Moonlight clinics — taking HIV treatment to those who live in the shadows

Every evening at 5 pm, Shivam Dwivedi sets out in a van along with a technician, consent book, test kits, referral slips and condoms to locations in Delhi and its outskirts that are hubs for transgender and other such “discreet” communities.

Shivam is on a “moonlight” clinic mission where counsellors speak to people gathered there and encourage them to get tested for HIV and start treatment depending on the outcome. An outreach counsellor with AIDS Healthcare Foundation (AHF), Shivam explains that their clinics are out on the road everyday except Sunday and are open till 9.30 pm.

Twilight provides the perfect cover for people to step out of the shadows as they feel comfortable to take a test and counselling, if required.

Such “friendly” clinics that reach out to people who may be HIV positive are important because many of them are nervous to come to a hospital, says Dr V Sam Prasad, AHF’s Country Program Manager, pointing to the discrimination that communities like transgenders or migrant labourers face. Transgenders live in the shadows and face a double stigma when a positive person is also transgender, he says. The HIV prevalence is sometimes as high as about 8 of the 100 transgenders tested, he points out.

As a practising doctor, Sam says, the transgender community faces difficulties in accessing healthcare facilities, which is why they seek “safe spaces” where the doctors understand them and the fluidity of their gender. It requires special skills to understand their gender orientation. “If you are not able to make them comfortable, they hide details from you,” he says.

They are a community in transition in search of an identity, sometimes referred to as transgenders and at other times as a third gender, says Sam. Getting a clear identity brings with it entitlements, including healthcare. And out of this effort to get healthcare across to the community was born the “moonlight” project.

It is important in addressing these communities living in the shadows and staying away from hospitals because treating a positive person ensures up to 97 per cent that HIV is not transmitted.

The mission is to treat as many people as possible with a global target of 20 million people by 2020, says Manvendra Singh Gohil, popular as ‘India’s gay prince’ and AHF’s Goodwilll Ambassador. “India has the third highest LGBT community and as an activist, I wanted to create as much visibility for the cause,” says Manvendra, stressing the need to reach out to hidden populations.

AHF’s moonlight clinics are in Delhi and Mumbai but it has partners in 13 other high-prevalence States. There are emerging states like Punjab because of the drug-use and infected needles and Surat that has high volumes of migrant population, he adds.

For “discreet” communities like transgenders, the targeted intervention through moonlight clinics ensure there are no delays between the testing and treating, says Manvendra. “People now come voluntarily to these clinics and we are forced to shut at 9.30 pm, despite more people coming in,” he says, a testimony to how “friendly” clinics are getting more people to step out of the shadows and take treatment.

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