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Strengthening the response to HIV: virtual learning from Aastha, India

Strengthening the response to HIV: virtual learning from Aastha, India. Dr Sanjeev Singh Gaikwad. The Context: Aastha Project. HIV prevention among male, female and transgender SWs in Mumbai and Thane from 2004 -2012 Large metropolitan area with many single male migrants

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Strengthening the response to HIV: virtual learning from Aastha, India

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  1. Strengthening the response to HIV: virtual learning from Aastha, India Dr Sanjeev Singh Gaikwad

  2. The Context: Aastha Project • HIV prevention among male, female and transgender SWs in Mumbai and Thane from 2004 -2012 • Large metropolitan area with many single male migrants • SWs ever reached: 80,000 SWs • Rapid scale up and innovations make it a model within BMGF Avahan • Special recognition by BMGF at International AIDS Conference, Toronto, 2006

  3. Aastha Project – cont’d • Aastha Innovations and lessons have been incorporated in the Indian National Guidelines for Targeted Interventions (2007) • Identified as learning site by NACO and FHI 360 Globally • Winner of FHI 360 Program Excellence Award in 2009 • Aastha has lead to FHI360 being requested by BMGF for transferring learning's to African countries.

  4. Large number of SWs: about 50,000 with > 1 new partner per day Extreme heterogeneity among SWs High churn rate of SWs

  5. Benchmark results….. • Avg. monthly STI screening coverage ranges between 31 - 45 % ( Currently 8-10k SWs) • 99% of all New SWs screened for STI • 85% of SWs Screened for Syphilis at least once and 69 % screened every 6 months • About 85.2% of SWs have undergone C&T at least once and 50.2% access C&T every 6 months on an average

  6. HIV Prevention approaches Sex Work Entry into SW Behavioral Poverty; Lack of support structures Decreased social status; Decreased autonomy Community Engagement and Ownership Violence Vulnerability to HIV Biomechanical Socialostracism HIV Biological Access to services

  7. Aastha: The focus on Quality….ACQUA (Aastha Continuous Quality Approach) Principle • Innovations of Aastha • Branding with niche marketing • Microplanning; Peer Educators as Managers for sites; individual tracking • Aastha Minimum Package • Community based monitoring of key indicators • Demand generation mechanisms • Aastha condom • Rapid response system • Counseling and Testing under PPP • SW specific CoC package • Aastha Enterprises • Vivek • FP-HIV Integration

  8. Impact of ACQUA • Monthly STI screening of SWs has been scaled up to 36% SWs (10,000 SWs/month) with quarterly STI screening at 93% • Six monthly uptake of VCT is 50% • Crisis response coverage is 99% with an average response time of 24 minutes and decreased police arrests • Uptake of prevention messaging and condoms is nearly 100% • Decrease in STI incidence from 37% to 3%

  9. Trend of HIV prevalence among SWs in Mumbai & Thane 60 50.2 50 44.76 40 38 30 28.1 25.2 17.1 20 18.6 10 13.7 0 2004 2005 2007 2010 Brothel Based(Mumbai) Brothel Based (Thane) Brothel Based Brothel Based

  10. Tools, manuals and monographs from Aastha are available at the FHI360 website India HIV Portal is being developed as a repository for learning resources. Virtual training sessions through webinars: links will be sent to interested persons Fixed time theme specific group chats and webinars Training of trainers on manuals and tools through virtual classrooms Bridge project (Africa-India-Asia Learning Network) supported by the Gates Foundation to provide virtual learning from Aastha and other Avahan and India projects. Virtual Learning on Aastha….

  11. Virtual learning…. • 45 abstracts presented as poster presentations during international conferences • 20 abstracts presented as oral presentations during international conferences • Learnings have disseminated to Gujarat SACS, Goa SACS, MPSACS, Uttarakhand SACS, UPSACS, other Avahan Partners like HLFPPT, Pathfinder • Disseminated learnings to 17 countries (Pakistan, Vietnam, Bangladesh, Papua New Guinea, Kenya, Nepal, Indonesia, Laos, Cambodia, Australia, Tanzania, Egypt, Ivory coast, Ghana, Ethiopia) • 15 publications including training manuals, SOPs, Monographs published and disseminated across the country and the globe.

  12. Thank You

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