the counsellor and the client sit at right angles to each other while they talk.

• O – stands for open posture: this means not crossing arms or holding a folder/ file in such a way that it indicates a closed body, and possibly a closed or ‘switched off’ mind. It can also refer to being careful not to have, or minimising, barriers between counsellor and client, such as a desk or bed.

• L – stands for leaning forward: this means leaning in towards the client at appropriate times to convey interest and concern. This should be used carefully so as not to intimidate a client too soon in an encounter. In addition, counsellors must be mindful of body space differences in people from different backgrounds. Good observational skills will soon pick up what is an appropriate space.

• E – stands for eye contact: this means keeping natural eye contact to show the client that the counsellor is listening to what is being said. Remember that for some people, too much eye contact may be experienced as threatening or disrespectful: good contextual knowledge will assist here.

• R – stands for relaxed posture: this means not fidgeting excessively or holding one’s body in a tense manner. It also does not mean adopting a slouched position. The counsellor should convey a calm sense of containment to the client and should be aware of excessive gesticulating, body movements, tapping feet, clicking pen, playing with hair, fiddling, etc.

• M – stands for minimal encouragers: these encourage the client to keep talking and show one is listening. These encouragers, such as ‘mmm, uh huh, I see’ could go along with nods of the head.

• A – stands for attentive silence: we are often tempted to interrupt a client to ask a question, make an observation, or to get clarity on a particular point. While these are not bad things to do, we should generally wait for an appropriate pause in the conversation to make a verbal response. If the client is talking easily then it is better to maintain an attentive silence which conveys interest and respect.

• P – stands for presentation: how does the client present themselves and how should the counsellor present themselves. Aspects to look out for include the following.

• What is the client’s general mood: is she/he positive and upbeat, pessimistic and depressed, angry and confused, defensive and wary?

• What kind of body language is the client using? The ideas expressed in SOLER (above) are useful to think about – is the client open, does the client use appropriate eye contact and physical distance, is the client tense and withdrawn?

• Is the client neat and appropriate in dress and physical presentation? It is not the role of the counsellor to judge the client’s fashion sense or pass moral judgment on an outfit – rather the counsellor is assessing the client’s general mood and wellbeing. A depressed person may often neglect their personal appearance and this can be an important warning sign.

• How does the client use language? Rate of speech, tone of speech and volume of speech can affect how we understand the client and can also suggest mood and mental state.

• The counsellor should also be appropriately dressed in attire which is suitable for his or her profession and the context in which the counselling takes place. The counsellor should be neat and tidy and convey an attitude of professionalism.


• The counsellor should develop an awareness of how she or he uses language and attempt to modify vocal skills to improve comprehension and communication. Awareness of vocal style can be gained through taping of one’s voice and reviewing for clarity or by asking for feedback from others, including the client. The kinds of things to look out for include the following. – Tone of speech and volume of voice: the tone can convey warmth and

empathy or indicate a desire to bring formality into a particular encounter.– Rate of speech: in general one should use a slower rate with a client

unfamiliar with one’s accent – but this should not become sing-song or patronising.

– Range of inflections: stressing certain words and varying emphasis will prevent boredom.

– modifying accent/ pronunciation: it may be useful in some settings to adapt pronunciation of certain words to accommodate local style and usage, in order to improve comprehension.

– Rhythm of speech: the counsellor should try to modify their rhythm of speech to be clear and interesting.

– Appropriate words and language: the counsellor needs to understand the particular context in which the counselling is being given, and to choose those words and phrases that clients also use and understand.


Annexure 11: Helping the Client Explore Their StorySource: Kustner, 2011

Reflection

When somebody takes the time to tell us their story, it is important that we respond in a way which respects what they have said and shows them we have grasped what they are trying to say.

Reflecting skills are those skills which allow the counsellor to respond directly to what a client has said to take the conversation further in a useful direction. They also show the counsellor has been listening or, if the response misses the mark, gives permission to the client to put the counsellor back on track.

It is always important to begin a response with a qualifier such as ‘It seems to me …’ or ‘It appears that …’ and to use a tone of voice which conveys tentativeness. This is not because the counsellor wishes to appear uncertain but to show respect for the client’s right to be the final judge of the ‘truth’ of their utterances, thoughts and feelings.

Key Reflecting ResponsesEach technique will be illustrated using the following client statement: ‘So now my partner has left, and I’m alone to deal with the big house and all the chores. He helped me a lot. I don’t know if I’m going to cope now.’

Reflection of Content (Paraphrasing)The facts of what the client is saying are reflected using a technique called paraphrasing. Paraphrases are short, clear response in which counsellor states the essential points of the client’s statements in the counsellor’s own words. Paraphrasing is not the same as simply repeating word for word what the client has said, but rather the counsellor uses


10 ways of starting a reflection• You feel…

• I gather…

• It seems to you…

• It sounds like…

• I guess you’re feeling…

• If I’m hearing you correctly…

• I wonder if you are saying…

• It seems like you’re feeling…

• Listening to you, it seems as if…

• I imagine that you may be feeling…

BUILD A FOUNDATION





RE

VI

EW

IN

G




Annexure 11: Helping the Client Explore Their StorySource: Kustner, 2011

Reflection

When somebody takes the time to tell us their story, it is important that we respond in a way which respects what they have said and shows them we have grasped what they are trying to say.

Reflecting skills are those skills which allow the counsellor to respond directly to what a client has said to take the conversation further in a useful direction. They also show the counsellor has been listening or, if the response misses the mark, gives permission to the client to put the counsellor back on track.

It is always important to begin a response with a qualifier such as ‘It seems to me …’ or ‘It appears that …’ and to use a tone of voice which conveys tentativeness. This is not because the counsellor wishes to appear uncertain but to show respect for the client’s right to be the final judge of the ‘truth’ of their utterances, thoughts and feelings.

Key Reflecting ResponsesEach technique will be illustrated using the following client statement: ‘So now my partner has left, and I’m alone to deal with the big house and all the chores. He helped me a lot. I don’t know if I’m going to cope now.’

Reflection of Content (Paraphrasing)The facts of what the client is saying are reflected using a technique called paraphrasing. Paraphrases are short, clear response in which counsellor states the essential points of the client’s statements in the counsellor’s own words. Paraphrasing is not the same as simply repeating word for word what the client has said, but rather the counsellor uses


10 ways of starting a reflection• You feel…

• I gather…

• It seems to you…

• It sounds like…

• I guess you’re feeling…

• If I’m hearing you correctly…

• I wonder if you are saying…

• It seems like you’re feeling…

• Listening to you, it seems as if…

• I imagine that you may be feeling…

his/her own words to restate the main points of the client’s statements.

An example:

‘So you’re saying that now that your partner has gone, you’ll have to take on more tasks, and you’re not sure you can manage.’

Reflection of FeelingBy accurately reflecting the feeling which a person is experiencing we provide a deeper understanding of how an event has affected the person and connect with the client at an emotional level, which can build trust and enhance rapport. Reflecting feelings accurately takes some practice.

In English, there are many ‘feeling words’ of various intensities, e.g. cross, angry, furious. Other South African languages, such as Sotho and Zulu, do not have many words to describe feeling states, and thus it takes a special skill to show that you understand what the client is feeling. Using metaphors can be useful in these instances e.g. ‘Your heart feels sore’ instead of ‘You feel depressed’.

An example:

‘It sounds like you’re feeling worried and overwhelmed.’ (With this response, we are still in the client’s frame of reference, and the client stays focused on his/her feelings and experience).

If the counsellor is not quite sure what the client is feeling, she or he can ask the client a feeling question: for instance, ‘How does it feel now that you’ve had to take on all of this on your own?’

Note that empathy is more quickly achieved if the right feeling can be identified and reflected by the counsellor, rather than it being elicited by a question.

Reflection of MeaningReflection of deeper empathy (sometimes called reflection of meaning) is achieved through linking the feeling to the content. Many counselling manuals and courses suggest that counsellors use the ‘you feel (the feeling, e.g. sad) because (the reason, e.g. your relationship broke down)…’ formula to reflect a combination of feeling and content. If used incorrectly and in a formulaic way this can immobilize the client and changes the client from being in a ’feeling mode’ to a ’thinking mode’, i.e. instead of feeling understood, the client is trying to work out whether the counsellor has got it right.

If used well, linking feeling to content can enhance empathy because it starts to bring depth, meaning and texture to the counselling encounter. By associating the feeling with a situation or an event the counsellor is helping to tie up the threads of the conversation and to help the client see why, in a certain situation, they responded in a certain way.

Sometimes if the client has already identified a particular feeling, the counsellor can expand and explore that feeling by asking the client to say more about the feeling or to describe its impact. The counsellor can also simply repeat the feeling word in a tentative and a questioning way, encouraging the client to go deeper and further.

An example:

‘If I’ve heard correctly, you’re saying that you feel scared and overwhelmed, because it seems as if your partner has left you to cope on your own.’

‘So your partner’s departure has raised a lot of feelings in you; perhaps anxiety, fear, anger…’

Both these responses allow the client to confirm or disconfirm what the counsellor is saying.


Reflection of Process Sometimes we reflect the client’s feelings related to counselling itself or towards the counsellor. This is called reflection of process (or immediacy).

An example:

‘You feel embarrassed talking to me about personal things,’ or ’When you said your partner had left you I noticed tears came into your eyes – this feels very sad for you.’

Immediacy skills can reflect on the relationship between the counsellor and client (or the ‘process’ of what is happening between them). If, for example, the counsellor asks the client a question about her relationship with her partner (‘How are things between you and your partner?’) and the client becomes very angry, the counsellor may need to address the client’s response as soon as possible.

The counsellor could respond in a number of different ways:

‘Susan, I noticed you got angry or anxious when I asked you about your partner. What was going on for you in that moment?’

‘Susan, that seemed to be an awkward moment between you and me there. Perhaps we should talk about it?’

‘Susan, it seemed you got very angry or anxious then. Could you tell me what angered you or made you anxious?’

Susan’s angry response might have been because she felt humiliated about her troubled relationship or felt put in a spot by the counsellor too early in the counselling session. She could have sensed a pattern of challenging questions from the counsellor, or she could have been defensive because a previous counsellor had been quite judgemental about her partner.

Only by using the skill of immediacy will the counsellor get to the root of the issue and allow the air to be cleared. Once the issue is out in the open it can be addressed and the relationship between the counsellor and client put back on an amicable and workable footing.

Meta-communication (communicating about a communication) is also a reflection of process.

An example:

‘Your voice seems to get much lower when you talk about your sister...’

Reflection of a process is an advanced skill only to be used by an experienced counsellor and always after a good, trusting relationship has been developed.

Reflection Tips• When a reflection is accurate the client feels encouraged to continue speaking

and to share more personal information. Here are some tips to help you reflect feelings.

• Listen to words and metaphors the client uses as clues to feelings, e.g. (client) ‘Everything seemed to happen at once’ – (counsellor) ‘You felt overwhelmed.’

• Observe the person’s non-verbal language, such as facial expressions, body movements, posture and gestures, e.g. tight fists could mean anger.

• Ask yourself how you might have felt if you experienced what the client describes (remember though, that people may react differently to events).

• If all else fails, ask the client how he/she feels (don’t ask too often!)


Paraphrasing

A paraphrase is a brief, tentative, statement which reflects the essence of what the person has just said. A good paraphrase:

• Captures the essence of what the person said. It leaves out the details;

• Conveys the same meaning, but uses different words;

• Is brief. Your paraphrase should be shorter than what the person just said;

• Is clear and concise. Your paraphrase should help clarify things, not confuse them; and

• Is tentative. We want the client to feel comfortable with disagreeing with or correcting the paraphrase. We use a paraphrase:

• To check perceptions: do you understand what the person has said? When you paraphrase what you think the person has said, they can react to your paraphrase and tell you whether it is accurate or inaccurate. Be sure your paraphrases are tentative enough so that the client will feel comfortable correcting you if you’re wrong;

• To clarify what the person has said: hearing an accurate paraphrase of what they have just said helps the client to clarify for themselves what they are thinking and feeling. Often a paraphrase will bring up new thoughts and feelings, acting as a prompt to further discussion. A good paraphrase may lead to interesting new explorations because it gives the client an opportunity to reorder their thoughts; and

• To give accurate empathy: an accurate paraphrase demonstrates to the person that you are listening, and that you understand. In effect, a good paraphrase says, ‘I’m with you.’ Some standard openings are: ‘Let me see if I’ve got it right’; ‘Sounds like...’; ’I think I hear you saying...’; and ’So, in other words...’

ClarifyingClarifying is a way of getting more information about something the client has said by asking them to make clearer what they have just said. As noted above, the simple act of paraphrasing what the client has said may bring clarity because in their response to the paraphrase they will automatically expand on their words and ideas. Sometimes, however, you are not sure what they mean by something and it is necessary to ask a question and to probe.

You can clarify what is not clear through asking questions for greater understanding or repeating client statements with a questioning inflection. For example if a client says: ‘I always take my heart pills because of the children,’ the counsellor could respond in at least two ways:

• By asking a clarifying question such as ‘When you said because of the children what did you mean?’; or

• By saying ’because of the children?’ with a rising inflection to indicate a question.

• Both methods prompt the client to expand further on the particular point and clarify for the counsellor what is meant. It is important that the counsellor comes across as genuinely interested in greater clarity, rather than curious and voyeuristic. It is helpful to present oneself as tentative, interested and intent on building a comprehensive picture of the client, their story, their needs and challenges.

Some standard openings of paraphrases are: • ‘Let me see if I’ve got it

right’;

• ‘Sounds like..’;

• ‘I think I hear you saying...’;

• ‘So, in other words...’


• It can be also helpful for the counsellor to position herself or himself as a ‘naive’ listener, keen to get to the heart of what the client is saying but assuming nothing. If the client really believes they are the experts on their own lives, they will be willing to tell you more about them so that you truly understand where they are coming from.

Exploring through QuestioningAsking questions in counselling is useful but should be kept minimum. Almost every beginner counsellor tends to overuse questions. The following tips are useful to remember when using this skill in counselling.

• Questions should serve a purpose – either clarifying or helping the client to think about the problem in a different way. Before asking a question, ask yourself: ‘Whose need is it for me to ask this question?’

• Clients might expect counselling to be conducted on a question-answer basis, because that is what a doctor or traditional healer consultation is like. After asking a question, use other counselling skills, like reflection of feelings and summarising to demonstrate that counselling is not primarily about asking and answering questions.

• Ask open-ended questions rather than closed questions. Continually asking closed questions has an immobilising impact in communication in counselling. Counselling should not feel like a talk show or interrogation session. An open-ended question has many potential answers, a closed one has only one or two possible answers.

• Asking hypothetical questions. These are usually open questions which prompt lateral thinking in clients. An example to a client could be ‘What will you do if your husband agrees to go to couple counselling?’

• Asking reflecting questions. These are questions which encourage clients to summarise or reflect on a particular discussion. This could be very effective in a session where a number of issues have come up. For example, the counsellor asks: ‘What, for you, are the main reasons why you and your partner don’t communicate well?’

• Asking evaluative questions. These are questions which take a specific issue and ‘evaluate’ a course of action. For example if a client wants to resign and start a small business from home the counsellor could ask: ‘How do you think this will work over the next six months?’

Some Pitfalls of Questioning• Leading questions: This type of question presumes that the questioner knows

the answer, and puts words in the other person’s mouth. (‘That’s hard for you, isn’t it?’ ’When will you tell your parents?’)

• Why questions: They can make people defensive, as they can imply that the person should know the answers. Such questions can sound critical, as though you are questioning their judgement. (‘Why isn’t this working for you?’ ‘Why do you not understand this?’)

• Intimate questions: Some questions are not appropriate to ask because they may not be relevant or may be too personal. Always try to ask questions that are valuable for advancing a specific conversation. Always be respectful and treat other people as you would want to be treated. Questions asked out of curiosity should be avoided. (‘Are you gay?’ ‘And then what did you do in bed?’)

• Poorly-timed questions. Questions that are poorly-timed interrupt the flow of a person relating their story. ‘How long has this been going on for?’–asked in the


midst of someone revealing that he is cheating on his girlfriend. ‘Well, what will you do?’ –asked while someone is still relating the details of her personal crisis.

SummarisingSummaries are essentially a series of paraphrases of issues from a client. A summary provides order and focus and sorts out relevant material to explore in an encounter. Good summaries act as natural ‘stopping and reflecting’ points in a conversation and can also be used to start sessions and bring them to a close. To effectively summarise, the counsellor has to really listen and attend to what the client is saying and how they are saying it.

Other uses of summaries include:• Giving direction to a counselling session;

• Preventing from getting stuck on a particular issue;

• Checking out if the counsellor has really understood what the client is trying to say;

• Linking different points and themes together;

• Helping the client gain some perspective of his/her situation;

• Helping the client see where they’ve been and where they are going; and

• Helping the client to identify possible areas to be explored further.

Some tips for summarising• A good summary is brief and includes not only the facts and the words but also

the feelings the client has expressed.

• Put the ideas and descriptions at least partly into your own words but the language should still be primarily in the words used by the client.

When to use a summary• It is a good way to begin or end the session.

• It is a useful skill at a point where a person appears to be stuck.

• It is helpful at the point where the person has spoken for a long time in a confusing or rambling way.

• It is useful when shifting modes, i.e. after you have explored and defined the problem, it is useful to summarise and then move on to exploring options.


Annexure 12: Helping the Client Explore Options and Self-help Strategies for Successful CopingSource: Kustner, 2011

The goal of counselling is to empower the client, and through the problem-treatment cycle the client moves from exploring problems to finding solutions. In exploring solutions, the client needs to discover their own inner resources and coping skills, as well as look at external sources of support such as:

• Self-help treatments and coping strategies;


• Other service providers; and

• Drawing support from family, friends and community.

Self-help Strategies and Successful Coping Responses 1. Be Proactive, instead of passively waiting for things to get better. This gives us an increased feeling of competence and self-esteem. Make a decision to do something about the situation you are in.

2. Practice Relaxation Techniques. Relaxation doesn’t just happen – it’s a skill you need to practice. Taking slow deep breaths helps you remain in control and get through the stress more efficiently.

3. Positive Self-talk. So often, if we really listen, we can hear the negative things we are telling ourselves: ‘She doesn’t like me’, ‘I’m going to mess this up’, ‘He’s funnier than I am’. By using positive self-talk, you can start to hear words of encouragement and support. You will be surprised at how different that feels. Try this with deep breathing and see how much better you feel.

BUILD A FOUNDATION





RE

VI

EW

IN

G




4. Physical Activity. It does not have to be much. Even just a brisk walk for 15 to 20 minutes can help lessen stress reaction and promote a general sense of well-being. Physical activity causes endorphins to be released, which are the body’s feel-good hormones. Regular exercise can also improve your body’s ability to handle stress in general.

5. Writing. Can be an effective means of working through stress as well as gaining a better understanding of what is bothering you. Keeping stressful thoughts to oneself can cause them to grow, as well as creating a new stress from holding on to these upsetting feelings. Write until you feel done.

6. Realistic Appraisals. Coping effectively with life’s problems and failures requires realistic expectations. Psychologists call these expectations and judgments appraisals. Life events aren’t a problem unless we appraise them as such. If our appraisals are realistic, we’re better able to react to day-to-day life events with a sense of proportion. It is possible to put an alternative interpretation in the place of an irrational judgment. Suppose someone treats you rudely. You may be tempted to think that that person is horrible, or ‘Everyone dislikes me’. An alternative interpretation could be: ‘I wonder what’s happening with that person for them to behave so rudely?’ We have the choice how to frame our perceptions.

7. Art. Creative endeavours are a known means of self-expression. Grab a piece of paper and some markers, paints, or crayons. Fill the page with colour. It does not matter what it looks like. Just do what seems to come next. Grab some magazines, scissors, and glue – make a collage. Make a mobile. Sculpt a shape out of mud. Arrange leaves and branches in a jar of water. The key is not to focus on the end product, but the process.

8. Meditation. Meditation need not be a complex, structured process that you learn from years of practice. You do not even need to buy a book. Think of a place that you love. Focus on the details. Focus on how it feels to be there, what sounds you hear, what smells arise. Focus all of your attention on the image. You may even fall asleep. Try doing this while taking slow deep breaths and listening to your favourite relaxing music.

9. Music. Listening to music is a powerful tool in coping. Music has the power to take the listener along any number of emotional paths. Pick your music wisely. Choose music that allows you to feel in a safe way, but does not create additional stress. Listening to cheery love songs, for example, may not facilitate coping if you are feeling sad and alone. Sometimes your music should be in the background; sometimes it should fill the room. Know what works for you, and allow yourself to do it.

10. Friends. Turning to friends during times of stress can be an invaluable coping tool. Friends can validate who you are and how you feel. They can provide a caring ear, ready and willing to listen and support you. Be aware of who your friends are. Surround yourself with caring supportive people who are quick to jump to your defence and want to protect you from getting hurt – not people who tend to put you on the spot or make you feel defensive.

11. Good Nutrition. Eating a healthy and well-balanced diet is not only good for the body but also for the mind. There is ample research to suggest that certain foods improve mood, concentration and mental agility. In addition, the act of preparing nutritious meals for friends and family assists with isolation and loneliness.

12. Smile. Even if it’s forced. The physical action of smiling sends positive messages to your brain.


Annexure 13: Help Your Client Make a PlanSource: Kustner, 2011

Problem-solving: The Traffic Light Model: Stop, Think, GoThe traffic-light problem-solving model is a useful way to approach problematic situations. Sometimes people rush into ‘solving’ problems without thinking of the pros and cons of their actions. This model encourages people to stop, think and then act; thereby they make informed and well thought-out decisions in solving their problems.

Stop Define the Problem: This is the most important step in the problem-solving model, and often requires the most time in counselling. This step involves gathering information and clarifying. It also involved breaking what seems to be a huge problem into its various parts or sub-problems (sometimes called partialising).

Think Explore all Options: This step involves exploring all possible options to solve the problem (or, to start with, just one part of the problem, perhaps something that is reasonably achievable). Encourage the client to brainstorm as many solutions to their problem as possible, even if they seem silly. Continue until all ideas are exhausted. It is important that you as counsellor do not have a preconceived idea on what the solution should be.

BUILD A FOUNDATION





RE

VI

EW

IN

G



STOP

THINK

DO


Look at alternatives and consider the consequences of each idea generated from the above brainstorming. Ask clients to look at the pros and cons of each solution. Usually the best solution is the one with the most advantages.

DoSelect an Option, Make a Plan and Take Action: Encourage the client to select the most effective option, according to whether it is practical, appropriate and realistic. Be patient and gently support the client to make their choice.

Develop a Plan: Ask the client to think about how they can put their choice into action. Ask who, what, when, how, and where questions so that the plan is specific, achievable, realistic and within a time-frame. It is sometimes helpful if the client writes their plan down.

Take Action: Acknowledge that this step is usually the most difficult for people. To help build the client’s confidence, it can be helpful to start with an action where the client has a relatively good chance of succeeding. Using role-play to ‘practice’ what the client will do and say and to anticipate possible reactions can also be helpful. Reassure the client that you will explore the outcome in the next session.

Evaluate: This is an important opportunity to see what worked, what didn’t work and why. Reassure clients that if they don’t succeed, to try, try again!

Information Every Counsellor Should HaveTo help the client evaluate options, you must have accurate and up-to-date information about.

• HIV/AIDS and STIs;

• Identity, gender and sexuality;

• Referral services available;

• Legal and human rights and an understanding of methods of redressing rights violations; and

• Community support services.


Annexure 14: Dealing with Suicide and Self-harmSource: University of Melbourne, 2009

Assess the Risk of Suicide or Harm to Self or Others . People with mental disorders sometimes feel so helpless about their life, that future appears hopeless to them.

Engage the person in conversation about how they are feeling and let them describe why they are feeling this way. Ask them if they are having thoughts of suicide.

If they are, find out if they have a plan for suicide. This is not a bad question to ask someone who is mentally unwell. It is important to find out if she/he is having these thoughts in order to refer her/him for help.

If you believe the person is at risk of harming herself or himself then:




• Try to stop the person continuing to use alcohol or drugs, in case they have been using these.

Encourage the person to get appropriate professional help . You can encourage the person to consult a doctor who knows about mental disorders, and who is able to prescribe medication if necessary. Then you can follow-up by giving ongoing support to the person and their family. If the person is very unwell, i.e. you think they are suicidal or psychotic, and she/he is refusing to get any help from a doctor, encourage the family to consult the doctor so that they can explain the situation and get professional support.

Assessing Suicide RiskSource: Kustner, 2011

If the client answers ‘Yes’ to any of the following questions, you must take it seriously and follow it up:

• Have you thought of how to commit suicide?

• Do you have a plan?

• Have you decided when?

• Have you ever tried it before?

Don’t be scared to ask – you won’t give the client any ideas, but rather they will feel relieved that someone has asked! Just about everyone has considered suicide, however fleetingly, at one time or another. However, if the client has a plan of suicide, the risk is very high.

If you feel that the client is in any way at suicide-risk, try not to leave them on their own after the counselling session.

Encourage the client to speak to a psychologist or doctor, and walk with them to the health care professional, if possible. Ask the client if you can call a trusted friend or family member to come and fetch them, even if they have their own transport.


Annexure 15: PowerPoint Presentation – Mental Health


Notes








population status.








module

C

module

A

module

C

module

D




module



C2 Family Support

C3 Mental Health





D3 Positive Living





C4 M

SM w

ith F

emal

e Pa

rtne

rs

Facilitator Guide

MSM with Female Partners

C4

Pehchan 1B Basics of HIV Prevention and Outreach Planning (Pre-TI)C4 Facilitator Guide: MSM with Female Partners


About Pehchan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2


Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3


Module Acknowledgments: MSM with Female Partners . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

About the MSM with Female Partners Module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9


Activity Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Activity 1: Introduction to MSM with Female Partners Module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Activity 2: Understanding MSM with Female Partners . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Activity 3: Gender and Health Implications for Female Partners of MSM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Activity 4: Sexual and Reproductive Anatomy and Physiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Activity 5: Reaching out to MSM with Female Partners . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Annexure 1: Gender and Health Implication for Female Partners of MSM. . . . . . . . . . . . . . . . . . . . . 20

Annexure 2: Male and Female Reproductive Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Annexure 3: Case Studies – MSM with Female Partners . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

Pehchan2 C4 Facilitator Guide: MSM with Female Partners

About this ModuleThis module is designed to help training participants: 1) understand the issues of men who have sex with men (MSM) who also have sex with female partners; 2) become familiar with how gender impacts health; 3) learn basic sexual anatomy and differences between male and female; and 4) learn basic strategies to reach out to MSM with female partners and provide appropriate support and linkages to services. In the Pehchan programme, this module is used to familiarise CBO staff on the specific needs of MSM with female partners.




Pehchan 3C4 Facilitator Guide: MSM with Female Partners








Module Acknowledgments: MSM with Female PartnersEach component of the Pehchan Training Curriculum has a number of contributors who have provided specific inputs. For this component, the following are acknowledged:

Primary Authors Sylvester Merchant, Lakshya Trust; Yadavendra Singh and Harjyot Khosa, India HIV/AIDS Alliance


Technical Input Vaibhav Sarai, Consultant; Debjyoti Ghosh, SAATHII; J. Robin, SIAAP; Bharat Patil, Lakshya Trust; Priti Parbhughate, ICRW; Ashish Agarwal, Samman Foundation; Harish Kamble, HST; Sunita Grote and Sonal Mehta, India HIV/AIDS Alliance.


References • Fact sheets on sexual and reproductive health and rights - Key topics for civil society

organisations working with and for young people. (2011). New Delhi. India HIV/AIDS Alliance.

• Training Manual – An Introduction to Promoting Sexual Health for Men Who Have Sex with Men and Gay Men (2001). New Delhi. The Naz Foundation (India) Trust.


About the MSM with Female Partners Module

No. C4

Name MSM with Female Partners

Pehchan Trainees • Counsellors

• Peer Educators (PEs)

• Outreach Workers (ORWs)


Training Objectives By the end of this module, participants will:

• Understand the needs of MSM with female partners, especially their sexual and reproductive health (SRH) needs;

• Understand the importance of non-judgmental attitudes and confidentiality when dealing with MSM who have female partners;

• Gain knowledge on male and female sexual and reproductive anatomy and its role in reproduction; and

• Understand the programmatic approaches to reach out to MSM with female partners





Audio-visual Support 1. Audio-video clip ‘Male reproductive system’.2. Audio-video clip ‘Fertilisation and the reproductive system’.

Annexures 1. Annexure 1 on ‘Gender and Health Implications for Female Partners of MSM’.

2. Annexure 2 on ‘Male and Female Reproductive Anatomy’. 3. Annexure 3 on ‘Case Studies’. 4. Annexure 4 on ‘Fact Sheets on Sexual and Reproductive

Health and Rights’ available in digital file.


Activity Index1


Take-home material

1 Introduction to MSM with Female Partners Module


2 Understanding MSM with Female Partners

1 hour N/A N/A N/A

3 Gender and Health Implications for Female Partners of MSM

1 hour 30 minutes

Annexure 1 on ‘Gender and health implications for female partners of MSM’

N/A N/A

4 Sexual and Reproductive Anatomy and Physiology

1 hour 30 minutes

Annexure 2 on ‘Male and female reproductive anatomy’

1. Audio-video clip ‘Male reproductive system’2. Audio-video clip ‘Fertilisation and the reproductive system’

Annexure 4 on ‘Fact sheets on sexual and reproductive health and rights’

5 Reaching out to MSM with Female Partners

2 hours Annexure 3 on ‘Case studies’

N/A N/A



Activity 1: Introduction to MSM with Female Partners Module

Time 15 minutes


• Be able to articulate the objectives of this training module.

Materials N/A



Methodology Welcome the participants, and ask them to share their thoughts on, or experiences of, MSM who have female sexual partners. Ask them if they have heard queries from MSM about their female partners and the problems thereof? Write down the responses from the participants on a flip-chart. This will help you to refer to these points during the course of the day. Some of the key words that are relevant to this module are family pressure, aspirations for a child, emotional attachment to female partners, etc.

Ask participants to voice their expectations from this module and list these on the board.

Map their expectations with the objectives of the module, and tell them which of their expectations would be met in the day’s training. It is also important to explain why some expectations are beyond the scope of this module.

Note: Female partners of MSM refer not only to spouses but also to girlfriends and any other sexual or non-sexual partners including sex-workers. While the primary concern with sexual relationships are health risks, including the transmission of HIV and other sexually-transmitted diseases (STDs), one also needs to consider the social and psychological aspects of such relationships. In fact, many MSM people are often married but not sexually involved with their spouses, and their spouses are not aware of their alternate sexual lives.

Note to FacilitatorIn reaching out to the MTH community, Pehchan Programme works with some MSM who have female partners and offers psychosocial support and friendly services to help address some of their distinct needs.

During discussions, please ensure that the participants understand that Pehchan’s focus is on the MTH community. Complementing this mandate, addressing the needs of MSM and their female partners represents a key strategy of the programme to increase its responsiveness and impact.


Activity 2: Understanding MSM with Female Partners

Time 1 hour

Learning Outcomes By the end of this activity, the participants will learn:

• About the different kinds of female partners MSM have, and some of the common issues faced by MSM with female partners; and

• The importance of being non-judgmental while dealing with issues of MSM with female partners.

Materials N/A



Methodology Divide participants into two groups. Ask the groups to answer the following questions and list their responses on separate flip-charts.

• Who are the female partners of MSM? (For Group 1)

• Why do you think MSM have female partners? (For Group 2)

Lead a discussion among participants to help them understand why MSM have female partner(s). Ensure that the discussion covers the following points:

• The reasons vary from one individual to another.

• It is important to note that MSMs, irrespective of their sexuality and the number of partners they have, may care deeply about their female partners. Some of them may be bisexual and have a healthy sexual relationship with their female partners.

• They may have familial obligations – parents, siblings and children.

• Emphasise the importance of being non-judgmental about MSM who have female partners.

Use the following statements to elicit the opinions of participants.

• An MSM who has a wife and a boyfriend is cheating on the boyfriend.

• An MSM cannot have both a wife and a boyfriend — he should choose one or the other.

• Does an MSM have the right to make his female partner unhappy?

• Kothis cannot be bisexual.

• If you are a transgender (male to female) married to a woman, you cannot keep your wife happy.

• How can hijras be married?

• MSM people have no right to marry.

Note to FacilitatorThere are various female partners that an MSM can have, e.g. wife, girlfriends, female sex workers, casual sex partners, etc.

There could be various reasons for having female partners, such as societal pressure (marriage, reproduction), peer pressure (having girlfriends), and sexual pleasure (wife, female sex workers, casual sex partners).


After encouraging a healthy debate on these issues point out judgmental attitudes/views that may be expressed, and remind participants (especially counsellors) that regardless of their own personal views, they must have a non-judgmental attitude when dealing with clients. Bring out different opinions by letting participants debate these issues, and gently point out where they are making value judgments about another’s behaviour and thoughts.

Note to FacilitatorAs the participants have already undergone a training session on sexuality and gender, you may quickly revisit the concepts of gender and sex and their social constructs and implications on the following:

• Health and well-being.

• Access to and understanding of information about health-related issues, including sexual and reproductive health.

• Experience of illness.

• Attitudes toward maintaining own health and that of family members.


Activity 3: Gender and Health Implications for Female Partners of MSM



• Know how gender differences influence health and health-seeking behaviour.

Materials Annexure 1 on ‘Gender and Health Implications for Female Partners of MSM’.



Methodology

The Gender and Health Case Study Divide the participants into three to four groups, preferably homogenous groups comprising participants from a particular state or district.

Distribute copies of the Annexure 1 on ‘Gender and health implications for female partners of MSM’, chart papers and markers to each group, and give participants 15 minutes to discuss the case and answer the questions accompanying the case study.

Ask each group to present its findings to the larger group. During the presentation and the discussion that follows, ensure that the following points are covered.

• The regional differences in status of women, with particular reference to female sexual partners of MSM.

• Lack of access to accurate health information for both MSM and their female partners.

• Limited migration and mobility for women, as compared with opportunities for men.

• Subordination of women in patriarchal family and social systems.

• Usage of protection when having multiple sexual partners.

• The lack of family support systems for MSM and for women in general.


Case Study: Urmila and AshokUrmila is married with two children and stays in a village with her in-laws. She works in the fields. Her husband, Ashok, works in the city and sends money every month to his mother. Urmila is completely dependent on her mother-in-law for any monetary requirement.

Sometime ago, her father-in-law became ill, and had to be admitted to the nearest hospital, which was 25 km away. It was Urmila’s responsibility to attend to her father-in-law.

Due to the nature of his work, Ashok visits his family only twice a year. There is an NGO in the area where Ashok’s works and it organises a health camp regularly. Ashok cares deeply for his wife, but he cannot deny the fact that he prefers emotional and sexual relationships with men. While Urmila is in a monogamous relationship with her husband, Ashok has a number of male partners.

Recently, Urmila developed a chronic fever, and the family insisted she consults a traditional healer, who gives her local medication, her fever has not subsided. Her father-in-law, the head of the family, refuses to let her go to the city for treatment.

Questions 1. What are some of the health risks that Ashok and Urmila face? As Ashok is an MSM,

does his behaviour create any additional risks for Urmila? Could Urmila’s fever be a symptom of a sexually-transmitted infection (STI)?

2. Is Urmila’s position in the family and social structure having an impact on her access to treatment?

3. How can you relate this case with the communities and regions you work in?


Activity 4: Sexual and Reproductive Anatomy and Physiology



• Understand the sexual and reproductive systems of males and females, and their role in sexual pleasure and reproduction;

• Understand how pregnancies happen, and the different contraceptives available to prevent pregnancy;

• Understand how STIs and Reproductive Tract Infections (RTI) are transmitted from one partner to another through sexual contact, and how they can be prevented; and

• Identify the sexual and reproductive health (SRH) needs of female partners of MSM.

Materials Annexure 2 on ‘Male and Female Reproductive Anatomy’. One per group.

Audio-visual Support 1. Audio-video clip ‘Male Reproductive System’.2. Audio-video clip ‘Fertilisation and the Reproductive System’.

Take-home Material Annexure 4 on ‘Fact Sheets on Sexual and Reproductive Health and Rights’.

Methodology Show the videos and tell participants that a quiz would be taken at the end of the screening of the video to understand how much they have learned. After the video ends, divide the participants into two groups, Group A and Group B. Give Group A the hand-out depicting the male reproductive system anatomy and Group B the hand-out depicting the female reproductive anatomy.

Next, ask a participant from Group A to come up to the whiteboard and draw the female reproductive system. The rest of Group A should help their team member. The representative also needs to explain what each part’s function is.

Explain to them that the terms used in the videos were medical terms, and that they may translate the name into local language for the benefit of the other participants.

Group B should then judge whether the drawing matches the hand-out given to them.

Repeat the exercise with Group B and the male reproductive system.

Use the activity to discuss the following:

• Parts of male and female sexual and reproductive anatomy that are associated with pleasure;

• Menstruation and pregnancy;

• Role of condoms and other contraceptives in preventing pregnancy;

• High-risk sexual behaviour (including anal sex) and how STIs and RTIs can be transmitted to female partners; and

• SRH services for female partners.

Conclude by giving each participant a copy of the Annexure on ‘Fact sheets on sexual and reproductive health and rights’

Discussion Points

• Facilitators should remind participants that the transmission of HIV from an infected mother to her unborn child can be avoided.

• Sexual activities can generate pleasure without penetration.


Activity 5: Reaching out to MSM with Female Partners

Time 2 hours


• Explore strategies to help MSM and their partners with their psycho-social issues, without disclosure of marital status and/or sexuality; and

• Understand Pehchan’s programmatic strategies of reaching out to MSM with female partners.

Materials Annexure 3 on ‘Case Studies’.



Methodology Divide the participants into three groups. Distribute Annexure 3 ‘Case studies’ to each group. Participants in all the three groups need to review the case studies and prepare a presentation for rest of the participants on their suggested outcomes. After 30 minutes, have each group present its findings to the larger group. For the ensuing discussion, ensure that the following points are covered.

• Participants should be aware of their own attitudes towards MSM who have sexual relations with women, and ensure that their own personal feelings and attitudes do not colour their interactions with these individuals.

• Remind participants that disclosing marital status or sexuality is not required. Whether or not to disclose is an individual’s choice, and participants should understand that their role is only to:• Help an individual weigh the pros and cons of disclosure; and• Support the individual in dealing with the consequences of his decision

regarding disclosure.

TipWhen participants are sharing their findings in the larger group, identify volunteers who are more confident and vocal to enact the roles in the case study being discussed.

As participants warm up to the role-playing, encourage the less vocal/shy participants to play some of the roles.

Note to FacilitatorA number of strategies can be adopted when dealing with the issues of MSM with female partners. Some examples are:

• Creation of support-groups for married MSM;

• Referral of wives of married MSM to friendly services; and

• Development of IEC/BCC materials relating to issues of concern for MSM with female partners. Programmatic strategies are more elaborately discussed in Human and Legal Rights, Community Preparedness for Sustainability and Friendly Services module.


Case Studies

Case Study 1Refer to the Case Study of Urmila and Ashok discussed above. In the study, it is mentioned that Ashok cares deeply about his wife.

Questions• Should Ashok’s caring extend to helping her access proper healthcare facilities?

• If yes, then what are the options available to them? If not, why?

If the participants feel that Ashok should help his wife access proper healthcare, you can remind them that Friendly Services are an integral part of Pehchan, and help them make a list of the available facilities that are available to the couple.

If the participants feel that Ashok should not get involved in his wife’s health problems, explore the reasons for their opinions and reflect on any prejudicial or judgmental attitudes that they may voice.

