TARGETED INTERVENTION UNDER NACP III ( 2007 -2012 )

1. TARGETED INTERVENTION UNDER NACP III( 2007 -2012 )

2. Why Targeted Intervention? Any epidemic has following four stages- Wave IV Wave III Wave II Wave I Adolescents Spouses & Children of Male STD Pts Sex Workers/ IDUs Male STD Pts, Mobile Groups Long-term socio-economic impact, Orphans Survivors, AIDS Pts, ANCs, Pediatric AIDS Spread of HIV, STD patients Trauma, illness & death, STD & TB patients

3. HIV infection among different population groups In India, HIV/AIDS concentrates upon High Risk Groups (FSW, MSM and IDU) and Bridge Population (Truckers & Migrants). The need, therefore is to actively control HIV/AIDS among these groups.

4. HIV Positive contacts per year Population 1,000 100,000 25% infected, 400 partners per year FSWs 1,000 clients (e.g. migrants, truckers) 2% infected, 12 partners per year 240 The importance of working with core groups – FSWs

5. The importance of working with core groups – MSM • Truckers • Taxi/auto drivers • Single male migrants • Panthis Client or other category MSM – not focus of TI • Hijras • Regular partners of kothis Locus of intervention – typically ‘cruising sites’ or hotspots High risk MSM – focus of TI • Male sex workers • Kothis • Double deckers Anal receptors Anal receptors & penetrators Anal penetrators

6. The importance of working with core groups – IDUs Wives and Wives and girlfriends of Clients of FSWs girlfriends of Substance users clients of FSWs Female Sex Workers IDU “Feminization” of the epidemic HIV Husbands and boyfriends of FSWs RISK RINGS Substance Users

7. The importance of working with core groups – Migrants/Truckers

8. Lessons from NACP-II • Dilution in TI; more focus on Core Groups • Programmatic link between TI and Continuum of Care • Need to strengthen Supportive Supervision; support to SACS / NGO • Strategic shift from Support to Empowerment

9. Main focus of TI • Prevention • Reversal of the progression of the infection and Reduction in the overall level of prevalence • Evidence-based approach

10. Guiding principles of TI In any health condition, with any population, the uptake of prevention service depends on outreach. This holds more true in the case of marginalized populations such as sex workers, MSM, and IDUs. The core of FSW/MSM/IDU HIV prevention efforts is therefore about outreach and the provision of dedicated services, which can be accessed by these marginalized groups.

11. Targeted Interventions Under NACP-III 1. More focused approach Bridge Population Truckers Migrant Workers Core Groups FSWs IDUsMSM 2. Specific package of services for HRGs 3. Emphasis on CBO-led Interventions

12. Components of TI Management of STIs Behaviour Change Communication Condom Promotion HRGs Enabling Environment Referrals & Linkages Community Mobilization

13. Condom Promotion • Every person should have access to condoms when he/she needs it • Primary Strategy: Free supply of condoms to HRGs through TI NGOs/CBOs • Secondary Strategy: promoting social marketing of condoms through Social Marketing Organizations

14. Community Mobilization • Community members get to participate in collective decision-making • Formation of various committees like DIC Management Committee and Clinic Committee empowers the community • It creates community norms for service uptake and safe sexual behaviours

15. Referrals & Linkages • Linkages to STI and health services with strong referral and follow-up • Promotion/distribution of commodities including free condoms, lubricants, needles/syringes • Linkages to other health services (e.g. for TB) and voluntary counselling and testing centres (VCTCs) • Provision of safe spaces (DICs)

16. Management of STIs • STI services: an opportunity for prevention education to the individual as well as to his/her partner • Planning for STI services done with the HRGs • Clinicians should have an attitude of respect towards the community. • Availability of services should be as per the needs of the community (for e.g. late-night access) • Accessibility of services at optimal locations (i.e. not too far from the major sex work sites)

17. Enabling Environment • To enable HRGs to negotiate safer sex, TIs must address several vulnerabilities • Vulnerability within the sex circuit includes aspects such as violence, and exploitation by clients • Broader socio-economic vulnerabilities include factors such as poverty and illiteracy • Reduction of vulnerabilities entails creating a crisis response system • It also calls for advocacy with policy makers, law enforcers and opinion leaders

18. Behaviour Change Communication • It is vital to change the community’s behaviour to ensure that they indulge in safer sex • This involves creating awareness about the importance of using condoms, services available for STIs and the importance of regular screening • It also means creating a demand for these services • TIs need to encourage analytical thinking and problem-solving among HRGs so as to help them overcome their barriers to HIV/STI risk reduction

19. Remember! • HIV is no longer a killer disease • It is a manageable disease, just like Diabetes and Blood pressure • But for this it is necessary to • regularly check one’s status at VCTCs • use condoms during every sexual act • If HIV+, regularly take the medicines & live a healthy life • Hence TIs should develop their linkages with government departments, VCTCs, Hospitals, ART centers, CCCs and such like

20. Conclusion • The focus of the TIs should be that • all key populations are being met regularly • all key populations are able to access condoms and use it correctly and consistently • all are regularly screened for STI and HIV • all in need of care and support are able to access the same • the environment around sex work is safe • With sincere efforts, the HIV epidemic can be reversed much before 2015, as desired by the Millennium Development Goal (MDG)