Rani Jayakodi, 25, is an outreach worker for Seva Nilayam’s integrated health and development programme in Tamil Nadu, Southeast India. A person living with HIV herself, she takes care of 50 families affected by HIV/AIDS in the villages that surround the centre. To ease the stress of living and working with HIV, she begins each day with a daily yoga practice on the roof of her mother’s house.

Rani prepares herself for a day of work, facing up to life with HIV as she does so.
“I love my job as an outreach worker, where I get lots of time to interact with people living with HIV and AIDS. Initially I was very shy. I didn’t want to come out. But now I am motivating other people and encouraging them to come out and disclose their status”.

Community health workers visit a woman who is suffering from an AIDS-related illness. Both Rani (left) and Mrs Selvarani (right) work for Seva Nilayam’s health and development programme.

A village health guide demonstrates the correct way to use a condom during an educational workshop run by the Seva Nilayam health and development programme. She is one of a group of volunteers that provide homecare, basic health and nutrition advice, and information on how to prevent HIV and AIDS.

A mother cares for her dying son at Arulagam Hospice in Tamil Nadu, Southeast India. As the AIDS epidemic in India worsened, increasing numbers of dying people were in need of care that the hospitals could not provide.

Mother and son in the terminal ward of Arulagam Hospice. This hospice is often the last refuge for people dying of AIDS-related diseases, who may have been rejected by their families. In this case the mother had moved into the hospice to be with her son in his last moments saying ‘He is my child, I cannot just throw him away.’

Rani pays a routine visit to the family of a woman living with HIV.

A volunteer theatre group performs an AIDS education play in the centre of Ramakrishnapuram village in Tamil Nadu, Southeast India. The actors are affiliated to the Seva Nilayam health and development centre, which provides primary health care, AIDS education and support for neighbouring communities.

Ivan Shekker, 45, sits with Vladimira and her 19-year-old daughter Yulia in their grimy home in an apartment block in Kiev. Both are HIV-positive and injecting drug users. Ivan is one of the founders of Club Eney, a non-governmental organisation that works to reduce HIV transmission among injecting drug users. He takes clean needles and safety boxes to their flat every week.

Ivan sits with Yulia in the bedroom that she shares with her mother. Yulia is HIV-positive, and since meeting with Shekker she no longer shares needles with her friends.
“It is very, very hard not to want drugs after you have already tried them. Because drugs allow people to experience feelings and emotions that they would never have in their normal lives. But when people have suffered enough there is a chance that they will stop,” Ivan Shekker.

Yulia injects herself with a clean needle in the bedroom she shares with her mother, in their derelict Kiev apartment. Both are injecting drug users and became HIV-positive by sharing needles while they were injecting.

A young woman helps a friend inject in a Kiev apartment. They benefit from the needle exchange programme offered by Club Eney.

A young drug user lies back in a Kiev apartment, feeling the effects of injecting. She benefits from the needle exchange programme offered by Club Eney.
“There are many contributing factors. One is emptiness: emptiness of the soul, for want of a better word, which is a consequence of consumer society,” Yevgeniy Krivosheyev, founder and president of Club Eney, speaking about what drives so many young people to start using.

Outreach workers from a Crimean non-governmental organisation, Hope and Salvation, approach a woman who is selling sex at the side of the road. They offer counselling, condoms and clean needles.

An outreach worker from a Crimean nongovernmental organisation, called Hope and Salvation, talks to a woman who is selling sex at the side of the road.

Ivan and a volunteer give medical advice and condoms to one of the women who sell sex by the motorway, on the outskirts of Kiev.

Ricardo Herrera (right) with his partner Cesar Ponce in their living room. Ricardo, 32, is an HIV-positive counsellor who works for Vida Libre, a non-governmental organisation offering HIV education, care and support in Guayaquil, Ecuador.
“I realised that I really liked working as a counsellor and enjoyed visiting the hospital. Even when I couldn’t help people in some material way I would at least be able to cheer them up. I would go to guys who were having a serious health crisis and say, ‘If I could recover, so can you’.”