(Needless to say, your feedback should be in a non-judgmental manner!). Discuss with them why it is important for Ashok to care about his wife’s health.

Case Study 2One of Ashok’s partners is Ravi, an effeminate male who is also married. His wife hears some gossip about his sexuality in their neighbourhood. She gets very disturbed. One day she confronts Ravi about his sexuality, which he strongly denies. After this incident, Ravi decides to visit the counsellor.

Questions • List all the possible dilemmas that Ravi could be facing.

• What are the possible solutions that Ravi could come up with while discussing his problems with the counsellor?

• If Ravi is willing to bring his wife to the drop-in-centre (DIC), how should the counsellor handle the wife’s questions (and distress) without endangering Ravi’s right to confidentiality?

Remind participants of the pillars of counselling (covered in Module C3 on Mental Health), and tell them that as Ravi is their client, his best interests need to be primary. Therefore, confidentiality is of utmost importance. He should not be negatively judged because he misguided his wife about his sexuality.

When exploring strategies, they should encourage Ravi to come up with his own solutions, as each person’s situation is unique and externally imposed solutions, while appearing ideal, may not necessarily be the best for Ravi. They should however help Ravi weigh the pros and cons of each strategy.


Case Study 3Srikanth recently got married and is very happy in his marriage. He likes his wife a lot. After one month of his marriage he comes to know that one of his ex-boyfriends tested positive for HIV. Though he is very worried, he is very scared to get himself tested. He stopped having sex with his wife because he did not want to infect her. His wife, however, wants a child, and doesn’t understand why Srikanth is avoiding her. This situation leads to tension in their lives. Srikanth approached a CBO for counselling.

Questions • What are the arguments that the counsellor could make to persuade Srikanth to

go for HIV testing?

• If he does agree to get tested, and turns out negative, how should he take care of himself, his wife, and other partners from infection?

• If he does turn out positive, should he disclose his HIV status to his wife?

• How can he do so without talking about his sexuality?

• How can Srikant be persuaded to get his wife tested for HIV?

• What options can they explore regarding having children?

Case Study 4 Naushad is a Peer Educator (PE) in a TI Plus organisation. He is very happy to know that his CBO will address the issues of MSM with female partners. During one of the support-group sessions, there were a lot of questions from the community as to why his CBO is trying to reach the female partners: is the CBO trying to disclose their sexuality to their female partners? Many were reluctant to reveal their marital status to the group, and few had revealed their sexual behaviour with men to their female partners.

Questions • Can you identify a few reasons why some members of the community are

nervous about reaching out to female partners?

• What strategies can be developed to address these concerns?

• What services can a CBO provide to the MSM with female partners?

• What services can a CBO provide to the female partners of MSM?

Note: One of the strategies that could be applied is the design of a targeted intervention (TI) where, rather than only visit houses of MSM, the ORWs and PEs visit each house in the target area. For instance, if an ORW/PE finds out from an MSM that he wants his wife/female partner to become aware of HIV and why it is important to get tested, the ORW/PE could design his/her intervention to reduce suspicion.

While there is no foolproof strategy to reach out to the female partners of MSM, some organisations have tried this method and have been successful.

Note to FacilitatorParticipants might not want the client to disclose his positive status to his female partner due to the fear of revealing his sexuality.

Remind them that HIV is not just contracted through sexual behaviour but also in various other ways such as infected needles/syringes and blood transfusion.


Annexure 1: Gender and Health Implication for Female Partners of MSM

Case Study: Urmila and AshokUrmila is married with two children and stays in a village with her in-laws. She works in the fields. Her husband, Ashok, works in the city and sends money every month to his mother. Urmila is completely dependent on her mother-in-law for any monetary requirement.

Sometime ago, her father-in-law took ill, and had to be admitted to the nearest hospital 25 km away. It was Urmila’s responsibility to attend to her father-in-law.

Due to the nature of his work, Ashok visits his family only twice a year. There is an NGO in the area where Ashok works and it organises a health camp regularly. Ashok cares deeply for his wife but he cannot deny the fact that he prefers emotional and sexual relationships with men. While Urmila is in a monogamous relationship with her husband, Ashok has a number of male partners.

Recently, Urmila developed a chronic fever, and the family insisted she visit a traditional healer. In spite of the ‘medicines’ the healer gave her, her fever has not subsided. Her father-in-law, the head of the family, refuses to let her go to the city for treatment.

Questions• What are some of the health risks that Ashok and Urmila face?

• How Urmila’s social condition had an impact on her access to treatment?

• As an MSM, does Ashok’s behaviour create any additional risks for Urmila?

• How does gender affect decisions about work? What does this mean for gender differences in access to economic barriers?

• Describe the power-structure in Ashok’s family and community. How does this structure impact the health of male and female characters in this case?

• How can you relate this case with the communities and regions you work with?


Annexure 2: Male and Female Reproductive Anatomy

Female Reproductive System

Female Genitalia


Male Reproductive System


Annexure 3: Case Studies – MSM with Female Partners

Case Study 1 Refer to the Case Study of Urmila and Ashok. In the study, it is mentioned that Ashok cares deeply about his wife.

Questions• Should Ashok’s caring extend to helping her access proper healthcare facilities?

• If yes, then what are the options available to them? If not, why not?

Case Study 2One of Ashok’s partners is Ravi, an effeminate male who is also married. His wife hears some gossip about his sexuality in their neighbourhood. She gets very disturbed. One day she confronts Ravi about his sexuality, which he strongly denies. After this incident, Ravi decides to visit the counsellor.

Questions • List all the possible dilemmas that Ravi could be facing.

• What are the possible solutions that Ravi could come up with while discussing his problems with the counsellor?

• If Ravi is willing to bring his wife to the drop-in-centre (DIC), how should the counsellor handle the wife’s questions (and distress) without endangering Ravi’s right to confidentiality?


Case Study 3Srikanth recently got married and is very happy in his marriage. He likes his wife a lot. After one month of his marriage he comes to know that one of his ex-boyfriends has tested positive for HIV. Although very worried, he is also very scared to get himself tested. He has stopped having sex with his wife because he does not want to infect her. His wife however, wants a child, and doesn’t understand why Srikanth is avoiding her. This situation leads to tension in their lives. Srikanth approached a CBO for counselling.

Questions • What arguments could the counsellor use to persuade Srikanth to go for HIV

testing?

• If he does agree to get tested, and turns out negative, how should he take care of himself, his wife, and other partners from infection?

• If he does turn out positive, should he disclose his HIV status to his wife?

• How can he do so without talking about his sexuality?

• Should the client lie to his female partner if he thinks that is the only way to expose her to testing and treatment for HIV?

• What options can they explore regarding having children?

Case Study 4Naushad is a Peer Educator (PE) in a TI Plus organisation. He is very happy to know that his CBO will address the issues of MSM with female partners.

During one of the support group sessions, there were a lot of questions from the community as to why his CBO was trying to reach female partners. Many wanted to know whether the CBO was trying to disclose their sexuality to their female partner.

Many were reluctant to reveal their marital status to the group, and few had revealed their sexual behaviour with men to their female partners.

Questions • Can you identify some of the reasons as to why some of the community could be

nervous about reaching out to female partners?

• What strategies can be developed to address these concerns?

• What services can a CBO provide to the MSM with female partners?

• What services can a CBO provide to the female partners of MSM?

BACKTOTOP NEXTMODULE








population status.








module

C

module

A

module

C

module

D




module



C2 Family Support

C3 Mental Health





D3 Positive Living





C4 M

SM w

ith F

emal

e Pa

rtne

rs

C5 T

rans

gend

er a

nd H

ijra

Co

mm

uniti

es

Facilitator Guide

Transgender and Hijra Communities

C5

Pehchan 1C5 Facilitator Guide: Transgender and Hijra Communities


About Pehchan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2


Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3


Module Acknowledgments: Transgender and Hijra Communities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

About the Transgender and Hijra Communities Module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9


Activity Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Activity 1: Knowing Transgender and Hijra Communities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Activity 2: Typology of Transgender and Hijra Groups . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Activity 3: Vulnerability of Transgender and Hijra Communities to HIV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Activity 4: Sexual Health, STI and HIV in Transgender and Hijra Communities. . . . . . . . . . . . . . . . . . 19

Activity 5: Transformation and Feminisation Processes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

Activity 6: Reaching and Mobilising Transgender and Hijra Communities . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

Activity 7: Mobilising Transgender/Hijra Groups to Access Quality Treatment and Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

Activity 8: Social Exclusion, Rights and Entitlements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

Annexure 1: Working Definitions of the Terms ‘Transgender’ and ‘Hijra’ . . . . . . . . . . . . . . . . . . . . . . . . . 40

Annexure 2: The Transgender Umbrella . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

Annexure 3: Aspects of Transformation and Feminisation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

Annexure 4: Journey towards Social Inclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

Annexure 5: PowerPoint Presentation – Transgender and Hijra Communities . . . . . . . . . . . 46

Pehchan2 C5 Facilitator Guide: Transgender and Hijra Communities

About this ModuleThis module is designed to help training participants: 1) understand the basics of transgender and hijra identity; and 2) become familiar with the challenges facing transgender and hijra community members in the current context. In the Pehchan programme, this module is used to familiarise CBO Programme Managers, Counsellors, and Outreach Workers on the specific needs of transgender and hijra-identified individuals.





Module Acknowledgments: Transgender and Hijra CommunitiesEach component of the Pehchan Training Curriculum has a number of contributors who have provided specific inputs. For this component, the following are acknowledged:

Primary Authors Agniva Lahiri, PLUS; Lakshmi Narayan Tripathi, Astitva; Gauri Sawant, Sakhi Char Choughi; A Revathi, Consultant; Ranjit Sinha, Bandhan; and Simran Sheikh, India HIV/AIDS Alliance


Technical Input Amitava Sarkar, SAATHII; Olga Aaron,SIAAP; and Vaibhav Sarai, Consultant


References • T, Lakshmi et al. (2011) Hijras Transgender specific HIV Intervention. NACP IV working

groups. National AIDS Control Organisation.

• Brown, M.L., and Rounsley, C.A. (1996) True selves: Understanding transsexualism for families, friends, coworkers, and helping professonals. San Francisco. Josey-Bass, a Wiley Company.

• Chakrapani, V. (2010) Social Exclusion and the Transgender/Hijra Communities.Transgender Issue Brief. United National Development Programme.

• A move towards Inclusion; Establishment of Tamil Nadu Aravanigal. (2007). (Transgender Women) Welfare Board. State Government of Tamil Nadu.

• From the Third Eye (2010), Film-based research project, SAATHII and United Nations Development Programme, India.


About the Transgender and Hijra Communities Module

No. C5

Name Transgender and Hijra Communities

Pehchan Trainees • Project Managers, Project Officers

• Counsellors

• Outreach Workers (ORWS)


Training Objectives At the end of the day’s training, the participants will:

• Understand the experiences of transgender and hijra communities in various local contexts; and

• Understand and address the sexual and general health needs of transgender and hijra Communities.





Audio-visual Support 1. PowerPoint presentation ‘Transgender and Hijra Communities’.

2. Audio-video clip from the movie ‘From the Third Eye’.

Annexures 1. Annexure 1 on ‘Working Definitions of the Terms Transgender and Hijra’.

2. Annexure 2 on ‘The Transgender Umbrella’.3. Annexure 3 on ‘Aspects of Transformation and Feminisation’.4. Annexure 4 on ‘Journey towards Social Inclusion’.


Activity Index1

No. Activity Name

Time Material1 Audio-visual Resources Take-home material

1 Knowing Transgender and Hijra Communities

45 minutes


Refer to the slides ‘Working Definition of Terms’ from the PowerPoint presentation ‘Transgender and Hijra Communities’

Annexure 1 on ‘Working Definitions of the Terms Transgender and Hijra’

2 Typology of Transgender and Hijra Groups

50 minutes


Refer to the slides titled ‘The Transgender Umbrella’ from the PowerPoint presentation ‘Transgender and Hijra Communities’

Annexure 2 on ‘The Transgender Umbrella’

3 Vulnerability of Transgender and Hijra Communities to HIV

30 minutes


Refer to the slides titled ‘Vulnerability to HIV and Risk Factors: Some Findings’ from the PowerPoint presentation ‘Transgender and Hijra Communities’

N/A

4 Sexual Health, STI and HIV in Transgender and Hijra Communities

40 minutes

N/A Refer to the slides titled ‘Sexual Health, STIs and HIV in Transgenders and Hijras’ from the PowerPoint presentation ‘Transgender and Hijra Communities’

N/A

5 Transformation and Feminisation Processes

1 hour N/A Refer to the slides titled ‘Case Studies in Transformation and Feminisation’ from the PowerPoint presentation ‘Transgender and Hijra Communities’

Annexure 3 on ‘Aspects of Transformation and Feminisation’

6 Reaching and Mobilising Transgender and Hijra Communities

30 minutes


N/A N/A

7 Mobilising Transgender and Hijra Groups to Access Quality Treatment and Care

45 minutes

Chits of paper for listing characters

N/A N/A

8 Social Exclusion, Rights and Entitlements

55 minutes

N/A Audio-video clip from the movie ‘From the Third Eye’

Annexure 4 on ‘Journey towards Social Inclusion’



Activity 1: Knowing Transgender and Hijra Communities

Time 45 minutes


• Understand the distinctions and commonalities between the terms‘transgender’ and ‘hijra’ and their traditional/cultural contexts; and

• Learn about the national-level working definitions of the terms‘transgender’ and ‘hijra’ as developed under the National AIDS ControlProgramme of India.



Refer to the slides ‘Working Definition of Terms’ from the PowerPoint presentation ‘Transgender and Hijra Communities’.

Take-home Material Annexure 1 on ‘Working Definitions of the Terms Transgender and Hijra’.

Methodology Divide the participants into groups and distribute chart paper and markers to each group.

Write the words ‘Transgender’ and ‘Hijra’ on the board, and ask the participants to close their eyes for a couple of minutes and think about what comes to their mind when they hear these terms.

Ask each group to spend the next 15 minutes creating two visual representations, one for the term ‘Transgender’ and the other for the term ‘Hijra’. They can draw whatever comes to their mind, including symbols. However, the graphics should contain no words or phrases.

After they complete the exercise, ask them to work in the same groups for another 15 minutes. This time each group should write words and/or phrases that they feel describe the two terms best. Ask the participants to use their own experiences while selecting the words and phrases.

Ask each group to present their findings to the larger group. After the presentation, lead a discussion in which the participants identify the distinctions between the two terms on the following parameters:

• Gender versus culture or profession; and

• Global versus Indian.

Create working definitions for each term. Display the PowerPoint slides ‘Working Definition of Terms’ from the PowerPoint presentation ‘Transgender and Hijra Communities’ and read out the working definitions of the terms ‘Transgender’ and ‘Hijra’ developed under India’s National AIDS Control Programme IV (NACP IV). Distribute copies of Annexure 1 on ‘Working Definitions of the Terms Transgender and Hijra’ to each participant.

Note to FacilitatorDefinitions that the participants develop during the training may vary slightly from the programme’s standard ones.

Resolve any confusion by saying that for the moment Pehchan definitions should be used by CBOs to maintain consistency, and that CBOs can bring up concerns during Pehchan SSR coordination meetings with their SRs and Alliance India.

file:///C:\Users\hkhosa\AppData\Local\Temp\wz849a\D2-%20TGHijras%20Issues\Main%20Module\D2_Annexures\D2_Annex01_Working_Definitions.docx


Background Information(NACP IV working groups, May 2011)

HijraHijras are individuals who voluntarily seek initiation into the hijra community, whose ethnic profession is Badhai (ritual of clapping hands and asking for alms when blessing new-born babies, or dancing at auspicious ceremonies such as weddings). Due to the prevailing socio-economic and cultural conditions, a significant proportion of them have been forced to enter into begging and sex work for survival.

These individuals live in accordance to the hijra community’s norms, customs and rituals which may vary from region to region.

Transgender • TG is a gender identity.

• TGs usually live or prefer to live in the gender role different from that which they are born into.

• This has no relation to an individual’s sexual preferences.

• TG is an umbrella word which includes transsexuals, cross-dressers, intersexed persons, and gender-variant persons.

• TG includes people who have not undergone any surgery or physiological changes.

Note: The above definitions are adopted under the Pehchan programme.


Activity 2: Typology of Transgender and Hijra Groups

Time 50 minutes


• Identify various region-centric typologies of transgender and hijra groups in India.


Audio-visual Support Refer to the slides titled ‘The Transgender Umbrella’ from the PowerPoint presentation ‘Transgender and Hijra Communities’.

Take-home Material Annexure 2 on ‘The Transgender Umbrella’.

Methodology

Part I: Understanding TypologiesDivide the participants into groups, preferably each group comprising of participants from a particular state or district. Distribute chart papers and markers to each group and give the participants 15 minutes to do the following:

• Identify the transgender/hijra communities in their region; and

• For each type of transgender/hijra community identified, briefly describe:

• Where these communities are located (geographically); and • The basic characteristics of each community – what kind of vocation are the

members involved in, and what differentiates this community from others.

Ask each group to present their discussions. During each presentation do the following:

• Expand on their findings of each region or local scenario.

• Relate the findings with the participants’ understanding of gender and identity, and the variations therein.

• On the whiteboard, draw a horizontal line, marking one end of the line as male and the other as female. Explain to the participants that this line represents the range of gender identity that lies between sexual binaries of male (or man) and female (or woman), and ask them where they would place transgender and hijra identities within this range.

• Facilitate the discussion to see if participants can identify hijras as belonging to a separate culture or profession and not as a gender identity.

• Explain to them how a third sex has come to be recognised to fit with the Indian cultural traditions wherein hijras are considered as a ‘third sex’ (as per NACO).

• Explain how, for the purpose of HIV interventions, both trangenders and hijras are classified under one umbrella.

• Point out that the transgender and hijra identities defined by partcipants and others cannot be rigidly delineated, and that gender and gender identities can be fluid, both within the communities, as well as at the individual level.

Plotting Transgender and Hijra Identitites Between the Male-Female Binaries of Gender Identity.

Male

Where do trangender and hijra identities fit along the line that joins the two binaries of male and female gender? Identity?

Female?


Display the slides titled ‘The Transgender Umbrella’ from the PowerPoint presentation ‘Transgender and Hijra Communities’, and wrap up the activity with the message that despite the differences in typology, the socio-economic status and marginalisation that these communities experience are largely common. Participants need to respect all identities and work towards a common betterment cause.

Distribute copies of Annexure 2 on ‘The Transgender Umbrella’ to each participant.

Some Major Typologies of Transgender and Hijra Identities in India

HijrasHijras are biological males who reject their masculine identity at some point in their lives to identify as women, or ‘not-men’, or ‘in-between man and woman’, or ‘neither man nor woman’. Hijras can be considered as the western equivalent of transgender/transsexual (male-to-female) persons, however, they have a long tradition/culture and have strong social ties formalised through a ritual called ‘reet’ (becoming a member of the hijra community).

There are regional variations in the use of the term ‘hijra’. For example, the term kinnar is used in Delhi (North India) and the term Aravani is used in Tamil Nadu (South India). Many hijras earn through traditional work called ‘badhai’, as mentioned earlier. Some hijras engage in sex work for lack of job opportunities, while some may be self-employed or work for non-governmental organisations (NGOs).

Aravanis and ThirunangiMany hijras in Tamil Nadu call themselves as Aravani. The Tamil Nadu Aravanigal Welfare Board, a state government initiative under the Department of Social Welfare, defines aravanis as biological males who self-identify as women who feel trapped in a male body. However some aravani activists want the public and the media to use the term thirunangi (respected women) rather than aravani while addressing them.

Shiv-ShaktisShiv-Shaktis are males who claim to be ‘possessed’ by, or are considered close to, a goddess. Usually, males are inducted into the Shiv-Shakti community by senior gurus who teach them the norms, customs, and rituals of the community. During the ‘induction ceremony’, Shiv-Shaktis are ‘married’ to a sword (symbolising male power or Shiva) and from then on, are seen as the bride of the sword. Occasionally, Shiv-Shaktis cross-dress and use accessories and ornaments meant for women. Most of the people in this community belong to lower socio-economic class and earn their living as astrologers, soothsayers, and spiritual healers; some also seek alms.

JogappasJogappas are males who are ‘dedicated’ to ‘Yellamma’, a deity in Southern India, by their family members. Also, some males who express feminine gender characteristics themselves choose to join this community. Joining the Jogappa community is subjected to the acceptance by the community. An initiation ritual formalised by the guru marks the acceptance of a person as a jogappa. Most jogapppas wear female clothes but some choose to wear lungis2. All grow their hair long and use ornaments and accessories meant for women. Jogappa community norms discourage both emasculation and getting married to a woman. Those community members who transgress the community norms cannot perform religious rituals, and this may affect their social standing within the Jogapppa community.

2 A lungi is a traditional garment worn around the waist mostly by men of the Indian subcontinent


Launda Dancers Laundas (a slang word in Hindi for ‘boys’) are groups of young men who entertain guests at marriages in North India, especially in Bihar and Uttar Pradesh. Weddings in these regions are usually elaborate, marked by revelry, alcohol, music and dance. Launda dancers are seen as essential to an age-old tradition of laundanaach – an integral part of the weddings in this region where young effeminate boys dress in women’s clothing and dance during marriage processions and other revelry.

The dancers usually belong to the lower middle class and poor families and come to Bihar and Uttar Pradesh from nearby states during peak marriage seasons (April to June and November to February). During marriage celebrations, they often live in unhealthy conditions, sometimes sharing the living space with goats and cows kept for domestic use. They are fed poorly and sanitation standards are almost non-existent.

In many rural parts of Bihar and Uttar Pradesh, it is relatively common practice for men to have sex with these effeminate young men. This usually happens because these boys are easily recognisable and having sex with them is often seen as a test of manliness (referred to as mardangi in local parlance). In some households with strong feudal mindsets, landlords keep laundas in the house and is seen as prestige and sign of virility and power. After the marriage season, some of the older boys join their peers and travel to other parts of the country while others return home.

Note: Questions might come up regarding the inclusion of kothis under transgender and hijra definitions. The facilitator should explain that some proportion of those who call themselves hijras may also identify themselves as kothis. But not all who call themselves kothi identify themselves as transgenders or hijras. Kothis are a heterogeneous group and can be best described as biological males who show varying degrees of femininity. Some kothis may be bisexual and some may also be married. Kothis are generally seen to be coming from a lower socio-economic status, and some engage in sex work for survival.


Activity 3: Vulnerability of Transgender and Hijra Communities to HIV

Time 30 minutes


• Identify the factors which make transgenders and hijra communities vulnerable to HIV.


Audio-visual Support Refer to the slides titled ‘Vulnerability to HIV and Risk Factors: Some Findings’ from the PowerPoint presentation ‘Transgender and Hijra Communities’.


Methodology Ask the participants why, in their view, the transgender and hijra population are important for HIV prevention and care.

List their responses on the whiteboard or on flip-charts, and use this opportunity to discuss and clarify issues of vulnerability and risk to HIV in these populations. Display the slides titled ‘Vulnerability to HIV and Risk Factors: Some Findings’ from the PowerPoint presentation ‘Transgender and Hijra Communities’ and use the graphs in the slides to augment the discussion.

Discuss how in the NACP, transgender and hijra groups are considered to be high-risk groups (HRGs) and why they are the focus in the Pehchan programme.

Background Material(Lakshmi et al, 2011)

Vulnerability to HIV and Risk FactorsIn India, hijras and transgenders are seen as a separate socio-religious and cultural group. Primary and secondary data suggest that transgendersand hijras are not a homogeneous population but have various sub-groups, such as those who earn their living from sex work, from begging, and by living in a dera and who are into traditional occupation of toli-badhai.

Each sub-group has different health needs and concerns that call for different approaches. Some key findings from the study are given below:

• Most hijras and transgenders are still a hidden population and largely out of reach. This makes it difficult to meet their HIV prevention needs, which continue to remain largely unaddressed.

• The primary sexual practice among transgeders/hijras is unprotected anal sex, and on most occasions they perform the role of a receptive partner.

TipTell participants that knowledge about HIV among members of transgender and hijra communities is still inadequate, and their field experiences will be invaluable in contributing to our growing understanding of the epidemic in gender minorities.

Encourage them to share case studies and inputs throughout the day’s activities.

81.8

15.5

2.6

10-15 years 15-20 years above 20 years

Respondents Age at First Sexual Encounter


• Transgenders/hijras have very limited access to water-based lubricants and report low condom usage. Such practices make them more vulnerable to HIV and other STI infections.

• In a study on transgenders and hijras, nearly 7 out of 10 members interviewed felt that their community was at a higher risk of HIV transmission because of unsafe sexual practices by many members of the community. Also, nearly 8 out of 10 persons interviewed reported that they had their first sexual activity by the age of 15. A significant number of them had multiple commercial partners in a month (UNDP, 2010).

• Hijras and transgendersare a mobile population involved in sex work in various environments and places. Hence they are at risk of infecting themselves and their partners.

• Nearly 4 out of 10 members interviewed in the study reported having multiple commercial partners in a month. Nearly a half did not remember the number of male partners they had in the past month. A little more than half earned their livelihood through sex work. About 8 out of 10 reported staying away from their primary area of residence for long periods, with more than half of them (60%) migrating for sex work.

• Data also suggests that about 3 out of 4 trangenders/hijras interviewed were not accepted or supported by their families and society due to their gender status, forcing them to move out of their homes.

• Only 2 out of every 10 trangender/hijras were illiterate. However, half of them dropped out of the school between classes 6 and 12.

• Trangender/hijras are stigmatised and discriminated by law enforcement agencies and rowdies and are often teased and harassed by the general public. They usually do not report incidents of sexual harassment and rape to the police. A little more than half (57%) reported violence by police, rowdies or others.

13.9

< 10 no. 11-20 nos. 21-30 nos. 30 above Can’t remember

No response

Male Commercial Partner (last month)

13.6

7.3 8.2

16.4

40.6

Occupation and Sources of Earning

17.5

27.1

31.3

46.9

2.8

3.1

6.1

11.1

4.0

Badhai Toli

Dancing at other occasions

Begging street/Train/Traffic signals

Sex-work

Unemployed

Domestic servant

Skill/Unskilled labour

Self-employed

Other

24.8

41.2

11.8

17.8

4.4

Accepted Not Accepted Rejected Suggested to hide it

Finding a cure for it

TG/Hijras: Acceptance by Family and Society


• The social hierarchy and community norms among hijra communities have both positive and negative influences on the members’ HIV-risk behaviours. In eastern and northern India, there is no talk about sexuality in certain hijra gharanas or clans, and this increases their vulnerability to HIV transmission. For example, hijras from certain gharanas are not supposed to have sex as they are dedicated to the goddess and, in some cases, gurus may not allow distribution of condoms to them.

• All these factors make the trangender/hijra communities extremely vulnerable to HIV. According to the data, over half the respondents (53%) reported the need for a separate intervention programme for transgenders.

18.4

Illiter

ate

3.5

Litera

te with

no

formal

educ

ation

18.6

1-5th

grad

e

23.4

6-9th

grad

e

25.4

10-1

2th gr

ade

9.8

Gradua

te

0.9

Other

Education Levels

57.5

34.2

0.67.6

Yes No Not aware No response

Have You Ever Faced Violence by Police, Goondas or Others in Profession


Activity 4: Sexual Health, STI and HIV in Transgender and Hijra Communities

Time 40 minutes


• Identify safer sex options for transgenders and hijras.

Materials N/A

Audio-visual Support Refer to the slides titled ‘Sexual Health, STIs and HIV in Transgender and Hijras’ from the PowerPoint presentation ‘Transgender and Hijra Communities’.


Methodology

Part I: Case DiscussionsDisplay the slides titled ‘Sexual Health, STIs and HIV in Transgender and Hijras’ from the PowerPoint presentation ‘Transgender and Hijra Communities’ and conduct a brief interactive session on each question or scenario given in the slide. Question: Why do transgender and hijra people have a higher risk of contracting HIV?

• It is not by choice or as a result of any ‘sin’ or ‘mistake’ or being a ‘bad person’.

• The increased vulnerability is the result of social marginalisation and discrimination in all areas of life, including employment, family, education and healthcare settings. This in turn results in: (i) opting for sex work; (ii) having poor literacy levels; (iii) having a low sense of self-worth; and (iv) being vulnerable to physical and sexual assault.

Case Scenario A trangender sex worker complains: ‘Whenever I ask my clients to use condoms, they run away thinking I have AIDS. I am losing my business because of this’.

Ask the question: How should the ORW respond?

Use this occasion to reinforce the importance of condoms during sex work and other sexual interactions. Make the session lively by providing examples of ‘tricks’ on how a transgender can stay safe and also at the same time not turn away potential clients for want of condoms .

What can a trangender or hijra sex-worker do if she does not have a condom and a client comes to her?

• Try a trick called ‘Talk More, Do Less’: She should keep the client engrossed in conversation peppered with erotic talk, gestures and physical stimulation (but not sex) so that he (client) is in a state of constant arousal. She should not mention condoms at all. In most instances, the client is content with this form of arousal and may not press for full sex, in which case the trangender can avoid the dilemma of using a condom.

Participants could be encouraged to share some of their own experiences.

Note to FacilitatorThis session reviews the subject of sexual health, sexual needs, STI, and HIV from a transgender/hijra perspective. Ensure that the session does not delve deeply into the basics of these topics, as they are covered in other modules.

The session is structured in such a way that the trainer refreshes the participants’ memory by asking questions, presenting PowerPoint slides containing case scenarios, and sharing facts while discussing each case.


Ask the question: What can a trangender or hijra sex-worker do when she does not have a condom but is already at a sex solicitation site?

• The trainer should encourage the participants to think of ways by which they can address her dilemma. The trainer can use the example given above to lead the discussion. Explain: How the hijra sex-worker in question can be creative and delay penetrative sex by asking the client to ‘save it’ (sex) for another time. The sex worker can, in the mean time, give a massage, indulge in ‘small sex’ by bringing him to orgasm by masturbating him with her hands, thighs or breasts. She can also use oral sex to stimulate him.

Participants may be encouraged to share some of their own experiences. Transgenders and hijras may often state: ‘I don’t want to go for HIV testing. At both public and private hospitals, they always laugh at me.’

How should they be counseled and guided?

• The project worker should first acknowledge that such situations do happen at these centres and she/he should empathise with the community member.

• She/he should point out that the only way to know the HIV status is to get tested.

• Indicate that HIV testing is free and done with strict confidentiality procedures in place and that the information on her status is not revealed to others without the permission of the individual concerned.

• Remind the client that counsellors in the project can help in accessing services and also explain risk-reduction strategies.

A hijra was heard saying: ‘Anyway AIDS means death. Also if my Guru comes to know that I have AIDS, I will no longer be able to stay with her. My friends will ignore me so it is better not to know my HIV status’.

How should they be counseled and guided?

• Being HIV positive does NOT mean a ‘death sentence’. Highly effective treatment for HIV is available and provided free of cost at government centres. Test results are not shared with anybody by the centre. Like anyone else, a transgender/hijra who tests positive can choose to keep the test results to herself without informing others. It is important to get tested as it helps towards living a productive life and for starting early treatment.

• You can also tell the participants that ‘Positive Living’ – living a meaningful, productive life with HIV – will be covered in another module.

Part II: Information Sharing on Various Issues

Some Common Symptoms of STIs• Pain or burning sensation during urination.

• Discharge from the penis, anus or vagina.

• Frequent or dark urination.

• Pain or itching in the genital area, buttocks, inner thighs, or abdomen.

• Pain during intercourse.

• Sores, warts, blisters, bumps or swelling of the penis, scrotum, anus, vagina or genital area.

• Rashes on the palms or soles.

• Skin and the white area of the eyes turning yellow.


Issues Related to Transgenders and Hijras Living with HIV• Most transgenders and hijras living with HIV in India do not know their HIV status.

• Counselling and testing services are rarely targeted or sensitive to the trangender/hijracommunity needs.

• Negative experiences in healthcare also make testing less accessible.

• Furthermore, knowing one is HIV positive and living with HIV means bearing additional and unwanted stigma.

Sexual and Mental Health Among Trangenders and Hijras

Sexual HealthHijras/Trangenders communities face several sexual health issues, including HIV. Both personal and contextual factors influence sexual health conditions and access to and use of sexual health services. For example, most trangenders and hijras are from the lower socio-economic strata and have low literacy levels that pose a barrier to seeking healthcare. Consequently, these communities face unique barriers in accessing treatment services for STIs.

Mental HealthRemind the participants that the issues of mental health have been dealt with in detail in Module C3: Mental Health.

The mental health needs of these communities are barely addressed in the current HIV programmes. Their problems, reported in different community fora, include depression, suicidal tendencies, stigma, lack of social support, and violence-related stress.

Many trangenders, especially youth, face great challenges in coming to terms with their gender identity and/or gender expression since it is not consonant with socially prescribed gender roles and identities. They face several issues: shame and internalised transphobia; fear of disclosure and coming out; adjusting, adapting or not adapting to social pressure to conform; fear of relationships or loss of relationships; and self-imposed limitations on gender expressions.

Alcohol and Substance Abuse Among Trangenders and HijrasAvailable evidence suggests the need to address alcohol and substance use/abuse among hijras and transgenders. A significant proportion of them consume alcohol, possibly to escape the stress and depression they face in their daily life. Hijras give several reasons to justify their alcohol consumption, ranging from the need to ‘forget worries’ (because there is no family support or no one cares about them) to managing rough clients during sex-work. However, as a result, their alcohol use is also associated with the inability to use condoms or to insist that their clients use condoms. This increases the risk of HIV transmission and acquisition.

Transphobia Transphobia is an irrational fear of, and/or hostility towards, people who are transgenders, hijras or who otherwise transgress traditional gender norms. The most direct victims of transphobia are people who are transsexual – those who are labeled one sex at birth but transition into another sex later.

The cause of transphobia is still a subject of research and debate, but it is believed that it reflects the fragile nature of gender identity. Males and females are genetically and physically not so different. The fact that someone can convincingly identify as a member of the opposite sex calls the concept of gender into question. People who are quietly struggling with their own gender identity and people for whom gender identity is especially important to them might be frightened, even angry, when confronted with the fragility of gender.


Part III: Visibility GameGiven below is a communication game which helps participants understand the vulnerability that stems from the visibility of transgenders and hijras and understand social exclusion and transphobia. Ensure that participants do this exercise in a calm environment with no distractions.

Divide the participants into groups of four to five people. Form an even number of groups so that groups can be paired. Give each group a name like A, B, C, D, or 1, 2, 3, 4 and pair the groups – for example, pair Group A with Group B, and Group C with Group D.

The exercise is done with two groups forming one unit. Ask members from Group A to stand up and those from Group B to sit in front of them. Make sure there is sufficient distance between the two groups.

Give two minutes for the participants of Group B to carefully observe all the members of Group A. Tell them to observe the participants of Group A and note:

• What they are wearing?

• How they are standing?

• Are they trying to show or hide anything?

• Who is feeling comfortable?

• Who is looking shy?

• Any other special observations?

Do the same with the other groups. After letting one set of groups act as observers, reverse the roles – the group that was sitting and being observed now becomes the observer group.

After two minutes, ask the groups to reconvene and ask participants to share their feelings. Although not all participants will react similarly, most people feel uncomfortable when they are under scrutiny, and some participants will report feelings of discomfort at being watched. Relate this discomfort to the visibility of transgender and hijra communities and the scrutiny that they are subject to in public places, and ask the participants to consider the price that these communities pay for such scrutiny.

End the session on a positive by pointing out that while visibility may come at a cost, this visibility is also about one’s identity and dealing with the discomfort in the present paves the path for future acceptance and social integration.


Activity 5: Transformation and Feminisation Processes

Time 1 hour


• Identify safer methods for transformation and feminisation for transgenders (male-to-female).

Materials N/A

Audio-visual Support Refer to the slides titled ‘Case Studies in Transformation and Feminisation’ from the PowerPoint presentation ‘Transgender and Hijra Communities’.

Take-home Material Annexure 3 on ‘Aspects of Transformation and Feminisation’.

Methodology

Part I: Transformation Ask participants to either list down on a sheet of paper, or to share within small groups, answers to the following questions:

• What do you understand by the terms ‘transformation’ and ‘feminisation’?

• What are the needs of individuals who are considering a ‘transformation’ or a ‘feminisation’ process?

• What do you think are the processes involved in ‘transformation’?

List the responses of the participants on a flip-chart and clarify any misperceptions and queries by discussing the following:

• Issues related to the transformation process.

• Castration.

• Hormone replacement therapy (male-to-female).

• Sex-reassignment surgery (SRS).

• Other methods of transformation.

Part II: Becoming More FeminineDivide the participants into smaller groups of four to five persons and share with each group the case studies. Refer to the slides titled ‘Case Studies in Transformation and Feminisation’ from the PowerPoint presentation ‘Transgender and Hijra Communities’.

Ask each group to spend five minutes to discuss among themselves what they would say and do to help reassure somebody from the community who may want to undergo similar procedures. Tell them that their responses should cover:

• Various treatment options;

• Processes involved in transformation/transitioning; and

• Health hazards that are associated with these procedures.

Note to FacilitatorGuide the participants through the exercise by asking them to think about the male and female body characteristics.

Ask them what they feel they would want to ‘change’ and how they think such a change can happen (such as through surgery, medicines, etc).

Also, ask them if they have heard about the availability of such methods in the areas they live.


Ask each group to choose a volunteer to present their findings to the larger group. Use this activity to make sure that participants have understood the key concepts in safer transformation and feminisation. Distribute copies of Annexure 3 on ‘Aspects of Transformation and Feminisation’ to each participant.

Background Material(Brown and Rounsley, 1996)

Aspects of Transformation and FeminisationTransitioning is a complicated process that involves any or all of the gendered aspects of a person’s life. People will choose elements based on their own gender identity, body image, personality, finances, and sometimes on the attitudes of others. A degree of experimentation is used to know what changes best fit them. Transitioning also varies between cultures and sub-cultures, according to differences in the societies’ views of gender. Given below are some of the key elements of transitioning:

• Legally and/or socially changing their name to something consistent with their gender identity.

• Asking others to use ‘she’ and ‘her’ while addressing them, instead of ‘he’ or ‘him’.

• Having one’s legal gender changed on the driver’s license, ID cards, etc.

• Personal relationships take on different dynamics in accordance with gender.

• Changing the type and style of clothing, jewellery, accessories, and make-up.

• Adopting the mannerisms or gender role.

• Surgery and/or hormone therapy.

• Changing their pitch.

When a person undergoes changes (some or all) as stated above, and the person believes that his transition to the opposite gender is complete, that stage is referred to as ‘transformed’. Transitioning is sometimes confused with sex-reassignment surgery (SRS), which is just one element of transitioning. Many people who transition choose not to have SRS. Whereas SRS is only a physical change, transitioning is a physical, social, and emotional change. Some gender-queer and some intersex people have little or no desire to change their body but will transition in other ways.

Medical and surgical procedures exist for transsexual and transgender people. Treatments include hormone replacement therapy for fat distribution and breasts; laser hair removal or electrolysis to remove excess hair; surgical procedures, such as SRS, for feminising the body and its functions, such as voice, skin, face, breasts, and waist.

The choice of these procedures depends on the degree of gender dysphoria, presence or absence of gender identity disorder and standards of care. Most categories of transgenders are not known to seek these treatments.

Treatment such as hormone therapy and other procedures related to transitioning from male to female can be very expensive and the process may need a lot of time. Lack of proper knowledge and information in the community make many seek alternative or traditional methods.

