Making HIV Care Accessible

A counselor interacts with a client at TAAL+, an integrated health center that provides high-quality and affordable HIV care. (Photograph by Anita Khemka, consultant photographer, EpiC India)

Namrata Wadkar (name changed), a 48-year-old resident of Aurangabad, Maharashtra, was on antiretroviral therapy (ART) since 2012. In 2020, she started having severe joint pain that continued to grow. She visited the U.S. Agency for International Development (USAID)-supported TAAL+ clinic where she was advised a bone density scan. It revealed ART-induced severe osteoporosis, which mimics bone cancer characteristics in laboratory tests. Slight changes in her medical regime and a six-month course of injections to increase bone strength helped her get back on her feet. “I can now do all my daily chores without any assistance,” she says. “The right diagnosis and advice by TAAL+ improved the quality of my life.”

Peer-led intervention

TAAL (Treatment, Adherence, Advocacy and Literacy) was launched in 2006, as a peer-led community pharmacy to provide high-quality and affordable HIV diagnostics, treatment and peer counseling services to people living with HIV. In 2020, with support from USAID, TAAL transitioned from a community pharmacy to TAAL+, an integrated health center. It launched an e-pharmacy in February 2023.

“We have continued to expand our mandate to promote person-centric, integrated and sustainable health platforms through our partnership with TAAL+, catering to emerging needs of clients for diagnosis and referral for mental health, noncommunicable diseases, co-infections like tuberculosis, hepatitis B & C, and access to prevention tools like pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis through engagement with private sector health care providers,” says Deepika Joshi, USAID’s HIV division chief in India.

Stronger online presence

The first TAAL community pharmacy was established in January 2006, in Pune, by the Network of Maharashtra by People Living with HIV/AIDS (NMP+). “TAAL grew out of a movement that began in 1997 when seven friends who were HIV positive came together to support one another,” says Manoj Pardeshi, founder of TAAL and NMP+. Since then, the network has grown to nearly half a million people, providing a safe space by ensuring privacy and confidentiality.

“In 2021, discussions started with FHI 360 [a nonprofit human development organization] and USAID to increase accessibility, affordability and quality of HIV, hepatitis and mental health services, and help more patients get therapy,” says Manoj Pardeshi, founder of TAAL and NMP+. TAAL+ has wholesale, retail, export-import licenses and is a government-approved vaccine center.

Building on its successful efforts, the TAAL+ e-pharmacy was launched with support from PEPFAR, the U.S. President’s Emergency Plan for AIDS Relief. “To me, this approach embodies the best of our countries’ values. India’s strong, plural and supportive community-driven solutions, and the American desire for self-reliance and innovation,” said Michael Hankey, U.S. Consul General, Mumbai, at the launch of the TAAL+ e-pharmacy.

TAAL+ aims to expand its online platform to “increase the quality of services, develop online sales platforms and multiply the client base toward self-sustainable social enterprise and further scale up,” says Pardeshi.

The TAAL+ e-pharmacy was launched in February 2023, with support from PEPFAR. (Photograph by Anita Khemka, consultant photographer, EpiC India)

Care and support

Drugs for a month’s ART treatment can cost between Rs. 1,200 and Rs. 5,000 at pharmacies. However, Emcure Pharmaceuticals, pharma partner for TAAL+, provides them for around Rs. 360. “We have strong partnerships with major Indian pharmaceutical companies through which we access medicines at low costs, and this is the benefit we pass on to our clients,” adds Pardeshi.

USAID-supported projects like EpiC and ACCELERATE have provided zero-return capital to help build the enterprise. TAAL+ has also received support from the National AIDS Control Organization, State AIDS Prevention and Control Societies, community-based organizations run by and serving people living with HIV/AIDS, and physicians.

The TAAL+ model, however, is not just about selling medicines. “It is about playing the role of friend and guide who has walked this journey before,” says Pardeshi. “When managing a lifelong health condition, swallowing pills is not enough. Our business is unique because it is holistic, addressing the whole person, including issues of discrimination and stigma that may be limiting access to care in other settings.”

This is the kind of support Sheetal Bajwa (name changed), a 32-year-old transwoman, needs. She received peer counseling and treatment at TAAL+. “The medical staff also considered my hormone therapy and my skin complexion, which is very important in our professional work while choosing the treatment plan,” she says. She has been associated with TAAL+ for nine months and is getting healthier. “I gained the weight I had lost before,” she says, “and my skin has started glowing again.”

Paromita Pain is an assistant professor of Global Media Studies at the University of Nevada, Reno.

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