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Targeted Interventions for Prevention, Care and Treatment
The prevention of new infections in high risk groups is a major thrust in National AIDS Control Programme III. The most effective means of controlling the spread of HIV in India is through the implementation of Targeted Interventions (TIs) amongst persons most vulnerable to HIV/AIDS, such as female sex workers (FSWs), men who have sex with men (MSM) and transgender (TGs) and injecting drug users (IDU). In addition, the bridge populations of truckers and migrants also require focused interventions.

It is estimated that more than 90% of HIV transmission in India is related to unprotected sexual intercourse or sharing of injecting equipment between an infected and an uninfected individual. Not everyone in the population has the same risk of acquiring or transmitting HIV. Much of the HIV transmission in India occurs within groups or networks of individuals who have higher levels of risk due to a higher number of sexual partners or the sharing of injection drug equipment.

These core high risk groups (HRGs) of individuals who are most at risk include:
  • Female sex workers (FSWs)
  • High risk men who have sex with men (MSM), and transgender (TGs)
  • Injecting drug users (IDUs)
The broader transmission of HIV beyond these HRGs often occurs through their sexual partners, who also have lower risk sexual partners in the ?general? population. For example, a client of a sex worker might also have a wife or other partner who is at risk of acquiring HIV from her higher risk partner. Individuals who have sexual partners in the highest risk groups and other partners are called a ?bridge population?, because they form a transmission bridge from the HRG to the general population.

For the overall reduction in the epidemic, targeted interventions (TIs) are aimed to effect behaviour change through raising awareness among the high risk groups and clients of sex workers or bridge populations. These interventions are aimed to saturate three high risk core groups with information on prevention; address clients of sex workers with safe sex interventions, and build awareness among the spouses of truckers and migrant workers, women aged 15 to 49 and children affected by HIV or vulnerable population groups.

Apart from prevention of HIV infection, TIs facilitate prevention and treatment of sexually transmitted diseases as they increase the risk of HIV infection, and are linked to care, support and treatment services for HIV infected.

TIs Approach
Given the HRGs special vulnerabilities, prevention strategies include five elements ? behaviour change, treatment for sexually transmitted infections (STI), monitoring access to and utilisation of condoms, ownership building and creating an enabling environment.

In fact impetus to enabling environment under NACP-III drives the prevention strategy. It encourages peer led interventions by community based organisations or NGOs both in the rural and urban areas and focuses on clients of sex workers, partners of MSM and IDUs. All TIs are rights based, they empower the communities. NGOs/CBOs engaged in TIs are networked and linked to general healthcare facilities to ensure that HRGs access them without stigma or discrimination; they are also linked to Community Care Centres, Counselling and Testing Centres and ART centres. The prevention strategies are thus linked to care and treatment, and empower the community against stigma and discrimination.

TIs for FSW
Targeted interventions among female sex workers bring awareness about health implications of unsafe sex and HIV/AIDS issues. The TIs reduce sex workers vulnerability to STIs and HIV/AIDS through promotion of:
  • STI services
  • Condom use
  • Behaviour Change Communication (BCC) through peer and outreach
  • Building enabling environment
  • Ownership building in the community
  • Linking prevention to HIV related care and support services

Chandigarh SACS is implementing four exclusive TIs among FSWs while one composite TI also covers FSWs along with MSM

Specific TIs for IDUs
Apart from targeted interventions for general population, the following specific interventions are provided to IDUs to reduce their vulnerability.
  • Detoxification, de-addiction and rehabilitation
  • Needle exchange
  • Substitution therapy
  • Abscess management and other health services
Chandigarh SACS is implementing two exclusive TIs among IDUs

Specific TIs for MSM
  • Use of lubricants and appropriate condoms
  • Behaviour Change Communication (BCC) through peer and outreach
  • Building enabling environment
  • Linking prevention to HIV related care and support services
Chandigarh SACS is implementing two exclusive TIs among MSM while one composite TI also covers MSM along with FSWs

TIs for Bridge Populations
Bridge populations comprise people, who, through close proximity to high risk groups are at the risk of contracting HIV. Quite often they are clients or partners of male and female sex workers. Truckers and migrant labours are major bridge populations. They are a critical group because of their ?mobility with HIV?. Their living and working conditions, sexually active age and separation from regular partners for extended periods of time predispose them to paid sex or sex with non-regular partners. Further, inadequate access to treatment for sexually transmitted infections aggravates the risk of contracting and transmitting the virus.