Castration The most commonly practiced way of transformation by hijras is through castration or removal of testicles (called nirvani in trangender and hijra community parlance). Surgeries are often carried out under septic conditions by dai’s (a local community member or


self-taught nurse) who plays the surgeon based on her experience of operating on other hijras. Hijras sometimes call this operation nirbaan or nirvana (also called mukti in Hindi, which means ‘release’, suggesting ‘transition’ of a person from one ‘life’ to another).

Indian legal statutes do not permit the forced castration of males; therefore, there is secrecy around nirvani. The operation is always conducted in the early hours of the day and the whole process is seen as a religious ritual, although it is often viewed as a barbaric and brutal custom.

Most hijras in India are forcibly castrated, but a few submit themselves to the process. In almost all the cases, breasts develop after castration because the source of male hormones – the testicles – are removed and the female hormones, which are normally suppressed, will take over, ensuring emergence of secondary sexual characteristics (sparse growth of facial hair, change in voice, etc).

Hormone Replacement Therapy (male-to-female) Taking hormones causes changes such as growth of breasts and smoothing of skin. It does not usually stop facial hair growth or cause the voice to change. Irreversible changes caused include breast development, enlarged nipples and stretch marks .

Reversible changes include decreased libido, redistribution of body fat, and reduced muscle development. The psychological changes with hormone replacement therapy are hard to define, because the therapy usually causes physical changes first. If not taken in appropriate dosages, hormone replacement therapy can cause various side effects, including death.

Estrogens used in hormone replacement therapy typically have side-effects that include mood swings, headache, nausea, dizziness, acne, skin darkening, high blood pressure, fatigue, depression, obesity, blood clotting, heart disease, diabetes, gallstones, liver disease, weakening of bones, advanced age, brain damage, and infertility. Excessive estrogens can cause blood clots and strokes. This is especially important to consider and monitor if the person is living with HIV.

Participants should also know:

• Taking more hormones does not mean the hormones will work faster.

• Taking too many hormones pills can damage the liver, which means that hormones will not work in future because body will not be able to process them.

• Hormones will not change the body immediately and the effects may take more than a year to show.

• Use of hormones should not be treated lightly. Dosage may depend on factors such as age, body size, smoking habits, alcohol use and whether the testicles are present or have been removed surgically.

• For better effect, hormones should be taken in a combination of estrogens and anti-androgens. Estrogens help people become more feminine and help in developing breasts and large nipples, and anti-androgens block the male hormones produced in the body, even if the testicles have been removed. They also reduce facial and body hair.

• Birth control pills such as Mala D, Sukhi, etc., are NOT the same as female hormones or hormone therapy.

• Hormones should only be taken with a prescription and under the supervision of a physician.


Sex-reassignment Surgery (SRS) SRS refers to the surgical and medical procedures undertaken to align the physical appearance and genital anatomy of intersex and transsexual individuals with their gender identity. SRS encompasses surgical procedures that reshape a male body into a body with a female appearance (or vice versa) and refers to the procedures used to make male genitals into female genitals and vice versa.

Most transgenders and hijras receive no professional counselling before surgery, and they sometimes have surgeries without understanding the consequences. A transgender should take hormones before any sex-related surgery. Someone who is unhappy with the effects of hormones may decide not to have surgery or even stop taking hormones.

SRS can be completed in one or two surgeries, depending on the surgeon’s technique. Possible complications due to this surgery, regardless of the type of surgery performed, include:

• Post-operative infections (as with any surgical procedure);

• Blood loss;

• Deep-vein thrombosis (clot in the leg veins,which is preventable with compression stockings and/or drugs);

• Vaginal stricture (the narrowing of the opening of the vagina) and urethral stricture (urethra is the tube through which urine is conveyed out of the male body from the bladder; urethral stricture is the narrowing of that opening);

• Pubic hair in undesirable places;

• Numbing of the external genitals (vulva, clitoris) due to severing and lack of healing of nerve tissue during surgery;

• Excess erectile tissue, resulting in sexual side effects;

• Rectovaginal fistula (a hole between the ‘new’ vagina and the colon, this is rare); and

• Urethral fistula (a hole in the urethra, again this is rare).

Post-operative care is important for better healing and results.

Note: Other related procedures for transformation and feminisation include facial feminisation surgery, breast augmentation (in cases where hormones fail to work), voice feminisation surgery (to alter the pitch of the voice), and buttock augmentation.


Activity 6: Reaching and Mobilising Transgender and Hijra Communities

Time 30 minutes


• Understand the different structures prevalent within transgender and hijra communities; and

• Understand the key steps in reaching out to and mobilising these communities.

Materials Board and chart papers with markers.



Methodology

Part IDivide participants into small groups, giving each group chart papers and markers. Ask each group to consider the following questions:

• What are the barriers to reaching out and mobilising transgender and hijra communities?

• What are the possible ways to deal with the barriers?

After 15 minutes, ask each group to share their findings, writing their responses on the board.

Introduce the following two approaches through which these communities can be reached, and conduct an interactive discussion on their advantages and disadvantages of the following:

• Approach 1: CBO-led interventions – working with gharana and hijra leaders in dera3-jamath4 settings; and

• Approach 2: Melas (fairs) and event-based interventions.

Part IIAsk the groups to plan out an intervention and its activities based on the approaches discussed. (They could plan these interventions on hypothetical cases or using cases of communities in their intervention areas.)

After 15 minutes, ask each group to share its intervention plan to the larger group. Ask the other groups to give feedback to the presenting group, pointing out gaps and giving recommendations.

3 The space or location that a group of hijra gharana members, live in as a community.

4 The place where the deras gather


Approach 1: CBO-led Interventions• For effective implementation of an intervention, it is important to understand how

the gharana5 systems work. Remember that each gharana is different from the other and different rules apply within each of them.

• Peer educator (PE) should ideally be recruited after consultation with the guru (head of gharana, as mentioned earlier). Saukens6 of certain gharanas could be recruited as PEs.

• Capacity-building initiatives and some of the communication messages should be vetted by the gurus. It is important that the guru understands the content of these messages.

• It is important to develop only such interventions which can clearly show benefits to the gharana and its members, and do not come across as threatening to the authority of the guru.

• In interventions for hijras living with gurus in deras, PE should be aware of the protocols and rules of the deras. Outreach timings should match the availability of hijras in deras. Also it is important that the project build rapport with the guru.

• In interventions for hijras not living in deras, attention should be paid to seeking out those areas where they live or congregate. For hijras living with panthis and outside the deras, rapport-building with their partners is extremely important. Involving the partners in a programme activity could help in many ways.

Essential Components of a Gharana Intervention

Psychological SupportA support group from within the community will give members a sense of belonging and security. A helpline can also be started to provide assistance to hijras. The helpline can serve as a crisis support and information centre and provide appropriate information on sexual and reproductive health and sexual-reassignment surgery issues. This would help prevent visits to quacks for their sexual health problems and to discuss SRS.

Health ReferralsThe interventions should establish linkages with local health facilities so that clients with complaints such as STI may then be referred for treatment. Also, hijras with sexual and reproductive health problems should be referred to appropriate specialists.

Drop-in Centers (DICs)DICs can be set up to provide a platform for psycho-social support to hijras and for providing information on linkages to services. Information and counselling on nutrition, adherence and legal issues may also be provided. DICs should be created with the objective of providing a safe space for community members to drop-in any time and be their true selves. In case of gharanas registered as CBOs, the DICs could be the dera-jamath itself.

Vocational Training and Literacy Alternate income-generation activities should be planned with the support of vocational training centers of various government departments for the hijra population who are willing and interested in vocational training. Training could be provided after assessing their interests.

5 Hijra clans are called gharanas.

6 Sauken – elders who officiate over functions and rituals in a gharana.They guide the community members on the ways of the clan and maintain the sanctity of the same. In a colloquial sense they are also ‘facilitators’ for managing disputes, settlement of claims and payments of dues.The sauken is the single most important cat-alyst for overseeing events, activities and rituals. Members of the Lashkar gharana, wherever they live in India, are known to be the saukens for the hijra community.


Self-help and Support GroupsIn order to increase awareness, address stigma and discrimination, and empower hijras to protect themselves, self-help groups (SHGs) can be formed through a systematic process involving state institutes and NGOs.

Outreach and Peer EducationOutreach should be peer-led. Every PE should be from the hijra community and preferably from the same dera-jamath. Their capacity should be built in areas of communication and social skills. They should also be able to provide regular counselling to the target community and motivate them for regular medical check-ups. They should lead the outreach process in interventions where the community prefers to stay invisible to save themselves from stigma and discrimination. Through outreach, the PE should be able to assess the needs of the community and plan services accordingly. Effective outreach helps in successful implementation of the project activities and in better service-delivery.

Possible Advantages of Dera-based Intervention• In deras, where the guru is convinced about the usefulness of an intervention, the

activities are implemented effectively, as members of the dera comply with the directives given by the guru.

• There is greater ownership of the intervention by the dera and in the larger context, the gharana.

• This approach is likely to reach all current and future hijra-members of that dera and the associated gharana.

• An effective way to reach hijras is by using the nayak or guru as a focal person.

Possible Challenges in Dera-based Intervention• Convincing nayaks or gurus may take a long time and may require the help of

one or more saukens.

• Developing specific communication material for hijras.

• The package may need to pay adequate attention to issues which are a priority to the hijra community, such as taking a rights-based legal approach, general health measures, capacity development components, etc.

Approach 2: Melas (fairs) and event-based interventionsLarge numbers of transgenders and hijras often congregate at special festivals and community melas (fairs). These can be occasions when they are involved in multi-partner sex and sex-work. These gatherings, which are periods of intense sexual activity as well as a platform for networking, present a rare opportunity for reaching out to transgenders. Few approaches that can be planned during these gatherings are:

• Development of messages and materials appropriate for such settings.

• Mapping of all festivals in the state with help from SACS.

• Understanding how festivals/melas are organised in order to plan the intervention.

• Development of a mechanism to create opportunities for creating advantageous positions in such melas. It may be necessary to use CBOs or NGOs to ensure that peer workers are placed in vantage positions in fairs. These organisations would be better-off if they had prior familiarity with such events but since this intense activity may only be for a few days in each place, their expertise may be used for many such events.

• Build the capacity of PEs so that they are effective in these settings.


• In order to sustain the work done at such melas, as well as to maximise the benefit from this approach, a follow-up strategy should be created where efforts are made to network with willing transgenders by reaching out to them through mobile phone and also by sharing information about drop-in facilities, ICTCs, etc.

Possible Advantages• It is well known that many transgenders remain hidden and are difficult to reach

through gharanas or NGOs, and that some transgenders only indulge in multi-partner sexual relationships during melas/festivals. Hence melas provide a good platform for reaching out to them.

• Transgenders come from far and near to these fairs/melas and for some of them being part of such events is considered sacred. Hence, an approach like this may well end up as the only meaningful way of reaching them.

• Such events also serve to reach the clients of transgenders.

Possible Challenges• It may well be a one-time intervention or sensitisation for some transgenders/

hijras, especially when there is no possibility of a follow-up.

• Transgenders may not be receptive to HIV or other health messages in the environment of a fair/mela. Therefore, a clearly thought-out process is needed for the success of this approach.

Some of these events in India are:• Ajmer Sharif (in Rajasthan);

• Haji Malam, Thane (in Maharashtra);

• Kaliyath Sharif, Haridwar (in Uttar Pradesh);

• Udhavaru (in Gujarat);

• Koovagam, Kothadai and Bannari (in Tamil Nadu);

• Shahkalp Poora(in Maharashtra);

• Mahashivarathri (in Odisha and Gujarat);

• Sambalpur Mela(in Odisha);

• Ghutiary Sharif (in 24 Parganas, West Bengal);

• Surajpur Mela (in Haryana);

• Meeraj, Bannarghetta Jatra and Yellamma Jatra (in Karnataka); and

• Kuttikulangara (in Kerala).


Activity 7: Mobilising Transgender/Hijra Groups to Access Quality Treatment and Care

Time 45 minutes


• Identify the barriers that transgenders and hijra communities face in accessing treatment and care services; and

• Explore solutions at individual and organisational levels.

Materials Blank paper for listing characters.



Methodology Note: As this activity needs a large space, outdoors are preferrred for this activity.

Tell the participants that they are going to play the ‘Health Walk Game’. Give each participant a piece of paper and assign a character from a context she/he can identify with (e.g. location where she/he works or lives). A tentative list is given below (based on the partcipnat inputs, add or modify this list):

• Hijra guru or jammath leader

• Housewife, spouse of a local business man

• Transgenders or hijra activist

• PE of a transgender intervention project

• Primary school teacher

• Young transgender in school

• Primary school girl, aged 13

• Nurse in a local clinic

• Expat community worker from NGO

• Chief of police

• Trucker

• Transgender in a wheel chair, aged 19

• Widow with three children, aged two to 12

• Panthi

• Transgender sex-worker

• Head of hijra gharana

• Editor of a local newspaper

• Hijra living in a dera

• Transgender who begs in the train

• Gay man

• Social worker at a local community center

• Transgender living with HIV, aged 21


• Landless farmer and father of two

• Lesbian

• Mother of two small children who is a victim of domestic violence

Ask the participants to stand in a row, with enough space in front of each to take at least a dozen steps. Instruct them that you will read out certain statements one-by-one. Each participant is to consider whether or not the statement applies to the ‘character’ she/he is portraying.

If the participant feels that the statement applies to her/his ‘character’, the participant takes one step forward towards the finished line. If she/he feels that the statement does not apply to her/his ‘character’, she/he does not move.

Read out the statements one-by-one, giving time for participants to consider whether they should take a step forward or not.

Suggested statements:

• I can go easily to an ICTC centre for testing.

• I can influence decisions made by my community.

• I get to meet visiting officials from government offices.

• I have time, and access, to watch TV, go to the movies, and spend time with my friends.

• I am not in danger of being sexually abused or exploited.

• I get to see and talk to my parents.

• I can speak at meetings or a public forum and express my opinion.

• I can pay for treatment in private hospital, if necessary.

• I went to or expect to go to secondary school.

• I went to or expect to go to college.

• I will be consulted on issues affecting my health and rights.

• I am not in danger of being physically abused.

• I sometimes attend workshops and seminars.

• I will be consulted on decisions about my mobility.

• I have access to plenty of information about HIV.

• I have access to social assistance if I need it.

• I can vote in local elections.

• I could be interviewed on radio about my views.

• I can access free ART.

• I can access DOTS.

• I have access to condoms according to my need.

• I can carry condoms freely whereever I go.

• I have information about SRS and other related issues.

• I can seek proper and prompt treatment and diagnosis.

• I have access to lubes.

• I can have health insurance.

• I have access to safe drinking water.

• I have mosquito nets in my house and can protect myself from malaria.


After the exercise, assess where each participant is standing. Ask the following questions to the whole group (without moving them from their positions) as prelude to a discussion on ‘empowerment’:

• How do you feel about your own position and that of others? • What do the start and finish lines represent?

• Why do you think some people were closer to or crossed the finish line and some were left behind?

• Did your identity influence your access to rights?

• Had you been playing your real-life identity, would you have been in an advantageous position or a disadvantageous position?

• Do you think that the ones who are closest to the finish line have any responsibilities towards the ones closer to or at the start line? If yes, what can they do to empower them?

If any participant says ‘No, this statement does not apply to the character I am playing’. See if she/he is staying at the same place, or is one actually moving backward?’ Explain with the following examples:

• The 21 year old transgender living with HIV, without access to an ICTC centre or ART, for example, would actually be adversely affected and therefore be moving backwards in life, not remaining at the same position.

• A transgender activist, whose parents want to have nothing more to do with her, would suffer emotionally and socially, so while moving forward in attaining her rights, she may be moving backward in her personal life.

Relate the exercise to the questions of accessibility of quality treatment and care for transgenderand hijra communities. Discuss self-stereotyping and self-stigmatisation which prevent some people from reaching out to facilities available.

Special Note: Community-Specific Barriers Faced by Hijras in Access to Health A hijra does not seek medical advice/help unless permitted to do so by her guru. The hijra reaction to herpes, a common problem in the community known as Nagin, provides a ready example of the power dynamics in health matters. When herpes lesions appear on a hijra’s body she discusses the matter with her guru, who may advise her to visit a quack. As herpes is self-limiting (and has no cure) this approach may look harmless. However, it is important to remember that early treatment can prevent or minimise the complications of herpes, such as recurrence and secondary infections.

Hijras rarely go to a qualified medical practitioner for genital problems. Doctors often only listen to their symptoms and prescribe medicines without physical examination. Sometimes, they consciously avoid making physical contact with a transgender/hijra.

Transgender and hijras also find sharing their health problems with the doctor difficult, because of overbearing or condescending attitudes of medical practitioners.

Large numbers of transgenders and hijras frequent non-qualified medical practitioners who have a long history of treating members of the community. They perceive these healthcare providers as more caring than their qualified counterparts. They are more approving of these providers because they believe these providers understand their needs better and have no qualms in examining them.

Note to FacilitatorIn this session, you will address issues of access to quality care and how community members can be mobilised to access these services. Participants will also understand the current patterns of health-seeking behaviour and whether there are any structural issues that affect their access. Specifically the session is designed to:

• Sensitise participants to power relations and to the marginalisation experienced by certain members of society and the perceived barriers to access;

• Identify different forms of structural barriers at work in the TG and Hijra community; and

• Illustrate that sustainable rights-based development is related to shifting power and better access to healthcare.


Another factor that determines the uptake of health services is the medical fees. Given their poor economic status and lack of skill in managing finances, members from this community end up visiting facilities/providers who charge less for their services.

For most transgenders/hijras, seeking healthcare ranks low in their list of priorities. For example, many members spend their money on personal grooming, such as laser treatment for hair removal.

Living on the fringes of society, they often encounter criminals and end up getting raped and/or molested. As their complaints are not treated seriously by law enforcement officers, they are exposed to these acts often. They cannot go to clinics and claim they were raped and/or molested due to apathy and fear of being treated as a male.

Changing Scenarios for Medical CareTwo factors have made a change in recent years: NGO interventions and efforts of some hijra CBO office bearers.

A few private doctors have started examining them but a large number of medical professionals are still apathetic/lethargic to their issues. Most of the doctors who have started examining them are still on a learning curve, as they are yet to develop a sound understanding of typical hijra health problems.

At this stage, the change in doctors’ attitude appears to be taking place more on a personal rather than structural level.


Activity 8: Social Exclusion, Rights and Entitlements

Time 55 minutes


• Define the term ‘social exclusion’ and understand its impact on transgender and Hijra communities; and

• Identify ways and means of addressing social exclusion.

Materials N/A

Audio-visual Support Audio-video clip from the movie ‘From the Third Eye’.

Take-home Material Annexure 4 on ‘Journey towards Social Inclusion’.

Methodology The purpose of this session is to explain the term ‘social exclusion,’ to summarise the various issues faced by these communities that result in their exclusion, and to highlight the relation between social exclusion and vulnerability to HIV and other health risks. The facilitator should screen the movie ‘From the Third Eye’. After the screening of the film, she/he leads a discussion which includes the following questions:

• What do we mean by social exclusion?

• How are people socially excluded?

• What could be the possible impact of social exclusion?

• What are the possible solutions to dealing with social exclusion?

Distribute copies of Annexure 4 on ‘Journey towards Social Inclusion’ to each participant, and end the day’s activities on a positive note by discussing the social and legal events that are taking place in India that positively impact the status of the transgender and hijra community in the country.

During the debriefing of the film, point out that participants and their CBOs need to do two things:

• Identify existing community-friendly services (medical, legal, etc.) to deal with all the challenges discussed during the day; and

• Strategise on how to convert unfriendly ones into friendly ones through sensitisation/advocacy with key stakeholders. (Tell them that this will be dealt in greater detail in Module D4 on Community Friendly Services).

Wrap up the day’s activities by pointing out that for transforming lives, physical transformation is not enough. Transformation of personal attitude along with transforming surrounding social structures is also needed. It can be achieved through awareness-generation, sensitisation, and advocacy with doctors, lawyers, community leaders, policy-makers, family members, and other stakeholders.

Note to Facilitator‘From the Third Eye’ explores the basic needs of male-to-female TGs in eight states in India, and looks at the steps taken by them in dealing with the barriers to inclusion.

The film not only helps in visualising their struggles and sufferings but also reflects their skills and tenacity to survive against all odds.


Background Information(UNDP, 2010)

Social Exclusion and the Transgender/Hijra Communities

Exclusion from social and cultural participation:

• Exclusion from family and society

• Lack of protection from violence

• Restricted access to education, health services; and public spaces

Exclusion from economy,

employment and

livelihood opportunities

Exclusion from Politics and Citizen Participation

• Restricted access to collectivisation

• Restricted rights of citizenship

• Restricted participation in decision-making processes

Social Exclusion of Hijras/Transgender

Exclusion from Social and Cultural Participation

Exclusion from Family and SocietyDespite what is perceived as Indian society’s general climate of acceptance and tolerance, there appears to be limited public knowledge and understanding of same-sex sexual orientation and of people whose gender identity and expression are incongruent with their biological sex. Human rights violations against sexual minorities, including the transgender communities in India, have been widely documented.

Discrimination in Healthcare SettingsHijras face discrimination in the healthcare settings where providers are less equipped with knowledge about sexual diversities and not sensitive to the needs of various sexual minorities.

Social and Economic Discrimination and Deprivation Due to exclusion from economic participation and lack of social security, hijras and transgender communities face a variety of social security issues.They lack specific social welfare schemes and face barriers in the usage of existing schemes.

Here the facilitator must explain how, despite social welfare departments providing a variety of social welfare schemes for socially and economically disadvantaged groups, there are none or very few schemes for hijras.

They lack access to life and health insurance schemes. Most hijras are not covered because of lack of knowledge, inability to pay premiums, or not being able to get enrolled in the schemes. Thus, most rely on government hospitals in spite of pervasive discrimination.

They also face loss or lack of income and the lack of livelihood options. Most employers deny employment even to qualified and skilled TGs. The lack of livelihood options is a key


reason for a significant proportion of TGs choosing or continuing to remain in sex-work, with its associated HIV and other health-related risks.

Exclusion from Acess to Legal, Civil and Political RightsLegal issues can be complex for people who change their sex, as well as for those who are gender-variant.

Legal issues include legal recognition of their gender identity, same-sex marriage, child adoption, inheritance, wills and trusts, immigration status, employment discrimination, and access to public and private health benefits. Getting legal recognition of gender identity as a woman or a transgender is a complicated process.

Lack of legal recognition has important consequences in getting a government ration (food-price subsidy) card, a passport, or in opening a bank account.

Difficult to VoteAlthough transgenders have the option to vote as a woman or ‘other’, the legal validity of the voter’s identity card in relation to confirming one’s gender identity is not clear.

Difficult to Register an AssociationSome legal provisions (e.g., Indian Trust Act, Societies Registration Act) that enable a group of individuals to form a legal association pose challenges for these communities. For example, the need for address proof and identity proof of all members of the group is the basic requirement to register an association. However, most transgenders and hijras do not have identity and/or address proof or even if they do, they have documents only with their male identity. Similarly, opening a joint bank account to carry out financial transactions of their association can be difficult due to stigma and discrimination.

They face challenges in collectivisation and strengthening their community organisations. There are more than 100 organisations and networks (including agencies providing services for MSMs) who work with transgenders in India. Many have faced challenges in legally registering their organisations. In spite of the above challenges, a few hijra CBOs across India were able to meet the legal requirements for registration.

Difficult to Buy or Rent Space Buying or hiring office space for their legally valid associations is very difficult. Even if they get one, the landlords quote unfair rent prices.

Difficult to Get FundingTransgender and hijra associations rarely get external financial support, even from those funders who might want to primarily fund HIV prevention activities. Through NACP III, for instance, only a few TG and hijra CBOs have been granted TI projects. [Editor’s note: Increased investment in TG and hijra CBOs is expected in NACP IV.]

Many of the existing TG and hijra organisations lack basic systems that are essential for effectively running an organisation. It is crucial that the capacity of these organisations be enhanced for effective community mobilisation and providing quality services.

Difficult to Get Sex-change Operation The Indian legal system is also silent on the issue of a sex change operation or sex reassignment surgery (SRS, as mentioned above). According to Section 320 of the Indian Penal Code (IPC), ‘emasculating’ (castrating) is punishable by law. Technically, even if one voluntarily (with consent) chooses to be emasculated, the doctor is liable for punishment and the person undergoing emasculation could also be punished for ‘abetting’ this offence. (However, under Section 88 of the IPC, an exception is made in case an action is undertaken in good faith and the person gives consent to suffer that harm).


Difficult to Get Police HelpHijras who cross-dress and who are in traditional occupations of begging and dancing are often harassed by police under the Section 268 IPC for public nuisance or under obscenity covered in Section 292 IPC. They can also be potentially harassed by police under Section 377 IPC and the Immoral Trafficking Prevention Act (ITPA) can be used on those in sex work. Also Section 375 IPC which deals with rape is not gender neutral,and thus does not address transgender/hijra sexual violence and rape. Also as discussed earlier, they are perceived as men and therefore not really accepted as weak victims of rape by the police.

Begging or mangti which is a traditional form of livelihood for these communities is punishable under the Bombay Prevention of Begging Act, 1959. They can be arrested and the individual is sent to a detention centre for a year which is under the Social Welfare Department. The detention centre has separate cells only for men and women and the transgender live with men. Often, they are required to strip in front of the officials.

Journey Towards Social Inclusion• Reading down of Section 377 IPC.

• The setting up of the Tamil Nadu Aravanigal Welfare Board offers free SRS for hijras and transgenders in select government hospitals.

• Transgenders and hijras are counted in the national census.

• Transgendersand hijras can apply for passport as ‘O’ or ‘T’ sex.

Most of them have voter/election commission issued ID card as ‘Others’.

• Support for some hijra and transgender CBOs from the Global Fund (GFATM) Round-9 through the Principal Recipient India HIV/AIDS Alliance – both for organisational development and service provision.

• National Legal Services Authority (NLSA) providing free legal aid to transgenders. Also legal literacy classes on the rights of transgendered people has been initiated since January 2011. NLSA’s state and districts counterparts are active in this regard and can be approached for support.

• Pension scheme for transgender and hijras in Delhi/NCR.

• Free Legal aid service for TGs and hijras in Haryana.

• Reservation in government jobs for transgender and hijras in Punjab.

• Reservation under OBC 2A Category for receiving state benefits in Karnataka.


Tamil Nadu: A Move Towards Inclusion Establishment of the Tamil Nadu Aravanigal (Transgender Women) Welfare Board

In a pioneering effort to address the issues faced by transgenders , the government of Tamil Nadu established a Transgender Welfare Board in April 2008, the first of its kind by any state government in India, in fact in the Indo-Pacific region.

The Board addresses a variety of concerns including education, income-generation and other social security measures.

The Board has already conducted an enumeration of the transgender populations in all 32 districts of Tamil Nadu. In some places identity cards, with gender identity mentioned as ‘Aravani, have been issued.

The government has also started issuing transgender with ration cards to buy food and other items from government-run fair-price shops. In May 2008, a Tamil Nadu government order directed that transgenders to be enrolled in government educational institutions and included as ‘other’ or ‘third gender’ category in admission forms.

Free sex-reassignment surgery is also performed for hijras/transgenders at selected government hospitals.


Annexure 1: Working Definitions of the Terms ‘Transgender’ and ‘Hijra’Source: (NACP IV working groups, May 2011)

HijrasHijras are individuals who voluntarily seek initiation into the hijra community, whose ethnic profession is Badhai (ritual of clapping hands and asking for alms when blessing new-born babies, or dancing at auspicious ceremonies such as weddings). Due to the prevailing socio-economic and cultural conditions, a significant proportion of them have been forced to enter into begging and sex work for survival.

These individuals live in accordance to the hijra community’s norms, customs and rituals which may vary from region to region.

Transgender• TG is a gender identity.

• TGs usually live or prefer to live in the gender role different from that which theyare born into.

• This has no relation to an individual’s sexual preferences.

• TG is an umbrella word which includes transsexuals, cross-dressers, intersexedpersons, and gender-variant persons.

• TG includes people who have not undergone any surgery or physiologicalchanges.

Note: The above definitions are adopted under the Pehchan programme.


Annexure 2: The Transgender UmbrellaSource: http://houston.culturemap.com/newsdetail/12-10-10-four-diverse-houston-art-projects-awarded-grants-from-the-idea-fund/


Annexure 3: Aspects of Transformation and Feminisation(Brown and Rounsley, 1996)

Transitioning is a complicated process that involves any or all of the gendered aspects of a person’s life. People will choose elements based on their own gender identity, body image, personality, finances, and sometimes on the attitudes of others. A degree of experimentation is used to know what changes best fit them. Transitioning also varies between cultures and sub-cultures, according to differences in the societies’ views of gender. Given below are some of the key elements of transitioning:

• Legally and/or socially changing their name to something consistent with theirgender identity.

• Asking others to use ‘she’ and ‘her’ while addressing them, instead of ‘he’ or‘him’.

• Having one’s legal gender changed on the driver’s license, ID cards, etc.

• Personal relationships take on different dynamics in accordance with gender.

• Changing the type and style of clothing, jewellery, accessories, and make-up.

• Adopting the mannerisms or gender role.

• Surgery and/or hormone therapy .

• Changing their pitch.

When a person undergoes changes (some or all) as stated above, and the person believes that his transition to the opposite gender is complete, that stage is referred to as ‘transformed’. Transitioning is sometimes confused with sex-reassignment surgery (SRS), which is just one element of transitioning. Many people who transition choose not to have SRS. Whereas SRS is only a physical change, transitioning is a physical, social, and emotional change. Some gender-queer and some intersex people have little or no desire to change their body but will transition in other ways.

Medical and surgical procedures exist for transsexual and transgender people. Treatments include hormone replacement therapy for fat distribution and breasts; laser hair removal or electrolysis to remove excess hair; surgical procedures, such as SRS, for feminising the body and its functions, such as voice, skin, face, breasts, and waist.

The choice of these procedures depends on the degree of gender dysphoria, presence or absence of gender identity disorder and standards of care. Most categories of transgenders are not known to seek these treatments.

Treatment such as hormone therapy and other procedures related to transitioning from male to female can be very expensive and the process may need a lot of time. Lack of proper knowledge and information in the community make many seek alternative or traditional methods.

CastrationThe most commonly practiced way of transformation by hijras is through castration or removal of testicles (called nirvani in trangender and hijra community parlance). Surgeries are often carried out under septic conditions by dai’s (a local community member or self-taught nurse) who plays the surgeon based on her experience of operating on other hijras. Hijras sometimes call this operation nirbaan or nirvana (also called mukti in Hindi, which means ‘release’, suggesting ‘transition’ of a person from one ‘life’ to another).


Indian legal statutes do not permit the forced castration of males; therefore, there is secrecy around nirvani. The operation is always conducted in the early hours of the day and the whole process is seen as a religious ritual, although it is often viewed as a barbaric and brutal custom.

Most hijras in India are forcibly castrated, but a few submit themselves to the process. In almost all the cases, breasts develop after castration because the source of male hormones—the testicles—are removed and the female hormones, which are normally suppressed, will take over, ensuring emergence of secondary sexual characteristics (sparse growth of facial hair, change in voice, etc).

Hormone Replacement Therapy (Male-to-Female)Taking hormones causes changes such as growth of breasts and smoothing of skin. It does not usually stop facial hair growth or cause the voice to change. Irreversible changes caused include breast development, enlarged nipples and stretch marks .

Reversible changes include decreased libido, redistribution of body fat, and reduced muscle development. The psychological changes with hormone replacement therapy are hard to define, because the therapy usually causes physical changes first. If not taken in appropriate dosages, hormone replacement therapy can cause various side effects, including death.

Estrogens used in hormone replacement therapy typically have side-effects that include mood swings, headache, nausea, dizziness, acne, skin darkening, high blood pressure, fatigue, depression, obesity, blood clotting, heart disease, diabetes, gallstones, liver disease, weakening of bones, advanced age, brain damage, and infertility. Excessive estrogens can cause blood clots and strokes. This is especially important to consider and monitor if the person is living with HIV.

Sex-reassignment Surgery (SRS)SRS refers to the surgical and medical procedures undertaken to align the physical appearance and genital anatomy of intersex and transsexual individuals with their gender identity. SRS encompasses surgical procedures that reshape a male body into a body with a female appearance (or vice versa) and refers to the procedures used to make male genitals into female genitals and vice versa.

Most transgenders and hijras receive no professional counselling before surgery, and they sometimes have surgeries without understanding the consequences. A transgender should take hormones before any sex-related surgery. Someone who is unhappy with the effects of hormones may decide not to have surgery or even stop taking hormones.

SRS can be completed in one or two surgeries, depending on the surgeon’s technique. Possible complications due to this surgery, regardless of the type of surgery performed, include:

• Post-operative infections (as with any surgical procedure);

• Blood loss;

• Deep-vein thrombosis (clot in the leg veins,which is preventable withcompression stockings and/or drugs);

• Vaginal stricture (the narrowing of the opening of the vagina) and urethral stricture(urethra is the tube through which urine is conveyed out of the male body fromthe bladder; urethral stricture is the narrowing of that opening);

• Pubic hair in undesirable places;

• Numbing of the external genitals (vulva, clitoris) due to severing and lack ofhealing of nerve tissue during surgery;


• Excess erectile tissue, resulting in sexual side effects;

• Rectovaginal fistula (a hole between the ‘new’ vagina and the colon, this is rare);and

• Urethral fistula (a hole in the urethra, again this is rare).

Post-operative care is important for better healing and results.

Note: Other related procedures for transformation and feminisation include facial feminisation surgery, breast augmentation (in cases where hormones fail to work), voice feminisation surgery (to alter the pitch of the voice), and buttock augmentation.

Participants should also know:

• Taking more hormones does not mean the hormones will work faster.

• Taking too many hormones pills can damage the liver, which means thathormones will not work in future because body will not be able to processthem.

• Hormones will not change the body immediately and the effects may takemore than a year to show.

• Use of hormones should not be treated lightly. Dosage may depend on factorssuch as age, body size, smoking habits, alcohol use and whether the testiclesare present or have been removed surgically.

• For better effect, hormones should be taken in a combination of estrogensand anti-androgens. Estrogens help people become more feminine and helpin developing breasts and large nipples, and anti-androgens block the malehormones produced in the body, even if the testicles have been removed.They also reduce facial and body hair.

• Birth control pills such as Mala D, Sukhi, etc., are NOT the same as femalehormones or hormone therapy.

• Hormones should only be taken with a prescription and under the supervisionof a physician.


Annexure 4: Journey towards Social Inclusion

• Reading down of Section 377 IPC.

• The setting up of the Tamil Nadu Aravanigal Welfare Board offers free SRS forhijras and transgenders in select government hospitals.

• Transgenders and hijras are counted in the national census.

• Transgendersand hijras can apply for passport as ‘O’ or ‘T’ sex.

• Most of them have voter/election commission issued ID card as ‘Others’.

• Support for some hijra and transgender CBOs from the Global Fund (GFATM)Round-9 through the Principal Recipient India HIV/AIDS Alliance—both fororganisational development and service provision.

• National Legal Services Authority (NLSA) providing free legal aid to transgenders.Also legal literacy classes on the rights of transgendered people has beeninitiated since January 2011. NLSA’s state and districts counterparts are active inthis regard and can be approached for support.

• Pension scheme for transgender and hijras in Delhi/NCR.

• Free Legal aid service for TGs and hijras in Haryana.

• Reservation in government jobs for transgender and hijras in Punjab.

• Reservation under OBC 2A Category for receiving state benefits in Karnataka.

Tamil Nadu: A Move Towards Inclusion Establishment of the Tamil Nadu Aravanigal (Transgender Women) Welfare Board

In a pioneering effort to address the issues faced by transgenders , the government of Tamil Nadu established a Transgender Welfare Board in April 2008, the first of its kind by any state government in India, in fact in the Indo-Pacific region.

The Board addresses a variety of concerns including education, income-generation and other social security measures.

The Board has already conducted an enumeration of the transgender populations in all 32 districts of Tamil Nadu. In some places identity cards, with gender identity mentioned as ‘Aravani, have been issued.

The government has also started issuing transgender with ration cards to buy food and other items from government-run fair-price shops. In May 2008, a Tamil Nadu government order directed that transgenders to be enrolled in government educational institutions and included as ‘other’ or ‘third gender’ category in admission forms.

Free sex-reassignment surgery is also performed for hijras/transgenders at selected government hospitals.


Annexure 5: PowerPoint Presentation – Transgender and Hijra Communities


Notes








population status.








module

C

module

A

module

C

module

D




module



C2 Family Support

C3 Mental Health





D3 Positive Living





D1 H

uman

and

Leg

al R

ight

s

Facilitator Guide

Human and Legal Rights

D1

Pehchan 1D1 Facilitator Guide: Human and Legal Rights


About Pehchan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2


Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3


Module Acknowledgments: Human and Legal Rights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

About the Human and Legal Rights Module. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9


Activity Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Activity 1: Understanding Rights and the Difference between Legal Rights and Human Rights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Activity 2: Understanding the Universal Declaration of Human Rights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Activity 3: Dealing with Rights Violations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Activity 4: The Right to Confidentiality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Activity 5: Institutions of Recourse and Legal Processes in India . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Activity 6: Wrap-up . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Annexure 1: Timeline of Human Rights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Annexure 2: Universal Declaration of Human Rights (UDHR) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

Annexure 3: FIR Format . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

Annexure 4: PowerPoint Presentation – Human and Legal Rights. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

Pehchan2 D1 Facilitator Guide: Human and Legal Rights

About this ModuleThis module is designed to help training participants: 1) understand basic human rights and their importance in working with sexual minorities; 2) learn how to apply the principles of International Human Rights to local settings; 3) understand human and legal rights from the perspective of men who have sex with men (MSM), transgenders and hijras; and 4) build skills to recognise rights violations and mitigate them. In the Pehchan programme, this module is used to introduce basic principles of human and legal rights to CBO Programme Managers and Outreach Workers.





Module Acknowledgments: Human and Legal RightsEach component of the Pehchan Training Curriculum has a number of contributors who have provided specific inputs. For this component, the following are acknowledged:

Original Author Aditya Bandopadhyay, Adhikaar


Technical Input Debjyoti Ghosh, SAATHII


References • First Information Report (FIR) & You, Police and You – Know your Rights. (2011).

Commonwealth Human Rights Initiative. New Delhi.

• Universal Declaration of Human Rights. (December 10, 1948). UN General Assembly. Available on http://www.unhcr.org/refworld/docid/3ae6b3712c.html


About the Human and Legal Rights Module

No. D1

Name Human and Legal Rights


• Counsellors




• Understand the concept of human rights;

• Be able to relate how these rights can be applied in the context of MTH community; and

• Have a basic understanding about Indian laws that have relevance to the MTH community.





Audio-visual Support PowerPoint Presentation on ‘Human and Legal Rights’.

Annexures Annexure 1: ‘Timeline of Human Rights’.Annexure 2: ‘Universal Declaration of Human Rights’.Annexure 3: ‘FIR Format’.Annexure 5: ‘FIR and You’ available on digital file.


