Session-1 Role of a Counsellor/ANM in a Targeted Intervention

1. Session-1Role of a Counsellor/ANM in a Targeted Intervention

2. Learning objective: • Reviewing understanding of STI, HIV/AIDS • Understand the importance of counselling and role of the ANM in the TI program. • NACP III- objectives, strategies and focus on prevention

3. Sexually Transmitted Infections (STI) • Infections transmitted through sexual contact. • Sexual contact is contact with the human genitals (male or female). • It may be oral, anal or vaginal.

4. Reproductive Tract Infections (RTI) • Infections of the reproductive system. • May occur as • a result of STI • as a result of overgrowth of normal germs in the genital tract or as a result of a physician’s intervention (for example, intrauterine device (IUD) insertion without proper infection control), or procedure (for example, illegal abortion).

5. Common signs/symptoms • Itching around the vagina and/or discharge from the vagina for women • Discharge from the penis for men • Pain during sex or when urinating • Pain in the pelvic area • Sore throats in people who have oral sex • Pain in or around the anus for people who have anal sex • Chancre sores (painless red sores) on the genital area, anus, tongue and/or throat • A scaly rash on the palms of hands and the soles of feet • Dark urine, loose, light-colored stools, and yellow eyes and skin • Small blisters that turn into scabs on the genital area • Swollen glands, fever and body aches • Unusual infections, unexplained fatigue, night sweats and weight loss • Soft, flesh-colored warts around the genital area

6. Prevention and Treatment of STI • STI can be prevented • Most STI are treatable and curable • The presence of an STI increases the risk of transmission of HIV

7. STI Treatment • Qualified and trained practitioner • Syndromic management efficient approach • Treatment may be a single dose or require longer duration • important to ensure that the treatment is complete as prescribed by the doctor • Partner treatment is also necessary to prevent re‐infection • Condom use

8. Those involved in sex-work • Monthly check‐up • Complete check‐up means - oral, anal and genital area examined • Speculum examination for females • Proctoscopic examination for those involved with anal sex

9. As a counsellor/ANM you play a key role in health promotion and prevention and treatment for HIV/STI

10. Counselling • "Confidential dialogue between a client and a care provider aimed at enabling the client to cope with stress and take personal decisions related to HIV/AIDS. The counseling process includes an evaluation of personal risk of HIV transmission and facilitation of preventive. • This includes information, education and psychosocial support and allows individuals to make decisions that facilitate coping and preventive behaviours. (WHO)

11. Counselling in HIV/AIDS • There are three levels or times when HIV/AIDS related interventions e.g • Counselling is needed: • While the individual is still HIV-free • When seeking a HIV test • When the individual is infected • When AIDS has resulted in death

12. Why is counselling necessary? • Behavioral change can prevent a person acquiring HIV infection or transmitting it to others. • Infection with HIV is lifelong • A diagnosis of HIV infection can create psychological problems • Stigma associate with behavior and infection

13. TOR of ANM/Counsellor

14. Counseling: Ensure that all the HRGs visiting the project clinics are counseled • Conduct risk assessment and counsel HRG/KP for risk reduction, condom use and safe sex practices • Encourage HIV testing of HRG/KP/partners. • Encourage screening of STI/RTI and treatment of same (HRG/KP/partners).

15. Develop referrals and linkages to other services- Ensure all • HRGs visiting the clinics also visit the referrals centers (ICTC). • HRGs who referred to referral centers are visiting the referred units and availing services. • Positive HRG/KP referred to care and support services (DLN/ART center).

16. Develop referrals and linkages to other services • KP with symptoms of TB are referred to DMC • IDU requiring de-addiction should be referred to de-addiction center. • Need Assessment is conducted and Social entitlements provided appropriately • Update Project Manager on the status during the monthly review meeting.

17. Coordinate with PEs and ORWs to ensure • Service uptake by HRGs in their respective sites. • HRGs coming for STI are being tracked for follow up visits.

18. Outreach counseling service: • Ensure field visits (at the hotspot level) for holding counseling sessions as per the plan and as per the requirement of the outreach team. • E.g. if a ORW reports that a KP is motivated to come to the clinic following repeated one-one contacts, or the ORW reports of the KP who is positive who threats suicide, depression etc. the counsellor should undertake site visits to counsel them.

19. Record Maintenance and reporting: • Maintenance of the clinic as per the standards and relevant registers are maintained on day to day basis and are safe. • Ensure coordination with the MIS officer in the context of clinic data on a weekly basis and assist the MIS officer as and when required.

20. Administrative: • Ensure the procurement of STI drugs through GMP certified firms/ shops.

21. NACP-III • Goal: To halt and reverse the epidemic in India over the next five years • The objectives of NACP-III • Prevention of new infections (saturation of HRG coverage and scaling up interventions for the general population) • Increased proportion of PLHIV receiving care, support and treatment • Strengthening capacities at district, state and national levels • Building strategic information management systems

22. Concept of Targeted Intervention in the Framework of NACP III

23. HIV/AIDS Scenario in India • An estimated 2.13tmillion living with HIV/AIDS • Adult prevalence 0.36% • 87% cases heterosexual transmission • Heterogeneous distribution • Concentrated epidemic • Based on HIV Sentinel Surveillance data for the last three years, districts classified into four categories A – D: Categorization of Districts based on HIV Sentinel Surveillance Data

24. 1.8 4.3 1.9 84.6 5.6 Sexual IDUs Bloodand Blood Products Perinatal Unidentified Routes of HIV Transmission

25. Groups infected/affected by HIV/AIDS CORE GROUP • Core Group or High Risk Group – FSWs, IDUs, MSM/TG • Bridge Populations – Truckers, Migrant Workers Bridge Population General Population

26. 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

27. The importance of working with core groups – MSM/TGs • 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

28. 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

29. The importance of working with bridge populations – Truckers/Migrant Workers

30. 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 FSWs, MSM/TG, and IDUs. The core of FSW/MSM/TG/IDU HIV prevention efforts is therefore about outreach and the provision of dedicated services, which can be accessed by these marginalized groups.

31. - Community-Led - Promote safe behaviour - Education & Capacity building - Promote quality services - Linkages for health care services, counselling, condoms etc Concept of TI

32. Components of TI under NACP-III Outreach Behaviour Change Communication Commodity Provision HRGs Community Mobilization and enabling Environment Clinical Services Referrals and linkages

33. Summary • Different HIV epidemics require different approaches. Efficient interventions should target specific populations. This does not imply that the impact of the epidemic is restricted to these populations. • Successful TI should focus energy, resources and services on populations at risk, as the most efficient and effective way to reach people affected by HIV. • Implementing successful targeted interventions requires specific knowledge about the environment in which the risk behaviour takes place.

34. Summary • It is not enough to target the individual at risk, but consider environmental factors that influence risk. • Change in behavior is the ultimate goal of Targeted Interventions. Hence the role of ANM/Counsellor is vital in the program. • As a counsellor it is important to gain knowledge on health related issues leading to the spread of HIV. • Early detection of STI is important. • Treating STI is a good prevention strategy for HIV.