TIs to Reduce the Vulnerabilities of Bridge Population
The interventions are aimed at controlling the spread of HIV and STI through information raising about their transmission and prevention. All interventions are aimed at promoting safe sex through use of condoms. They also facilitate easy access to condoms, treatment for STI, counselling and testing services.

How are Interventions reached to Truckers?
These interventions involve interaction with the target community about sexually transmitted infections, HIV/AIDS and safe sex. For better recall and understanding information, education and communication materials are used in such community interactions. Peer educational activities are also undertaken for effective outreach of the messages. So far, all interventions were carried out by NGOs at locations where truck drivers halt for sufficient duration like along highway stretches, business activity areas, check posts or port areas. Under NACP-III, a larger gamut of organisations constituting National Highway Authority of India, social marketing organisations in the promotion of condoms, NGOs and truckers? organisations at state and district level are involved in a concerted effort for better outreach of the interventions. The ultimate aim is to harness the trucking community, associations, brokers and others in driving these interventions. Since the numbers of long distance truckers in Chandigarh are less, therefore, a standalone TI project among truckers is not being implemented in Chandigarh. Long distance truckers are being provided services at the halt point along highway. Chandigarh SACS is providing IEC services to the truckers in Chandigarh.

Interventions aimed at Migrants
The interventions for migrants are focussed on temporary, short duration migrants. They are of special significance to the epidemic because of their frequent movement between source and destination areas. For reaching interventions to migrants, NGOs identify active volunteers from among them and train them in spreading preventive messages among their fellow workers. Factory owners, construction companies and other employers engaging the services of these migrants are also motivated to undertake preventive HIV education activities among them. Chandigarh SACS is implementing three exclusive TIs among migrants.

The details of TI project being implemented by the TIs are as below:-

S. No

Name of the Partner NGO & unique code

Address of Head Office

Theme

Target

Areas of Intervention

Budget Allocated 2013-14 (Rs. In Lakhs)

1.   

Family Planning Association of India, (FPAI), Mohali Branch (Code: 0400067)

SEHAT Bhawan,

Site No. 3, Phase 3-A, Sector 53, SAS Nagar (Mohali), Punjab, PIN - 160059

FSWs

800

Lal Bahadur Shastri Colony - Sector 56, Janta/Bhaskar Colony - Sector 25, Daddumajra Colony, Daddumajra Village, Dhanas, Sarangpur , Janta Colony (Naya Gaon), Kumhar Colony,- Khuda Ali Sher, - Sector 1, 23, 24

12.73

2.   

Servants of the People Society (SOPS) (Code: 0400068)

Lajpat Rai Bhawan, Sector 15-B, Chandigarh, UT 160015

 

FSWs

800

Maloya Colony, Maloya Village, Kajheri Village, Burail Village, Colony No. 5, Palsora, - Buttrela, Attawa, Badheri, Nehru Colony, Majdoor Colony, Pundit Colony, Sector 34, 38, 40, 41, 43

12.73

3.   

Society for Social Health (SOFOSH) (Code: 0400069)

House No. 206/2, Sector 41-A, Chandigarh? 160036

 

FSWs

850

Mauli Jagran Colony, Ramdarbar, Hallomajra, Behlana, Raipur Khurd, Raipur Kalan, Rajiv Colony, Jagatpura, Budanpur, Faidan, Sector 32, 48

12.98

4.   

Yuvsatta (Code: 0400070)

Room No. 12, First Floor, Karuna Sadan Building, Sector 11, Chandigarh

FSWs

900

Manimajra, Dariya, Bapudham, Colony No. 4, Sanjay Colony, Industrial Area I, Transport area, Sector 26, 27, 28, 29, 30

13.96

5.   

Family Planning Association of India, (FPAI) Panchkula Branch (Code: 0400071)

Kothi No. 62-C, Village Haripur, Sector 4, Panchkula, Haryana

MSM

1000

Mauli Jagran, Vikas Nagar, Rajiv Colony, Raipur Kalan, Raipur Khurd, Dariya, SBS Colony, Railway Station, Ramdarbar, Hallomajra, Manimajra, Motor Market, Pipliwala Town, Morigate, Nagla Basti, Colony No. 4, Sanjay Colony, Industrial Area I, Sector 28, 29, 30, 32, 33, 47, 48

15.36

6.   