Activity Index1


Take-home material

1 Understanding Rights and the Difference between Legal Rights and Human Rights

2 hours Chart paper and markers, post-it notes, whiteboard

Refer to the slides titled ‘Your Country’s Rights’ to ‘Types of Rights’ from the PowerPoint Presentation ‘Human and Legal Rights’

Annexure 1: ‘Timeline of Human Rights’

2 Understanding the Universal Declaration of Human Rights

2 hours N/A N/A Annexure 2: ‘Universal Declaration of Human Rights’

3 Dealing with Rights Violations

1 hour 30 minutes

Chart paper and markers

Refer to the slides titled ‘Dealing with Rights Violations’ to ‘Types of Offences’ from the PowerPoint Presentation ‘Human and Legal Rights’

Annexure 3: ‘FIR Format’Annexure 5: ‘FIR and You’

4 The Right to Confidentiality

1 hour Sugar candy for prizes

N/A N/A

5 Institutions of Recourse and Legal Processes in India

40 minutes N/A Refer to the slides titled ‘Indian Legal Hierarchy’ to ‘Alternate Redressal Mechanism’ from the PowerPoint Presentation ‘Human and Legal Rights’

N/A

6 Wrap-up Quiz 40 minutes N/A N/A N/A



Activity 1: Understanding Rights and the Difference between Legal Rights and Human Rights

Time 2 hours


• Understand the concepts of ‘Rights’, ‘Legal Rights’ and ‘Human Rights’.

Materials Chart paper, sheets of paper and markers.

Audio-visual Support Refer to the slides titled ‘Your Country’s Rights’ to ‘Types of Rights’ from the PowerPoint Presentation ‘Human and Legal Rights’.

Take-home Material Annexure 1: ‘Timeline of Human Rights’.

Methodology

Part I Start with an informal discussion by asking the following questions to gauge participants’ existing knowledge on this subject:

• What do you understand when the term ‘Rights’ is used?

• How do you see ‘Rights’ as being relevant in your daily life?

Divide the participants into groups of four and read aloud the following scenario from the PowerPoint slide titled ‘Your Country’s Rights’:

Imagine that you are in a newly discovered land, where no one has lived before and where no laws or rules exist. You and the other members of your group will be the first inhabitants of this new land. What are the important rights you will suggest for everyone, including yourself, in your new country?

Instruct the participants to individually list rights which she/he thinks should be guaranteed for everyone in this new country. After they have worked individually, they should discuss their lists within their group and agree unanimously upon a set of rights for their country. Each selected right should be written down on a separate sheet of paper.

Part IIOn the whiteboard, draw a tree with two main branches and a thick trunk. Label the trunk as ‘Indian Constitution’.

Then label one branch as ‘Fundamental Rights’. These are defined as the basic human rights of all citizens. These rights apply irrespective of race, place of birth, religion, caste, creed, or sex. They are enforceable by the courts, subject to specific restrictions.

Now label the other branch as ‘Directive Principles of State Policy’. These are guidelines for framing laws by the government. These provisions are not enforceable by the courts, but the principles on which they are based are fundamental guidelines for governance that the State is expected to apply in framing and passing laws.

Explain to the participants how the tree represents the Constitution of India and how the branches represent the two parts that deal with the rights for the citizens. If needed, elaborate further on both Fundamental Rights and Directive Principles of State Policy to the participants. Ask each group to read out their country’s rights and list their responses either under ‘Fundamental Rights’ or the ‘Directive Principles of State Policy’.

Note to FacilitatorFundamental Rights are basic rights that every human is entitled to being a citizen of India. These include right to equality, right to freedom, and right to education.

Directive Principles of State Policy are the guidelines that provide the basis to form any law and policies in India.

It may be helpful to keep the Preamble, the Fundamental Rights (Part III) and the Directive Principles of State Policy (Part IV) of the Indian Constitution at hand and refer to them and other reference materials whenever needed.

http://en.wikipedia.org/wiki/Human_rights

http://en.wikipedia.org/wiki/Human_rights

http://en.wikipedia.org/wiki/Caste


Part IIIUsing the PowerPoint slide titled ‘Buying a house in this country’, present another scenario wherein a citizen wants to buy a house from another citizen of the new country.

Ask the participants:

• Whether a citizen of the country has the right to buy a house that belongs to another citizen. If yes, then does the owner of the house reserve the right to turn down the offer if he is not getting a lucrative proposal?

• What if the person wanting to buy the house forces the house owner to sell the house? Do you think the house-owners’ rights have been infringed upon?

• Does the house-owner have the right to refuse to sell his property?

• Does the person wanting to buy the house have an absolute right to buy the property, or is it conditional on whether the house owner wants to sell it? Point out that the owner has the absolute right to enjoy their property and not sell, and that the prospective buyer has the conditional right to buy the property, the condition being that the current owner wants to sell it.

Part IVUsing the PowerPoint slides, discuss the following points:

• What are rights? Refer to the slide titled ‘What are Rights?’

• What are Absolute and Conditional Rights?

Ask the participants to work in their groups to create a law, or a set of laws, for their country that will protect the rights of the buyer as well as the rights of the seller/owner. List their responses on a flip-chart and discuss the following:

• Do these laws offer absolute protection to either side (buyer and seller) or do they conditionally protect them?

• Are all the laws about what people should do, or are some of them based on what people should not do?

• Rights bring about duties (e.g. right not to be disturbed by your neighbour, and the neighbour’s corresponding duty not to disturb you).

Draw a fence around the tree (drawn earlier on the whiteboard). Explain that the fence represents the legal institutions of India that uphold the rights protected by the Constitution of India. On the tree, draw leaves around each of the rights and explain that the leaves represent the different laws that help citizens claim their rights or help bind citizens to their duties. Refer to the branch of the tree labeled ‘Fundamental Rights’, and ask the participants where they think this list of ‘Fundamental Rights’ came from. Also ask them if they think there are other countries in the world which have given their citizens the same rights. Draw a vertical line on a flip-chart, and mark the Indian Constitution’s commencement in 1950 and ask the audience if they can plot the timeline of Human Rights evolution, if they are unable to do it, then guide the participants through the same by referring to the slides in PowerPoint Presentation titled ‘Human and Legal Rights’.

Display the PowerPoint slide with the tree and tell the participants that India is one of the countries that is a signatory to various conventions (for example, the International Convention on Civil and Political Rights, and the International Convention on Economic, Social and Cultural Rights).

Note: The stars in the slide represent the international conventions which affirm and help protecting our rights at national and international levels.

Wrap-up the session by discussing the importance of rights for every individual in any country.


Activity 2: Understanding the Universal Declaration of Human Rights

Time 2 hours


• Learn about Universal Declaration of Human Rights (UDHR).

• Understand the scope and limitations of UDHR.

Materials N/A


Take-home Material Annexure 2: ‘Universal Declaration of Human Rights’.

Methodology Facilitator should start the session by explaining UDHR to participants (Part I). Also elaborate that after clarifying fundamental concepts of UDHR, participants are expected to perform role plays (Part II) based on articles from UDHR.

Part I: Lecture and Discussion Start the session by giving a brief overview on the concept of and the articles enlisted in the Universal Declaration of Human Rights (UDHR) (Refer to Annexure 2). Elaborate to the participants that the United Nations General Assembly adopted the UDHR on 10 December 1948. This Declaration gave international recognition for the first time to the rights and freedoms of individual across the world, irrespective of borders or citizenship.

Background Information (UN General Assembly, 1948)

Forty eight countries out of the fifty eight countries that were members of the UN at the time originally ratified the document. Essentially, all the countries in the world have ratified it since then. Its core provisions are binding international laws, regardless of the existence of treaty ratification or state of war, including the prohibitions against slavery, genocide, torture, and cruel inhuman treatment of war prisoners.

Today, UDHR continues to impact people’s lives and inspire human rights activism and legislation all over the world. It emphasises that irrespective of nationality, place of residence, sex, national or ethnic origin, colour, religion, language, or any other status all individuals are equally entitled to human rights without discrimination.

The international community embraced UDHR as a document having universal value – ‘a common standard of achievement for all peoples and all nations’. It lists numerous rights – civil, political, economic, social and cultural – to which people everywhere are entitled.

The Declaration contains, in addition to its preamble, thirty articles that outline people’s universal rights. Some of the rights championed by the Declaration are:

• The right to life, liberty and security of person;

• The right to education;

• Right to participate fully in cultural life;

• Freedom from torture or cruel, inhumane treatment or punishment; and

• Freedom of thought, conscience and religion.

Annexure 2 provides the full text of the UDHR.


Part II: Role PlaysAsk two participants to volunteer for a role play. One of the participants has to perform the role of a ‘powerful’ person called Ashok who is ‘influential and authoritative’. The other participant has to enact Ramesh who is less powerful than Ashok but holds high principles and commands respect from the community.

Ask Ashok to enact a situation where he desperately wants to buy Ramesh’s house for 50 lakh rupees (US$100,000), as per the market rate. However, Ramesh is not interested in selling the house at any cost. Ask Ramesh to play the role of a person who despite the intimidation and inducements from Ashok does not fall under the pressure exerted and refuses to sell it for that price.

Role play ends with Ashok not being able to force his will on Ramesh, who is unwilling to sell at that price.

Ask two more participants to volunteer for the second role play. Then assign the role of the powerful person called Ranjit and a less powerful person as Arjun.

Ask them to enact the following situation: Ranjit has 2 lakh rupees (US$4,000) in his account and he wants to buy a car from Arjun for that amount although the car is valued at 5 lakh (US$10,000). While the power dynamics remain the same as in the first role play, what differs here is that Arjun is willing to negotiate/bargain with Ranjit for a fair price.

This time the role play ends on a different note, with Arjun selling for a price he wanted and there is a settlement.

Notes: Facilitator should ask rest of the participants about their views and opinions on the two role plays. Conclude by explaining that in the first situation, settlement was not achieved due to unilateral demand of one party. However, in the second instance mutual agreement achieved desired settlement.

Facilitator should relate the discussion to UDHR and stress on the point that these role plays highlight some of the articles of UDHR, such as:

Article 12 • No one shall be subjected to arbitrary interference with his privacy, family, home

or correspondence, nor to attacks upon his honour and reputation. Everyone has the right to the protection of the law against such interference or attacks.

Article 17• Everyone has the right to own property alone as well as in association with

others.

• No one shall be arbitrarily deprived of his property.

While summing up the session explain to participants that UDHR is a milestone document in the history of human rights and it sets out, for the first time, fundamental human rights to be universally protected.


Activity 3: Dealing with Rights Violations



• Know the typical violations faced by the MTH community and recourse available;

• Understand the processes required to file a First Information Report (FIR) and a General Diary;

• Know the steps to be taken in case of inaction by law enforcement authorities;

• Identify some of the Indian laws which are used against the MTH community;

• Identify some of the Indian laws under which protection can be sought; and

• Articulate the rights of an Indian Citizen who has been arrested.


Audio-visual Support Refer to the slides titled ‘Dealing with Rights Violations’ to ‘Types of Offences’ from the PowerPoint Presentation ‘Human and Legal Rights’.

Take-home Material Annexure 3: ‘FIR Format’.Annexure 5: ‘FIR and You’ available on digital file.

Methodology Divide the participants into two groups and ask them to work on the case study provided in the PowerPoint slide titled ‘Dealing with Rights Violations’.

Ramesh, a kothi, known as Rukmini by his close kothi friends, was beaten up by some local boys because of his feminine characteristics. He comes to you in a bruised and a battered condition.

Ask the groups to identify which of Ramesh/Rukmini’s rights have been infringed upon and suggest steps to redress the complaints of Ramesh/Rukmini. When the participants share their responses, ensure they also consider the value of:

• Filing an FIR;

• Conducting a thorough medical examination;

• Sensitising the community about the infringement of rights; and

• Following-up to ensure a police investigation.

Using the slide titled ‘Differences between a General Diary (GD) and a First Information Report (FIR)’, define a General Diary and then explain the difference between them. Lead the participants through the process of filing an FIR (refer to PowerPoint slide titled ‘How to file an FIR?’). Give each participant a printout of Annexure 3 on ‘FIR and You’ and Annexure 5 on ‘FIR Format’ and elaborate on the content.

Using the PowerPoint slide titled ‘What can you do if your FIR is not registered?’ and then discuss what steps are to be taken if the police refuse to file an FIR. Ask the participants if they would like to speak about their own experiences.

Discuss how sexual reassignment surgery (SRS) in India is often looked upon as illegal, as it ‘causes bodily harm’; this issue is likely to be important to a number of participants.

Note to FacilitatorViolence diminishes human rights and can be found in various forms, including:

• Torture

• Cruelty

• Inhuman or degrading treatment

• Punishment

• Discrimination


Ask participants to give examples of violations against the MTH community. Once an extensive list has been prepared, specify the laws with which a person can find recourse to her/his rights violations. Facilitator can refer to the PowerPoint slides titled ‘Some laws which are being used specifically against MTH community members’ and ‘Impact of regressive laws and their misuse on HIV efforts’.

Explain to the participants the following rights of an Indian national who is arrested under the law:

• The right to be told the grounds for arrest;

• The right to make one phone call;

• The right to be represented by a lawyer;

• The right to not be forced to make any statement incriminating oneself; and

• The right to apply for and obtain bail.

In this context, explain the difference between cognisable and non-cognisable offences, as well as bailable and non-bailable offences (see PowerPoint slide titled ‘Types of Offences’).

Using the PowerPoint slide titled ‘Section 377, Indian Penal Code’, discuss the section briefly with the participants. Ask them what they think about the provisions under this section and what their views are about the Delhi High Court judgment of 2009. Ask the participants to list the rights, as given in the Constitution of India, that would be infringed if an individual (MTH) were prosecuted under Section 377.

Before moving on to the next session, summarise the key learnings from this session.


Activity 4: The Right to Confidentiality

Time 1 hour


• Know that the right to confidentiality is a conditional right and know its importance in the life of a person living with HIV; and

• Be able to understand issues related to the right to confidentiality and its implications for the MTH community and people living with HIV.

Materials Prizes (sugar candy)



Methodology Ask the participants the following questions:

• What is meant by confidentiality? • Is it necessary for people who are closely related to a person living with HIV to

know his/her HIV status?

• Who has the right to disclose a person’s HIV status to others, particularly to his/her spouse or other sexual partners? Is it the person living with HIV or the counsellor/doctor treating the person? In this scenario, which right has precedence – the Right to Privacy of the person living with HIV or the Right to Health of another person?

• What might happen if someone were to disclose the HIV status of a person in the neighborhood or in his/her family? Do you think the individual might face discrimination because of this? Will the individual be stigmatised?

Tell the participants about the legal recourses available when there have been instances of illegal disclosure. Describe laws being used against the MTH community and note that currently India does not have any specific laws to protect privacy. An effort has been made in this direction with the ‘Right to Privacy Bill’ that has been tabled in Indian Parliament. Considering the current situation and impact that breaches of confidentiality can have on the quality of a person’s life, tell the participants that these rights can be defended under the Fundamental Right to Life. Also, in case the breach is conducted by a medical professional, there are laws, such as the Consumers Protection Act, 1986, that apply, as well as the Consumers’ Forum, where such malpractices can be heard. Note that it can be difficult to prove such misconduct, and the process may further undermine privacy.

Ask the participants if they think clients in Pehchan programme have a Right to Confidentiality. If yes, how is it maintained? Here, discuss with the participants that among the project staff the Counsellor should be the only person to know a client’s HIV status, unless the individual decides to disclose his/her status to other staff members.

Consider the following scenario:

Raman, who is HIV-positive and aware of his status, is practicing unsafe sex with many members in his community.

• Do you think Raman has a right to do what he is doing? If yes/no, why?

• Is Raman endangering others’ lives by doing so?

Note to FacilitatorIt is important that participants understand that while there are no foolproof methods to ensure confidentiality, whether it be related to HIV status, sexual orientation or other sensitive issues, they need to consider the importance of confidentiality in the life of members of the MTH community, especially if they are infected with HIV.

Allow participants to reflect on their own experiences of breached confidentiality, either that they might have faced themselves or those that they might have been witness to.


• Do his sexual partners have the right to know about Raman’s HIV status?

• If Raman thinks that he does not have to disclose his status and that his partners’ protection is not his concern, is it his fault if his partner does not insist upon protection?

• What would you do if you found out that one of your organisation’s clients was behaving in this manner?

After allowing participants to discuss the above questions, tell them that when it comes to the Right to Confidentiality, it is a conditional right. Explain carefully how Raman and his sexual partners should be practicing safe sex. Irrespective of his partners’ knowledge of his HIV status, he should ensure safe sex, and the partners should take precautions while having sex with him.

Consider another scenario:

Again, Raman is HIV-positive and knows about his status. He meets with a counsellor in a CBO. During the counselling session, Raman explains that he practices unsafe sex with his partners. After the session, the counsellor is in a dilemma.

• Should the HIV status of Raman be shared? If yes, how and who should do this? If no, then why not?

• Can the counselor breach the right to confidentially of Raman in this case?

• Should the counselor support Raman to be open about his positive status?

At this stage, the facilitator should remind the participants that, in all events, a person getting tested for HIV should be the first one to know about his/her HIV status. Any breach of confidentiality about his/her HIV status would be unethical and illegal.

Consider a final scenario:

Mahesh is a kothi who comes to a CBO regularly. He has a nickname, Manisha, and prefers being called that when he is around like-minded people. He has a boyfriend who is very fond of him. However, Mahesh’s parents are trying to get him married, and he is not interested. He is feeling depressed and has suicidal tendencies because of this; the only thing which keeps him going is the hope that one day he and his boyfriend can live together. Ask the participants what they can do to help Mahesh out in this kind of a situation, while protecting his Right to Confidentiality.

Note: Give away sugar candies for the best responses. These should ideally include the basic steps for a comprehensive approach through advocacy, sensitisation programmes and mobilising the community.


Activity 5: Institutions of Recourse and Legal Processes in India

Time 40 minutes


• Be able to identify the hierarchies in the legal system and the alternatives available to MTH members through which they can get recourse.

Materials N/A

Audio-visual Support Refer to the slides titled ‘Indian Legal Hierarchy’ to ‘Alternate Redressal Mechanism’ from the PowerPoint Presentation ‘Human and Legal Rights’.


Methodology Using the PowerPoint slides titled ‘Indian Legal Hierarchy’, map out the course of a typical criminal case (e.g. where it starts and the routes its takes). Do the same for a civil case. Briefly describe the alternative dispute redressal mechanism in India involving Nyaya Panchayats and Lok Adalats. Using Rukmini’s case (refer Activity 2), help the participants trace the different paths of recourse available for her, including higher institutions of resort if local institutions fail to provide her relief.


Activity 6: Wrap-up

Time 40 minutes

Learning Outcomes At the end of this activity, the participants will:

• Summarise the various concepts they have learnt throughout the training session.

Materials N/A



Methodology Conduct a quiz to check participants’ understanding of the subject. Divide the participants into groups. Ask questions to one group, and allow other groups to judge whether the answer is correct or not. Some questions that could be asked are as follows:

• What are Rights?

• What is the difference between Human Rights and Legal Rights?

• Are all Human Rights also Legal Rights?

• Are all Legal Rights also Human Rights?

• Why is it necessary to understand the implications of HIV on Human Rights?

• What are the services that you can provide to a client to protect his/her rights?

• When did the Constitution of India come into power?

• Are there any Human Rights in the Constitution of India?

• Are the Fundamental Rights in the Constitution the same as Human Rights as given in Universal Declaration of Human Rights?

• What is the difference between Fundamental Rights and Directive Principles of State Policy?

• Who protects the Fundamental Rights?

• What is the current status of Section 377 of the Indian Penal Code?

• What is the difference between an FIR and a GD?

• What are your rights when you get arrested?

• What are bailable and non-bailable offences?

• What are cognisable and non-cognisable offences?

• What is meant by the Right to Confidentiality?

• Where can you go if your Right to Confidentiality is breached?


Annexure 1: Timeline of Human Rights

27 BC – AD 476 Roman Empire’s Natural Law: Rights of Citizens

1689 British Bill of Rights: Notion of Natural Rights of Life

1776 American Declaration of Independence

1789 French Revolution and Declaration of the Rights of Man

1833 onwards Abolition of Slavery in Europe and the Colonies

1914 – 1919 World War I

1919 The League of Nations

1939 – 1945 World War II

1945 United Nations

1947 India’s Independence

1948 Universal Declaration of Human Rights

1950 Constitution of India

Note to FacilitatorAsk the participants how India got involved in the United Nations at such an early stage, considering it was still a part of the British Empire, and not a sovereign state. Once the participants give their answers, mention that all British colonies at that point of time, such as India, Canada and Australia, were given independent seats despite still being colonies, as a goodwill gesture.


Annexure 2: Universal Declaration of Human Rights (UDHR)Source: UN General Assembly, UDHR, 1948.

The Universal Declaration of Human Rights is the basic international pronouncement of the inalienable and inviolable rights of all members of the human family. The Declaration was proclaimed in a resolution of the General Assembly on 10 December 1948 as the “common standard of achievement for all peoples and all nations” in respect for human rights. It lists numerous rights - civil, political, economic, social and cultural - to which people everywhere are entitled.

The Universal Declaration of Human Rights:

PreambleWhereas recognition of the inherent dignity and of the equal and inalienable rights of all members of the human family is the foundation of freedom, justice and peace in the world,

Whereas disregard and contempt for human rights have resulted in barbarous acts which have outraged the conscience of mankind, and the advent of a world in which human beings shall enjoy freedom of speech and belief and freedom from fear and want has been proclaimed as the highest aspiration of the common people,

Whereas it is essential, if man is not to be compelled to have recourse, as a last resort, to rebellion against tyranny and oppression, that human rights should be protected by the rule of law,

Whereas it is essential to promote the development of friendly relations between nations,

Whereas the peoples of the United Nations have in the Charter reaffirmed their faith in fundamental human rights, in the dignity and worth of the human person and in the equal rights of men and women and have determined to promote social progress and better standards of life in larger freedom,

Whereas Member States have pledged themselves to achieve, in cooperation with the United Nations, the promotion of universal respect for and observance of human rights and fundamental freedoms,

Whereas a common understanding of these rights and freedoms is of the greatest importance for the full realisation of this pledge,

Now, therefore,

The General Assembly,

Proclaims this Universal Declaration of Human Rights as a common standard of achievement for all peoples and all nations, to the end that every individual and every organ of society, keeping this Declaration constantly in mind, shall strive by teaching and education to promote respect for these rights and freedoms and by progressive measures, national and international, to secure their universal and effective recognition and observance, both among the peoples of Member States themselves and among the peoples of territories under their jurisdiction.


Article 1All human beings are born free and equal in dignity and rights. They are endowed with reason and conscience and should act towards one another in a spirit of brotherhood.

Article 2Everyone is entitled to all the rights and freedoms set forth in this Declaration, without distinction of any kind, such as race, colour, sex, language, religion, political or other opinion, national or social origin, property, birth or other status.

Furthermore, no distinction shall be made on the basis of the political, jurisdictional or international status of the country or territory to which a person belongs, whether it be independent, trust, non-self-governing or under any other limitation of sovereignty.

Article 3Everyone has the right to life, liberty and security of person.

Article 4No one shall be held in slavery or servitude; slavery and the slave trade shall be prohibited in all their forms.

Article 5No one shall be subjected to torture or to cruel, inhuman or degrading treatment or punishment.

Article 6Everyone has the right to recognition everywhere as a person before the law.

Article 7All are equal before the law and are entitled without any discrimination to equal protection of the law. All are entitled to equal protection against any discrimination in violation of this Declaration and against any incitement to such discrimination.

Article 8Everyone has the right to an effective remedy by the competent national tribunals for acts violating the fundamental rights granted him by the constitution or by law.

Article 9No one shall be subjected to arbitrary arrest, detention or exile.

Article 10Everyone is entitled in full equality to a fair and public hearing by an independent and impartial tribunal, in the determination of his rights and obligations and of any criminal charge against him.

Article 111. Everyone charged with a penal offence has the right to be presumed innocent until proved guilty according to law in a public trial at which he has had all the guarantees necessary for his defense.

2. No one shall be held guilty of any penal offence on account of any actor omission which did not constitute a penal offence, under national or international law, at the time when it was committed. Nor shall a heavier penalty be imposed than the one that was applicable at the time the penal offence was committed.


Article 12No one shall be subjected to arbitrary interference with his privacy, family, home or correspondence, nor to attacks upon his honor and reputation. Everyone has the right to the protection of the law against such interference or attacks.

Article 131. Everyone has the right to freedom of movement and residence within the borders of each State.

2. Everyone has the right to leave any country, including his own, and to return to his country.

Article 141. Everyone has the right to seek and to enjoy in other countries asylum from persecution.

2. This right may not be invoked in the case of prosecutions genuinely arising from non-political crimes or from acts contrary to the purposes and principles of the United Nations.

Article 151. Everyone has the right to a nationality.

2. No one shall be arbitrarily deprived of his nationality nor denied the right to change his nationality.

Article 161. Men and women of full age, without any limitation due to race, nationality or religion, have the right to marry and to found a family. They are entitled to equal rights as to marriage, during marriage and at its dissolution.

2. Marriage shall be entered into only with the free and full consent of the intending spouses.

3. The family is the natural and fundamental group unit of society and is entitled to protection by society and the State.

Article 171. Everyone has the right to own property alone as well as in association with others.

2. No one shall be arbitrarily deprived of his property.

Article 18Everyone has the right to freedom of thought, conscience and religion; this right includes freedom to change his religion or belief, and freedom, either alone or in community with others and in public or private, to manifest his religion or belief in teaching, practice, worship and observance.

Article 19Everyone has the right to freedom of opinion and expression; this right includes freedom to hold opinions without interference and to seek, receive and impart information and ideas through any media and regardless of frontiers.

Article 201. Everyone has the right to freedom of peaceful assembly and association.

2. No one may be compelled to belong to an association.


Article 211. Everyone has the right to take part in the government of his country, directly or through freely chosen representatives.

2. Everyone has the right to equal access to public service in his country.

3. The will of the people shall be the basis of the authority of government; this shall be expressed in periodic and genuine elections which shall be by universal and equal suffrage and shall be held by secret vote or by equivalent free voting procedures.

Article 22Everyone, as a member of society, has the right to social security and is entitled to realisation, through national effort and international cooperation and in accordance with the organisation and resources of each State, of the economic, social and cultural rights indispensable for his dignity and the free development of his personality.

Article 231. Everyone has the right to work, to free choice of employment, to just and favorable conditions of work and to protection against unemployment.

2. Everyone, without any discrimination, has the right to equal pay for equal work.

3. Everyone who works has the right to just and favorable remuneration ensuring for himself and his family an existence worthy of human dignity, and supplemented, if necessary, by other means of social protection.

4. Everyone has the right to form and to join trade unions for the protection of his interests.

Article 24Everyone has the right to rest and leisure, including reasonable limitation of working hours and periodic holidays with pay.

Article 251. Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.

2. Motherhood and childhood are entitled to special care and assistance. All children, whether born in or out of wedlock, shall enjoy the same social protection.

Article 261. Everyone has the right to education. Education shall be free, at least in the elementary and fundamental stages. Elementary education shall be compulsory. Technical and professional education shall be made generally available and higher education shall be equally accessible to all on the basis of merit.

2. Education shall be directed to the full development of the human personality and to the strengthening of respect for human rights and fundamental freedoms. It shall promote understanding, tolerance and friendship among all nations, racial or religious groups, and shall further the activities of the United Nations for the maintenance of peace.

3. Parents have a prior right to choose the kind of education that shall be given to their children.


Article 271. Everyone has the right freely to participate in the cultural life of the community, to enjoy the arts and to share in scientific advancement and its benefits.

2. Everyone has the right to the protection of the moral and material interests resulting from any scientific, literary or artistic production of which he is the author.

Article 28Everyone is entitled to a social and international order in which the rights and freedoms set forth in this Declaration can be fully realised.

Article 291. Everyone has duties to the community in which alone the free and full development of his personality is possible.

2. In the exercise of his rights and freedoms, everyone shall be subject only to such limitations as are determined by law solely for the purpose of securing due recognition and respect for the rights and freedoms of others and of meeting the just requirements of morality, public order and the general welfare in a democratic society.

3. These rights and freedoms may in no case be exercised contrary to the purposes and principles of the United Nations.

Article 30Nothing in this Declaration may be interpreted as implying for any State, group or person any right to engage in any activity or to perform any act aimed at the destruction of any of the rights and freedoms set fort h herein.

Fifty years have passed since the Declaration was adopted. Despite a continuing struggle in many regions of the world, significant progress has been made in developing legal, moral and institutional regimes consistent with the principles proclaimed in the UDHR. For instance, many human rights non-governmental organisations (NGOs) refer to the Declaration to hold governments accountable for their policies and actions.


Annexure 3: FIR FormatBook No. ___________

FORM NO. 24.5 (1) First Information Report (FIR)

First Information of a Cognisable Crime Reported under Section 154, Criminal Penal Code

Police Station ....................................District .............................. No. ..................

Date and hour of Occurrence ......................................................

1. Date and hour when reported

2. Name and residence of informer and complainant

3. Brief description of offence (with section) and of property carried off, if any

4. Place of occurrence and distance and direction from the Police Station

5. Name and address of the criminal

6. Steps taken regarding investigation/ explanation of delay in regarding information

7. Date and time of despatch from Police Station

Signature .................................................................. Designation .............................................................. (First information to be recorded below) NOTE: The signature of seal or thumb impression of the informer should be at the end of the information and the signature of the writer of (FIR) should be existed as usual. The above is the format and below is the law on the basis of which the cognisable crime is recorded.

FIR on Authentic InformationThe information given to the Police Officer for registration of a case must be authentic. It should not be gossip but should be traced to an individual who should be responsible for imparting information. It may be hearsay but the person in possession of hearsay should mention the source of information and take responsibility for it. An irresponsible rumour should not result in registration of FIR.


Annexure 4: PowerPoint Presentation – Human and Legal Rights


Notes








population status.








module

C

module

A

module

C

module

D




module



C2 Family Support

C3 Mental Health





D3 Positive Living





D1 H

uman

and

Leg

al R

ight

s

D2 T

raum

a an

d Vi

olen

ce

Facilitator Guide

Trauma and Violence

D2

Pehchan 1D2 Facilitator Guide: Trauma and Violence


About Pehchan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2


Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3


Module Acknowledgments: Trauma and Violence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

About the Trauma and Violence Module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9


Activity Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Activity 1: Introduction to Violence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Activity 2: Typology and Forms of Violence. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Activity 3: Impact of Violence – An Introduction to Trauma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Activity 4: Violence and Vulnerability to HIV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Activity 5: Violence and the MTH Community . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Activity 6: Strategies to Address Trauma and Violence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Annexure 1: Crisis Response Team under Pehchan – A Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

Annexure 2: PowerPoint Presentation – Trauma and Violence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

Pehchan2 D2 Facilitator Guide: Trauma and Violence

About this ModuleThis module is designed to help training participants: 1) deepen their understanding of trauma and violence; 2) identify different forms of violence; 3) understand the connection between violence and exploitation; 4) learn strategies to address violence; and 5) develop an action plan to respond to trauma and violence in their local context. In the Pehchan programme, this module is used to introduce basic principles of trauma and violence to CBO Counsellors and Outreach Workers.





Module Acknowledgments: Trauma and ViolenceEach component of the Pehchan Training Curriculum has a number of contributors who have provided specific inputs. For this component, the following are acknowledged:

Primary Authors M.L. Prabhakar and Dr Indumathi Ravishankar, SIAAP


Technical Input Aditya Bandopadhyay, Adhikaar; Debjyoti Ghosh, SAATHII


References • Giller, E.(1999) Impact of Violence – An Introduction to Trauma. Brooklandville. Sidran

Institute. Available from http://www.sidran.org/sub.cfm?contentID=88&sectionid=4

• Chakrapani, V., Newman, P.A., Shunmugam, M., McLuckie, A., and Melwin, F. (2007) Structural violence against kothi-identified men who have sex with men in Chennai, India: A qualitative investigation. New York. AIDS Education and Prevention: Vol. 19, No. 4, pp. 346-364.

• Allen, Jon G. (1995) Coping with Trauma: A Guide to Self-Understanding. Washington DC. American Psychiatric Press.

• Domestic violence: Isn’t it time someone called cut? (1999) short-film by Women’s Aid Federation of England, Bristol.

• World Report on Violence and Health. (2002). World Health Organization. Geneva.


About the Trauma and Violence Module

No. D2

Name Trauma and Violence


• Counsellors


Pehchan CBO Type Pre-TI and TI Plus


• Understand the concepts of trauma and violence;

• Understand the link between violence and vulnerability to HIV; and

• Develop action plans to address trauma and violence in their respective settings.





Audio-visual Support 1. PowerPoint presentation ‘Trauma and Violence’2. Short-film titled ‘Domestic Violence – Isn’t It Time Someone

Called Cut?’

Annexures Annexure 1 on ‘Crisis Response Team under Pehchan – A Guide’Annexure 2 on ‘World Report on Violence and Health’ available on digital file.


Activity Index1


Take-home material

1 Introduction to Module

1 hour N/A Short-film titled ‘Domestic Violence – Isn’t It Time Someone Called Cut?’

N/A

2 Typology and Forms of Violence

2 hours Chart papers and markers

Refer to the slides titled ‘Typology and Forms of Violence’ from the PowerPoint presentation ‘Trauma and Violence’

N/A

3 Impact of Violence: An Introduction to Trauma

1 hour N/A Short-film titled ‘Domestic Violence – Isn’t It Time Someone Called Cut?’

N/A

4 Violence and Vulnerability to HIV

1 hour N/A Refer to the slides titled ‘HIV and Violence’ from the PowerPoint presentation ‘Trauma and Violence’

N/A

5 Violence and the MTH Community

1 hour N/A Refer to the slides titled ‘Violence and the MTH Community Some Facts’ from the PowerPoint presentation ‘Trauma and Violence

N/A

6 Strategies to Address Trauma and Violence

2 hours Chart papers and markers

N/A Annexure 1 on ‘Crisis Response Team’



Activity 1: Introduction to Violence

Time 1 hour


• Articulate the objectives of this module.

Materials N/A

Audio-visual Support Short-film titled ‘Domestic violence: Isn’t It Time Someone Called Cut?’


Methodology Ask the participants to sit comfortably in their chairs, close their eyes, relax, and take deep breaths. Once you feel the participants have settled down, tell them that you will be playing a tape for them, and they should listen to this carefully, keeping their eyes closed throughout the tape. Play only the audio of the film titled ‘Domestic violence: Isn’t it time someone called cut?’

At the end of the film, allow the participants to sit still with their eyes closed for a minute or two, and then ask them to open their eyes.

Ask the participants to put in words what they felt was going on in the film based on the sounds they heard. Use the following questions to help them respond:

• What sounds did you hear?

• What do you think was going on?

• What feelings were you going through?

• How do you feel right now?

Then show the film with both the audio and visuals. Use the following questions to help link the earlier responses of the participants to the experience of watching the violence in the film:

• Describe what you saw in the film.

• What do you think is the first point of violence in the film?

• When do you think the victim in the film first felt fear?

• What was the victim afraid of?

• What are the types of violence displayed in the film?

• What do you think the victim was feeling?

• What do you think the victim did next?

• Why do you think the perpetrator was being violent?

• What do you think the victim can do to stop the violence?

• What are the words you associate with violence?

At this point, debrief the participants on the objectives of the module.

Note to FacilitatorTrauma and Violence are topics that involve human situations which cannot be easily generalised, as they differ from situation to situation and person to person. The module has been designed to trigger cognitive and emotional responses from participants; some of the responses may stem from their own experiences of violence. Allow these responses to guide the course of the activities. However, be prepared for some participants to get emotionally distressed. Depending on how the participants respond, the sessions may become unstructured. Therefore, at the end of every activity, sum up the key learning points.

At the beginning of this activity, tell the participants that the film being shown and the subsequent discussion may evoke unpleasant memories and strong negative emotions.

Tell them that such emotions are natural and are shared by countless others who have faced or witnessed violence. Reassure them that violence and its aftermath can be tackled and that this module offers ways to deal with the adverse effects, as well as find ways to bring an end to violence.


Activity 2: Typology and Forms of Violence

Time 2 hours

Learning Outcomes By the end of this activity, the participants will able to:

• Articulate a definition for violence;

• Identify forms of violence and their manifestations; and

• Understand that violence occurs at various levels, ranging from the individual to societal.


Audio-visual Support Refer to the slides on ‘Typology and Forms of Violence’ from the PowerPoint presentation ‘Trauma and Violence’.


Methodology Divide the participants into four groups and assign one of the following forms of ‘violence’ to each group:

• Physical violence;

• Sexual violence;

• Psychological (including mental, emotional, verbal and blackmail) violence; and

• Deprivation or neglect.

Give chart papers and pens to each group and ask them to list five examples of violence in each of the following settings:

• Family and intimate partner violence: violence which largely takes place between family members and intimate partners, usually at homes.

• Community violence: violence between individuals who may or may not know each other, generally taking place outside the home.

• Collective violence: violence committed by larger groups of individuals or by governments.

Provide 30 minutes for this discussion, and if necessary, extend it for another 10 minutes. Use the following leading questions:

• Is poverty violence? If yes, where does it feature?

• Is there any overlap in the different types of violence?

• Can violence be inflicted on oneself? If so, give examples.

• Are particular groups of people subjected to more violence than others? Introduce the term ‘gender-based violence’ here.

• What are the power dynamics between the perpetrator and the victim?

• Is there any intentionality from the perpetrators side?

Note to FacilitatorTypes of violence that may come up during the discussion:

• Hate crimes

• Molestation

• Forced sex work and trafficking

• Sexual harassment

• Stalking

• Incest

• Rape

• Custodial violence

• Poverty-related violence

• Sexual assault within marriage

• Violence against men/women in areas of armed conflict

• Displacement of persons during war/forced migration

In cases where more insidious or invisible forms of violence are not being mentioned, work with participants to describe them out and ask participants to categorise them under the larger groups.


Ask the participants about their learnings from the Legal and Human Rights Module (D1) regarding rights and privileges. In this context, ask them if they think abuse of power can lead to violence in special settings mentioned below:

• Teacher and student;

• Parent and child; and

• Employer and employee.

Point out that no one has an absolute right of power over anyone. A parent may admonish a child but cannot go beyond a line which may be lead to physical or emotional abuse.Using the slides titled ‘Typology and Forms of Violence’, sum up the discussion by asking the participants to construct a definition of violence.

Conclude the activity by reviewing types ofviolence, and discuss the implications of power and its potential for violence. (World Health Organization, 2002)

Defining ViolenceThe intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, that either results in, or has a high likelihood of resulting in injury, death, psychological harm, mal-development or deprivation.

World Health Organisation


Activity 3: Impact of Violence – An Introduction to Trauma

Time 1 hour


• What is trauma and how it is related to violence;

• How prolonged exposure to violence can lead to trauma; and

• How prolonged trauma might cause destructive behaviour.

Materials N/A

Audio-visual Support Short-film on ‘Domestic violence: Isn’t It Time Someone Called Cut?’.


Methodology Screen a section of the short-film titled ‘Domestic violence: Isn’t it time someone called cut?’ again, from the scene where the man comes towards the victim till the scene where she gets thrown to the ground.

Ask the participants to put themselves in that situation and try to elicit their feelings. Use the following scenario to get more responses from the participants:

‘Imagine a person being physically and verbally abused almost on a daily basis’ (play the last part of the clip again now, where the victim is kicked after being knocked down).

Ask them, would they be:

• Afraid?

• Developing a feeling of hatred towards the perpetrators?

• Angry? If yes, they would be angry against whom?

• Hating themselves for ‘inviting’ violence (or feel that they are responsible)?

• Fighting back?

• Experiencing physical reactions (e.g. sweating, racing pulse, frozen with fear, choking in the throat, heaviness in the legs, etc.)?

• Feeling despaired, if they experienced these emotions and bodily sensations day after day without hope of respite?

