Initiative of Maharashtra State AIDS Control Society. Status of Targeted Intervention Project since 1999

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1 Targetted Interventions Non Governmental Organisation Activities Priority Targeted Intervention for Groups at High Risk. The objective of Targeted Intervention Programme is to reduce the rate of transmission among the most vulnerable and marginalized population. One of the ways of controlling the disease from further spread is to carry out direct intervention programmes among these groups through multi pronged strategies, beginning from behaviour change communication, counselling, providing health care support, treatment for STD, and creating an enabling environment that will facilitate behaviour change. Targeted Intervention is one of the most important components of the National AIDS Control Programme Phase II. Collaboration with NGOs since 1999 In National AIDS Control Programme, Phase I 1992 to 1999 emphasis was given on awareness campaigns and environment building activities in the state. But in National AIDS Control Programme, Phase II 1999 to 2004 the focus has been shifted from awareness to change in behaviour through intervention, particularly for groups at high risk of contacting HIV/AIDS. Initiative of Maharashtra State AIDS Control Society. Status of Targeted Intervention Project since 1999 S.N. Year Targeted Group SWTDMWMSM IVDU S.C. Total I II III / 7

2 IV V In Maharashtra State AIDS Control Society took a lead and initiated 17 intervention activities. Out of which, 8 NGOs were working with long distance transport workers i.e. truckers intervention projects on highways in Pune, Nashik, Dhule, Raigad, Nagpur districts. While 9 were working with sex workers in Thane, Sangli, Pune, Kolhapur, Satara districts. During the year , Maharashtra State AIDS Control Society funded 22 Targetted Intervention projects in the State out of which 11 were working with long distance transport workers in Pune, Nashik, Dhule, Raigad, Nagpur, Thane, Jalgaon districts, 8 were working on Commercial sex workers in Thane, Pune, Kolhapur, Satara, Nagpur districts and 1 with street girls in Pune district and 1 with Men having Sex with Men in 5 districts of Maharashtra and 1 with IVDU in Thane district. In the year Maharashtra State AIDS Control Society funded 24 intervention projects in the State out of which 13 NGOs were working with long distance transport workers in Thane, Pune, Wardha, Nagpur, Sindhudurg, Dhule, Solapur, Nashik districts, 4 were working with sex workers in Thane, Kolhapur, Nagpur districts, 4 with Migrant Labour in Thane, Nashik, Kolhapur, Raigad district. 1 with IDVU in Thane and 1 with Street children in Pune district, while 1 with men having sex with men in 5 districts of Maharashtra. In the year Maharashtra State AIDS Control Society supported 22 targetted intervention projects in the Sate out of which 11 NGOs were working with long distance transport workers in Nashik, Pune, Dhule, Thane, Sindhudurg, Wardha, Solapur districts. 6 were working with sex workers in Thane, Kolhapur, Latur, Parbhani, Nagpur districts, while 5 were working with Migrant Labour in Thane, Nashik, Raigad, Chandrapur and Kolhapur districts. 2 / 7