Ricardo counsels a transgender friend outside the kiosk of a local hospital that treats people living with HIV and AIDS in Guayaquil. At the time, HIV prevalence in Guayas, Ecuador’s most populous province, was nearing that recorded in some African countries ten years previously. There was concern that this could lead to a major national epidemic.

Transgender hairdresser and NGO worker Fabiana Perez (right), talks to Jennifer Alvaredo at her salon in the El Guasmo district of Guayaquil, Ecuador. Perez, 21, was the co-ordinator of Amazonas, a non-governmental organisation that works with transgender people in Guayuaquil, giving legal advice and support as well as HIV, AIDS and health education.
“Transgenders like to have fun, more than they like to care for themselves. They lose interest when it comes to serious things like prevention and education”.

Fabiana turned down a law scholarship to get Amazonas off the ground. She knows this community and its problems intimately, having worked in salons and as a sex worker since leaving home six years ago. Not HIV-positive herself, she has had to overcome her own fears about the disease to do the work that she does.
“I had phobias because of ignorance. It was the fear of not knowing what to expect. But with the training and the sensitising I learnt that I could touch them and talk to them and that I was not going to get infected in that way”.

Fabiana travels by taxi around the city to recruit new members for Amazonas. The AIDS Alliance’s Frontier Prevention Project, of which Amazonas is a part, is designed to reduce HIV infections in relatively low-prevalence countries through awareness raising efforts.

Fabiana talks to transgender sex workers on the streets of Guayaquil. In Ecuador at this time, HIV infection rates within the general population were under one percent and HIV was thought to be largely confined to certain sub-groups. These included sex workers, transgenders and men who have sex with men.

Late night at the Penthouse nightclub, Fabiana advises peers about safe sex and HIV.

Some of the 300 orphans who live in this small village in Burkina Faso, on the edge of the Sahara desert. Many of their parents have died of AIDS-related illnesses, and they are cared for in the extended family system. Orphans also receive support from the community, which contributes funds and support services to ensure that the children are healthy, happy and educated.

Patients queue at the Oasis community-based health centre in Ougadougou. Oasis, which is a project of the non-governmental organisation Association African Solidarit, provides antiretroviral therapy and healthcare for people living with HIV and AIDS and their families.

Madame Raphaele Abalo, 47, is a beneficiary of Project Orange, in Ougadougou. She has five children and one grandchild. She began antiretroviral treatment a year before this picture was taken, and is one of the few people in the project willing to be identified as HIV-positive.
“When I began treatment I changed physically, and those who were refusing to greet me became friendly again. Some would even run and touch my hands to make sure it was really me. I would say to them: ‘Yes, it is true. God has let me live.’ That is why I encourage my brothers and sisters to take the HIV test.”

‘For your security, use a condom’.
One of 14 bright roadside kiosks in Ougadougou, which are painted with AIDS awareness and prevention messages. The popular kiosks, started by non-governmental organisation Association African Solidarit, provide cheap refreshments as well as employment for people living with HIV and AIDS.

A school in Rambo village. Members of the community in this small village on the edge of the Sahara desert meet to discuss ways they can improve the orphan support programme they have developed. There were close to 300 orphans in the village at this time, many of whose parents had died of AIDS-related illnesses.

Boukary Porgo, 15, is one of over a hundred orphans in Rambo village school. They receive social and financial support from a community-based organisation to continue their education despite the poverty of their elderly carers.
“Now that we have the means to send them to school, the children are not so shy. Fewer people treat them badly and they do not cry so much,” Boukary’s grandfather.

Rambo village children participate in a dance during a workshop conducted by a nongovernmental organisation based in Ouagadougou’s capital. Their Child-to-Child approach encourages the children to list their problems in order of importance to one another, such as ‘I do not eat before I go to school’, and ‘My parents cannot afford to buy stationery.’ The outcomes are then used to identify key challenges, and to support orphans and other children in particular need.