Note down their responses on a whiteboard or a flip-chart. At this point, introduce the topic of trauma by telling the participants that prolonged and/or frequent exposure to violence can lead to trauma. State that (psychological) trauma is caused as people get stuck in different responses and live with the feeling of helplessness, numbness, pain or fear, which in the long run, leads to physical ailments, mental health issues and/or influences their relationship with others (since behaviour gets altered). Point out that in the long run if these symptoms continue even after the episodes of violence have stopped, it is known as Post Traumatic Stress Disorder (PTSD).


Sum up the session by pointing out that:

• Trauma is not necessarily a result of prolonged exposure to violence. Trauma can also be caused by a single event.

• An event experienced as traumatic by one individual may not be traumatic for another; the experience of trauma depends on the person’s coping skills and perceived loss of bodily integrity and psychological control. Thus, it is an individual’s subjective experience that determines whether or not an event is traumatic.

• Trauma can influence an individual’s behaviour and make him/her more vulnerable to self-destructive behaviour (including not taking preventive measures against HIV), and can also negatively impact relationships with others. Therefore, it is essential to understand trauma and deal with it appropriately.

Remind the participants that when they come across a client who seems to be undergoing any of the symptoms discussed, the participant’s primary work would be to refer the client to a trained psychologist (in case the CBO does not have any in-house psychologists).

Background Information(Allen, 1995)

What is Trauma?Trauma is caused when people get ‘stuck’ in a particular situation and have to live with the feeling of helplessness, numbness, pain and fear, which in the long run leads to physical ailments, mental health issues and/or influences their relationship with others (behaviour gets altered).Traditionally, the focus of trauma is on the mind and solutions also involve approaches that focus on the mind. Both body and mind need to be focused to understand and heal trauma better. Evironmental issues too need to be addressed to handle trauma better.

Trauma needs special attention; hence, a timely intervention through appropriate referral becomes the key to addressing it. Mapping of resources within a geographical area with regard to support for trauma is essential for working with communities.

What is Emotional and Psychological Trauma?It is the result of stressful events that affect your sense of security, making you feel helpless and vulnerable.Traumatic experiences generally involve a threat to life or safety. However, any situation that leaves you feeling overwhelmed and lonely can be traumatic, even if there is no physical harm. It is the subjective emotional experience of an event, not the objective facts, that determine whether an event is traumatic.The more frightened and helpless one feels, the more likely one is to feel traumatised.

When is Something Traumatic? • When it happens unexpectedly.

• When one does not have the means to fight it.

• Someone does something harmful on purpose.

• One is unprepared for it.

• When it happens repeatedly.

Note to FacilitatorJon Allen, a psychologist at the Menninger Clinic in Houston, Texas, USA, and the author of Coping with Trauma: A Guide to Self-Understanding (1995), reminds us that there are two components to a traumatic experience – the objective and the subjective:

‘It is the subjective experience of the objective events that constitutes the trauma.... The more you believe you are endangered, the more traumatized you will be....Psychologically, the bottom line of trauma is overwhelming emotion and a feeling of utter helplessness. There may or may not be bodily injury, but psychological trauma is coupled with physiological upheaval that plays a leading role in the long-range effects.’ (p. 14)


Signs that Help Identify a Person is Under Trauma:• Emotional symptoms

• Shock, denial, or disbelief

• Anger, irritability, mood swings

• Guilt, shame, self-blame

• Feeling sad or hopeless

• Repeatedly talking about the traumatic incident

• Confusion, difficulty concentrating

• Anxiety and fear

• Withdrawing from others

• Feeling lonely, disconnected or numb

• Physical symptoms

• Loss of sleep or bad dreams

• Palpitation (racing heartbeat)

• Aches and pains

• Fatigue

• Agitation


Activity 4: Violence and Vulnerability to HIV

Time 1 hour


• Understand the link between violence and vulnerability to HIV.

Materials N/A

Audio-visual Support Refer to the slides on ‘HIV and Violence’ from the PowerPoint presentation ‘Trauma and Violence’.


Methodology Start an interactive discussion on the association between violence and vulnerability to HIV, and list the points made by the participants on a whiteboard or flip-chart. In order to steer the discussion along the desired lines, point out how:

• Violence plays a big role in causing HIV infection among MTH community members as coercive sexual acts may directly increase risk of HIV through physiological trauma and less protection;

• In India, stigma, discrimination, and violence makes MSM and transgender communities particularly vulnerable to HIV infection;

• In an abusive relationship, the victim may be more vulnerable to HIV, as abusive partners are more likely to have sexual partners other than the victim;

• Fear of violence can keep the MTH victim from insisting on precautions such as condoms and prevent them from seeking treatment for STIs; and

• MTH persons are not motivated to get tested for HIV or get the results because they are afraid that sharing their HIV positive status may result in more physical violence.

Using slides titled ‘HIV and Violence’ from the PowerPoint presentation ‘Trauma and Violence’, discuss ‘Circle of Stigma and Vulnerability’ in the light of the above points.


Reference Material(Chakrapaniet al., 2007)

Circle of Stigma and Vulnerability

Structural Level

Discriminatory Practices

Stigma

Vulnerability to HIV & AIDS

Indirect Direct

Police• False arrest• Refusing to offer protection• Harassment of community workers

Community• Stigma against

homosexuality & HIV/AIDS

• Taboos against homosexuality

• Pressures to marry and have children

Community Members• Social exclusion by

peer groups and other Kothis

Family Members• Blame for conflict

and family stress• Shame regarding

sexual orientation

Health Care Providers• Insensitive practice• Inadequate training

Health Care Providers• Refusal of service• Verbal harassment

Family Members• Violence from

parents and siblings

• Forced out of the house

Community Members• Physical violence

and blackmail by ruffians

Police• Verbal and

physical harassment• Sexual assault and

violence

Legal System• Criminalisation of

sex between men

Family• Arranged

marriage• Expectations to

maintain family lineage

• Taboos around sex and same-sex behaviours

Health Care System• Lack of services

with competency in working with MSM

• Inaccessibility to MSM


Activity 5: Violence and the MTH Community

Time 1 hour


• Understand the importance of learning about violence in the context of the MTH community.

Materials N/A

Audio-visual Support Refer to the slides on ‘Violence and the MTH Community Some Facts’ from the PowerPoint presentation ‘Trauma and Violence’.


Methodology Conduct an interactive discussion about different types of violence faced by MTH communities and why there might be a higher prevalence of violence among these communities compared to other population groups. Link the responses of participants to the discussions in preceding activities, and identify:

• The perpetrators of violence against individuals belonging to the MTH community; and

• The perpetrators of collective violence against the MTH community.

Discuss the impact of such violence, both at an individual level as well as at the community level. Using the slides titled ‘Violence and the MTH Community: Some Facts’ from the PowerPoint presentation ‘Trauma and Violence’, briefly describe the types of violence and give some facts about violence against MTH communities.


Activity 6: Strategies to Address Trauma and Violence

Time 2 hours


• Develop action plans to address trauma and violence in their respective settings.



Take-home Material Annexure 1 on ‘Crisis Response Team under Pehchan -A Guide’.

Methodology Faciliatate a discussion on the following questions:

• Is it realistic to work towards ending such violence?

• Why do we want to end this violence?

• Who needs to put a stop to this violence?

Present the structural violence model shown in the above section to the participants and instruct them to individually write a personal plan with their understanding of trauma and violence.

Ask them how they can prevent/address violence towards them and how would they deal with those who perpetrate acts of violence towards others. Encourage the participants to write/draw their ideas on a piece of paper.

Divide the participants into three groups, and ask each group to discuss and prepare points on how to establish a crisis intervention team in their area or organisation. Ask them to ponder over the following questions:

• What will be the objectives of crisis intervention team?

• What will be the constitution of the crisis intervention team?

• What should be the rationale behind the interventions designed by theteam?

• How can the intervention services be made more accessible and available for the community when they are needed?

• How can they document the various aspects of these processes?

Ask participants in each group to map all the resources in their area which they feel can make for a good resource in crisis response. Discuss their strategies in the larger group.

After the discussion, lead them into another discussion on current strategies, the key players and best practices. On a whiteboard/flip-chart, draw three concentric circles; the innermost circle representing the people closest to the victim of violence to whom the news has been conveyed (a PE, ORW, and the Counsellor), the second circle representing all the other people within the CBO (the project manager, other ORWs, PEs, etc.), and the third circle representing the various referral services and linkages with which they can address such acts of violence, such as the police, local clubs, lawyers, doctors, etc.


Conclude the group work activity by explaining how programmes such as Pehchan are addressing the issues of trauma and violence:

• Addressing the problem of trauma and violence should involve concrete, easy-to-implement, effective crisis management techniques in combination with local advocacy programmes;

• Creating an enabling environment for effective MTH HIV prevention programmes would build their self-esteem, which will help them focus more on their physical and mental health and well-being, specifically in relation to STIs and HIV; and

• In programmes such as Pehchan, trauma and violence responses will rely on creating Crisis Response Team (refer to Annexure 1) to assist victims for medical care and legal recourse, training community-friendly lawyers, beat-level police, and CBO staff to provide support for filing first-incident reports.

Wrap-up by giving a quick go-through of the day’s learnings on violence, different types of violence, perpetrators, victims, trauma, HIV, and violence and crisis management.


Annexure 1: Crisis Response Team under Pehchan – A Guide

Background and ObjectiveIt is well documented and known that men who have sex with men (MSM), transgender and hijra (MTH) population are vulnerable to violence due to their identity and non-confirmative gender expressions.

The perpetrators can include law enforcement agencies, local goons, healthcare providers, clients, family and community members. The violence may take several forms, most common being verbal and physical abuse and sexual assault. Therefore, to tackle such cases of violence setting up of Crisis Response Team (CRT) has been initiated under the Pehchan programme at the CBO-level.

The objectives of setting up of CRT are:

• To support MTH populations in cases of crisis;

• To build, sustain and strengthen relationships with relevant stakeholders such as law enforcement agencies; and

• To be champions for creating awareness on human rights issues of MTH populations.

For crisis management to be effective, it is essential to have:

• Trained and committed staff members who are willing to be ‘on call’ 24 hours a day and respond immediately when a crisis happens.

• Effective communication mechanisms.

• Availability of information about crisis response to community members.

• Experienced and committed lawyers and healthcare providers who are willing to provide assistance 24 hours a day.

• Networking, alliance-building, and sensitisation work with local stakeholders (especially MTH populations) through regular meetings and education as appropriate. This includes community-level legal literacy sessions.

• Close alliances with other civil society organisations, activists and local media who can advocate on behalf of the community when necessary.

• Reflections on crisis management cases to improve and build internal capacities.

• One member from TG hijra community and led by either community Project Manager or Project Director of the CBO.


Crisis Response Team in CBOs of Pehchan Programme

• The Crisis Response Team is established with representations from each site through community volunteers, outreach staff, programme staff and legal resource person familiar with the legal issues surrounding harassment of MTH populations.

• The team needs to establish detailed protocols for staffing and procedures for handling the crisis.

• Information about CRT should be widely circulated and discussed during the outreaches and events.

• The CRT should meet regularly ideally once in a quarter besides and emergency meeting. These meeting should be well documented.

• Funds available under Emergency legal aid may be used for local transport for handling crisis situation, post crisis meetings of CRT and legal aid. Also CRT needs to map additional resources for its long term sustainability.

• The meeting of CRT should be held at the hotspots so as to increase its visibility amongst the community members.

• CRT members should also be part of local sensitisation meetings carried out by the CBO.

The team may have 5 – 15 members, depending on need (i.e., frequency of incidents, size of area to be covered).

Crisis Response in Action • When a community member informs on one’s behalf or on behalf of another

member who gets harassed or abused, the member of the crisis team responding to the information gets in touch with other crisis team members to apprise them of the situation.

• The team ensures that at least one person from the crisis response team goes to the spot where the crisis has happened and meets the person concerned. It is important to provide immediate moral support and give the message that the person is not alone in this situation and the person has support from the programme.

• If a police report needs to be filed or it the situation any kind of police action, a team member and a lawyer should reach the police station immediately.

• If a person reports any physical injuries healthcare provider should be immediately contacted to provide first-aid and/or hospitalisation.

• Every crisis should be documented. This information can be used both to strategise for improving crisis response and for public advocacy. Also when this data is analysed over a period of time, it can reveal trends in the nature and frequency of these incidents.

• Immediate meeting for all the crisis team members should happen within 24 hours.


Capacity Building Following the formation of the CRT team at the CBO level, there is a need to build their capacities to handle and document the crisis situation. Advocacy officers (AO) along with Training Officers (TO) will make sure that this training happens at the CBO within a week of the formation of the team. Pehchan modules on ‘Human and Legal Rights’, ‘Violence & Trauma’ and ‘Trangender and Hijra Communities’ should be used for training CRT members. After three months, CRT members should be trained on ‘Mental Health’ and ‘Community Preparedness for Sustainability’ module. Refresher training should be organised every six months. AO should prepare the training calendar and share it with the team at SR and PR level.

Documentation and M&E Indicators Often violence is under reported and not talked about. It is important to document it effectively and use the data for advocacy with relevant authorities. Some indicators and method for good reporting include:

Outcome Indicator Percentage of MSM reporting cases of violence by law enforcement authorities/police

Rationale/Purpose MTH face high levels of stigma and discrimination and are often suspected of spreading HIV/AIDS. Pehchan uses advocacy strategies to address stigma and discrimination, particularly in situations where stigma prevents member MTH from seeking services or using condoms or accessing social security measures etc. Common forms of violence (physical, mental & social harm) faced by MTH include:

• Harassed (verbally and physically) in public settings by police & other law enforcers;

• Harassment, blackmail, extortion and forced sex by the police, denial of legal redress by police & lawyers (many times police don’t register complains); and

• Unjustifiable arrests.

Numerator Number of MTH responded to the question related to the violence.

Denominator Number of MTH surveyed.

Disaggregation MSM, Transgender, Hijra.

file:///Users/suemacdonald/Documents/SMD%20work/Alliance%20India/pehchan%20modules/layout/FINAL%20text%20and%20images/D%20/D2%20-%20one%20of%20the%20annexures%20disc%20only?/../AppData/Local/Microsoft/ysingh/AppData/Local/Microsoft/Windows/Temporary Internet Files/Content.Outlook/AppData/Local/Microsoft/Windows/Temporary Internet Files/Content.Outlook/AppData/Local/Microsoft/Windows/Temporary Internet Files/kbiswas/AppData/Local/Microsoft/Windows/Temporary Internet Files/Content.Outlook/AppData/Local/Microsoft/Windows/Temporary Internet Files/Content.Outlook/3IOXE0QM/REPORTING TEMPLATE REVEIW.xls


Measurement Tool Study at Baseline, Midline and End line

Method of Measurement

The indicator will be measured during baseline and then again would be monitored during the midline and finally during the end line assessment to see the improvement in the situation after the programme implementation.In the survey of a sample of men who have sex with men, respondents will be asked about violence at the hand of the law enforcers in the preceding six months.

Indicator Number of incidents of violence and harassment reported

Rationale/Purpose MTH face high levels of stigma and discrimination generally and in the context of being suspected of spreading HIV/AIDS. Pehchan for MTH use advocacy strategies to address stigma and discrimination, particularly in situations where stigma prevents members MTH from seeking services or using condoms or accessing social security measures etc. Common forms of violence (physical, mental & social harm) faced by MTH include:

• Harassed (verbally and physically) in public settings by police & other law enforcers;

• Harassment, blackmail, extortion and forced sex by the police;

• Denial of legal redress by police & lawyers (many times police don’t register the complains); and

• Arrests (unjustifiable) without clear IPC section defined.

The indicator also will be measured during baseline and then again would be monitored during the midline and finally during the end line assessment to see the improvement in the situation after the programme implementation.

Data collection frequency

Quarterly Monthly Capture the data as when in the crisis management register as an when an incident is reportedBaseline & End line

Measurement Tool Crisis management register, survey tool


As and when an incident of violence is reported to CRT it is documented in the Crisis management register

Interpretation This indicator measures the experiences of MTH in the effectiveness of efforts to reduce stigma and discrimination. It also to identify individuals who experience hostility on a regular basis.


Indicator Number of incidents of violence and harassment addressed within 24 hours

Rationale/Purpose As a part of the strengthening the response to address needs of the community a rapid response system will be developed to address the immediate and long-term impact of trauma and violence faced by the community from various sources.

Data collection frequency

Quarterly Monthly Capture the data as when in the crisis management register as an when an incident is reported

Measurement Tool Crisis management register


As and when an incident of violence is reported to the CRT it is documented in the Crisis management register

Interpretation Fear of encountering stigma and discrimination can substantially alter the risk behaviour and service utilisation of High Risk Groups(HRGs). Immediate response by the team is required so that this does not get repeated again and the MTH are not harassed, abused or denied access to services or venues because of their association or membership in a particular group. Thus immediate response to the incident from the Pehchan team is essential to not allow the incident to get repeated and give support immediately to the MTH who has faced the violence. At the point of reporting the incident to the crisis response team and the first level of plan of action developed and immediate emotional / coping support for trauma and violence is provided then it will be treated as ‘addressed’ for recording purpose.


Annexure 2: PowerPoint Presentation – Trauma and Violence








population status.








module

C

module

A

module

C

module

D




module



C2 Family Support

C3 Mental Health





D3 Positive Living





D2 T

raum

a an

d Vi

olen

ce

D3 P

ositi

ve L

ivin

g

Facilitator Guide

Positive Living

D3

Pehchan 1D3 Facilitator Guide: Positive Living


About Pehchan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2


Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3


Module Acknowledgments: Positive Living . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

About the Positive Living Module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9


Activity Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Activity 1: Overview of HIV/AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Activity 2: HIV and Immunity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Activity 3: Positive Living . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Activity 4: Opportunistic Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Activity 5: ART and Treatment Adherence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Activity 6: Positive Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Activity 7: Special Needs of PLHIV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Activity 8: Psycho-social Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Activity 9: Stigma and Discrimination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

Activity 10: Nutrition, Exercise, and HIV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Activity 11: Palliative Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

Activity 12: Caregiving . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

Activity 13: Positive Speaking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

Annexure 1: Basics of HIV/AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

Annexure 2: Positive Living and HIV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

Annexure 3: Positive Prevention Needs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

Annexure 4: Sexual Practices and Risks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

Annexure 5: Psycho-social Care. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

Annexure 6: Nutrition, Exercise and HIV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46

Annexure 7: Palliative Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

Annexure 8: PowerPoint Presentation – Positive Living . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

Pehchan2 D3 Facilitator Guide: Positive Living

About this ModuleThis module is designed to help training participants: 1) understand clinical basics of HIV and AIDS, with special reference to people living with HIV (PLHIV); 2) become familiar with antiretroviral treatment (ART) and treatment adherence; 3) identify specific needs of PLHIV; and 4) learn principles of care giving for PLHIV. In the Pehchan programme, this module is used to introduce basic principles of positive living to CBO Programme Managers, Counsellors, and Outreach Workers.





Module Acknowledgments: Positive LivingEach component of the Pehchan Training Curriculum has a number of contributors who have provided specific inputs. For this component, the following are acknowledged:

Primary Authors Dr. Vijay Prabhu, Consultant; Dr. Venkatesh Chakrapani, C-SHaRP; Dr. E. M. Sreejit, Consultant


Technical Input J. Robin, Olga Aaron, SIAAP; Bharat Patil, Lakshya Trust; Vijay Francis, Humsafar Trust; Krishna Kumar, Nokhu Ayakhu; Ashish Agarwal, Samman Foundation; Moyazam Hossain, Sudha Jha, SAATHII; Yadvendra Singh, Simran Sheikh and Vijay Nair, India HIV/AIDS Alliance


References • Basics of HIV/AIDS. (2012). Agragati Developing HIV/AIDS Workplace Policy

Workshop. SAATHII. Kolkata.

• Sexual Practices and Risk. (2004) Positive Living Manual.3rd Edition. British Columbia Persons with AIDS Society.

• Targeted Interventions Under NACP III. (2007) Operational Guidelines. Volume I. Core High Risk Groups. National AIDS Control Organisation. Ministry of Health & Family Welfare. Government of India. Available on http://www.nacoonline.org/NACO/

• Targeting HIV Prevention, 2009, Animation, Boehringer C.H., Sohn A,G., and Ko. Ingelheim. Germany.

• Country Progress Report India. (2010). United Nations General Assembly Special Session. New Delhi.

• Antiretroviral therapy for HIV infection in adults and adolescents: Recommendations for a public health approach. (2010 revision). Department of HIV/AIDS. World Health Organization. Geneva

• HIV Prevention, Care, Support and Treatment Literacy for MSM and TG Persons. (2009) World Health Organization. Geneva

• Food Pyramid. (1998). Southeastern Michigan Dietetics Association (SEMDA). Canton. Michigan. Available on http://semda.org/members/


About the Positive Living Module

No. D3

Name Positive Living


• Counsellors




• Gain understanding of medical information on HIV and AIDS, with special reference to people living with HIV (PLHIV);

• Gain understanding of antiretroviral treatment (ART) and ART adherence;

• Be able to identify the needs of PLHIV; and

• Gain information on caregiving and its importance.

Total Duration One and a half days. A day’s training typically covers 8 hours.




Audio-visual Support 1. PowerPoint presentation ‘Positive Living’2. Short film titled ‘Targeting HIV Replication’

Annexures 1. Annexure 1 on ‘Basics of HIV/AIDS’2. Annexure 2 on ‘Positive Living and HIV’3. Annexure 3 on ‘Positive Prevention Needs’4. Annexure 4 on ‘Sexual Practices and Risks’5. Annexure 5 on ‘Psycho-Social Care’6. Annexure 6 on ‘Nutrition, Exercise and HIV’ 7. Annexure 7 on ‘Palliative Care’8. Annexure 8 on ‘Living Well with HIV’ available on digital file


Activity Index1

No. Activity Name


Take-home material

1 Overview of HIV/AIDS

30 minutes N/A Refer to the slides titled ‘Basics of HIV/AIDS’ from the PowerPoint presentation ‘Positive Living’

Annexure 1 on ‘Basics of HIV/AIDS’

2 HIV and Immunity

20 minutes N/A Short film titled ‘Targeting HIV Replication’

N/A

3 Positive Living 20 minutes N/A N/A Annexure 2 on ‘Positive Living and HIV’

4 Opportunistic Infections

40 minutes N/A Refer to the slides titled ‘Opportunistic Infections’ from the PowerPoint presentation ‘Positive Living’

N/A

5 ART and Treatment Adherence

45 minutes N/A Refer to the slides titled ‘Anti-retroviral treatment’ from the PowerPoint presentation ‘Positive Living’

N/A

6 Positive Prevention

45 minutes N/A N/A Annexure 3 on ‘Positive Prevention Needs’ Annexure 4 on ‘Sexual Practices and Risks’

7 Special Needs of PLHIV


8 Psycho-social Care

45 minutes N/A N/A Annexure 5 on ‘Psycho-Social Care’

9 Stigma and Discrimination


10 Nutrition, Exercise and HIV

45 minutes N/A N/A Annexure 6 on ‘Nutrition, Exercise and HIV’ Annexure 8 on ‘Living Well with HIV’

11 Palliative Care 45 minutes N/A N/A Annexure 7 on ‘Palliative Care’

12 Caregiving 45 minutes N/A N/A N/A

13 Positive Speaking

30 minutes Chart papers, markers

N/A N/A



Activity 1: Overview of HIV/AIDS

Time 30 minutes

Learning Outcomes By the end of this activity, the participants will understand:

• The definition of HIV and AIDS;

• Modes of transmission of HIV;

• Methods of prevention of HIV;

• Ways in which HIV is not transmitted; and

• How the HIV infection progresses.

Materials N/A

Audio-visual Support Refer to the slides titled ‘Basics of HIV/AIDS’ from the PowerPoint presentation ‘Positive Living’.

Take-home Material Annexure 1 on ‘Basics of HIV/AIDS’.

Methodology Conduct a small quiz to gauge the existing knowledge of the participants prior to the start of training. Some sample questions could be:

• What is the most common route of HIV transmission?

• Is HIV curable? (Yes/No)

• There is a higher risk of transmission of HIV through oral sex than anal sex. (True/False)

• India has the highest number of the PLHIV in the world. (True/False)

• What are symptoms of Sexually Transmitted Infections (STIs)?

• How do you know if someone is infected with HIV?

Using the slides titled ‘Basics of HIV/AIDS’ from the PowerPoint presentation ‘Positive Living’, cover the gaps in the participants’ knowledge to ensure that they can answer the following:

• What is HIV? What is AIDS?

• Can HIV/AIDS be cured?

• How is HIV spread?

• How HIV is NOT spread?

• How to prevent HIV transmission?

• How to diagnose HIV infection?

• How the HIV infection progresses?

• How to monitor HIV progression?

• What are CD4 cells and what is their importance in monitoring HIV progression?

• How to treat an HIV infection?

Divide the participants into small groups, preferably region-wise, and ask them to discuss the prevalent myths and misconceptions regarding HIV in the geographical areas where they work. Ask each group to share their findings in the larger group.

Clarify their misconceptions, if any. Distribute copies of Annexure 1 on ‘Basics of HIV/AIDS’ to all participants.

Note to FacilitatorParticipants of this training module may have prior knowledge of the topics covered in this session, given their past experience or trainings. It may be useful to assess the existing knowledge levels to pace the session appropriately.

file:///\\192.168.0.5\commondrive\2005-2008\Current Programmes\Projects by Donor\Pehch<0101>n-GFATM R 9\Training Unit- Pehchan\Training Module\Final version\Module E\E3 - Positive Living\E3_AVSupport\E3_PosLiving AVSupport.pptx


Activity 2: HIV and Immunity

Time 20 minutes


• Understand the effect of HIV infection on body’s immunity; and

• Understand what CD4 cells are and their importance for treating HIV infection.

Materials N/A

Audio-visual Support Short film titled ‘Targeting HIV Replication’.


Methodology Screen the audio-video clip from the movie ‘Targeting HIV Replication’. The film demonstrates the spread of HIV infection, including the entry of the virus into the human body, its replication inside human cells, and how it weakens immunity. Also use the opportunity to show how ART works at different stages of the infection. After the participants have viewed the video, ask them the following questions to ensure that they have learnt how HIV affects the immune system:

• What does the immune system do for a healthy person?

• What happens to the immune system when a person is infected with HIV?

• Does a person with HIV know what is happening to his/her body?

• Why a person with HIV is more vulnerable to TB than a person who is not infected with HIV?

Encourage the participants to share what they already know about HIV/AIDS (for example, ask them to expand on the acronym AIDS, or ask them to describe the effects of the virus on immunity).

Note to FacilitatorAs far as possible, avoid scientific jargon to explain topics such as CD4 cells.

It is important to present information in a manner that is culturally relevant, easy to follow, and which does not compromise the accuracy of medical information.

It should enhance reasoning, retention, and assessment of HIV-risk behaviours.

file:///\\192.168.0.5\commondrive\2005-2008\Current Programmes\Projects by Donor\Pehch<0101>n-GFATM R 9\Training Unit- Pehchan\Training Module\Final version\Module E\E3 - Positive Living\E3_AVSupport\E3_Targeting HIV Replication.mpg

file:///\\192.168.0.5\commondrive\2005-2008\Current Programmes\Projects by Donor\Pehch<0101>n-GFATM R 9\Training Unit- Pehchan\Training Module\Final version\Module E\E3 - Positive Living\E3_AVSupport\E3_Targeting HIV Replication.mpg


Activity 3: Positive Living

Time 20 minutes


• Understand Positive Living.

Materials N/A


Take-home Material Annexure 2 on ‘Positive Living and HIV’.

Methodology Define Positive Living by describing it as ‘a way of life for people who are living with HIV’. Emphasise why it is important that people living with HIV come to terms with their medical condition, gather the strength to disclose their status to friends and families, look after their jobs, comply with the treatment regime, and at the same time stay upbeat about life in general. Explain how this session can:

• Improve the knowledge and skills of outreach workers (ORWs) and counselors on positive living so that they are equipped to provide appropriate education and counselling on positive living to MSM, transgenders, and hijras (MTH) living with HIV; and

• Help overcome fear and barriers to positive living.

Emphasise to the participants how they can play an important part in the lives of people living with HIV (PLHIV) by being sensitive to their needs.

Ask the participants to identify the various challenges that PLHIV face in their day to day lives, such as stigma and discrimination, and remind them how PLHIV can lead productive and healthy lives if they are aware and have access to correct information, treatment, care, and support. Tell them ORWs and PEs play a major role in providing them this information.

Give each participant a printout of Annexure 2 titled ‘Positive Living and HIV’ and tell them the importance of the following:

• Being aware: MTH people knowing what their rights are in terms of employment, welfare, access to health services, education, and family life.

• Treatment: access to right treatment, including drugs against opportunistic infections, and anti-HIV medicines.

• Support: acceptance, affection, respect, and love from friends and family and from fellow members of the MTH community, including hijra gurus/nayaks. It also means supportive laws and an enabling environment to protect people against stigma and discrimination.

• Care: psycho-social support and access to necessary medical treatment, a healthy diet, clean water, and accommodation.

Note to FacilitatorIdentify a member from the MTH community living with HIV who is willing to narrate experiences of living with the infection. If such an individual can be identified, even from among the participants or resource persons then tell the participants that at the end of the day’s activities, they will have the opportunity to interact with a member from the MTH community living with HIV.


Activity 4: Opportunistic Infections

Time 40 minutes


• Articulate what is meant by the term Opportunistic Infections (OIs) and how they are transmitted;

• Recognise signs and symptoms of common OIs;

• Articulate the importance of early diagnosis, referral, and treatment of OIs;

• Articulate how OIs can affect PLHIV; and

• Articulate how to manage OIs.

Materials N/A

Audio-visual Support Refer to the slides on ‘Opportunistic Infections’ from the PowerPoint presentation ‘Positive Living’.


Methodology Using the slides titled ‘Opportunistic Infections’ from the PowerPoint presentation ‘Positive Living’, explain:

• The concept and examples of Opportunistic Infections (OIs), their diagnosis, and relation to CD4 cells;

• Treatment of OIs and effect of ART on them;

• Link between immunity levels and risk of OIs ;

• Drug prophylaxis for OIs; and

• How to identify symptoms of OIs.



Activity 5: ART and Treatment Adherence

Time 45 minutes

Learning Outcomes By the end of this activity, the participants will be able to articulate:

• What is ‘anti-retroviral treatment’ (ART) and its importance in the management of HIV infection;

• The criteria and appropriate time to start ART; and

• Importance of ART adherence and its importance in the management of HIV infection.

Materials N/A

Audio-visual Support Refer to the slides on ‘Anti-retroviral treatment’ from the PowerPoint presentation ‘Positive Living’


Methodology Using the slides titled ‘Anti-retroviral treatment’ from PowerPoint presentation ‘Positive Living’, introduce participants to:

• Definition of anti-retroviral treatment (ART);

• When to start ART;

• Things to know before starting treatment;

• Side-effects of ART;

• Importance of ART adherence;

• Importance of monitoring ART; and

• Drug interactions.

Note to FacilitatorParticipants of this training Present the information using simple words and avoid using scientific jargon.



Activity 6: Positive Prevention

Time 45 minutes


• Articulate why it is important for PLHIV to protect themselves from other strains of HIV as well STIs;

• Identify and address the prevention needs of PLHIV; and

• Recognise that Positive Prevention involves counselling and discussing risk reduction strategies (options/choices).

Materials N/A


Take-home Material Annexure 3 on ‘Positive Prevention Needs’.Annexure 4 on ‘Sexual Practices and Risks’.

Methodology

Part IDiscuss the following components of positive prevention:

• Prevention of HIV transmission from PLHIV to others; • Prevention of new strains of HIV from infecting PLHIV;

• Prevent emergence and transmission of drug-resistant strains of HIV; and

• Prevention of other STIs.

Use the context of positive prevention to reinforce the messages on STIs and their links with HIV transmission.

Introduce the participants to a lesser discussed topic: ‘Sexual needs of PLHIV’. You can start by reminding the participants about the routes of transmission of HIV, including the most common route identified in India, sexual transmission.

Divide the participants into smaller groups and ask them to list reasons why, in their opinion, there is a higher incidence of HIV in the MTH community compared to other groups. Ask them to elaborate on the subject of sexual transmission of HIV and other STIs amongst the MTH community.

During the debriefing of the group work, list each group’s responses on flip-charts, and ensure that the following points have been covered:

• Knowledge;

• Beliefs about personal risk;

• Means to protect themselves and others;

• Skills to practice safe sex; and

• Support.

Note: Distribute Annexure 3 on ‘Positive Prevention Needs’.

Note to FacilitatorDo not forget to remind the participants that the viral load (amount of HIV in blood) may not relate to the level of the virus in semen or vaginal or anal fluids. Therefore, while HIV levels in blood may be undetectable by a lab test, they may still be present in high levels elsewhere (like semen).

Remind the participants that even when taking ARV drugs, PLHIV can transmit HIV during unprotected sex, so they should always use condoms. ARV drugs are meant to treat HIV and AIDS, and they can only reduce the levels of HIV in body fluids, not eliminate it.


Part IIList the various types of sexual practices (penetrative and non-penetrative) and discuss them with the group. Divide the participants into smaller groups and give each group two or three sexual practices (terms) and ask them to answer the following for each practice:

• What is the relative risk of HIV through this unprotected sexual practice? (Give 3 stars for highest risk, 2 stars for medium risk and 1 star for low risk)

• What types of STIs can be transmitted or acquired through this unprotected sexual practice?

• How to reduce the risk of acquiring or transmitting HIV or STIs through this sexual practice?

Give the participants 15 minutes to discuss these questions. Meanwhile, prepare a table similar to the one below on the whiteboard or flip-chart, where you can later fill in their responses.

Sexual practices HIV risk STI risk Harm reduction options

Peno-anal

Peno-vaginal

Peno-oral

Cunnilingus

Fingering

Rimming

Masturbation

French kissing

Conclude the group exercise by discussing the risks associated with various unprotected sexual acts and by providing facts about safer sex.

Part IIIIf time permits, discuss the following questions with participants:

• What are the possible reasons for disclosure or non-disclosure of HIV status to the following sexual partners?• Male regular or steady partner (panthi or others)• Wife• Casual partners• Clients of sex work

• What are the ways in which MTH living with HIV disclose their HIV status to their regular male partners or wives?

• Is it important to disclose HIV-positive status if condoms are going to be used in all sexual acts with the sexual partners? If yes, why? If no, then why not?

• What can be the possible strategies that could be adopted by MTH living with HIV if the following types of sexual partners do not want to use condoms?

• Clients of sex work• Regular or steady male partner


Sero-sorting refers to the practice of choosing sexual partners based on their HIV status. In other words, people ‘sort’ their potential partners according to whether they are HIV-positive or HIV-negative.

• Do you think ‘sero-sorting’ is a useful strategy for MTH living with HIV, i.e, to choose only PLHIV to have sex with? Why or why not?

• What could be the various reasons why MTH living with HIV may not want to use, or be able to use, condoms with their male sexual partners?

Distribute Annexure 4 on ‘Sexual Practices and Risks’.


Activity 7: Special Needs of PLHIV

Time 45 minutes


• Identify the special needs of a person living with HIV; and

• Respond more effectively to some of the special needs of PLHIV.

Materials N/A



Methodology Read out the following case study which is designed to encourage participants to think about the range of needs that PLHIV may have, especially PLHIV from the MTH communities:

Reshma, a transgender (TG) person, lives in one of the suburbs of Mumbai (India). She recently started coughing and has lost weight. A local medical practitioner examined her and sent her to the nearby ICTC where she tested positive for HIV. The counsellor at the ICTC also referred her to the chest clinic of the local district hospital where the treating doctor diagnosed her with TB. Reshma was very depressed. She is scared thinking about her future.

Ask the participants to work in small groups and discuss the following questions:

• What did you learn from this case study?

• Can you think of needs/requirements of Reshma?

• What do you think are the needs/requirements of MTH people living with HIV and how they may be different from others?

• Can you think of ways in which you can help people like Reshma?

Ask each group to share their answers, ensuring that the following special needs of MTH PLHIV are listed:

• Personal and family hygiene;

• Dealing with other medical conditions such as cough and pain;

• Spiritual support;

• Nutrition, diet, food;

• Income, employment;

• Effect on sex work;

• Disclosure;

• Dealing with immediate reaction of community members (both MTH and the larger community);

• Transport, lodging;

• Supportive and sensitive healthcare providers; and

• Nursing care.

Note to FacilitatorThis session will help in setting the tone for further discussions on various ‘needs’ covered in later sessions.


Activity 8: Psycho-social Care

Time 45 minutes


• Understand the psycho-social impact of testing positive for HIV; and

• Articulate the ways in which psycho-social care services can be provided through a programme like Pehchan.

Materials N/A


Take Home Material Annexure 5 on ‘Psycho-Social Care’.

Methodology Ask the participants to share what they think are the emotions and fears that MTH community persons who are newly diagnosed HIV-positive may experience and list them on a flip-chart. These should include:

• Guilt, anger or denial about infection;

• Depression;

• Fear of death;

• Conflicts with sexual or romantic partner/guru/nayak;

• Stigma and discrimination by other people and their consequences, for example, losing a job, loss of sex work; and

• Hopelessness.

Ask the participants to think about the kind of psycho-social support that could be provided, such as:

• How to accept life as a PLHIV;

• How to cope with emotions such as grief, anger, etc;

• To enable behaviour change and build self-esteem, assertiveness, and self-confidence;

• To identify social support groups and/or networks who can support PLHIV, especially PLHIV from MTH communities; and

• To explore beliefs, attitudes, and values related to sexual practices, gender, safer sex, and reducing or avoiding high-risk behaviours.

Conclude the session by briefly discussing the various modalities of delivering services that provide psycho-social support to PLHIV. Some of the activities in Pehchan could be:

• Providing psychological support and counseling to PLHIV, sexual partners, and family members;

• Starting support groups and self-help groups (SHGs) for PLHIV and promoting their activities;

• Facilitating groups that provide religious, spiritual, and emotional support;

• Establishing referral links with other agencies offering specialised psychological care;

Note to FacilitatorRemind participants that all models that aim to provide comprehensive care for PLHIV must include psycho-social care, and that Pehchan programme also attempts to address the psycho-social concerns of MTH community members.


• Raising awareness among hijra gharanas, families and other MTH communities to reduce stigma and discrimination; and

• Educating PLHIV and their families on the importance of understanding welfare schemes, inheritance issues, and financial planning for the future.

Distribute Annexure 5 on ‘Psycho-Social Care’ to each participant.


Activity 9: Stigma and Discrimination

Time 45 minutes

Learning Outcomes By the end of this activity, the participants will be able to understand:

• Various kinds of stigma faced by PLHIV, especially those who are from MTH communities; and

• Ways in which discrimination manifests towards PLHIV.

Materials N/A



Methodology

Part IStart by defining the word ‘stigma’ in simple terms2. Explain the factors that contribute to HIV/AIDS-related stigma such as:

• Morality attached to sex;

• Treating AIDS like an always fatal disease;

• Association of HIV infection to behaviours and practices that are considered socially unacceptable (such as homosexuality, drug use, sex work, etc.);

• Lack of understanding and misconceptions about how HIV is transmitted;

• Sensationalisation of HIV by media;

• Lack of access to treatment;

• Common perception about HIV infection as the result of personal irresponsibility; and

• Religious or moral beliefs that being infected with HIV is punishment for moral sins.

Describe what is meant by the term ‘Discrimination’. Describe what is meant by the terms self-stigma or ‘internalised stigma’.

Part IIInvite the participants to sit in a circle on the floor. Ask participants to explore their experiences of stigma and discrimination. If necessary, use the following questions to facilitate the discussion:

• Why are PLHIV discriminated against?

• Why are MTH community members discriminated against?

