NEW DELHI — Khushi Kumari had long kept her sexuality a secret, living alone like many of this sprawling city's gay, lesbian and transgender residents.
Today, Kumari, who was born male but lives as a woman, is out of the closet and has moved home with her family. "I said, 'Why hide it?'" Kumari explained one evening at Mitr Trust, an LGBT drop-in center in a bustling, working-class neighborhood of New Delhi. "It just made me depressed. I got mad hiding things all the time."
Kumari, wearing a brilliant yellow and green sari, gold-chain earrings and bright red fingernail polish, is a frequent visitor to Mitr, which she credits with giving her the confidence to live openly and seek medical care for her HIV infection. "Whatever you want to be, you can be here," she said.
Mitr, which means "friendship" in Hindi, was established to battle the spread of HIV/AIDS, as large boxes of condoms stacked in a corner attest. Its benefactors include a state health agency. But like many such community organizations, Mitr is also increasingly responsible for helping some of the most marginalized people emerge from society's shadows, providing medical care and financial counseling, even minting political activists.
Members of these groups now march annually through the streets of India's largest cities in World AIDS Day parades. In southern India, the nation's first transgender movie star runs a foundation devoted to empowering transgender Indians.
In many countries, gay men, transvestites and others most affected by HIV, the virus that causes AIDS, still suffer discrimination and violence. But as the global fight against the epidemic enters its fourth decade, the campaign's effect on civil society is emerging as one of its most profound legacies.
Some countries have granted rights to the lesbian, gay, bisexual and transgender community that go beyond those in the United States.
"This is the first disease where people affected demanded a seat at the table," said Dr. Chris Beyrer, an epidemiologist who heads the Center for Public Health and Human Rights at Johns Hopkins University. "LGBT communities are literally emerging out of the HIV response."
Same-sex marriage has been legalized in more than a dozen countries, including Argentina, South Africa and Uruguay. Thailand and Taiwan are among the places likely to follow, according to the International Gay and Lesbian Human Rights Commission.
One of India's highest courts threw out a 150-year-old law that criminalized gay sex, a landmark ruling sought by activists and the government's AIDS office.
Many countries, including Mexico, Panama and Turkey, have guaranteed equal rights for transgender citizens. Argentina has required health insurance plans to cover sex-change surgery.
Even in Malawi, in sub-Saharan Africa, where activists still report widespread discrimination, billboards proclaim: "Sexual minorities have rights too — uphold, protect and respect their rights."
Activists have fueled these changes. So, too, have governments that have become more democratic and media that increasingly portray gay and transgender characters in the mainstream.
Equally influential in many places have been public health efforts, experts say.
"HIV/AIDS legitimized public discussions about confronting discrimination," said Sonia Correa, who studies sexuality policy at the Brazilian Interdisciplinary AIDS Assn.
Health officials realized they couldn't control the spread of the disease if gay men, sex workers and drug addicts remained hidden.
"When men who have sex with men or transgender people face discrimination and criminalization, they are less likely to access the HIV information … and services they need," said UNAIDS Executive Director Michel Sidibe, who has made confronting prejudice a priority of the United Nations agency. Studies show that HIV prevalence is much higher among gay men in countries that criminalize homosexuality.
The push to de-stigmatize these communities reflects lessons learned in the United States, where many experts believe that grass-roots mobilizations in the 1980s and '90s helped turn the tide against the AIDS epidemic.
Major international donors, including the Gates Foundation, the U.S. government and the Global Fund to Fight AIDS, Tuberculosis and Malaria, have aimed spending at community-based groups that work with at-risk populations.
In India, targeted interventions are widely credited with helping prevent HIV/AIDS from exploding. Some experts predicted a decade ago that 25 million Indians would be infected. Today, 2.4 million are believed to have the virus.
"Without these community-based organizations, the government would never have reached these populations," said Robert Hecht, managing director of the Results for Development Institute, which has advised the Indian government.
In New Delhi, Mitr Trust now does much more than hand out condoms and preach safe sex.
"You don't have to pretend you are the manly son of the house here," said Mitr Director Rudrani Chettri as she led a tour of the center, a second-floor room decorated with photos of smiling clients. The center fills daily with clients who come to listen to music or just hang out.
Mitr offers counseling for 1,200 clients, many of whom are closeted and some of whom live in very abusive homes, according to Chettri. One gay client was raped regularly for years by his brother. Another was poisoned by relatives.
Outreach workers at Mitr meet at least every two weeks with their clients and ensure that they have regular medical checkups. A physician visits the center three times a week.
Mitr also helps clients with tasks such as opening bank accounts and getting identification cards. If a client has legal problems, Mitr helps them navigate the justice system.
The center lets its clients decide whether they want to be public about their sexuality — even whether they want to engage in prostitution. About 60% of Mitr clients engage in some kind of sex work. "This is not about judging," Chettri said.
Despite the progress, Chettri said, prejudice still keeps millions of gay and transgender Indians from living openly.
In other parts of the world, the challenges are even more daunting.
This year, police in Zambia arrested one of the nation's most outspoken human rights activists after he called for access to healthcare for sex workers, prisoners and members of the gay and transgender communities. Homosexuality is illegal in Zambia.
Elsewhere, activists are growing concerned about a conservative backlash. And in many countries, governments remain leery of community-based groups, fearing they could someday fuel political opposition.
"Community empowerment can be very scary for governments," said James Robertson, country director of the India HIV/AIDS Alliance.
A new Russian law barring "propaganda of nontraditional sexual relations" is widely seen as a crackdown on the country's nascent gay rights movement.
Not far from the Mitr center, a group of transgender friends who gathered in a cramped two-room apartment shared stories of being harassed by police or hooted at by passersby. One said a hospital denied her medical care for her HIV infection.
But as they sipped tea and snacked on samosas, they said they believed India was becoming more tolerant.
Shilpa Sarka, a 30-year-old Calcutta native with a wide smile and electric pink lipstick, said she now walks down the street openly with her partner, which would have once been inconceivable.
"Maybe someday," she said, "society will really accept us."