Madras Medical College, Chennai, India
Indian Network for People living with HIV AIDS
The Humsafar Trust
Centre for Sexuality and Health Research and Policy (C-SHaRP)
Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
In 1998, for my MD (postgraduate medical) degree, I joined the Institute of Venereology, Madras Medical College, Chennai. As my Institute was a referral centre for sexually transmitted diseases (STD) and HIV, I came across many sexual and gender minority persons and sex workers. I soon realised that their health is not only influenced by their individual risk behaviours, but also by the attitudes of health care providers and the Indian laws that essentially criminalised their behaviours. I believed that research evidence can bring changes in health policy and practice to improve the health of these marginalised communities. Hence, I started conducting small scale studies among the STD clinic attendees and presented in national conferences.
After completion of my MD course, in April 2001, I initiated a free STD clinic in a community-based organisation (Social Welfare Association for Men) that worked with sexual minorities. In 2002, when I was with SAATHII, I received a competitive scholarship from La Trobe University, Australia, to attend a one-week course on ‘Research Design in Qualitative Social Inquiry’. This resulted in a collaboration with La Trobe’s faculty to conduct a systematic literature review on sexual networks and HIV risk among men who have sex with men and transgender women in India.
In 2003, I was awarded an NIH Fogarty Fellowship by Yale University and I was trained on research methodology for 4 months during 2003/04. This fellowship led to collaborative projects and publications with Prof. Dr. Robert Dubrow and Prof. Dr. Trace Kershaw of Yale School of Public Health, and the collaborations continue to the present. In 2003, I was also awarded the Fund for Leadership Development Fellowship by the John D. and Catherine T. MacArthur Foundation, which supported my two-year project to train health care providers on health issues of sexual minorities in India (See www.indianLGBThealth.info).
From 2003, I also started conducting applied and policy-oriented HIV-related health research among people living with HIV, sexual minorities, female sex workers and injecting drug users. These studies were conducted primarily in collaboration with local community-based organisations led by these marginalised communities (e.g., Indian Network for People living with HIV, SWAM, Sahodaran, and the Humsafar Trust in Mumbai, India’s first community organisation led by gay men). In 2006/07, my research projects submitted through Indian Network for People living with HIV and the Humsafar Trust were funded by DFID (UK Aid), among others.
From 2005 onwards, my research collaborations with Dr. Peter A Newman, Professor and Canada Research Chair in Health & Social Justice, University of Toronto, began and they continue to the present. Those studies primarily focus on acceptability of new HIV prevention technologies (NPTs), such as pre-exposure HIV prophylaxis and rectal microbicides, among sexual and gender minorities. Through designing and implementing projects on HIV vaccine preparedness and acceptability of NPTs, I have learned new ways of conceptualising qualitative data (e.g., mental models) and new statistical methods such as discrete choice experiments.
In 2011, I and two other professionals, co-founded a not-for-profit research agency called Centre for Sexuality and Health Research and Policy (C-SHaRP), which provides sustained contributions to health-related policies and programmes for sexual and gender minorities in India (See www.c-sharp.in).
Over the past decade, through collaborative research with community agencies working with sexual and gender minority communities in various parts of India (funded by agencies such as Indian Council of Medical Research and the Canadian Institutes of Health Research), I and my research colleagues have:
- documented high levels of HIV-related sexual risk and psychosocial health problems (depression, problematic alcohol use and violence victimisation)
- documented the presence of inequities in health care access and use, i.e., barriers among MSM and trans people in accessing free HIV testing and free antiretroviral treatment in public hospitals
- provided empirical evidence that increased HIV vulnerability/risk is primarily due to sexual and gender minority stigma, HIV-related stigma, discrimination and violence
- demonstrated the presence of syndemics (mutually reinforcing health problems) and provided preliminary evidence for an association between syndemic burden and HIV risk.
These studies (please see the list of publications for more details) naturally led to my proposed five-year research project funded by the Wellcome Trust/DBT India Alliance. My project focuses on how syndemics are produced among sexual and gender minorities in India (See the Diagram), whether syndemics can explain health inequalities, and whether syndemically-oriented interventions can reduce HIV risk. This project is implemented under the guidance of Dr. Rajesh Kumar, Professor and Head, Department of Community Medicine and School of Public Health, PGIMER. Prof. Dr. Peter A Newman, University of Toronto, is my international mentor for this project.
Based on my research’s policy and programme contributions, I have been involved in several national level Technical Resource Groups (TRGs), including National AIDS Control Organisation’s TRGs on trans people and men who have sex with men. In 2014/15, I contributed to a national policy document on trans people as a member of the ‘Expert Committee on Transgender People’ established by the Ministry of Social Justice and Empowerment. Through these links with government departments and community engagement, research evidence from my proposed project will most likely be translated into action.