• What kind of discrimination do PLHIV from MTH communities face?

• Have you ever felt discriminated because of the identity or status? Would you like to share your experience?

• What would you do if you discovered that a person was infected with HIV?

2 The participants will have already been introduced to the terms ‘stigma’ and ‘discrimination’ in the training C1 module titled ‘Identity, Gender and Sexuality’.

Note to FacilitatorSince this session uses the principle of experiential learning, encourage all participants to contribute to the discussion as far as possible.

Care should be taken, however, not to push participants into sharing information that they are not comfortable discussing in a group.


After the discussion, ask the participants to list the number of ways (or levels) in which MTH people can be discriminated against. Describe how HIV/AIDS related stigma and discrimination can take different forms and are seen at societal, community and individual levels as well as in different contexts, such as:

• Family and community settings;

• Institutional settings, such as healthcare services, prisons, workplaces, educational institutions and social welfare settings; and

• At the national level, in the form of stigmatizing/discriminatory laws and policies (such as mandatory testing, limitations on travel, and access to health insurance).

Conduct an interactive discussion on how discrimination can be reduced or stopped, and how this is within the purview of the Pehchan programme.


Activity 10: Nutrition, Exercise, and HIV

Time 45 minutes


• Understand the importance of nutrition and exercise for PLHIV.

Materials N/A


Take Home Material Annexure 6 on ‘Nutrition, Exercise and HIV’. Annexure 8 on ‘Living Well with HIV’.

Methodology Start by stating how important it is for PLHIV to have access to adequate nutrition. Talk about the role of nutrition in HIV, and explain the relationship between malnutrition and HIV progression. You should emphasise how good nutritional care and support helps to break the vicious cycle of HIV and malnutrition by helping individuals maintain and improve nutritional status. Moreover, tell them how it will boost their immune response, manage the frequency and severity of symptoms, and improve the effectiveness of ART and other medical treatment.

Opportunistic infections (OIs) cause reduced nutritional intake (eg., a painful oral ulcer makes it difficult to eat and as a consequence, a person may eat a little but not as much as his body needs), or nutritional wastage (diarrhoea), thus contributing to nutritional deficiency. An HIV-weakened immune system can contribute to malnourishment, which in turn contributes to faster progression of HIV. Thus, improving nutritional status can help strengthen the immune system, thus reducing susceptibility to infections, preventing weight-loss and delaying the progression of HIV.

Initiate a discussion on the topic of balanced diet. Ask the participants what they understand by the term ‘balanced diet’. Ask them to list examples of food that constitutes balanced diet and to name some of the local food recipes or items that can be recommended to PLHIV.

Encourage the participants to consider the socio-economic status of the clients they would be serving and the seasonal availability of the food items when recommending a balanced diet. Guide the discussion to the conclusion that a diet containing all nutrients in appropriate amounts and proportion is called a balanced diet. Explore the food chart (Annexure 6) as a guideline to a balanced diet.

Another useful tool is the food triangle or pyramid, which is a nutrition guide which is divided into sections to show the recommended intake for each food group. It has basic foods at the base, including milk, rice, wheat, and potatoes; a large section of supplemental vegetables and fruits in the middle; and an apex of supplemental meat, fish and eggs. The quantity of food recommended differs according to the food group as mentioned in the table below. The different kinds of food should be consumed daily in the right quantity and proportion (balanced diet).


Discuss the purpose of good nutrition for PLHIV such as:

• To help transform the vicious cycle of HIV and malnutrition into a positive relation between improved nutritional status and stronger immune response;

• To maintain adequate intake of a balanced diet;

• To prevent weight loss and preserve muscle mass;

• To integrate nutritional interventions with HIV care;

• To improve/develop better eating habits;

• To manage symptoms that affect food intake, such as a sore mouth, diarrhea, etc.; and

• To improve overall quality of life.

Lead a discussion in which you list examples of food and ways of providing balanced nutrition, such as:

• Starting a community kitchen for members where all the nutritional requirements are prepared under supervision;

• Avoiding raw salads and vegetables because of the possibility of germs; and

• Eating freshly cooked vegetables.

Ask the participants to refer to the table in Annexure 6 on ‘Nutrition, Exercise and HIV’ that shows the combination of foods which are healthy for the body as well as sufficient in terms of providing the daily energy requirements (SEMDA 1998).

Food groups Type of foods Servings

Foods to build your body

Body-building foods give you protein and minerals.

•Fishandotherseafoods•Egg•Nutsandseeds•Drybeansandpeas•Milk,cheese

Eat two or three servings of different foods from this list every day.Example: You could have an egg at breakfast, drink milk at lunch and have fish at dinner.

Foods for protection

These foods provide vitamins and minerals that protect your body from infection.

•Darkgreenleafyvegetablessuchas spinach and cabbage

•Vegetablessuchascarrot,pumpkin, beans and tomatoes

•Fruitssuchasmango,oranges,banana, lemons and pineapple

Eat five servings of different foods from the list every day.Example: You could have banana at breakfast, beans at lunch and mango at dinner.

Foods for energy

Energy-giving foods are called carbohydrates

•Bananas•Potatoesandsweetpotatoes•Rice,breadandwheat

Eat five servings of different foods from this list every day. Example: You could have banana at breakfast, two slices of bread at lunch and potatoes at dinner.


Discuss hydration and its importance, stating that:

• It is important to cut down on tea and coffee and to avoid alcoholic beverages;

• Water is very important to our health;

• One needs to drink at least 9 glasses of fluids every day. This could be in form of water, coconut water, fruit and vegetable juices, milk, etc.;

• Water must be clean or boiled for at least five minutes before consumption;

• Avoid drinking water during meals; and

• It is better to eat fruit for dietary fibre and avoid fruit juices which contain little fruit and more sugar.

Discuss the importance of exercise for a PLHIV as it helps tone muscles, keeps the limbs supple, and preserves muscle mass. Regular exercises such as walking and jogging can make a person feel energized and can also help keep a body fit.

It is important that the degree of physical exertion should depend on the general health of the individual and advice should be taken from a healthcare provider prior to starting any form of physical exercise. It is important to avoid gaining weight as some ART medicines also cause redistribution of fat, affecting certain areas of the body, such as sunken cheeks, humps on the back of neck, or fat around the waist.

Explain some of the ways of managing diarrhea and vomiting in home settings:

• Bland food is good as it is easy to digest and has very little oil.

• Replace water loss through oral rehydration solutions (ORS).

• Avoid milk during prolonged periods of loose motions as PLHIV may have poor tolerance to milk and milk products.

• Add vitamins and minerals to the diet.

• Contact a doctor if diarrhea is prolonged.

Distribute printouts of the following take home materials:

• Annexure 6 on ‘Nutrition, Exercise and HIV’

• Annexure 8 on ‘Living Well with HIV’


Activity 11: Palliative Care

Time 45 minutes

Learning Outcomes By the end of this activity, the participants will be able to articulate:

• Principles of palliative care in the management of HIV; and

• Role of palliative care in the management of HIV.

Materials N/A


Take-home Material Annexure 7 on ‘Palliative Care’.

Methodology Start by defining palliative care. It relates to the care of a person whose disease is not responsive to medicinal treatment. In the context of HIV, explain that palliative care means treating someone who is not responding to ART and needs regular treatment for opportunistic infection and management of pain. Explain and discuss some of the broader areas in palliative care, such as:

• How palliative care improves the quality of life of PLHIV and that of their families;

• How palliative care is achieved through early identification, assessment of symptoms, and treatment of pain;

• Palliative care addresses problems that are physical, psycho-social, and spiritual in nature;

• How terminal care is also one of the components of palliative care;

• How palliative care can start right from the time of diagnosis of HIV infection; and

• How the scope of palliative care should extend beyond care of PLHIV and include friends, partners, community members, and families.

Introduce the components of palliative care, namely:

• Pain management;

• Symptom control;

• Nutritional support;

• Psycho-social support;

• Spiritual support;

• End-of-life care (terminal care); and

• Bereavement counselling.

Explain how palliative care is relevant at different stages of HIV.

Pre-ART: It involves addressing emotional distress, symptoms of HIV illness and opportunistic infections;

ART stage: It can come in the form of physical and psychological support at the time of starting ART and also for managing the symptoms of HIV-related illness, opportunistic infections and adverse effects of medicines; and

Palliative care: It can be given during hospital care as well as part of home-based care.

Give a printout of Annexure 7 titled ‘Palliative Care’ to each participant.


Activity 12: Caregiving

Time 45 minutes


• Understand the term ‘caregiving’;

• Understand the importance of caregiving for PLHIV from the MTH communities; and

• Understand the role of a caregiver from the perspective of PLHIV.

Materials Chart paper, markers.



Methodology

Part IIntroduce the concept of caregiving and explain that caregiving requires being warm, empathetic and gentle. A caregiver should be someone who can address the fear and anger that a PLHIV may go through, especially soon after testing positive. Caregivers should know that MTH PLHIV are one of the most severely affected groups among PLHIV, as they lose support from their own communities, friends, and family to a greater proportion than other PLHIV. Thus, a caregiver plays the role of a nurse, a counsellor, an information provider, a helper, and above all, a friend/companion. Conduct an interactive discussion using one of the following alternatives:

• Ask a PLHIV (if willing) among the participants to share his/her experiences of caregiving.

• Divide the participants into groups, and ask them to discuss the following case scenario and to suggest different ways of helping the protagonist in the following case study.

Arjun is a 33-year-old gay man who has HIV. His long-term partner Ramesh died of AIDS two years ago. His parents have abandoned him and have no contact with him. He is poor; his friends and neighbours do not talk to him. They fear that they may also get HIV from him if they mingle with him. Arjun is not so well educated and has poor vocational skills. His community has also abandoned him. He is now tired and weak and cannot work. To make matters worse, he has very little money to buy food.

Sum up the participants’ suggestions and summarise the key points on caregiving.

Part II Discuss the terms ‘treatment’ and ‘care and support for PLHIV’ and help participants identify sources of care and support for PLHIV. Divide the participants into small groups of three to four participants and explain that they will be doing an exercise wherein they would need to list the needs of PLHIV.

Give each group a different scenario, and ask them how they will determine the ‘treatment, care, and support’ possibilities for PLHIV (such as nutrition, ART needs, psycho-social counselling and palliative care) in the scenario given to them, keeping in mind that the person is from the MTH community.


Ask the participants to discuss ‘care, support, and treatment’ with the following questions in mind:

• Who is responsible for the care and support of PLHIV? Why?

• Do you think the MTH members living with HIV require different types of care and support? If yes, why? If no, why not?

• What are the differences between the needs of MSM, trangenders and hijras living with HIV? Are they different from each other? List the common requirements and those that are unique to each of these groups.

• What are the ways in which you can help people living with HIV?

• Where and how can a PLHIV get the help and support?

After each group presents their findings, sum up the activity as follows: Any course of action that improves a PLHIV’s health and length of life is a form of treatment. Treatment need not be always through medications. For example, personal and social or psycho-social support also constitutes treatment.

Explain that the type of treatment/care depends on the stage of illness, the socio-economic status, cultural and religious environment and gender. Treatment/care can happen in different settings depending on the resources available and the stage of illness. The process of treatment and care can pass through different settings, such as hospital, nursing homes, community care centres, home, and deras, in the case of hijras.

Further, effective coordination of information, resources and services at all the above locations is vital for effective and comprehensive care for PLHIV.


Activity 13: Positive Speaking

Time 30 minutes


• Understand the personal and social implications for an MTH person who is living with HIV, especially after being detected positive for HIV.



Take Home Material N/A

Methodology Start the session with sharing of experiences by a person living with HIV. Some of the questions participants can discuss with the speaker are:

• How did it feel when you first discovered that you were HIV positive?

• How did you cope with the result?

• What support structures did you rely upon?

• How did you disclose the result to your near and dear ones?

• How did your family, friends, partners, and community react?

Alternate Activity (if there is no volunteer available):

Divide the participants into three groups and give them chart papers and markers. Tell them to imagine a scenario where a person from the MTH community has been tested positive for HIV. Ask each group to list down the consequences and challenges an MTH PLHIV can potentially face after receiving an HIV test result.

• Ask the first group to discuss and make a list of the social consequences for the individual who has been tested positive.

• Ask the second group to make a list of the personal consequences for the individual who has been tested positive.

• Ask the third group to make a list of the various consequences for the individual’s family, sexual/romantic/marital partner, and the MTH sub-community the individual belongs to.

For the purpose of this exercise, explain with examples what is meant by ‘personal’ (loss of job, loss of support from the family); and ‘social’ (exclusion from society/friends). Ask each group to present their findings and lead the discussion. Some of the questions you may ask to facilitate the discussion are:

• How did the person (or someone in the group who is living with HIV and wants to volunteer) feel when they were told that s/he has been tested positive?

• Why do you think people who have been test positive have to bear these negative consequences?

• Do you think these consequences that they have to bear are right and justified? Why/ why not?

• How do you think these negative consequences can be avoided?

Allow the participants to bring up the issue of stigma and discrimination. Wind up the discussions by summarising points on how stigma and discrimination can be dealt with.

Note to FacilitatorAttempts should be made to invite a PLHIV from the MTH community who can also speak the language that the participants normally converse in.

Brief the person well in advance about the points that may be covered. Respect his/her privacy at all times. Do not force the speaker to talk about subjects s/he is uncomfortable with.

During group work, the facilitator can also encourage PLHIV individuals from the groups to share their experiences (provided they are willing to do so).


Annexure 1: Basics of HIV/AIDSAdapted from: SAATHII-AGRAGATI Developing HIV/AIDS Workplace Policy Workshop

HIV is the virus that causes AIDS. HIV stands for human immunodeficiency virus.

HIV is a retrovirus, which affects the immune system and destroys the body’s defences against infections. It is well known that protein synthesis takes place in our cells. DNA present in the nucleus of the cell activates RNA. RNA assembles amino acids to form proteins. But the reverse transcriptase enzyme that is present in HIV produces DNA from RNA. That is, it goes a step backward in protein synthesis. Hence it is called a retrovirus.

HIV affects the most productive age group of 15 to 49 years, which is also the most sexually active age-group.

Are HIV and AIDS the same?HIV stands for human immunodeficiency virus and AIDS stands for acquired immune deficiency syndrome.

In simple termsHIV is a virus that makes the human body’s immune system weak or deficient, while AIDS is an outcome of an HIV infection. However, being infected with HIV is not the same as having AIDS.

AIDS is actually a late stage of the HIV infection and comes about only when HIV has made your body’s immunity (defence system) too weak to fight off other infections. It may take several years for AIDS to develop. The healthier your body and the better you take care of it, the longer it will take for AIDS to develop.

What Does AIDS Stand for?The term ‘acquired’ implies that AIDS is not hereditary or present in your body from birth. It comes from an external source through certain behaviours or situations.

‘Immune deficiency’ means AIDS is something that makes your immunity deficient.

‘Syndrome’ implies that AIDS is a collection of diseases that attack your body when its immunity becomes weak. These diseases are often called opportunistic infections or OIs. An AIDS death is actually an outcome of these diseases. But if treated properly and in time, they need not be fatal. This means that AIDS need not be fatal. Two of the commonest OIs in India are tuberculosis and diarrhoea.


Some HIV/AIDS Facts and FiguresAbout 14,000 new infections occur every day throughout the world, and of these 2,000 occur among children (UNAIDS data).

About 95 per cent of the new infections occur in developing countries. In Sub-Saharan Africa, one in five adults is living with HIV/AIDS (UNAIDS data).

The National AIDS Control Organization (NACO) of India estimated in 2006 that there were about 2.50 million people infected with HIV in India. The adult HIV prevalence rate was 0.36 per cent in 2006. These data were based on the National Family Health Survey (NFHS) findings.

As of August 31, 2006, the total number of people who had reached the AIDS stage of HIV infection in India was 1,24,995. This included 88,245 males and 36,750 females. But there could be far more unreported or undetected cases (NACO data).

Data from voluntary confidential counselling and testing centres showed that 3,610 people got infected with HIV in West Bengal in 2006 (West Bengal State AIDS Prevention & Control Society data).

According to data for 2006 for West Bengal, HIV prevalence rates in West Bengal were 1.66 per cent, 0.40 per cent and 4.64 per cent among STI clients, ante-natal care clients (pregnant women) and injecting drug users. The figures for female sex workers and males who have sex with males were 6.60 per cent and 6.12 per cent, respectively (HIV Sentinel Surveillance Data, West Bengal State AIDS Prevention & Control Society / NACO).

History of HIV/AIDSThe disease was first discovered among gay or homosexual men (who had multiple sexual partners) in New York and Los Angeles in 1981. All these gay men suffered from severe defects in their immune functions. Some of them suffered from severe forms of a rare pneumonia (pneumocystis carini), others suffered from a rare form of skin cancer (Kaposi’s sarcoma). As it was found among gay men initially, it was called gay-related immunodeficiency (GRID).

Later, such symptoms were also seen among injecting drug users (IDUs) and haemophiliacs (who had received multiple blood transfusions). By 1983 this disease was seen among many other groups in other parts of the globe. Many women were affected, which suggested that the disease might be passed on through heterosexual sex also. It was becoming clearer that a much wider group of people was going to be affected. The Centre for Disease Control, Atlanta, USA, named this disease acquired immune deficiency syndrome or AIDS.

In 1984, similar symptoms were seen among children born to mothers who had the symptoms. By 1985, it was clear that the disease spread through penetrative sex, blood and blood products and from mother to child. As the number of deaths soared, medical experts scrambled to find a cause and more importantly a cure.

In 1984, France’s Institut Pasteur discovered what they called the HIV virus, but it was not until a year later that US scientist Dr. Robert Gallo confirmed that HIV was the cause of AIDS. Following this discovery, the first test for HIV was approved in 1985. The term HIV or human immunodeficiency virus was first coined by the International Committee on the Taxonomy of Viruses in May, 1986.

http://www.pasteur.fr/

http://aids.about.com/cs/expertadvice/p/gallo.htm


In India, the first case of HIV infection was detected in 1986 in Chennai among female sex workers. Over the next several years, increasingly effective medications to combat the virus (anti-retroviral therapy or ART), and to treat OIs that flourish when the immune system is damaged by HIV, have been developed. An international HIV vaccine initiative is also underway.

While the medical and scientific communities continue their efforts, it is important to remember that HIV can affect all persons irrespective of age, gender, sex, sexuality, class, caste and race. It would therefore not be appropriate to name HIV or AIDS as a gay men’s disease or the disease of any other particular section of society.

How Can You Get Infected With HIV?You can get infected with HIV if certain body fluids from an infected person’s body enter your body. By body fluids we mean blood, seminal fluids (semen, pre-cum) and vaginal fluids, which can host HIV and carry it from one person to another.

In almost 80-85 per cent of cases, HIV is passed on sexually. If you have unprotected penetrative sex – anal, vaginal or oral – with an infected person, body fluids from that person can enter your body. Different sexual acts have different risks. Unprotected anal sex and vaginal sex are considered to be more risky than unprotected oral sex.

You can get infected with HIV if you receive blood or blood products from an infected person.

HIV can enter your body if you share syringes or other sharp injectible instruments with an infected person because these instruments can lead to exchange of blood from the infected person to you.

HIV can also be transmitted from an infected mother to her child during pregnancy (through blood across the placenta), during delivery (through vaginal fluids or blood) or during breastfeeding (through milk).

HIV has also been detected in other body fluids such as saliva, skin oils, tears and sweat, but the concentration of the virus in these fluids is too little for transmission of the virus to take place. In addition to these – cerebrospinal fluid, amniotic fluid and faecal matter are some other body fluids where HIV can be found but these fluids are not very likely to be exchanged between people. Viral concentration is much higher in blood (including menstrual blood), vaginal fluids, seminal fluids, and breast milk.

Sexually Transmitted Infections (STIs) As the name suggests, STIs are infections that are transmitted through sexual contact. Like HIV, many STIs are transmitted through unprotected penetrative (anal, vaginal or oral) sex. Therefore these STIs can also be prevented in the same way as HIV – by staying in a mutually faithful and monogamous sexual relationship with an uninfected partner or practicing safer sex with each and every sexual partner.

However, there are some STIs that can also be transmitted through non-penetrative sexual acts. Activities involving close body contact during sex (such as body rubbing and deep kissing) may transmit these STIs. Maintaining oral and overall personal hygiene is the best way to prevent transmission of these STIs.


Like HIV, some STIs are also transmitted non-sexually, and are preventable in similar ways – safer sharing of injecting equipment, safer sharing of blood and blood products, and early and complete treatment of STIs in pregnant women for preventing mother-to-child transmission.

There Are a Large Number of STIs Known to Medical ScienceSome of the common ones are: chlamydia, genital warts, gonorrhoea, hepatitis A, hepatitis B, hepatitis C, herpes simplex virus, pubic lice, syphilis, and trichomoniasis.

Some Generic Symptoms of Common STIsIn males

• Discharge or pus from the penis or anus

• Sores, blisters, rashes or boils on the penis or testicles/in or around anus or mouth

• Lumps on or near the penis, testicles, anus

• Swelling on the penis or testicles

• Pain or burning during urination

• Itching in and around the genital areas – penis, testicles, thighs, anus

In females

• Pain in the lower abdomen

• Unusual and foul smelling discharge from the vagina

• Lumps on or near the vagina or anus

• Pain or burning during penetrative sex (vaginal)

• Itching in and around the genital areas – vagina, thighs, anus

• Sores, blisters, rashes or boils in or around vagina, anus or mouth

Attention: While STI symptoms in men are more likely to be visible, in women they are often inside the body and therefore not readily visible. This makes women more vulnerable to the harmful effects of STIs such as infertility and miscarriage. Regular medical check-ups are the best way to check STIs in early stages in women, particularly if a woman feels she may have been exposed to STIs through a certain behaviour or experience.

Link Between STIs and HIVThe predominant mode of transmission of both HIV and STIs is sexual (in that sense, HIV is also an STI). The presence of STIs in a person is often considered as a marker for potential HIV infection as well. Many of the measures for preventing the sexual transmission of HIV and STIs are also the same.


In addition: STIs often cause ulcers, blisters, sores and boils and most of these are located in/on/around the mouth, penis, vagina, or anus. During sexual intercourse HIV transmission can take place more easily through these openings in the skin or mucous membrane present in these organs. The T-cells, which are responsible for warning the immune system about invading organisms, are present in large numbers around these openings. Since HIV can very readily attach with T-cells, it becomes easy for it to enter the body riding piggyback on the T-cells.

Early and complete treatment of STIs is therefore desirable not only to reduce or prevent the harmful effects of STIs themselves, but also to prevent HIV infection.

In people already infected with HIV, STIs tend to compromise the immunity further, making it easier for HIV infection to progress in the body.


Annexure 2: Positive Living and HIV

DefinitionPeople living with HIV (PLHIV) often have to deal with many emotions such as fear, grief, depression, denial, anger and anxiety. Being ‘positive’ for HIV, does not mean end of life, it means that they have to start living positively. Positive living or living positively with HIV/AIDS means ‘to lead a normal life and practice HIV preventive and supportive measures’. Another aspect of positive living is to prevent the spread of HIV from an infected person to someone who is uninfected.

Dimensions of Positive LivingThere are many dimensions of positive living usually considered essential in the development and provision of any comprehensive HIV/AIDS care system. With the aim of meeting the physical, emotional, social and economic needs of PLHIV, ‘positive living’ should ideally include the following dimensions.

1. Hope

• Hope is a feeling that what is wanted can be had or that events will turn out for the best.

• Hope is a powerful feeling that many PLHIV may lack.

2. Openness or disclosure

• Positive living requires that there be an environment of openness wherein persons living with HIV can disclose their HIV positive status, ‘normalise’ their disclosure, and comfortably discuss HIV in their environment.

• Openness or disclosure helps in reducing stigmas.

• Openness or disclosure helps in dealing with internal HIV/AIDS phobia.

• PLHIV are often much happier in their relationships when their HIV status is known to their partner.

• Clinicians, counsellors and programs relating to HIV need to be sensitive to the complexity of the disclosure and understand that disclosure is not for all people and for all contexts.

3. Accepting one’s status

• Long-term denial (of one’s HIV sero-status) is detrimental and should be discouraged.

• Knowing and accepting one’s HIV sero-status helps to reduce stigma related to HIV.

• Knowing and accepting one’s status enables a more informed planning for the future.

4. Respect for human rights

• Respect for human rights is one of the important components of positive living, keeping in view the dignity of PLHIV.


• Society should treat all persons, including children living with HIV, with respect and compassion.

• PLHIV have the right to live life with respect and dignity regardless of sexual orientation. They should not be segregated, condemned or shunned.

5. Strong sense of purpose

• PLHIV often seem to lack or lose the sense of purpose in life after being diagnosed as HIV positive.

• PLHIV need assistance to retain a sense of purpose in life through job rehabilitation, and helping them improve their self-worth.

6. Accessibility and availability

• Accessibility and availability of healthcare services is important in ensuring positive living.

• Basic care provisions should be available at all levels.

7. Balanced and healthy nutrition

• Maintaining good general health and nutrition can contribute to the maintenance of immune system functioning.

• Living positively includes eating a healthy, balanced diet.

• Good and healthy nutrition can help in delaying the progression from HIV to AIDS.

• Nutritional care and support are important from the early stage of infection to prevent the development of nutritional deficiency.

8. Equity

• Health needs for positive living of the targeted population should be met in a fair and a just way.

• Geographical, economic and social barriers should be minimized to promote equity.

• Care should be provided to all PLHIV, regardless of gender, age, race, ethnicity, sexual identity, income, and place of residence.

9. Economic empowerment

• Many PLHIV are affected by loss of livelihood and poverty.

• Economic opportunities help PLHIV to live ‘positively’.

• Employment and engagement in business activities, financial independence and capacity-building training have empowered PLHIV, resulting in reduced social stigma and positive living.

10. Spirituality

• Positive living can also be achieved by addressing spiritual needs.

• Spirituality is an important resource that individuals use to cope with a chronic illness such as HIV infection.

• Spirituality offers a religious and an existential component encouraging us to find meaning in life, hope, self -transcendence, and rituals.

• Spirituality is a resource that PLHIV may find useful for coping with physiological and psychological challenges of the illness.

• It is important to remember that many PLHIV see their infection as a punishment from God and this belief needs to be addressed accordingly.


Techniques to Improve Positive Living The lives of PLHIV can be definitely led in a positive way with multisectoral responses and interventions. These range from individual-oriented services to community empowerment programs, with involvement from different departments and agencies. The participation of PLHIV in designing, implementing and evaluation of the interventions is vital to their effectiveness.

1. Providing good HIV screening and diagnostic services

• Laboratory capacity for detection and diagnosis.

• Adequate set-up for providing results and counseling in a confidential, private manner.

• Referral services should be widely available.

2. Counselling, psychological and social support

• PLHIV should be encouraged physically, socially and spiritually so that they can live long. PLHIV should be encouraged to live positively through messages like, ‘Don’t worry about this disease, you will get better soon’, ‘Don’t worry, we are with you’. PLHIV should also be encouraged to engage in sporting activities, vocational training, and hobbies like gardening to keep fit and earn a living.

(a) Counselling and psychological support

• Psychological intervention for coping with the diagnosis and accepting one’s HIV sero-status.

• Counselling to support development of individual plans of action.

• Counselling after diagnosis and educating PLHIV help delay the onset of clinical manifestations and prevent re-infection.

• Professional interventions for coping with severe emotional disturbances.

• Adequate sources of spiritual support.

• Multidisciplinary approaches such as meditation and other relaxation techniques help in positive living.

(b) Social support

• Financial support (insurance, loans, donations, subsidies).

• Home-based care.

• Referral systems (for legal, financial, educational, public administration concerns).

• Assistance to orphaned children.

• Advocacy and legal representation.

• Food distribution and serving of meals.

• Bereavement and funeral support.

3. Community education and participation

• Community education can be provided by information, education and communication strategies to effectively improve positive living.

• Community education can be achieved by distribution of pamphlets, posters, radio and television announcements, videos in waiting rooms, etc. to help PLHIV live positively.

• HIV/AIDS education programs should be provided at schools and community centers.


• Education for family members and caregivers should be provided by various programs and workshops.

• Religious leaders and human resources personnel in private and public sectors should be sensitized on HIV. A supportive environment for PLHIV is needed in their workplaces.

• Development of community support networks (PLHIV networks).

• Distribution programs for condoms and lubricants.

4. Nutritional interventions

• A balanced diet keeps our bodies strong and our immune systems healthy, making it harder for us to fall sick.

• HIV-positive people are more susceptible to infections from food and water, so it is especially important to follow safe cooking guidelines and drink water that has been purified.

• Nutritional assessment.

• Nutritional counselling and education should include food safety.

• Plan for action to prevent weight and muscle mass loss.

• Dietary changes to address associated drug reactions.

• Provision of food supplements, if needed, but only in consultation with a doctor.

5. Living positively with HIV

Positive living can be promoted by PLHIV taking care of themselves as follows.

• Keeping a positive outlook in life, having plans, projects and dreams.

• Maintaining an active social life.

• Paying special attention to basic rules of good hygiene.

• Exercising adequately.

• Getting enough sleep.

• Avoiding stress.

• Eating well and avoiding alcohol, tobacco, foods that have been improperly preserved, potentially contaminated water, and food sold by street vendors that is exposed to contamination. Making sure that fruits and vegetables are thoroughly washed.

• Eating a balanced diet.

• Avoiding re-infection with HIV.

• Staying in close touch with one’s doctor and HIV advisor/counsellor.

• Staying well-informed about scientific advances in HIV/AIDS and about new local resources available.

6. Others

• Never agonizing on HIV status.

• Planning for one’s children and future.

• Considering the need for disclosure of one’s HIV status to marital/sexual/romantic partners. If disclosure has to be made, it should be carefully planned, as far as possible with back-up support from friends, healthcare providers and other PLHIV.

• Joining support groups (PLHIV networks) to share experiences, socializing with other PLHIV, and working on joint awareness and advocacy initiatives.


Annexure 3: Positive Prevention NeedsRemember the following with regard to HIV prevention needs.

Knowledge: Remember that all community members do not have correct knowledge about HIV and HIV transmission. Peer Educators (PEs), Outreach Workers (ORWs) and Counsellors in the project will pass correct information to the community and dispel the myths and misconceptions about the disease.

Beliefs about personal risk: Remember that some PLHIV think (wrongly) that there is no need to practice safer sex (for example, using condoms) with their sexual partner who has also tested positive for HIV or that by being on ART and/or having undetectable viral load means they can have sex without practicing safer sex.

The means to protect themselves and others: Remember that MTH members who are PLHIV do not always have access to condoms and PEs and ORWs in the project should help in procuring them.

Skills: Remember that some PLHIV may not have the necessary skills to practice safer sex. For example, they may not know how to use condoms, or negotiate with their sexual partners/clients for using condoms. As a PE, ORW or Counsellor, it will be useful to enhance these skills. It also means empowering MTH living with HIV to take charge of their lives and be able to take decisions that will keep them safe.

Support: Remember that PLHIV also need support from their sexual/romantic/marital partners. The project staff can help in reinforcing the responsibilities of the sexual partners in ensuring a safe and healthy sexual life.


Annexure 4: Sexual Practices and RisksAdapted from: Sexual Practices and Risk. (2004) Positive Living Manual.3rd Edition. British Columbia Persons with AIDS Society.

Given below are the various sexual practices.

Penetrative Sexual Practices Non-penetrative sexual practices

• Vaginal sex: peno-vaginal intercourse

• Anal sex: insertive, receptive (peno-anal intercourse)

• Oral sex: fellatio (peno-oral sex)

• Anilingus: oro-anal sex

• Cunnilingus: oro-vaginal sex

• Fingering:introducingfingerintorectumor vagina

• Fisting:introductionoffistintorectumor vagina

• Dry kissing

• Wet(French)kissing

• Sensual touching

• Self-masturbation

• Mutual masturbation

• Necking

• Caressing

• Hugging

• Breast caressing

• Breast sucking

• Erotic talk

• Using sex toys

• Sharing fantasies

• Telephone sex

• Cyber sex

• Bubble bath

• Water sports

Anal Sex • Unprotected anal sex has the greatest risk of HIV transmission; more than oral

and vaginal sex.

• The chances of passing on HIV during unprotected anal sex are greatest if the person who has HIV is the active or insertive partner during sex.

• The risk is particularly high if the PLHIV has a high viral load, an untreated STI or ejaculates inside the sexual partner.

• If the PLHIV is a receptive partner during sex, the risk of passing on HIV is reduced, but is still present, especially if the person has a high viral load or an untreated STI.


Vaginal Sex (remember this may be important for every MSM married to a woman)

• During unprotected vaginal sex, HIV can be transmitted from either partner to the other.

• Transmission from the woman to the man is less likely than from man to woman, but if the woman is having her periods this may increase the risk that her partner will be infected.

Oral Sex• The risk of transmitting HIV by oral sex is much less certain than anal or vaginal

sex.

• High viral load, an untreated STI, ejaculating in the mouth of the person sucking, and bleeding gums or sores or wounds in the mouth of the person sucking seem to increase the (very small) risk.

Other Sexual Practices• Insertion of fingers or the fist into the anus or vagina does not generally involve

any exchange of body fluids, and therefore these activities are unlikely to lead to HIV infection.

• But if the skin of the inserted finger or hand has cuts or abrasions, there is a risk of HIV transmission from one partner to the other.

Facts about safer sex• A single male condom, when used correctly, provides excellent protection

against getting STIs and HIV (including re-infection with another strain of HIV).

• Condoms are usually made of latex. Some people are allergic to latex condoms. If this is the case, then polyurethane condoms are a safe alternative.

• A water-based lubricant should be used with condoms, as oil-based ones weaken condoms and can cause tiny tears.

• Avoid sex under the influence of drugs and/or alcohol as the latter can increase the risk of transmission of HIV to others by making you forget about safer sex.

• Any kind of physical contact such as hugging, dry kissing, massage is safe as long as there is no contact with body fluids.

• Masturbation, either self or mutual, is a healthy way to express sexual feelings.

• It is important to talk to your partner about safer sex. Agree on safer sex practices before any sexual contact.


Risk Reduction Charts

Your HIV transmission risk can be REDUCED

Your HIV transmission risk can INCREASE

An HIV-positive man having anal sex with an HIV-negative man/TG WITHOUT a condom

Take these facts into account

• Regular sexual health check-ups for both partners can ensure STIs are diagnosed and treated.

• If the HIV-positive man is an insertive partner, ejaculating outside the anus reduces risk, but HIV can still be present in pre-cum.

• A generous amount of water-based lubricant applied before and re-applied during anal intercourse can prevent soreness and bleeding.

• When fingering, to avoid damage, start gently first – make sure the anus is relaxed and use plenty of water-based lubricant.

• Take extra care when fisting or using dildos – it may be safer to avoid these before anal intercourse.

If the HIV-positive man:

• Ejaculates inside the anus;

• Has a high HIV viral load; and

• Has an untreated STI on/in his penis.

If the HIV-negative man/TG has:

• An untreated STI in the anus; and/or

• Soreness or bleeding inside the anus.

Remember

• It is more likely for HIV to be transmitted if the HIV-positive man has insertive anal sex with an HIV-negative man/TG.

An HIV-positive man having oral sex with an HIV-negative man/TG WITHOUT a condom


• Ejaculates outside the mouth;

• Has regular sexual health check-ups; and

• Has regular HIV health monitoring.

If the HIV-negative man has:

• Regular oral health check-ups (it may be safer to avoid brushing or flossing before performing oral sex on the penis).


• Ejaculates inside the mouth;

• Has a high viral load;

• Has an untreated STI on/in his penis; and

• Has serious bleeding in the mouth due to gum disease/s.

If the HIV-negative man/TG has:

• Unhealthy gums, or ulcers, or cuts in the mouth;

• A sore or inflamed throat or an untreated infection (like gonorrhea, syphilis) in the throat which may not show symptoms; and

• Has an untreated STI on/in his penis.


Condoms reduce risk Significantly when used correctly

Anal sex WITH a condom between an HIV-negative man and an HIV-positive man

• You can minimize the chance of ‘condom failure’ if you use the condom correctly

• Ensure that condom has not gone past its expiry date.

• Put in on properly (if you are not sure, practice by following the instructions in the pack).

• To enhance sexual enjoyment, put a small amount of water-based lubricant inside the reservoir (tip) of the condom.

• Use lots of water-based lubricant outside and all over the condom after you put it on.

• When the condom tears or slips off during sex. This can happen particularly if:

• The condom has expired;

• The condom has been unrolled before it is put on;

• The condom has been put on top of another condom;

• The condom has been exposed to heat or direct light;

• The condom does not have any water-based lubricant on it; and if

• You use saliva as a water-based lubricant or some oil-based substances as lubricant.


Annexure 5: Psycho-social Care

Some psycho-social issues that a person may face when learning about their HIV status

• Guilt or anger or denial about infection.

• Depression.

• Fear of death.

• Conflicts with sexual/romantic/marital partner/guru/nayak.

• Stigma and discrimination by other people and its consequences (losing job, loss of sex -work).

• Losing the will/purpose to live.

Psycho-social support is given• To help accept living life as a PLHIV.

• To help in coping with a positive test result.

• To cope with feelings of grief, anger and all the other emotions stated above.

• To enable behaviour change, building self-esteem, assertiveness, and self-confidence.

• To identify social support groups and/or networks who can support PLHIV, especially PLHIV from MTH communities.

• To explore beliefs, attitudes, and values related to sexual practices, gender, safer sex, and reducing or avoiding high-risk behaviours.

Supportive activities that could be provided• Providing effective psychological support and counselling to PLHIV, partners and

their families.

• Starting support groups and supporting their activities, establishment and activities of PLHIV self-help groups (SHGs).

• Facilitating groups which provide religious, spiritual and emotional support.

• Establishing referral links with other agencies offering specialized psychological care.

• Raising awareness among hijra gharanas, families and other MTH communities to reduce stigma and discrimination.

• Informing PLHIV and their families on the importance of understanding welfare schemes, inheritance issues and financial planning.


Annexure 6: Nutrition, Exercise and HIV

Relationship between malnutrition and HIV disease progression

• Opportunistic infections (OIs) cause reduced nutritional intake (e.g. painful oral ulcer) or cause nutritional wastage (diarrhoea), which in turn contributes to nutritional deficiency.

• An HIV-weakened immune system can contribute to malnourishment which in turn contributes to faster progression of HIV disease.

• Improving nutritional status can help strengthen the immune system, thus reducing susceptibility to infections, preventing weight-loss, and delaying progression of HIV disease.

The Food Pyramid3

• Different kinds of foods should be consumed daily in right quantity and proportion (balanced diet).

• Quantity of food recommended differs according to the width of the bands (in the pyramid). Food triangle or pyramid is a nutrition guide which is divided into sections to show the recommended intake for each food group. It has basic foods at the base, including milk, rice wheat and potatoes; a large section of supplemental vegetables and fruit; and an apex of supplemental meat, fish and eggs.

3 Food Pyramid. (1998). Southeastern Michigan Dietetics Association (SEMDA). Canton. Michigan. Available on http://semda.org/members/

http://semda.org/members/


Nutritional interventions for PLHIV The purpose of nutritional interventions should be to:

• Help transform the vicious cycle of HIV and malnutrition into a positive relation between improved nutritional status and stronger immune response;

• Maintain adequate intake of balanced diet;

• Prevent weight-loss and preserve muscle mass;

• Integrate nutritional intervention with HIV care;

• Improve/develop better eating habits;

• Manage symptoms, such as sore mouth and diarrhea, that affect food intake; and

• Improve quality of life.

Combination of foods that are good for the body, protect us as well as give us our daily energy requirements.