Servants of the People Society (SOPS) (Code: 0400072)

Lajpat Rai Bhawan, Sector 15-B, Chandigarh, UT 160015

 

MSM

1100

Janta Colony, Kumhar Colony, Lal Bahadur Shastri Colony, Daddumajra Colony, & Village, Dhanas, Maloya Village & Colony, Kajheri, Nehru Colony, Janta Colony (Naya Gaon), Attawa, Buttrela, Badheri, Palsora, Burail, Colony. No. 5, Sector 2, 10, 14, 15, 16, 17, 24, 25,? 40, 41, 43

15.56

7.   

Don Bosco Navjeevan Society? (DBNS) (Code: 0400112)

Don Bosco Navjeevan Centre, Sector 24, Chandigarh

IDUs

550

Daddumajra Colony & village Daddumajra, Dhanas, Attawa, Buttrela, Badheri, Khuda Ali Sher, Khuda Jassu, Khuda Lahora, Sarangpur, PU campus, Kaimbwala, Burail, Colony. No. 5, Maloya Colony, Nehru Colony, Janta Colony/Bhaskar Colony, Kumhar Colony, Lal Bahadur Shastri Colony, Sector 1, 12, 14,15, 16, 23, 24, 25, 35, 37, 38, 39, 40, 41, 43, 44, 45, 55, 56, 68

17.02

IDUs on OST out of line list

110

Two OST centers within the target areas of IDU TI for 110 IDUs as per NACO guidelines

1.68

8.   

Society for Education in Health & Allied Training (SEHAT) (Code: 0400074)

 

House No. 516 (First Floor), Ramdarbar (Residential Area), Phase II, Chandigarh

IDUs

600

Mauli Jagran, Raipur Kalan, Raipur Khurd, Mauli Jagran, Rajiv Colony, Indira Colony, Kishangarh, Bapudham, - Manimajra, Ramdarbar, Hallomajra, Behlana, Colony No. 4, Sanjay Colony,- Industrial Area I, Industrial Area II, Manimajra, Dariya, Transport areas, Sector 7, 19, 20, 22, 26, 27, 28,, 29, 32, 33, 47

17.22

IDUs on OST out of line list

120

Two OST centers within the target areas of IDU TI for 120 IDUs as per NACO guidelines

1.68

9.   

Indian Public Health Association (IPHA) (Code: 0400075)

School of Public Health, Postgraduate Institute of Medical Education & Research (PGI), Sector 12, Chandigarh

Composite (FSWs + MSM only)

FSWs

400

MSM

400

Total: 800

MSM: Bapudham, Indira Colony, Slum around IT park, Kishangarh, Subhash Nagar, Sector 7, 19, 20, 22

FSWs: Kaimbwala, Indira Colony, Kishangarh, Slum around IT park, Subhash Nagar, Sector 17, 18, 19, 20, 22

13.71

10.           

Ambuja Cement Foundation (Code: 0400099)

Village: Daburji, P.O. Lodhimajra, District Ropar (Pb.)

Rural/ Slum Migrants

10,000

Indira colony, Bapudham, Mauli Jagran, Dariya, Manimajra, Raipur Kalan, Raipur Khurd, Hallomajra, Transport Nagar - Sector 56, Makkhan Majra

12.46

11.           

Ambuja Cement Foundation (Code: 0400100)

Village: Daburji, P.O. Lodhimajra, District Ropar (Pb.)

Rural/ Slum Migrants

10,000

Colony No. 5, Burail, Attawa, Palsora, Maloya colony, Kajheri, Faida Village, Jagatpura

12.46

12.           

Indian Public Health Association (IPHA) (Code: 0400102)

School of Public Health, Postgraduate Institute of Medical Education & Research (PGI), Sector 12, Chandigarh

Industrial Migrants

10,000

Migrant workforce working at industrial area I and industrial area II, Chandigarh, Colony No. 4

12.46

13.           

Transport Corporation of India Foundation (TCIF) (Code: 0400113)

Plot No 21, Transport Area, Sector 26, Chandigarh

Truckers

5,000

Transport area, Sector 26, Motor Market, Manimajra, Industrial Area I & II

Ramdarbar, Dariya, Grain Market, Sector 39

9.03