title: Empowering communities and strengthening systems to improve transgender health: outcomes from the Pehchan programme in India.
abstract: Transgender populations face inequalities in access to HIV, health and social services. In addition, there is limited documentation of models for providing appropriately tailored services and social support for transgender populations in low- and middle-income countries. This paper presents outcomes of the Global Fund-supported Pehchan programme, which aimed to strengthen community systems and provide HIV, health, legal and social services to transgender communities across 18 Indian states through a rights-based empowerment approach.
  
  
  
  We used a pre- and post-intervention cross-sectional survey design with retrospective analysis of programmatic data. Using stratified sampling, we identified 268 transgender participants in six Indian states from a total of 48,280 transgender people served by Pehchan through 186 community-based organizations. We quantified the impact of interventions by comparing baseline and end line indicators of accessed health social and legal services. We also assessed end line self-efficacy and collective action with regard to social support networks.
  
  
  
  There were significant increases in community-based demand and use of tailored health, legal, social and psychological services over the time of the Pehchan programme. We report significant increases in access to condoms (12.5%, p<0.001) and condom use at last anal sex with both regular (18.1%, p<0.001) and casual (8.1%, p<0.001) male partners. Access to HIV outreach education and testing and counselling services significantly increased (20.10%, p<0.001; 33.7%, p<0.001). In addition, significant increases in access to emergency crisis response (19.7%, p<0.001), legal support (26.8%, p<0.001) and mental health services (33.0%, p<0.001) were identified. Finally, we note that the Pehchan programme successfully provided a platform for the formation, collectivization and visibility of peer support groups.
  
  
  
  The Pehchan programme's community involvement, rights-based collectivization and gender-affirming approaches significantly improved both demand and access to tailored HIV, health and social services for transgender individuals across India. Furthermore, the Pehchan programme successfully fostered both self-efficacy and collective identity and served as a model for addressing the unique health needs of transgender communities. Continued strengthening of health, social and community systems to better respond to the unique needs of transgender communities is needed in order to sustain these gains.
authors.affiliation: India HIV/AIDS Alliance, New Delhi, India; sshaikh@allianceindia.org.
authors.forename: Simran
authors.initials: S
authors.lastname: Shaikh
authors.affiliation: International HIV/AIDS Alliance, Brighton, UK.|Department of Health Research, Lancaster University, Lancaster, UK.
authors.forename: Gitau
authors.initials: G
authors.lastname: Mburu
authors.affiliation: India HIV/AIDS Alliance, New Delhi, India.
authors.forename: Viswanathan
authors.initials: V
authors.lastname: Arumugam
authors.affiliation: India HIV/AIDS Alliance, New Delhi, India.
authors.forename: Naveen
authors.initials: N
authors.lastname: Mattipalli
authors.affiliation: India HIV/AIDS Alliance, New Delhi, India.
authors.forename: Abhina
authors.initials: A
authors.lastname: Aher
authors.affiliation: India HIV/AIDS Alliance, New Delhi, India.
authors.forename: Sonal
authors.initials: S
authors.lastname: Mehta
authors.affiliation: India HIV/AIDS Alliance, New Delhi, India.
authors.forename: James
authors.initials: J
authors.lastname: Robertson
mesh_terms: D000328:Adult; D017280:Condoms / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D005260:Female; D005783:Gender Identity; D015658:HIV Infections / Q000517:prevention & control / Q000628:therapy; D006297:Health Services Accessibility; D006801:Humans; D007194:India; D008297:Male; D001523:Mental Disorders / Q000628:therapy; D009313:National Health Programs; D012189:Retrospective Studies; D021841:Safe Sex / Q000706:statistics & numerical data; D012725:Sexual Behavior; D012747:Sexual Partners; D012944:Social Support; D012959:Socioeconomic Factors; D063106:Transgender Persons / Q000523:psychology
keywords: Community; HIV; Hijra; India; Transgender