Food groups Type of foods Servings

Foods to build your body

Body-building foods give you proteins and minerals

• Fishandotherseafoods

• Egg

• Nuts and seeds

• Dry beans and peas

• Milk and cheese

Eat 2 or 3 servings of different foods from this list every day.Example: you could have an egg at breakfast, a milk drink at lunch and fish at dinner

Foods for protection

These food provides vitamins and minerals that protect your body from infection

• Dark green leafy vegetables such as spinach, cabbage

• Vegetables such as carrot, pumpkin, beans and tomatoes

• Fruitssuchasmango,oranges, banana, lemons and pineapple

Eat 5 servings of different foods from the list every day.Example: you could have banana at breakfast, beans at lunch and mango at dinner.

Foods for energy

Energy giving foods are called carbohydrates

• Bananas

• Potatoes and sweet potatoes

• Rice, bread and wheat

Eat 5 servings of different foods from this list every day. Example: you could have banana at breakfast, 2 slices of bread at lunch and potatoes at dinner


The importance of hydration • It is important to cut down on tea and coffee, and also avoid taking alcoholic

beverages.

• Water is very important to our health and the body needs water to grow and to keep healthy. Most drinks are made of water.

• Have nine cups of liquids every day. These could include water, green coconut water, fruit and vegetable juices and milk.

• Water must be clean. If there is no clean water available then boil the water for five minutes or else you can ask for boiled water from the restaurants you eat.

• Sometimes too many drinks during meals can dampen the appetite, so have lots of drinks between meals.

• Avoid fruit juices that contain little fruit and more sugar. It is better to eat the whole fruit, which gives good dietary fiber.

The importance of exercise • It is important to fight against inertia and laziness and walk every day.

• Exercise helps tone muscles, keeps the limbs supple and preserves muscle mass.

• Regular exercise such as walking can make a person feel energized and can also help keep infections away.

• It is important that the degree of physical exertion depend on the general health of the individual and advice should be taken from a care provider on this.

• It is important to avoid gaining weight (through exercise) as some ART medicines also cause fat mal-distribution affecting certain areas of the body. For example, sunken cheeks but humps on the back of neck or fat around the waist.

Management of diarrhoea and vomiting• Bland food is good as it is easy to digest; take food without too much oil.

• Replace water loss through oral rehydration solutions that are readily available.

• Avoid milk during prolonged periods of loose motions as PLHIV may have poor tolerance to milk and milk products.

• Add vitamins and minerals to the diet.

• Contact doctor if the diarrhoea gets prolonged.


Annexure 7: Palliative Care

• Palliative care improves the quality of life of PLHIV and also that of their families.

• Palliative care is achieved through early identification, assessment of symptoms and treatment of pain.

• Palliative care addresses problems that are physical, psycho-social and spiritual in nature.

• Terminal care is also one of the components of palliative care.

• Palliative care should start right from the time of diagnosis of HIV infection.

• The scope of palliative care should extend beyond care of PLHIV to include friends, partners, community members, and families.

Components of palliative care• Pain management

• Symptom control

• Nutritional support

• Psycho-social support

• Spiritual support

• End-of-life care (terminal care) and bereavement counselling

Palliative care applies at different stages of HIV• Pre-ART where it involves addressing the emotional distress and symptoms of

HIV illness and opportunistic infections (OIs).

• ART stage where it can come in the form of physical and psychological support at the time of starting ART and also for managing the symptoms of HIV-related illness, OIs and adverse effects of medicines.

• Palliative care can be given both during hospital stays and home-based care.


Annexure 8: PowerPoint Presentation – Positive Living


Notes








population status.








module

C

module

A

module

C

module

D




module



C2 Family Support

C3 Mental Health





D3 Positive Living





D4 C

omm

unity

Fri

endl

y Se

rvic

es

Facilitator Guide

Community Friendly Services

D4

Pehchan 1D4 Facilitator Guide: Community Friendly Services


About Pehchan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2


Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3


Module Acknowledgments: Community Friendly Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

About the Community Friendly Services Module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9


Activity Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Activity 1: Introduction to Friendly Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Activity 2: Mapping Community Priorities and Potential Barriers to Friendly Services . . . 13

Activity 3: Making Services Community Friendly . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Activity 4: Developing Linkages with Friendly Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Activity 5: Mapping Friendly Services: Concepts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Activity 6: Tools to Map Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Annexure 1: PowerPoint Presentation – Community Friendly Services . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

Pehchan2 D4 Facilitator Guide: Community Friendly Services

About this ModuleThis module is designed to help training participants: 1) understand the concept of friendly services for men who have sex with men (MSM), transgenders and hijras; 2) document existing services in the local context; 3) access and coordinate with these services or create community friendly services if none exist. In the Pehchan programme, this module is used to introduce basic principles of community friendly services to CBO Counsellors, Outreach Workers and Advocacy Officers.





Module Acknowledgments: Community Friendly ServicesEach component of the Pehchan Training Curriculum has a number of contributors who have provided specific inputs. For this component, the following are acknowledged:

Primary Author Dr. Maninder Setia, Consultant


Technical Input Vaibhav Sarai and Debjyoti Ghosh, SAATHII; Olga Aaron, SIAAP; Yadvendra Singh, Rohit Sarkar, Yashwinder Singh and Abhina Aher, India HIV/AIDS Alliance


References • Kumar S.S, Patankar P., and Setia M. (2011) From the Frontline of Community Action:

A Compendium of Six Successful Community Based HIV Interventions that have worked for MSM-TG-Hijras in India. United Nations Development Programme.


About the Community Friendly Services Module

No. D4

Name Community Friendly Services


• Counsellors




• Understand what is meant by the term ‘MTH friendly service’;

• Map the service priorities and the barriers faced in uptake of services by the MTH communities;

• Map existing friendly services in their programme area; and

• Identify ways in which services can be made friendly.





Audio-visual Support 1. PowerPoint presentation on ‘Community Friendly Services’.

Annexures 1. Annexure 1 on ‘From the Frontline of Community Action – A compendium of six successful community based HIV interventions that have worked for MSM-TG-Hijras in India’ available on digital files.


Activity Index1


Take-home material

1 Introduction to Community Friendly Services

1 hour Chart papers, markers

Refer to the slides titled ‘What are Friendly Services’ from the PowerPoint presentation ‘Community Friendly Services’

N/A

2 Mapping Community Priorities and Potential Barriers to Friendly Services

1 hour Chart papers and markers

N/A N/A

3 Making Services Community Friendly

1 hour N/A Refer to the slides titled ‘Making Services Friendly’ from the PowerPoint presentation ‘Community Friendly Services’

Annexure 1 on ‘From the Frontline of Community Action – A compendium of six successful community based HIV interventions that have worked for MSM-TG-Hijras in India’

4 Developing Linkages with Friendly Services

1 hour N/A Refer to the slides titled ‘Developing Linkages with Friendly Services’ from the PowerPoint presentation ‘Community Friendly Services’

N/A

5 Mapping Friendly Services –Identification

1 hour N/A Refer to the slides titled ‘Mapping Friendly Services’ from the PowerPoint presentation ‘Community Friendly Services’

N/A

6 Mapping Friendly Services – Tools

1 hour N/A Refer to the slides titled ‘Mapping Friendly Services – Tools’ from the PowerPoint presentation ‘Community Friendly Services’

N/A



Activity 1: Introduction to Friendly Services

Time 1 hour


• Understand what is meant by the term ‘friendly service’; and

• Identify the four basic categories of services to be linked with this programme.


Audio-visual Support Refer to the slides titled ‘What are Community Friendly Services’ from the PowerPoint presentation ‘Community Friendly Services’.


Methodology Divide the participants into four groups and give each of them a sheet of chart paper. Ask them to divide the paper into two columns. They should label the first column as ‘service’ and the second as ‘not a service’. Ask each group to spend ten minutes to come up with examples of what they think are services and what they think do not constitute as a service.

For instance, health and legal aid could be services. However, can travelling in an air-conditioned car be called an essential service? Lead the participants into a discussion to help them understand essential services and how they are different from luxuries and conveniences, and how essential services are guaranteed and protected by the law in India.

Ask each group to share their lists. List their responses on a flip chart and put each service under one of the following headings:

• Health services;

• Legal services;

• Government/documentation services; and

• Social security services.

Using the slide titled ‘General Health Services’, discuss the different kinds of health services that everyone needs such as reproductive health, STI, and HIV treatment.

Using the slide titled ‘MTH-related Health Services’, discuss the various services which should be made available specifically for the MTH communities.

Using the slide titled ‘MTH-related Legal Services’, discuss the legal support needed by persons from the MTH communities in of the following cases:

• Handling issues related to police harassment;

• Tackling blackmail;

• Parental pressures and harassment by the family members;

• Attempted suicides; and

• Legal standing of sexual reassignment surgeries.

Note to FacilitatorAsk the participants to think of services required by the MTH communities and from that list ask them to identify the services they need to link up with in order to make those services more accessible to the communities.


Using the slide titled ‘Government Documentation Services’, discuss why these services are important, and why some of the important government documents issued to Indian citizens, such as driver’s license, ration card, PAN card, passports, etc., should be considered valuable to MTH communities as well. Additional work is required with government to ensure that these basic documents are available and responsive to the special needs of the MTH communities.

Using the next slide titled ‘Social Security Services’, explain how MTH community members, if eligible, can be part of various government schemes, such as NREGA and NRHM. Next, facilitate a discussion on the need for having health insurance that is gender sensitive.

Introduce participants to the term ‘friendly services’ and ask them to describe what according to them will constitute these service. Using the PowerPoint slides titled ‘Characteristics of a Friendly Service’, explain to the participants that for a service to be qualified as friendly to the MTH community members, it should be:

• Utility-based: useful for the community member;

• Timely: available when required;

• Sensitive towards the different sexuality and gender expressions of the community members; and

• Non-discriminatory towards those accessing it.

Ensure the participants understanding what friendly services are by using various case studies. Example:

Reshmi, a transgender woman, has been just told by the counsellor at a health clinic that she is HIV positive. However, instead of following the standard post-test counselling process, the counsellor tells Reshmi that she needs conversion therapy. Is the counsellor providing a friendly service?


Activity 2: Mapping Community Priorities and Potential Barriers to Friendly Services

Time 1 hour


• Identify the service priorities of the MTH community and barriers to uptake of these services.




Methodology

Part I: Understanding Priorities of the CommunityDivide the participants into two groups and provide them with a sheet of chart paper and pens. Ask the first group to do the following exercise from the perspective of an MSM and the second group from the perspective of a transgender/hijra person. Ask them to draw four columns on the chart paper and name the columns as: Service, Utility Score, Urgency Score and Total Score. In the first column, ask them to list all the services they feel are required by the community that they are representing.

In the second column, they should score how useful is each service (see the adjacent box for scoring system).

In the third column, they should score how urgent is the need for each of the service (see box for scoring system).

In the fourth column, they should calculate the total score (utility score + urgency score).

After all the groups have completed the exercise, ask them to share their responses. By the end of this exercise, the participants will understand that the services with the highest scores are those which are of the highest priority to the community.

After the presentation, explain that:

• This exercise was to understand which services are important for the community at large;

• Services should be identified on the basis of the needs of the community; and

• There is a need to make these services friendly for the community.

Part II: Understanding Barriers for Accessing ServicesAs participants have now learnt how to identify service priorities, explain to them the need to identify barriers in accessing those services. Ask participants to work in the same groups and identify the barriers to uptake of three most important services identified by them as a group. Ask the groups to classify the barriers either as structural

Note to Facilitator

Scoring for Exercise

Assessing Utility Score (Column 2)

1 = least important, least useful

2 = not so important, not so useful

3 = important, useful

4 = most important, most useful

Assessing Urgency Score (Column 3)

1 = least important, least urgent

2 = not so important, not so urgent

3 = important, urgent

4 = most important, most urgent


(relating to the context or environment) or as individual (relating to the person).

After they have completed the exercise, ask them to share their findings. Point out that structural barriers are the ones that make a service ‘unfriendly’; in other words, though these services are available, they are not accessible because of the barriers. Tell them that the next step in this module will be on how to overcome these barriers and turn these challenges into opportunities to make these services friendly.


Activity 3: Making Services Community Friendly

Time 1 hour


• How to convince an organisation to offer friendly services.

Materials N/A

Audio-visual Support Refer to the slides titled ‘Making Services Friendly’ from the PowerPoint presentation ‘Community Friendly Services’.

Take-home Material Annexure 1 titled ‘From the Frontline of Community Action – A compendium of six successful community based HIV interventions that have worked for MSM-TG-Hijras in India’ available on digital file.

Methodology

Part I: Making Services FriendlyRemind participants about the four key elements of ‘friendly services’: utility, timeliness, sensitivity, and a non-discriminatory approach. Apart from these elements, explain why it is also important that the services should have other adjoining facilities. Divide the participants into smaller groups and ask each group to list the facilities that they think need to be added to friendly services.

After allowing them to brainstorm for 10 minutes, ask each group to present their findings and list them on a flip-chart. Ensure that their responses include the following points.

SpaceIt is important for service outlets to have enough space to deliver certain services to its clients; for example, counselling, clinical or testing services.

ConfidentialityThis is one of the most important aspects of service provision and is more relevant for communities that are marginalised and stigmatised.

The participants need to be told about the importance of confidentiality of the information gathered on the clients. Under no circumstances should such findings ever be discussed in any social settings. Always remember a single episode of ‘breach of confidentiality’ can have a lasting impact on the progress made with the clients and on the reach of the programme.

Respect and ToleranceThe organisation should be tolerant towards all community persons. Clients should not feel stigmatised in a space where they access services. The organisation should not impose any service on the client; the services should be offered only if the client is willing to access them.

SensitisationService providers need to be sensitised about different types of gender/sexual identities and its associated terminology and related cultural issues.

Note to FacilitatorIt is important to point out that being ‘friendly’ is applicable to all service providers across the board.

While the participants are going to work on making external services friendly, remind them that it is also important to keep internal services available in a CBO friendly.

A report by UNDP/Humsafar Trust titled ‘From the Frontline of Community Action – A compendium of six successful community based HIV interventions that have worked for MSM-TG-Hijras in India’ has documented strategies that have worked well in providing services to the community. Select examples from the report that you find relevant and present them to the participants. The report, which also shares the lessons learnt in their programmes, can be a good supporting manual for new CBOs and NGOs.

file:///\\192.168.0.5\commondrive\2005-2008\Current Programmes\Projects by Donor\Pehch<0101>n-GFATM R 9\Training Unit- Pehchan\Training Module\Final version\Module E\E4 - Friendly Services\Annexures\E4_Annex01_From_the_frontline.pdf


Part II: Best Approach for Service DeliveryAs a CBO, it is important not to replicate any existing government programmes. One needs to integrate the required services with the existing programmes to complement the government services. If needed, the organisation can develop referral cards to these services and distribute the cards during outreach activities. These cards should not identify an individual as a community person or reveal the person’s identity to others. These cards should carry generic captions such as ‘Wellness Card’ or ‘Health Card’.

If the organisation wants its name on the cards, it can use acronyms that will help maintain the confidentiality of the clients but at the same time be useful in data collection. There should be a weekly review of the number of cards distributed and the number of cards collected.

The organisation should also conduct exit interviews with clients on a regular basis to assess their satisfaction levels and to improve the services accordingly. The questions asked at the time of the exits interview could include the following:

• Were you happy with the services?

• What are the changes that you feel are required to improve the services?

• Are there any changes required in the referral cards?


Activity 4: Developing Linkages with Friendly Services

Time 1 hour


• How to create sustainable links with organisations through the various communication strategies to offer friendly services; and

• How to maintain links through follow-up procedures.

Materials N/A

Audio-visual Support Refer to the slides titled ‘Developing Linkages with Friendly Services’ from the PowerPoint presentation ‘Community Friendly Services’.


Methodology

Part I: Building LinksRemind participants that the breath of services provided to MTH communities can be expanded by linking with organisations that provide services useful to the MTH community persons. Using the slides titled ‘Develop a Relationship’, discuss with participants how best to liaise with other organisations:

• Meet the key administrative people in a service-provider organisation. The initial meeting should be to discuss relevant information about the community, your organisation, the project, relevance of the project, and the potential services required.

• Do not appear to be demanding or aggressive in the first meeting. Remember, it may take time before an agency or an organisation is willing to even arrange a first meeting.

• Developing linkages should be seen as a long-term commitment for any programme and as one of its long-term goals. Do not burden the personnel of the agency, with whom a linkage is sought with a lot of information in the first meeting itself.

• Identify a key person in the organisation who can liaise between your CBO and the service-provider organisation.

• Pay courtesy visits to the agency on a regular basis; this will keep them updated as well as involved.

• Try to get a written agreement from the agency and the authorities, if possible.

In order to turn existing services into friendly services, the existing barriers need to be removed through sensitisation. Using the slide titled ‘Sensitise the Service Provider’, orient service providers, including administrators, with tailored information. Remember not to burden them with all the information in the first session.

The sensitisation component should broadly include discussion on the MTH community profile, key problems faced, needs of the community, and basic conceptual information on gender and sexuality issues. Remember that for many service providers it will be the first time that they are being told about these issues; so it is important to be sensitive, patient and perseverant with them.


Discuss some of the potential barriers that the MTH community members have faced in the past and brainstorm with the service providers to find solutions to these barriers. Remember, sensitisation is an ongoing process and through sensitisation, one should seek long-term solutions for better service-delivery and not provide ad hoc or stop-gap solutions. Using the slide titled ‘Having Realistic Expectations’, explain the following to the participants:

• In spite of all the efforts made by the CBO, there may be still some service providers who are homophobic and transphobic. CBO members should not feel demotivated, especially if it is a new CBO that is planning to develop relationships with service providers.

• Some services cannot yield immediate results/outcomes because of time constraints. For example, in a public hospital the waiting times may be longer than usual.

One should also explain to the MTH community members the limitations of service providers. However, let them know that efforts are being made to streamline the processes for them. Update your database of service providers regularly, at least every six months.

Part II: Communication between StakeholdersDiscuss some of the processes and mechanisms that allow streamlining the communication between MTH community members and the service providers, with the CBO acting as the intermediary, Use slides titled ‘Communication Strategies’ to describe how the communication can be streamlined.

Encourage the community members to inform the CBO of the barriers that they face when access services, as the CBO play a pivotal role in acting as a mouthpiece for the community. Based on complaints from the community members, the CBO should reach out to the service providers and sensitise them so that they become community-friendly. After that, the community members should be encouraged to give feedback on the quality of the services received. This will help the CBO assess the difference made after their intervention.

Further, to ensure that a follow-up to the referral is conducted, the community persons should be given follow-up (referral) cards by the CBO, which are later collected by the service providers and returned to the CBO, after being filled out by the service providers.

In certain situations, there may be a reversal of roles in which the service provider refers community persons to the CBOs, especially in situations where community persons have no knowledge about the existence of the CBO as a support forum.


Activity 5: Mapping Friendly Services: Concepts

Time 1 hour


• Map and create a directory of friendly services.

Materials N/A

Audio-visual Support Refer to the slides titled ‘Mapping Friendly Services’ from the PowerPoint presentation ‘Community Friendly Services’.


Methodology Ask the participants what they understand by ‘Mapping of Services’. After eliciting their responses, elaborate:

• Why each CBO should identify service providers needed by the communities they serve, and list them; and

• Why these lists should be accessible, visually appealing, easy to use and understand, and not overly coded.

Describe the importance of tools used in mapping services. Describe how important it is:

• For CBOs to be aware of the different types of mapping tools.

• For programme staff to be able to provide information by using the tools as and when required (for example, if a client needs medical help, the administrator of the CBO should be able to suggest a few options based on the client’s time preferences, location, and requirements); and

• To have regular communication among CBO staff (ORW, Project Officers/Managers, and Administrative and Finance Officers) about updating existing databases (for instance, if a new clinic has opened in the neighbourhood, it should be updated in the database).

Divide the participants into groups based on the organisations they have come from, and ask them to:

• Identify the services necessary for their CBO; and

• For each service, identify a service-providing organisation and key personnel through whom to access those services. (Explain to them that it is important to include the name of at least one contact person for each of the services listed.)

Remind participants that getting names of contact persons is not always easy and possible. Also, remind them the importance of collecting visiting cards and other potential information/contact information from these services. Ask them to go through the following checklist to see if they have covered key people when it comes to linking with the external service provider organisations:

• Names of public hospitals and various departments in these hospitals, names of heads of the departments and other key staff in the departments, hospital administrators, private hospitals, small polyclinics, individual dispensaries, general physicians, Ayurvedic doctors, homeopathic doctors, microbiology and pathology laboratories, radiology centres, and 24-hour chemist shops.


• Legal services, including nearby police stations, names of the Officers-in-Charge in these police stations, legal consultants who work with marginalised communities, and individual lawyers/legal aid agencies willing to help MTH community members (government legal services authorities should be included).

• Government services, including addresses of local corporation offices, Block Development Officers, Panchayati Raj Institutions, water and electricity services; and HIV-related government bodies, such as SACS, DAPCUs, ICTCs, ART centres, Community Care Centres, and DOTS centres.

• Social security services, including addresses and other contact details of government schemes/programs, such as NREGA, NRHM, ration card services, BPL cards, Aadhaar cards, and local banks, insurance service providers, and post offices.

Explain to the participants that it is important to know their region/city/area very well. It is important for project implementers to:

• Know that maps of big cities are available, which can be useful tools for visualising the entire city;

• Know the details of the city/area where the project is based;

• Decide the level at which details are needed. For example, in some cities it may be easy to have details at the level of neighbourhoods, whereas in other cities (large metropolitan cities) details may be feasible only at larger levels (example: Mumbai, where each suburb may represent an entire town, it may be difficult to have detailed information across all areas of the city);

• Be familiar with local names of streets and other terms or expressions used to describe the regions; and

• Provide all the names of the regions, both old and new, in the service maps and contact databases.


Activity 6: Tools to Map Services

Time 1 hour


• Learn the various tools used in mapping of services.

Materials N/A

Audio-visual Support Refer to the slides titled ‘Mapping Friendly Services – Tools’ from the PowerPoint presentation ‘Community Friendly Services’.


Methodology

Part I: Drawing Maps of Service ProvidersDivide participants into smaller groups, preferably participants who are familiar with a particular geographic area, and give each group a printout of an outline map or chart paper. (See the adjacent box). Tell them that they are going to draw a map of the service providers they have identified from the previous exercise.

Ask participants to come up with a design strategy for their maps using design symbols or colour codes for different types of service providers. Also create a legend to document the symbols/codes created and used.

They can decide how to structure the map. For example, in a city such as Delhi, it may be easy to construct a map in concentric circles around the CBO, whereas in Mumbai, it may be easier to construct a map around the suburban railway lines. (Refer to the slides titled ‘Mapping Friendly Services – Tools’ from the PowerPoint presentation ‘Community Friendly Services’.) Participants can decide whether to create one map with multiple types of service providers or separate maps for separate types of services.

Give them about 30 minutes to develop their maps, guiding them whenever necessary.

Part II: Creating a Database in Excel SheetExplain that while maps provide a visual representation and will be very handy in the field, they are limited when it comes to the amount of information they can contain. Therefore, it is vital that CBOs maintain documents with particulars of service providers and one of the most convenient tools can to create this database is through Excel sheets. Excel sheets work well as databases because the information contained in them can be referenced in various ways, including sorting, filtering and searching.

Give a guided tour to participants on how they can create a directory of service providers.

In the first row of the Excel sheet, fill each cell with a description that suggests what data the column will contain. Suggested columns are: name of the organisation, status of the organisation, hours of operation, services, distance from the parent organisation, contact person, phone numbers, and email addresses (if available).

Create columns for the services: for example, HIV testing, ART availability, VDRL testing, HBV vaccination, and use a tick (symbol) for the services provided and a cross (symbol) for the ones not available with the service provider.

Note to FacilitatorBefore the training session, prepare outline maps of the areas from where the participants are coming.

If outline maps are not available, ask participants to design a map based on their knowledge of their areas.


Ask the participants to write in a separate column the various barriers (from the list made earlier) that clients might face when trying to access these services.

Fill the Excel sheet with some sample data. Demonstrate how you can use the search, filter and sort functions of Excel. (If you are not familiar with these, use the Help facility of MS Excel to learn them).

Sum-up the session with the following observations:

• Drawing maps which identify service providers in a certain geographical area and maintaining lists of services providers in Excel sheets are the simplest mapping tools that CBOs can use. Maps of service providers can be hung on the drop-in centre walls, and Excel sheets are easy to create, update and refer to; and

• Remind participants that maps and directories are living documents, and they need to be constantly updated with current information.


Annexure 1: PowerPoint Presentation – Community Friendly Services


Notes








population status.








module

C

module

A

module

C

module

D




module



C2 Family Support

C3 Mental Health





D3 Positive Living





D4 C

omm

unity

Fri

endl

y Se

rvic

es

D5 C

omm

unity

Pre

pare

dnes

s

for

Sust

aina

bilit

y

Facilitator Guide

Community Preparedness for

Sustainability

D5

Pehchan 1D5 Facilitator Guide: Community Preparedness for Sustainability


About Pehchan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2


Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3


Module Acknowledgments: Community Preparedness for Sustainability . . . . . . . . . . . . . . . . . . . . . . . 7

About the Community Preparedness for Sustainability Module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9


Activity Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Activity 1: Introduction to Community Preparedness for Sustainability Module . . . . . . . . . . . . . . . . 11

Activity 2: What is Community Preparedness? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Activity 3: Moving from HIV-centric to Community-centric Programmes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Activity 4: Some Guiding Principles for Achieving Community Preparedness . . . . . . . . . . . . . . . . . . 18

Annexure 1: PowerPoint Presentation – Community Preparedness for Sustainability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Pehchan2 D5 Facilitator Guide: Community Preparedness for Sustainability

About this ModuleThis module is designed to help training participants: 1) understand the concept of community preparedness; 2) become familiar with the rationales and processes to shift the focus of programmes for men who have sex with men (MSM), transgenders and hijras (MTH) from HIV-centric to community-centric; 3) learn strategies to help MTH communities become self-reliant and sustainable; and 4) appreciate the importance of critical thought processes in planning for strong CBOs and communities. In the Pehchan programme, this module is used to introduce basic principles of community preparedness to CBO Programme Managers, Counsellors, and Outreach Workers.





Module Acknowledgments: Community Preparedness for Sustainability Each component of the Pehchan Training Curriculum has a number of contributors who have provided specific inputs. For this component, the following are acknowledged:

Primary Authors Prity Prabhughate, ICRW; S.V. Sreeram, Ashodaya; Sonal Mehta, India HIV/AIDS Alliance


Technical Input Dr. Samarjeet Jana, Consultant; Vaibhav Sarai, Consultant; Debjyoti Ghosh, SAATHII; Olga Aaron, SIAAP


References • Targeted Interventions Under NACP III. (2007). Operational Guidelines. Volume I. Core

High Risk Groups. National AIDS Control Organization. Ministry of Health & Family Welfare. Government of India. Available on http://www.nacoonline.org/NACO/


About the Community Preparedness for Sustainability Module

No. D5

Name Community Preparedness for Sustainability


• Counsellors




• Understand the concept of community preparedness;

• Understand why and how programmes for members of the MTH community should shift from being HIV-centric to community-centric; and

• Understand processes involved in MTH CBOs becoming self-reliant and sustainable.





Audio-visual Support 1. PowerPoint Presentation on ‘Community Preparedness for Sustainability’


Activity Index1

No. Activity Name

Time Material1 Audio-visual Resources Take-home material

1 Introduction to Module

1 hour 30 minutes

Chart paper, markers

Refer to the slides titled ‘Introduction’ from the PowerPoint Presentation ‘Community Preparedness for Sustainability’

N/A

2 What is Community Preparedness

2 hours Chart papers, markers

Refer to the slides titled ‘What is Community Preparedness’ from the PowerPoint Presentation ‘Community Preparedness for Sustainability’

N/A

3 Moving from HIV-centric to Community-centric Programmes


Refer to the slides titled ‘Moving from HIV Centric to Community Centric Programming’ from the PowerPoint Presentation ‘Community Preparedness for Sustainability’

N/A

4 Achieving Community Preparedness: Some Guiding Principles


Refer to the slides titled ‘Some Guiding Principles of Community Preparedness’ from the PowerPoint Presentation ‘Community Preparedness for Sustainability’

N/A



Activity 1: Introduction to Community Preparedness for Sustainability Module



• Define what a ‘community’ is; and

• Identify its features and characteristics.


Audio-visual Support Refer to the slides titled ‘Introduction’ from the PowerPoint Presentation ‘Community Preparedness for Sustainability’.


Methodology Using the slides titled ‘Introduction’ from the PowerPoint Presentation ‘Community Preparedness for Sustainability’, discuss the following points:

• NACP III clearly articulated that communities should be the primary focus of responses to the HIV epidemic.

• NACO’s Targeted Intervention (TI) Operational Guidelines outline processes involved in helping communities most affected by HIV to set up a response.

• Transitioning programmes to community-based organisations (CBOs) is the ‘what’ part of the policy. The ‘how’ part of the policy depends on affected communities being prepared to take responsibility for implementing a prevention programme, while looking at community advancement as the larger agenda.

• It is in this context that we need to understand community preparedness as a stage in which communities advance their needs beyond HIV and find solutions through which such needs can be addressed.

• This module is not intended to be a skill-based module, but rather a module geared towards facilitating thought processes.

Ask the participants what they understand by the term ‘community’ and list their responses on a flip-chart. Divide the participants into five groups and provide chart paper to each group. Ask each group member to list the various communities that they are a part of. The list should be ranked in a descending order, with the community that majority of the group members identify with being at the top of the list.

Ask a member from each group to read out the list of the communities compiled in the group to the rest of the participants. Reflecting on the lists, discuss reasons why communities are formed. Some of the reasons are:

• For a common cause.

• For a sense of belonging and identity.

• For more social or political power to its members.

Note to FacilitatorThis module is designed to prompt participants to assess, evaluate, envision and plan for their CBO and community through various activities.

Note to FacilitatorRemember that the choice of the communities listed in this exercise could be sexual, religious, social, cultural, regional, and local.


Encourage the participants to add to the list of points above; then write them down on another chart paper and put it up on the wall. Discuss the term ‘community’ with the help of the PowerPoint presentation and explain that:

• There is no universally accepted definition for the term ‘community’; it means different things to different people.

• The term ‘community’ refers to a group of people who come together based on certain shared common values and is sometimes associated with the term ‘social cohesion’.

• A person identifies with a particular community depending on factors such as need, benefits of membership in such a group, and access to resources available to the community.

• A person can be a part of various communities at the same time.

• Communities often overlap in terms of priorities and needs.

Give an example of how communities overlap and can be labeled as ‘interconnected communities’. For instance, a common priority among the sexual minority community groups and HIV programme is being able to seek health services without discrimination.

Divide the participants into three groups and ask them to brainstorm on the following topics within their groups:

• Group 1: What are the unique characteristics of the MTH community?

• Group 2: What are challenges that MTH community face?

• Group 3: What keeps the community together and what are their strengths?

After about 10 minutes, ask each group to present some of the key points they discussed. Write down the responses on a flip-chart under three columns marked as ‘characteristics’, ‘challenges’ and ‘strengths’.

Ask each group how the participants reached a consensus regarding the question given to them. If there were differences of opinion, how did they resolve them? Explain to the participants that the above exercise exemplifies certain processes that occur in a community. Very often there is a common larger cause or issue which unites individuals into communities and links them to other communities. While there might be various members who would have varied opinions/perceptions of the problems and solutions, continuous dialogue is what is necessary keep this process ongoing.

Note to FacilitatorIt is important in this interaction to allow participants to voice their opinion on what other common demands, wants and needs bring these communities together.


Activity 2: What is Community Preparedness?

Time 2 hours


• Understand what the term ‘community preparedness’ means; and

• Understand the importance of community preparedness.

Materials Chart papers, markers.

Audio-visual Support Refer to the slides titled ‘What is Community Preparedness’ from the PowerPoint Presentation ‘Community Preparedness for Sustainability’.


Methodology Ask the participants what they understand by ‘Community Preparedness’, and write their responses on a chart paper. Using the slides titled ‘What is Community Preparedness’ from the PowerPoint Presentation ‘Community Preparedness for Sustainability’ describe community preparedness as a process that makes communities self-reliant by identifying solutions through community-based activities and mobilising local resources to provide for their needs.

List the following elements that characterise the term ‘community preparedness’:

• Encouraging self-reliance;

• Finding community-based solutions;

• Identifying appropriate collaborations;

• Ensuring voices are heard; and

• Identifying community resources, including funding to address community needs and enable financial sustainability.

Explain the importance of community preparedness:

• Resources are finite.

• HIV-targeted interventions do not necessarily deal with non-HIV related matters (such as the psycho-social issues) that are often equally important for the community.

• In absence of any formal funding, a community may find it difficult to meet its needs, and CBOs may struggle to survive.

Read out the following case study and ask participants to list the solutions that the community can find to address Bebo’s situation.

Bebo, a hijra, has been leading a dual life. The family knows that Bebo is very effeminate but has no clue that she has embraced the hijra culture. One day, however, a neighbour comes over and complains to Bebo’s father that his son is nuisance and abuses the father for having such a child. Incensed, Bebo’s father throws Bebo out of the house. Bebo has nowhere to go. What can the community do in this situation?

After they give their responses, initiate a group activity titled ‘How prepared are we?’


Here, the idea is to make the participants find out more on how a community (or a CBO) should prepare themselves in order to address various issues. Divide participants into four groups and give each group four sheets of blank paper. Ask each group to discuss the following four questions and write down the answers to each:

• What are the services provided by your CBO and what resources does the CBO have? (Responses should list any services and programmes of the CBO, as well as available resources, including funds and facilities but also stakeholder relationships and formal partnerships).

• What are the gaps you see in your CBO?

• What do you think can be done to address these gaps?

• What are the potential problems/obstacles you anticipate in resolving issues faced by MTH CBOs?

Ask each group to stick their response sheets on the four walls of the room, with answers to the first question on one wall, to the second question on another, and so on. Next, ask the participants to walk around the room and read silently what the other groups have written. Facilitate a discussion by doing the following:

• Describe the common themes that emerge across the groups.

• Point out the disagreements that emerge among the groups.

• Brainstorm all possible reasons for these agreements and disagreements.

• Remind participants that the purpose of this exercise is to merely highlight the fact that all CBOs have their unique strengths and weakness; despite their differences, there are enough commonalities that bring all of them together under the larger umbrella of serving the MTH community.

Explain how this exercise will help them identify available resources within their organisation and what they can do to utilise them for the communities they serve. Explain how the information generated from this exercise can be used as the basis for resource mapping, deliberations and re-envisioning of the programme the organisation offers. (Refer to Module A3 on Resource Mobilisation for inputs on innovative means of mobilisation).

Show the table below to make the participants understand how a CBO can address a problem by (a) conducting a participatory exercise to understand the unmet needs of the community; and (b) mapping a course of action to address these needs by mobilising available resources.

Gaps (e.g. missing services)

Ways to fill gap Possible obstacles Resources available to fill gap

Example: Health insurance


Remind participants that: • CBOs need to constantly deliberate on ways to be prepared to meet the needs

of the community and on how to sustain those efforts.

• Community preparedness is a process that is best achieved through the participation of its constituents, MTH community members.

• A community is said to be prepared if its members are self-reliant and their needs are met.

• Representation of members from all sub-sections of the community is important to arrive at a common understanding and a plan of action.

• Mapping resources and anticipating problems helps to plan ahead.

Note to FacilitatorIn all likelihood, the participants will have mentioned issues and needs that go beyond HIV services.

Point this out to them, and explain that it is because of these needs that the shift from HIV-centric programming to community-centric programming is important.


Activity 3: Moving from HIV-centric to Community-centric Programmes

Time 2 hours


• Develop a vision for their organisations beyond HIV-centric programmes.


Audio-visual Support Refer to the slides titled ‘Moving from HIV Centric to Community Centric Programming’ from the PowerPoint Presentation ‘Community Preparedness for Sustainability’.


Methodology Divide the participants into smaller groups, and ask them to develop ideas that will ensure community involvement and engagement for an effective HIV prevention intervention. Ask them to consider the following questions: Is health a priority issue for community? If so, what are the barriers to accessing healthcare services? If not, how do we ensure health becomes one of the community priorities?

• How do we address a lack of interest among MTH community members when HIV-related messages are communicated repeatedly by peer educators?

• When community members continue to face stigma and discrimination, how do we encourage them to utilise healthcare services?

• How can we creatively address the needs of the community beyond HIV-related services so as to provide psycho-social support, mental health, family support, social inclusion, linking with government schemes, advocacy for additional schemes, etc.

• How do we work towards broader social inclusion of MTH populations?

• How do we shrug off the label of ‘people who work in the field of HIV prevention’?

After giving the participants adequate time to discuss various scenarios, ask each group to share their discussions. Note these responses on separate sheets of chart paper, with each sheet dedicated to one question. That way, all the answers can be noted down for other participants to see.

Using the PowerPoint slides titled ‘An HIV-centric CBO and a Community-centric CBO’, discuss how HIV-centric programmes deal only with HIV, whereas community-centric programmes are more holistic and look at the various aspects involved in community members’ lives. Through this discussion, participants will:

• Understand how some CBOs may not be HIV-centric and are already dealing with other community-centric issues. For example, in addition to HIV, a CBO may be working to address violence or the need for psycho-social support among community members served by CBO.

Note to FacilitatorYou can adapt the questions to capture the interest of participants.

However, please ensure that participants are able to work at the conceptual level required for this activity. If you find that some participants are quiet, it may be because they are not as comfortable with these issues as others are. You will need to draw them into the discussion.


• Understand that when a CBO decides to expand its focus beyond HIV programming to broader community issues, organisational development becomes essential to ensure strong organisations are available to advance community goals.

• Understand how it is important for the community to look beyond the resources made available for HIV. Resources for HIV prevention are becoming scarce, and if CBOs do not utilise the existing support structures to build and develop their organisations, they may end up without resources to carry out their goals.

Divide the participants into three groups, and ask them to explore issues related to sustainability. Moderate the discussions in each group to ensure that all important areas that could form part of a CBO are covered, such as:

• Financial resources;

• Social capital; and

• Availability of government schemes.

After each group makes their presentations to the larger group, use the slides titled ‘Financial Resources, Social Capital and Government Schemes’ and further elaborate on the topic.

Remind the participants that CBOs and community members need to reflect and examine the focus of their programmes and CBOs. Will this focus offer them ways to achieve sustainability while allowing them to meet community needs?

Point out that shifting focus from HIV/AIDS programming to other community issues is a difficult task as it can lead to discussion of key economic issues for community members themselves, such as livelihoods.


Activity 4: Some Guiding Principles for Achieving Community Preparedness

Time 2 hours


• Identify some of the guiding principles of community preparedness.

Materials Chart papers, markers.

Audio-visual Support Refer to the slides titled ‘Moving from HIV-centric to Community-centric Programming’ from the PowerPoint Presentation ‘Community Preparedness for Sustainability’.


Methodology Summarise the learnings of the previous session by reminding the participants that:

• Community-preparedness is a process wherein communities engage in deliberations to understand and plan actions to ensure sustainability of services meant to cater to the needs of the community.

• For a community to be prepared, CBOs need to undergo a paradigm shift from being HIV-centric to being community-centric in their approach and programming.

Using the PowerPoint slide titled ‘Some Guiding Principles’, list the various guiding principles of community preparedness and spend some time in discussing with the group the following:

• Shifting Focus from Being HIV-centric to Community-centric As discussed in the previous exercise, such a shift would mean that CBOs have to think innovatively about ways to mobilise and develop resources to support unfunded mandates, such as an employment initiative that may not be presently funded under any programme in their CBO.

