Ensuring health, nutrition and justice for marginalised women and girls in the COVID-19 response

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Ration being distributed at Sunder Nagari, New Delhi with support from Alliance India and United Religions Initiative (URI).

Ration being distributed at Sunder Nagari, New Delhi with support from Alliance India and United Religions Initiative (URI).

In India out of the 8, 50,000 people who inject drugs (PWID), more than 80% of them were found to be sexually active with their female sex partners (FSP). Of these, nearly 70% of PWID have regular female sex partner. A regular sex partner is defined as a spouse or a girlfriend of a PWID in a steady relationship. However, with negligible condom use of 15.9% (Integrated Biological and Behavioural Surveillance (IBBS) 2014-15), the risk of transmission of HIV, HCV as well as other sexually transmitted infections (STIs) to these vulnerable females or FSP is very high.

In the context of the COVID-19 pandemic, the virus does not discriminate, and marginalized FSPs who may not be considered a real priority become extremely vulnerable. In India, like elsewhere else, demographic data from hot spots and states is informing policy decisions and clinical research strategies. Women and men are affected by COVID-19, but biology and gender norms are shaping the disease burden. The success of the response—the ability of both women and men to survive and recover from the pandemic’s effects—will depend on the quality of evidence informing the response and the extent to which data represents sex and gender differentials.

Further; women carry a different kind of burden from COVID-19. Inequities are disproportionately affecting their wellbeing and economic resilience during lockdowns. Even during these times, households are under strain, but child care, elderly care, and housework typically fall on women. Concerns over increased domestic violence are growing. With health and social welfare services overstretched and under-resourced, women’s health services – includes especially sexual and reproductive health, mental health, drug use – especially linked with marginalized at-risk women and girls become disrupted. This has an adverse impact on their access to food, nutrition, even sanitary napkins.

In response to the above, Alliance India continues to consistently demonstrate and promote models of public health and community-led responses to leverage intersectional, human-rights centered frameworks, transdisciplinary science-driven methods, and community-driven approaches to sufficiently prevent complex health and social adversities for women, girls, and vulnerable populations. Through an ongoing pilot intervention for over 400 FSPs in east Delhi’s Sundar Nagari, being implemented in partnership with the Delhi State AIDS Control Society and the Bhartiya Parivartan Sansthan; Alliance India continues to support this approach to COVID-19. Since special measures are required, Alliance India reached out to the United Religions Initiative (URI) to mobilize grocery items, vegetables, and sanitary napkins for over 220 female sex partners and people who inject drugs. The supplies included a monthly kit each containing rice, flour, cooking oil, pulses, salt, sugar, spices, and vegetables, on 16th and 18th April 2020. Alliance India arranged for the distribution of these materials, thanks to the support from the leadership and staff of the Bhartiya Parivartan Sansthan who continue to relentlessly work for the community even during the lockdown.

In the past month, since the imposition of the national lockdown, we have learnt that even rigorous implementation of science-driven approaches might not match the pace of COVID-19 threats in the face of reduced human capacity, shortages of food, drugs and supplies, and increased demands on already strained sexual and women-friendly health and HIV prevention services. For clinical services and programmes, Alliance India is advocating for additional resources to be directed to, not diverted from, the HIV prevention, harm reduction, sexual and reproductive health workforce so that effective, evidence-based approaches are deployed.

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