RENU APPACHU

India,

Renu Appachu's sexual health clinics target men who are key to the spread of sexually transmitted diseases.

This profile below was prepared when Renu Appachu was elected to the Ashoka Fellowship in 2003.

Fellow Sketch

Renu Appachu has been developing models to improve the health and well-being of sex-workers. 

She began her journey by  leveraging sex-workers to engage and influence the behaviour of men to follow safe sexual practices. Sex workers acted as “role models’ and brought their partners to clinics set up in nearby areas. Non-judgemental information about male sexual health, open discussions on sexuality and counseling helped build trust with a wide community, including transexual and trasngender minorities. Today, she continues to conduct workshops and provide medical facilities, counseling and sex education. Renu also conducted a 6 month program providing awareness and medical services in prisons to reduce the spread of sexual diseases owing to higher incidence of men having sex with men due to enclosed living and work environments. 

Her engagement with sex workers showed her the need to create solutions for young girls being trafficked. In response, she started rescuing and rehabilitating them, providing home care for those who wanted to get out of this work and find alternate livelihoods. The Jagruthi staff provided counseling to overcome trauma to the children, once they were brought to the home. They also create unique Individual Intervention Plans reflecting the child’s needs, interests, aptitude, planning a skill development plan in line with their future development. These young girls eventually decide whether they want to live independently or reintegrate with their families.

Note: This was updated in February, 2014. Read on for the ELECTION profile

INTRODUCTION

Renu Appachu's sexual health clinics target men who are key to the spread of sexually transmitted diseases.




THE NEW IDEA

Convinced that men can make a difference in controlling the spread of sexually transmitted diseases and HIV/AIDS by being responsible for their own sexual health, Renu is setting up sexual health clinics in strategic locations to turn transmitters of disease into healthy people. "Role models" bring in their sex partners and clients to these clinics. By providing a place where they can obtain nonjudgmental information about male sexual health, Renu has established trust with the closed community of men who have sex with men (MSMs), transsexuals, transgenders, and transvestites.

In enclosed living and work environments, like prisons, group homes, the hotel industry, and male-dominated corporations, there tends to be a higher incidence of men having sex with other men. To address this issue, she is providing awareness programs and medical facilities to corporate and industry workers.

Renu is in close contact with the male sex workers network in the country, as well as with organizations of men who have sex with men, transsexuals, transgenders, and transvestites. She and her peer counselors are invited to these communities' festivities and gatherings. During this time they disseminate information about sexuality, sexual health, clinical facilities, and counseling.




THE PROBLEM

It is estimated that by 2010, 25 million Indians are going to be HIV-positive. Such numbers would make India the AIDS capital of Asia. At present, the number of men infected with HIV/AIDS and sexually transmitted diseases is three times that of women. On the surface, the culture in India is sexually conservative with great taboos on sex and sexuality. However, a well-networked society exists that does indulge in "alternative" sex and pornography. Most men who have sex with men lead dual lives–in public, they are married men with children, but secretly they prefer male sex partners. Many live their secret lives through a network of commercial sex workers or partners.

In India, men enjoy great power and exercise it in health-related, reproductive, and sexual decisions. It is almost impossible for a woman, wife, or sex worker to negotiate for a condom in the bedroom. When men have multiple sex partners they put all partners at risk.

In five years of experiences with this community, Renu has found that many commercial sex workers were sexually abused as boys, some as young as 8. Lacking experience and training for other trades, these young males get caught in the vicious circle of sex work.

MSMs, transvestites, transgenders, and transsexuals are the most socially marginalized. They are unable to find healthcare, and they are not willing to go to hospitals. Thus they are underserved and their sexual health remains ignored, leading to high incidence of STDs and HIV.




THE STRATEGY

Jagruthi, Renu's organization, provides counseling services for this population. She has created a comfortable, nonjudgmental atmosphere in her office and offers health services and advice for health-related decisions.

For Jagruthi clients who lack other trade skills, Renu and her team provide a nurturing environment to help them build self-esteem and self-confidence. Jagruthi's personal-development program (PDP) inculcates skills to pursue safer livelihoods. Staff members offer training in various marketable skills, like writing, communication, graphic design, office administration, teamwork, and time and financial management. Their training and encouragement gives their clients the confidence and the necessary preparation to earn a livelihood outside of the sex industry.

Renu's team works in the field to meet the men in their area of operation, to build rapport and gradually gain their trust. Subsequently, they provide information on sexual health and behavior. This intervention includes education about safe sex practices and condom use. The field staff disseminate information and motivate MSMs to take advantage of the available services. Jagruthi approaches the broader community through a network of peers. Renu also works to bring members of the community into Jagruthi as staff to maintain that high level of trust and understanding. Clients can be trained as peer educators and counselors and thus become the primary point of contact for educating other men.

A high percentage of MSMs are sex workers. Jagruthi encourages them to take advantage of the clinics' sexual health and medical services. Once they see the health and care benefits that Jagruthi has to offer, they often advocate to their clients to take advantage of the same services. Renu now trains trainers among peer educators and counselors to increase the number of men they reach.

Renu is also generating awareness at the school and college level. Realizing that most young boys are victimized between the ages of 8 and 13, she is working with schools to help children learn to distinguish between "good touch" and "bad touch." With permission from the concerned authorities, she is setting up shop outside colleges to provide relevant counseling and to spread sexual awareness among students. Similarly, she also works with men who live or work in close quarters and enclosed environments: prisons, hotels, quarries, and slums. Her intervention aims to prevent victimization of young boys and unhealthy exploitation and experimentation.

At general hospitals and clinics, Renu is influencing the management and doctors to focus on men's sexual health. As of now, hospitals and clinics only have testing centers; they deal with other problems generically. She is also establishing programs to educate doctors and NGOs to the importance of men's sexual health.

Her close association with the Rotary Club, the Rajamahal Vilas extension, has resulted in involving other Rotary Clubs to conduct awareness programs in their respective areas so that they will be able to spread the message of prevention of HIV/AIDS.




THE PERSON

Although Renu is a member of the a warrior clan came from Coorg-Kodava, a territory in Karnataka, she was always uncomfortable with the hunting of animals. As the oldest of four sisters and a brother, she took on great responsibility for her family. Educated in convents in Coorg, Mysore, and Bangalore she habitually shared her food and clothing with the less-privileged children and persons. While in College, she supported five of her classmates with their education.

When she lost her father in 1975, she took on the responsibility of lending emotional support to her mother and was a guiding force for her brother. She also partnered in setting up the SIL Mirror Industry and transformed it into a successful business. She partnered with one of her sisters in the venture. Though her background is entrepreneurial, her heart was always in working with the underprivileged. While on one of her business trips to Calcutta she happened to meet Mother Theresa who advised her to work with the downtrodden and needy.

Upon her return to Bangalore, Renu handed the reins of the business to others and volunteered to work with a home for the aged. In 1993 she joined Samraksha and headed their education program, working with the Bangalore prison system, as well as various vocational training centers for impoverished men and women. In 1995 she founded an organization called Jagruthi. The organization has a holistic approach of working with children, women, and men in the area of health, education, environment, and infrastructure development.

Renu's work with sexually marginalized communities is rooted in Jagruthi. People there are comfortable with her, and she often participates and presides over many of their formal functions.