• Mainstreaming Explain how the ultimate aim of the MTH community and CBOs working with MTHs should be to become an integral part of society without feeling socially excluded.

• Conflict Resolution As seen in most of the exercises in this session, all members may not agree on the list of priorities and needs, nor will their perceptions be the same. To add to this, the MTH community is characterised by different sub-communities that have their own characteristics and unique needs. Therefore, conflict resolution and ensuring all the voices are heard are important to a holistic understanding of what preparedness means to a community and a CBO. Conflicts among community members should be resolved in such a way that the parties involved feel like the resolution is a win-win situation.


• Transparency and Accountability Transparency and accountability together enable community members to have a say about issues that matter to them and gives them a chance to influence decision-making and hold those making decisions to account. A CBO can increase its transparency by presenting the information of its work in plain and readily comprehensible language and formats appropriate for different stakeholders, including community members themselves. Information should retain enough detail necessary for analysis, evaluation and participation. To increase accountability, the CBO can invite members and outsiders to participate in regular meetings and discussions. This can increase the CBOs accountability towards the communities they serve.

Wrap-up the day’s activities by explaining how community preparedness is an essential part of supporting the establishment and development of strong MTH CBOs to meet the challenges of HIV as well as the breadth of issues faced by community members.


Annexure 1: PowerPoint Presentation – Community Preparedness for Sustainability


Notes








population status.








module

C

module

A

module

C

module

D




module



C2 Family Support

C3 Mental Health





D3 Positive Living





D5 C

omm

unity

Pre

pare

dnes

s

for

Sust

aina

bilit

y

D6 L

ife S

kills

Edu

catio

n

Facilitator Guide

Life Skills Education

D6

Pehchan 1D6 Facilitator Guide: Life Skills Education


About Pehchan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2


Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3


Module Acknowledgments: Life Skills Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

About the Life Skills Education Module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9


Activity Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Activity 1: Introduction to Life Skills Education (LSE) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Activity 2: Sexual and Reproductive Health Rights (SRHR) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Activity 3: Five Steps to Life Skills . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Activity 4: Behaviour and Assertiveness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Activity 5: Wrap-up . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Annexure 1: Life Skills Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

Annexure 2: Words I Can Use to Describe Myself . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

Annexure 3: Johari Window Exercise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Annexure 4: Myths and Reality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Annexure 5: Decision-making . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Annexure 6: Types of Behaviour . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

Annexure 7 : Case Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

Annexure 8: Asset Mapping . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

Annexure 9: PowerPoint Presentation – Life Skills Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

Pehchan2 D6 Facilitator Guide: Life Skills Education

About this ModuleThis module is designed to help training participants: 1) understand the basic concepts and principles of Life Skills Education (LSE) for men who have sex with men (MSM), transgenders and hijras (MTH); 2) provide skills to sensitize CBO staff on life skills and equip them to respond to the needs of MTH community members; 3) learn techniques to build self-worth and enhance self-esteem of CBO clients; 4) develop listening and communication skills; and 5) build staff capacity to respond to difficult situations constructively. In the Pehchan programme, this module is used to introduce basic principles of LSE to CBO Counsellors.





Module Acknowledgments: Life Skills Education Each component of the Pehchan Training Curriculum has a number of contributors who have provided specific inputs. For this component, the following are acknowledged:

Primary Author Sarita Barapanda, Consultant


Technical Input Vaibhav Sarai and Debjyoti Ghosh, SAATHII; Olga Aaron, SIAAP


References • Partners in Life Skills Education: Conclusions from a United Nations Inter-Agency

Meeting Department of Mental Health. (1999). World Health Organization. Geneva.

• Economic, Social and Cultural Rights. (2003). Commission on Human Rights. 59th Session. Economic and Social Council. United Nations.


About the Life Skills Education Module

No. D6

Name Life Skills Education


• Counsellors




• Understand the concept of life skills and their importance in sexual and reproductive health in the MTH community; and

• Enhance skills and capacities for self-awareness, assertive behaviour and decision-making.





Audio-visual Support 1. PowerPoint presentation on ‘Life Skills Education’

Take-home Materials 1. Annexure 1 on ‘Life Skills Education’2. Annexure 2 on ‘Words I Can Use to Describe Myself’ 3. Annexure 3 on ‘Johari Window Exercise’4. Annexure 4 on ‘Myths and Reality’5. Annexure 5 on ‘Some Things I May Value’6. Annexure 6 on ‘Decision-Making’7. Annexure 7 on ‘Types of Behaviour’8. Annexure 8 on ‘Case Study’9. Annexure 9 on ‘Asset Mapping’


Activity Index1

No. Activity Name


Take-home material

1 Introduction to Life Skills Education

45 minutes N/A Refer to the slides titled ‘Introduction to Life Skills Education’ from the PowerPoint presentation ‘Life Skills Education’

Annexure 1 titled ‘Life Skills Education’

2 Sexual and Reproductive Health Rights

45 minutes N/A Refer to the slides titled ‘Sexual and Reproductive Health’ from the PowerPoint presentation ‘Life Skills Education’

N/A

3 Five Steps to Social Skills

2 hours N/A Refer to the slides titled ‘Beliefs and stereotypes’ to ‘Myths and Reality’ from the PowerPoint presentation ‘Life Skills Education’

Annexure 2 titled ‘Words Ican use to describe myself’ Annexure 3 titled ‘Johari Window Exercise’Annexure 4 titled ‘Myths and Reality’Annexure 5 titled ‘Some Things I May Value’Annexure 6 titled ‘Decision-making

4 Behaviour and Assertiveness

2 hours N/A Refer to the slides titled ‘Types of Behaviour’ from the PowerPoint presentation ‘Life Skills Education’

Annexure 7 titled ‘Types of Behaviour’Annexure 8 titled ‘Case Study’Annexure 9 titled ‘Asset Mapping’

5 Wrap-up 30 minutes N/A N/A N/A



Activity 1: Introduction to Life Skills Education (LSE)

Time 45 minutes


• Articulate the objectives of this module; and

• Understand the meaning of Life Skills Education (LSE).

Materials N/A

Audio-visual Support Refer to the slides titled ‘Introduction to Life Skills Education’ from the PowerPoint presentation ‘Life Skills Education’.

Take-home Material Annexure 1 on ‘Life Skills Education’.

Methodology Write the words ‘Life Skills’ on a flip-chart and ask participants to brainstorm on:

• The challenges one faces in life, especially as a member of the MTH community;and

• The skills needed to negotiate life’s challenges effectively.

Encourage participants to brainstorm and share their life’s aspirations, successes and challenges with each other in the group and critically analyse the skills one would need to deal with them.

It would be useful to list their responses on the flip-chart, as these responses could be used as talking points in subsequent activities.

Give each participant a printout of Annexure 1 titled ‘Life Skills Education’ and ask for a volunteer to read aloud from the document. As the volunteer reads the document, link the concepts and ideas therein to the issues discussed by participants in the brainstorming session.

Tell participants that the content of the day’s training is a result of series of discussions held with many MTH persons who felt that the community generally lacked life skills and the ability to overcome conflict situations; they suggested that the community required a broad set of competencies – social, cognitive and emotional – to negotiate and make healthy decisions about sexual and reproductive health choices.

Sum up the session by explaining that life skills are skills acquired through teaching or direct experience that are used to handle problems commonly encountered in daily life. Describe how the session will broadly help the participants to:

• Engage in a process of self-awareness;

• Explore effective decision-making; and

• Understand assertive communication and behaviour.

Note to Facilitator‘Life Skills’ can be defined as psychosocial competencies and interpersonal skills that help people make informed decisions, think critically, and communicate effectively.

According to the World Health Organization, ‘Life Skills’ are abilities for adaptive and positive behaviour that enable individuals to deal effectively with the demands and challenges of everyday life.

The terms ‘psychosocial competencies’, ‘interpersonal skills’, ‘informed decisions’, and ‘adaptive and positive behaviour’ are technical terms which may not be easily understood by all participants. If you would like to introduce these terms in the session, you need to explain these terms clearly.

file:///Users/suemacdonald/Documents/SMD%20work/Alliance%20India/pehchan%20modules/layout/FINAL%20text%20and%20images/D%20/D6/../../../../../../../../../../../../../../../../../../AppData/Local/Microsoft/Windows/Temporary Internet Files/hkhosa/AppData/Local/Microsoft/hkhosa/AppData/Local/Temp/wz4cef/E6 - Life Skills Education/E6_AV Support/E6_AVSupport.pptx

file:///Users/suemacdonald/Documents/SMD%20work/Alliance%20India/pehchan%20modules/layout/FINAL%20text%20and%20images/D%20/D6/../../../../../../../../../../../../../../../../../../AppData/Local/Microsoft/Windows/Temporary Internet Files/hkhosa/AppData/Local/Microsoft/hkhosa/AppData/Local/Temp/wz4cef/E6 - Life Skills Education/E6_Annexures/E6_Annex_01_AboutLifeSkills.docx


Activity 2: Sexual and Reproductive Health Rights (SRHR)

Time 45 minutes


• List the sexual and reproductive health rights of all individuals; and

• Understand the importance of life skills in attaining sexual and reproductive health.

Materials N/A

Audio-visual Support Refer to the slides titled ‘Sexual and Reproductive Health’ from the PowerPoint presentation ‘Life Skills Education’.


Methodology Start by introducing the participants to the topic of sexual and reproductive health rights (SRHR) and their importance in the context of life skills. Use the situations and the skills listed in the previous activity to explain why it is important to talk about rights while dealing with life skills. Using the slides titled ‘Freedoms’ from the PowerPoint presentation ‘Life Skills Education’ explain to the participants that every individual has various sexual and reproductive rights, which give him/her certain freedoms:

Freedom to Freedom from

• Choose whether or not to marry and have a family

• Decide when or whether to have children

• Choose a partner

• Enjoy sexual pleasure

• Express oneself sexually

• Access quality sexual and reproductive health care

• Harassment

• Stigma and discrimination

• Violence and coercion

• Unwanted pregnancy

• Government interference

• Torture and ill-treatment

Further explain that if rights are taken as the guiding principle, then along with rights there are individual responsibilities. Use the following example to explain this:

Right Individual Responsibility State Responsibility

Right to Sexual Pleasure

• To respect partner’s bodily integrity and privacy.

• To respect partner’s freedom to choose, including the right to say no to any sexual practice.

• To repeal laws that criminalise certain forms of sexual activity such as sexual activity between consenting adults, premarital sex, homosexuality, prostitution, etc.

• To ensure universal access to sexual education, information and quality services.

• To protect people from sexual violence and coercion.

Note to FacilitatorWhen it comes to the right to sexual pleasure, explain to the participants that in many cultures, sex is looked down upon and is not openly discussed. Moreover, patriarchal institutions seldom attribute pleasure to the receptive partner in sex as it is considered to be a method for procreation and not pleasure.




Explain why it is important to talk about rights while dealing with life skills. A few key points to elaborate on include the following.

• A highly important component of the right to health is the right to sexual and reproductive health. As confirmed by the Commission on Human Rights, 2003, ‘Sexual and reproductive health is an integral element of the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.’

• The presence or absence of rights relating to sexuality and reproduction has a huge impact on how people live, their physical security, bodily integrity, health, education, mobility, and social and economic status.

• In our society, same-sex relationships are stigmatised and strongly discouraged. Many MTH individuals are forced to marry and have families.

• Violence in the context of sexual relationships is not uncommon. There is also a lack of capacity to negotiate in some sexual relationships that can lead to violence.

• Lack of social support and the threat of violence leads to increased risk-taking and greater vulnerability to sexually transmitted infections (STIs) and HIV. In schools and within families and communities, feminine boys are more likely to be bullied. Consequently, they tend to run away, exposing themselves to more violence in the streets.

Describe how Life Skills Education can influence behaviour and personal choices. Explain that on a individual as well as community level it is important to:

• Develop awareness of and respect for sexual and reproductive health rights;

• Identify strategies for promoting and establishing these rights as essential rights; and

• Reflect on the importance of sexual and reproductive health rights in the personal as well as professional lives of people.


Activity 3: Five Steps to Life Skills

Time 2 hours


• Understand the concept of self-awareness and begin the process ofbecoming more self-aware;

• Explore the beliefs and values which underlie their interactions with thepeople around them; and

• Understand the steps in informed decision-making.

Materials N/A

Audio-visual Support Refer to the slides titled ‘Beliefs and Stereotypes’ to ‘Myths and Reality’ from the PowerPoint presentation ‘Life Skills Education’.

Take-home Materials Annexure 2 on ‘Words I Can Use to Describe Myself’.Annexure 3 on ‘Johari Window Exercise’.Annexure 4 on ‘Myths and Reality’.Annexure 5 on ‘Some Things I May Value’.Annexure 6 on ‘Decision-Making.

Methodology

Part I: Developing Self-awarenessExplain how self-understanding is the first step towards acquiring life skills. Understanding one’s own personality, values, strengths, weaknesses, needs and motivations is the foundation towards improving the quality of one’s life and relationships.

Give each participant a printout of Annexure 2 titled ‘Words I Can Use to Describe Myself’. Ask all participants to read the list and ask if they need clarifications for words they do not understand. Request each participant to write what they think are the top six words that best describe their personality. Participants should do this exercise independently without consulting fellow participants.

After ten minutes, tell each participant to choose at least two fellow-participants who knows him/her well. Each of the chosen two should now take a separate sheet of paper and write down (without consulting each other) five or six words which describe the participant. After they are done, they should hand these descriptions over to the participant.

At the end of the exercise, each participant should have three lists of descriptive words, one list which they have created for themselves and the other two which has been prepared by their friends or acquaintances in the training.

Give each participant a printout of the Annexure 3 titled ‘Johari Window Exercise’ and tell the participants to draw at 2x2 grid on a chart paper with the following quadrants/rooms.

• Room 1 (Open) is the part of ourselves that we and others see;

• Room 2 (Blind Spot) contains the aspects that others see but we are not aware of;

• Room 3 (Hidden) is our private space, which contains aspects we know but keepthem from others; and

• Room 4 (Unknown) is the mysterious room where the unconscious orsubconscious parts of ourselves that are seen by neither ourselves nor otherscan be found.






In the quadrant titled ‘Room 1 (Open)’ fill words used by participant as well as their peers. This quadrant represents traits of the subjects that both they and their peers are aware of.

In the quadrant titled ‘Room 2 (Hidden)’ write words selected only by subjects but not by any of their peers, representing information about themselves that their peers are unaware of. In the quadrant titled ‘Room 3 (Blind Spot)’, write words selected only by the peers. These words represent personality traits that the subject is not aware of but others are. In the last quadrant titled ‘Room 4 (Unknown)’, write words not selected by either the subjects or their peers. While doing so participants will realise that these represent behaviors or motives not recognised by anyone participating in the exercise. This may be because these words do not apply to the subject or because there is collective ignorance of the existence of these traits.

Explain to the participants that in order to develop life skills, it is important to be aware of one self, and know one’s strengths and weaknesses. This exercise is a first step in understanding themselves. However, caution them that personality is not static or absolute, and examining oneself and one’s behaviour in different context over a period of time should be an ongoing process.

About the Johari WindowThe Johari Window, named after the first names of its inventors, Joseph Luft and Harry Ingham, is one of the most useful models to describe awareness and human interaction. A four-paned ‘window’ divides personal awareness into four different types, as represented by its four quadrants: open, hidden, blind, and unknown. The four quadrants in a Johari Window can be explained as follows:

Quadrant I (Open): known by the person himself/herself and also known by others.

Quadrant II (Blind Spot): not known by the person about himself/herself but is known to others. This could be simple information or can include deep issues (e.g. feelings of inadequacy, unworthiness, rejection, low self-esteem) which are difficult for individuals to face directly but can be seen by others.

Quadrant III (Hidden): known to the person but kept hidden from, and therefore unknown, to others. This hidden or avoided self represents information, feelings, etc., anything that a person knows about himself/herself, which is not revealed but is kept hidden from others. The hidden area could also include fears, hidden agendas, manipulative intentions, and secrets – anything that a person knows but does not reveal to others, for whatever reasons.

Quadrant IV (Unknown): unknown to the person and also unknown to others. Examples of such unknown factors may include:

• An underestimated or untried ability (through lack of opportunity, encouragement, confidence or training);

• A natural ability or aptitude that a person does not realize they possess;

• A fear or aversion that a person does not know they have;

• An unknown illness; and

• Repressed or subconscious feelings, conditioned behavior, or attitudes from childhood.

The larger the first quadrant, the closer to self-realization is the individual. A large first quadrant emphasises personal freedom and capability of a person to enjoy life and respect others rights and dignity. People whose first quadrant is large tend to have better and productive relationships. A shy person may, for example, have difficulty in developing a large Quadrant I, and they may tend to hide either behind silence or work so that very little is known to others. Some of the characteristics could be anxiety, tension, suspicion,


distrust, and depression. The goal of a healthy relationship is to maximise the Public Area (first quadrant).

The ‘secret area’ contains traits you know about but are unwilling or unable to share with others The ‘blind area’ describes areas of self-deception, like the rude person who thinks he is motivated by a desire for authenticity. The ‘unconscious’ area represents the part of the self that people may examine when they try to ‘find themselves’. According to the Johari Window, you are being most sincere when self-image and reputation converge in the public area, not when you are just focusing on your thoughts and feelings.

Part II: Examining Beliefs and StereotypesExplain to the participants that along with understanding oneself, one needs to understand the environment one lives in. Tell them that the following exercise will help them:

• Question their own beliefs regarding the division of work in our society; and

• Recognise stereotypes of people in our society.

Tell the participants that they should do this activity independently without any consultation from peers. Read out the three case studies from the slides titled ‘Beliefs and Stereotypes’ to ‘Myths and Reality’ in the PowerPoint presentation ‘Life Skills Education’ and ask them to pick a case study of their choice. Give each participant a chart paper and some crayons/markers and ask them to pictorially depict the scene of the case study they have selected.

Case Study 1

Think of your own village or a village that you have visited, and visualise a farmer working in the field. Please draw this scene as realistically as possible. You can draw the clothes the farmer wears, head gear if any, the farming instruments they use, and others working in the field.

Case Study 2

Think of a local train (e.g. Mumbai suburban train) and visualise the passengers in the train. Please draw this scene as realistically as possible; you can draw the clothes the passengers in the train are wearing and what they are carrying, etc.

Case Study 3

Think of a family and visualise the members of that family. Please draw this scene as realistically as possible. You can draw the number of members in a family, the clothes they wear and the work they do.

Now tell participants to write their names on the sheets and attach them to the wall designated for this exercise. Tell the participants to move around in the room and look at the drawings of all the participants. After the whole group reassembles, ask the participants how and why they visualised the scenes drawn (e.g. a farmer ploughing the field, or why particular kind of a person is there in the local train), consider the way people are depicted, count the number of men, women and others in the illustrations, etc. Talk about our ideas about specific groups, or individuals, and how these are based on certain perceptions and beliefs and sometimes are stereotypes.

If you notice that some of the participants have gone beyond stereotypes that can prevail in our society, point this out and ask them why they broke stereotypes in their drawings.



Part III: Exploring Myths and RealityExplain how the session on ‘Myths and Reality’ will help participants to question:

• Various myths about homosexuality and sexual orientation; and

• Their own views and those of their colleagues on the role of an individual in society.

Divide the participants into two groups, A and B. With the help of the Annexure 4 titled ‘Myths and Reality’ start by reading out ‘myths’ one by one and ask Group A whether they agree with it or not. Allow them to discuss it amongst themselves, and then ask a volunteer to share the responses of Group A. Now ask Group B whether they agree with the answer or not. Let them discuss it, and a volunteer from Group B can then give the answer.

After listing the responses from the two groups, read out what is the reality. Repeat the steps in the same way for rest of the myths in the list. After the exercise is over give the handouts Annexure 4 titled ‘Myths and Reality’ to the participants.

Part IV: Identifying My Values Explain how this session on values will help participants to understand what values are and how to differentiate between individual, family and spiritual values. Use the following exercise to explain this concept.

Discuss the term ‘values’ as below:

• ‘Value’ means something that has intrinsic merit, or is something that you rate highly (Webster Dictionary).

• Identifying one’s values helps one gain a true understanding of oneself, as values are reflected in one’s behavior on a day-to-day basis.

• Choices and decisions, such as one’s career path, relationships and even the way one is going to live in the future, are based on values.

Now mix the participants from different CBOs and make them sit in groups of four. Each group is asked to make a list of values that they identify with. Tell them that a simple way of identifying values is to think of ‘What is important to me/us?’

After they list their values, explain the different values such as: • Personal values: Self-respect, privacy, peace of mind, independence, obedience,

respect for elders, etc.

• Family values: Respect for elders in the family, family happiness, authority of parents, obedience of children, disciplining children, giving children a good education, etc.

• Work values: Exercising competency, professional ambition, etc.

• Career values: Personal growth, professional advancement, etc.

• Cultural values: Touching the feet of elders, covering one’s head in a temple, respecting one’s parents, etc.

At this point, ask them to categorise the values that they have written down under the five different types described above. Also, ask following questions to make the participants think introspectively:

• Are there any overlaps in the values presented?

• Have they listed values which can be put in some other category?

• Do personal values come out of family values? How do spiritual values fit into these categories? Should all of them be put together?

• Are there any common values that exist among all the participants? If so, what

Note to FacilitatorSome of the values that participants may list:

• Live interdependently with my partner.

• Respect and keep my spouse happy.

• Advance in my career.

• Earn money through ethical means.

• Gain knowledge.

• Care for my parents in their old age.

• Share my life with someone I love.

• Be independent.

• Respect elders.

If you discover that participants are finding it difficult to articulate values, ask them leading questions to trigger their ideas.

Note to FacilitatorIt is critical for participants to identify their own core values, as these are reflected in their day-to-day behaviour and in the decisions and choices that they make.


are they?

• What area in the values inventory did you find it hard to answer? Why?

• Do you think values are important? Are your values different from the values of your family?

Give each participant a printout of Annexure 5 titled ‘Some Things I May Value’ and discuss some of the terms therein. From the list, ask each participant to choose eight values that he/she already has and eight values that he/she would like to acquire.

Point out that value may change from time to time. Frequently a personal change of circumstance affects values. Explain that other people’s values can be understood by observing their behaviour; for example, when somebody stays in an abusive relationship, the choice that s/he makes might depend upon what value s/he puts on her/his own happiness and self-worth.

Discuss how the values held by a person determine the outcomes of a situation. For example, a victim in an abusive relationship whose sense of personal integrity is strong will be less tolerant of such a situation than one whose self-esteem is low, and the former is more likely to take steps to avoid or stop the abuse than the latter.

Part V: Understanding the Decision-making Process Explain how this session will help participants understand the process of decision-making and understand the steps involved in the process. (See box.)

Divide participants into eight small groups. Give each group a printout of one case study from the Annexure 6 titled ‘Decision-Making’, along with chart paper, and ask them to:

• Discuss the given scenario;

• Outline key steps to follow while taking a decision;

• Look at possible decisions that can be taken (there can be more than one decision); and

• Write it on a chart paper that can be then presented to the larger group.

Ask each group to share their findings. As they do so, emphasise the fact that life is full of challenges and the choices that one makes can have far-reaching consequences. Remind the participants that the choices people make are based on the values they hold, and it is useful to examine one’s own values critically in order to make informed decisions. Remind the participants that it is important to accept responsibility for actions they take.

Ask the participants to close their eyes and think for five minutes on the following:

• Decisions that have been made for me in the past: If I had been able to make the decision myself, would I make a different one?

• Decisions that I have made for myself: On what values did I base those decisions? Would I change those decisions? Do I have any regrets?

• Decisions that I will have to make in the future.

Ask them to also focus on the consequences of the choices they have made and will make in the future.

Note to FacilitatorThe decision making process should include most or all of the following steps:

1. Stop and think. Take a ‘time-out’ period to distance yourself from any emotional distress which the challenge may be causing.

2. Define the problem.

3. Think about the situation.

4. Seek advice from others.

5. Consider family values and personal values.

6. Consider cultural practices and religious beliefs.

7. Consider options or alternatives available.

8. Imagine the consequences and possible outcomes of each option.

9. Consider the impact of actions on other people.

10. Choose the best alternatives.

11. Make the decision.

12. Act on the decision.

13. Accept responsibility for your actions.


Activity 4: Behaviour and Assertiveness

Time 2 hours


• Learn about different types of behaviour and why assertive behaviour can be the best choice in any situation; and

• Learn how assertive behaviour leads to better self-esteem.

Materials N/A

Audio-visual Support Refer to the slides titled ‘Types of Behaviour’ from the PowerPoint presentation ‘Life Skills Education’.

Take-home Material Annexure 7 on ‘Types of Behaviour’.Annexure 8 on ‘Case Study’.Annexure 9 on ‘Asset Mapping’.

Methodology

Part I: Kinds of BehaviourUsing the PowerPoint slide titled ‘Types of Behaviour’ from the PowerPoint presentation ‘Life Skills Education’, explain the different types of behaviour which people generally display.

Passive BehaviourAn individual with passive behaviour does not protect his/her rights or needs and tends to get bullied and forced into situations s/he would not like. They avoid expression of opinions or feelings. Individuals with passive behaviour exhibit low self-esteem, exhibit poor eye contact and slumped body posture, and tend to speak softly or apologetically.

Passive-aggressive BehaviourAn individual with passive-aggressive behavior can seem passive/calm on the surface but are really acting out in a subtle, indirect way. They usually feel powerless, stuck and are quite resentful. They rarely confront the aggressor, and tend to work behind the scene and undermine by making snide remarks, and use sabotage or speak with sarcasm. They often smile and try to pacify the aggressor.

Aggressive BehaviourAn aggressive individual communicates in a way that violates the rights of others. This can be a result of low self-esteem, and such people can be verbally and/or physically abusive. Aggressive communication too is born of low self-esteem often caused by past physical or emotional abuse, unhealed emotional wounds, and/or feelings of powerlessness. Aggressive individuals display a low tolerance for frustration, use humiliation, interrupt frequently, and often criticize, blame or attack others.

Assertive BehaviourThis is the best type of behavior, and includes the ability to stand up for one’s legitimate rights without violating the rights of others. Assertive behaviour involves three categories of skills: self-affirmation, expressing positive feelings, and expressing negative feelings.




Distribute printouts of Annexure 7 titled ‘Types of Behaviour’ to participants for their reference. Now divide the participants into groups of four and give each group one of the Annexure 8 titled ‘Case Study’. Each study describes a scenario and is accompanied by a set of questions.

After 15 minutes of group discussion, ask each group to present their case and their answers to the questions in the case. Encourage discussions/opinions of others participants during this exercise.

Part II: Self-esteem or How Much Do I Value Myself?Introduce the topic of self-esteem. Explain how the session will help participants in:

• Understanding what is self esteem and the link between self esteem, assertive behaviour and good decision-making; and

• Recognising the qualities that they like most in themselves and the areas they would like to improve.

Explain that:

• Self esteem is the opinion one has about himself or herself;

• Everyone possesses self-esteem;

• Some people have high self-esteem and some people have low self-esteem;

• Many times it is easier for us to identify our negative points, which often leads to low self-esteem;

• Our self-esteem has an effect on our behaviour and the choices we make; and

• When we do not have a good opinion about ourselves, we can enter into a self-destructive phase in which we make the wrong choices.

Introduce the concept of asset-mapping. Mention to the participants that asset mapping here does not talk about material assets but about how we assess ourselves and our qualities as individuals. Give each participant a printout of Annexure 9 titled ‘Asset Mapping’ and ask them to fill it out.

After they have duly filled their sheets, ask a few participants to share their findings. As they do so, ensure that you and the other participants listen attentively, and appreciate their assets. Point out that assets are not static – people evolve and change – and with these changes come new assets and enhancement of existing assets takes place. Ask the participants to keep this list with themselves and look at it a year later to assess their own personal growth.


Activity 5: Wrap-up

Time 30 minutes

Learning Outcomes At the end of this activity, the participants will:

• Summarise the various concepts they have learnt throughout the training session.

Materials N/A



Methodology Remind participants of the common challenges faced by the MTH community when it comes to personal development, especially with regard to their sexual and reproductive health but also in respect to other aspects of their lives.

Ask them to reflect on skills that each of them needs to sharpen to deal with challenges. Remind participants that life skills are acquired and honed by facing life’s experiences, coupled with continual reflection on one’s thoughts, feelings and actions. If time permits, select some of the situations and experiences discussed during the day and conduct role-plays where participants enact skills such as decision-making, assertive behavior, and effective communication.


Annexure 1: Life Skills Education

Life Skills are:• Psychosocial competencies and interpersonal skills that help people in taking

informed decisions, think critically and communicate effectively; and

• Abilities for adaptive and positive behaviour that enable individuals to deal effectively with the demands and challenges of everyday life.2

Life Skills Commandments • Life skills are essentially those abilities that help promote overall well-being and

competence.

• Life skills are the beginning of wisdom which focuses on behavioural change.

• Life skills enable individuals to translate knowledge, attitude and values into actual abilities, that is, what to do and how to do it, given the scope and opportunity to do so.

• Effective acquisition and application of life skills can influence the way one feels about others, ourselves and will equally influence the way we are perceived by others. It contributes to perception of self-confidence and self-esteem.

• We all use life skills in different situations such as:

• To negotiate effectively at home, school or work place, we need to have thinking skills as well as social skills; and

• When faced with difficult situations we tend to think critically, to analyze all the pros and cons of the situation, to think out of box, and to find a solution to seemingly difficult problems.

2 As defined by the World Health Organization


Annexure 2: Words I Can Use to Describe Myself

Able Dependable Intelligent Patient Sensible

Accepting Dignified Introverted Powerful Sentimental

Adaptable Energetic Kind Proud Shy

Bold Extroverted Knowledgeable Quiet Silly

Brave Friendly Logical Reflective Smart

Calm Giving Loving Relaxed Spontaneous

Caring Happy Mature Religious Sympathetic

Cheerful Helpful Modest Responsive Tense

Clever Idealistic Nervous Searching Trustworthy

Complex Independent Observant Self-assertive Warm

Confident Ingenious Organized Self-conscious Wise/Witty


Annexure 3: Johari Window Exercise

Known to Self Not Known to Self

KNOWN TO OTHERS

OPEN BLIND SPOT

NOT KNOWN TO OTHERS

HIDDEN UNKNOWN


Annexure 4: Myths and Reality

Myth Reality

All homosexuals take up professions pertaining to music, dance, and fashion designing.

Not true. The reality is that homosexual men and women have varied interests and enjoy doing a lot of things, and one of them could be in the field of music, dance, and fashion designing. These misconceptions stem from the stereotypes that have been created around these particular areas.

Homosexuality is a choice; people either chose to be homosexuals or heterosexuals or bisexuals.

There have been many scientific studies on this matter. The truth is that no one knows what causes homosexuality. We can guess at what it is by talking about chemicals in the brain. This also speaks to those who claim to be able to cure homosexuality. That’s like saying you can cure someone from liking the colour blue or the taste of chocolate.

AIDS is a disease that gay people get.

Untrue. Anyone who has unprotected sex of any kind is at risk for HIV if they are unaware of their partner’s sexual history.

All hijras would like to be addressed and categorised as women.

Untrue. The current social movement is to have the category Others along with man and woman. Many hijras have no desire to change their gender. Though some have undergone hormone treatments and sex reassignment surgery, they would still like to be called hijras instead of women.

All gay men are promiscuous. Untrue. This is a common misconception that men in homosexual relations are promiscuous. They, like any other individual in a relationship, are sexually active. Like most individuals in society they too enjoy and cherish a loving, caring and nurturing relationship.

Being gay is a lifestyle choice. Untrue. Most gay people have said that they were born with their sexual orientation. And there is limited support to theories that suggest that homosexuals can be turned straight. Accepting the fact that your sexual orientation is the first step to understanding yourself and recognizing the fact that it is not a lifestyle choice but an intrinsic part of who you are.

Lesbians try to replicate the man-woman aspect of heterosexual relationships.

In a female to female relationship, there might be some woman who may portray masculine characteristics, but outward appearance is never indicative of your personality or characteristics.

The preconceived notion of butch-femme relationship is usually based on heteronormativity, i.e., the view that being straight is normal and other forms of sexuality are imitations of heterosexuality. Lesbian relationships are not an imitation of anything; being a lesbian is a unique way of representing sexuality without the preconception of what is so called normal.


Annexure 5: Decision-making

Scenario I

You are a seventeen year old boy and recently you have befriended a young boy of eleven, who seems to really like you. This young friend would really like to explore his relationship with you and has invited you to his house, as his parents are away on a vacation and the house is completely empty.

What should you do?

Scenario II

You are a 25 year old young gay man, and your parents would like you to marry early and bring home a bride.

What should you do?

Scenario III

You are madly in love with your boyfriend, but he seems to hardly care as he is in multiple relationships. You have had a lot of fights and your boyfriend has been physically abusive, and many a times you have been bruised in these violent encounters.

What should you do?

Scenario IV

You are a 20 year-old boy working in a bar. Recently there have been many organizations that have been visiting your bar and discussing about HIV and AIDS and you have been thinking a lot about AIDS. You think that your past experiences may have put you at risk to be HIV positive, but you are afraid to find out for sure. A close friend has suggested that you get an HIV test.

What should you do?

Scenario V

Your small NGO has been working in the field for the rights and dignity of lesbians/gays/bisexuals and transgendered (TGs), and has been struggling to acquire the necessary certificates for providing tax exemption. During a meeting with the official of the tax department, you were abused and refused certificate on the grounds that your work is ‘sinful’ and not for the benefit of society.

What should you do?

Scenario VI

You have gone for a job interview, and you fulfill the eligibility criteria. However during the interview process, the panel of interviewers make it clear that they would not offer you the job as you are effeminate and that would disrupt the office atmosphere.

What should you do?

Scenario VII

You are a married gay man, and you are yet to reveal your homosexuality to your wife. Your wife does not like the fact that you are so interested in her personal belongings and has been very angry that when she found out that you’ve been borrowing her clothes and jewellery.

What should you do?

Scenario VIII

You are a 20 year-old man and your parents died a year ago, and now there is no one to pay for your final year in college. A rich man has been kind to you and has offered to support you and wants to be in a relationship with you.

What should you do?


Annexure 6: Types of Behaviour

1. Passivea. Denies feelings, does nothing, feels hurt/frustrated but keeps quiet

b. Allows others to choose and listens to others

c. Does not achieve a goal

2. Aggressive a. Tends to be loud

b. Denies feelings and rights of others

c. Chooses for others

d. Achieve goals at the expense of others

3. Passive-aggressivea. Alternates between passive and aggressive

b. Causes anger and confusion in others

4. Assertive a. Accepts own feelings; feels good about self

b. Makes sure that his/her feelings are heard

c. Chooses for self

d. May achieve a goal (It is important to acknowledge the ‘may’ part. You may not always get your way or resolve your conflict, but you will feel better having expressed your feelings.)

Components of Assertive BehaviourThere is a need to believe in yourself, because if you do then you not only consider your feeling but you also consider the recipients feelings.

Some of the key characteristics of assertive behaviour include:

• Eye contact: Look directly at the other person when you are speaking. This communicates that you are sincere about what you are saying, and that it is directed to that individual.

• Body posture: The seriousness of your messages to others will increase if you face the person, stand or sit appropriately close, lean towards the person, and hold your head erect. Do not use your hand or point your fingers as this is threatening.

• Facial expression: Effective assertions require an expression that agrees with the message. Do not smile while stating how angry you are. Conversely, do not say you are not upset, when your face expresses that you are displeased.


• Voice tone, inflection, volume: A level, well-modulated conversational statement is convincing without being intimidating. A whispered monotone seldom convinces another person that you mean business, whereas shouting increases the recipient’s defences.

• Timing: Spontaneous expression will generally be your goal, since hesitation may diminish the effect of an assertion. Judgment is necessary, however, to select an appropriate occasion. For example, you need to speak to your boss in the privacy of an office, rather than in front of a group of people where your boss may respond defensively.

• Content: What you say is important, though it often is less important than most of us generally believe. People who have for years hesitated because they ‘didn’t know what to say’ have found the practice of saying something to express their feelings at the time to be a valuable step toward greater spontaneous assertiveness. Be sure to express your own feelings and to accept responsibility for them. It is not necessary to put the other person down (aggressive) in order to express your feelings (assertive). Become aware of inflammatory words and avoid using them.

Please keep in mind that assertiveness is a choice and is the best choice.


Annexure 7 : Case Study

Case Study IRaj’s partner was a very loving man. However sometimes when he was frustrated he would slap and beat Raj. But then when he realizes what he did, he would come and apologize to Raj and beg Raj to forgive him. He would shower Raj with gifts and flowers and be the most wonderful and passionate person. Raj had been hospitalized many times due to his partner’s beating.

Questions1. What kind of behaviour does Raj’s partner show?

2. Is this common? And what do people do when they are in similar situation?

3. What should be the outcome of situation?

4. What should Raj do?

5. What should the partner do?

Case Study IISaniya Hijra landed a job in a bar, and in just one week the Supervisor attacked her for not doing something that he wanted her to do. Saniya unable to respond went and cried in front of her friends. Subsequently, the Supervisor began waiting for opportunities to get hold of Saniya and abuse her. Nowadays Saniya tries to get out of the way and avoid the Supervisor, as she does not know what his response is going to be.

Questions1. What kind of behaviour does Saniya Hijra show?

2. Is this common? And what do people do when they are in a similar situation?

3. What should be the outcome of the situation?

4. What should Saniya do?

5. What are the key steps to be taken when you are in a workplace situation?


Case Study IIIYou are visiting a hospital and you have been sitting, waiting to meet the doctor for quite a while. However, patients who have come after you are checked by the doctor, while the doctor has been ignoring you. When you meet the doctor, he curtly and rudely tells you that he does not have time and asks you to go and show your problem to somebody else.

Questions1. What kind of behaviour does the doctor show?



4. What should you do?

5. What are the key steps one should take when they are in a similar situation?

Case Study IVYou are travelling in a bus and there is a rush. A male fellow passenger sitting beside you is smoking and blowing the smoke towards you. He has also been rubbing against you and making obscene gestures, trying to attract your attention.

Questions1. What kind of behaviour does this fellow passenger show?



4. What would you do?

5. What are the key steps one should take when they are in a similar situation?


Annexure 8: Asset MappingAsset mapping is a way to identify the strengths that you have at your disposal. It is also an excellent way to shift the focus away from what you do not have and place greater attention on what you do have.

Answer the following questions with as many answers as you can.

1. (Mind) What are your gifts of the mind? Example: good listening skills, creative, analytical, etc...

2. (Emotions) What are your gifts of the heart? Example: compassionate, empathetic, tolerant, etc…

3. (Body) What are your gifts of the hand? Example: practical skills like driving, writing, etc…

4. (Spirit) What are your gifts of the spirit? Example: things you have faith in; family, friends, spiritual connect with God, etc…

5. What are your areas of interest? Example: dancing, listening to music, art, etc…


6. What are you passionate about? Example: helping others, working, making friends, dancing…Note: a passion can be anything that you feel really excited about. It is important to note that a passion may be something that you struggle with or are not able to do. This is okay.

7. What are some of your most powerful relationships? Example: relationship with my partner, my boss, my community member, etc…

You have just identified your core strengths and interests. This is healthy self-esteem. Let’s make this a daily thing!


Annexure 9: PowerPoint Presentation – Life Skills Education








population status.








module

C

module

A

module

C

module

D




module



C2 Family Support

C3 Mental Health





D3 Positive Living





D6 L

ife S

kills

Edu

catio

n