3 In the year , Maharashtra State AIDS Control Society is funding 12 new T.I. projects in Maharashtra alongwith the existing 21. We have thus reached the number of 33 interventions being implemented in 18 districts of Maharashtra. In addition to this we plan to scale up the existing projects as well as increase the number to 50. Statement showing high risk districts, Map of ongoing Targetted Intervention Projects & Medico Social Information of Population with high risk behaviour, they are as given on the next page: Advertisement for inviting applications from NGOs to scale up the existing activity In the year advertisement was released in newspapers. In response to the advertisement the society received total 216 proposals (Sex Workers 34, Truck Drivers 78, Migrant Workers 24, Street Children 2, IEC (Mixed) 77, Men Having Sex with Men 1. After scrutiny and as per guidelines of NACO and World Bank 12 targeted intervention projects were launched in In order to scale up the activity the advertisement was again released in the newspapers on 8th May 2003 which resulted in tremendous response and we received 439 proposals. (Sex Workers 70, Men having sex with men 0, Truck Drivers 189, Migrant Workers 41, Auto Rickshaw 10, Jail Inmates 34) from all over Maharashtra. The initial scrutiny has been completed. We have shortlisted 35 NGO proposals. A short orientation workshop on proposal development is planned in February After completion of JAT visit the selected proposals will be put up in the Executive Committee of Maharashtra State AIDS Control Society for approval. Capacity building of NGOs Capacity building of NGOs Since 1999 Maharashtra State AIDS Control Society has organised various training programmes and workshops for NGOs in collaboration with USAID/FHI/DFID/AVERT, Maharashtra. These workshops focused on issues like counselling, communication and need assessment, project monitoring and implementation strategy, T.I. proposal development, HIV/TB co infection. Till December 2003 total 449 NGO representatives have been trained. Avert Maharashtra Support 14 NGO staff were trained on basic facts of STD/HIV/AIDS, Sex and sexuality, 4 NGO representatives were sponsored for 4th West Bengal sexual health conference held in Kolkata, 2 NGOs representatives are trained as master trainers in sex and sexuality issues through stepping stones approach by Action aid India supported by Avert Society Mumbai. Exposure visits for NGO representatives with MSACS officers Under UNDP Programme exposure visits to Goa and Andhra Pradesh SACS were arranged. 3 NGOs for each visit were selected and the exposure visit was given in various Targeted 3 / 7

4 Interventions and innovative projects in the states. Future Plans Exposure visits to state of Gujrat and West Bengal is planned in current financial year. Evaluation Process of Targeted Interventions The Targeted Intervention Projects implemented by NGOs were evaluated by International Institute of Population Sciences, Mumbai. In March 2002, 10 targeted intervention projects and in the year March 2003, 9 targeted intervention projects were evaluated. NGO with satisfactory performance were continued, while those whose performance was below par were discontinued by Maharashtra State AIDS Control Society. Since 1999, Maharashtra State AIDS Control Society has discontinued total 9 projects whose performance was not satisfactory. Mapping of the High Risk Groups We have already completed HRG Mapping Study in 22 districts of the state. This study was conducted by Black Stone Market Facts India under technical and financial support from AVERT Society in association with Maharashtra State AIDS Control Society and Mumbai District AIDS Control Society. First Study Facilitation Group / State Steering Committee meeting was held on 9th and 10th July, 2003 to share the objectives, scope and coverage of the mapping study. The data collection formats were also discussed with the group. Second SFG/SSC meeting was held on 10th September, 2003 to discuss the preliminary information on target groups sites mapped in each study district. The proposed analysis and chapterisation. Plan for the report was also discussed. Third SFG/SSC meeting to share the findings of mapping study is due. Financial Report NACO organised a review meeting on 9th January, 2004, in which the findings of the study were presented. Based on the comments the report will be further modified. The financial report will be submitted to NACO on 16th February, S. Districts N. S. Districts N. 1. Ahmednagar 12. Nasik 2. Amravati 13. Osmanabad 3. Aurangabad 14. Parbhani 4. Beed 15. Pune 4 / 7

5 5. Chandrapur 16. Raigad 6. Dhule 17. Ratnagiri 7. Jalgaon 18. Sangli 8. Kolhapur 19. Satara 9. Latur 20. Sindhudurg 10. Mumbai 21. Solapur 11. Nagpur 22. Thane The following HRGs were studied Core Group - Female Sex Workers (Brothel based and non brothel based). - Men who have sex with men. (MSM). - Transgenders/Eunuchs. - Injecting Drug Users (IDUs). - Truckers. Other Groups - Migrant Labourers. - Street Children. Future Plans The remaining 12 districts of Maharashtra will be covered during The district wise needs assessment of HRG map will also be undertaken in the state. Lessons Learnt As per plans developed by NACO, the NGOs play a pivotal role in the prevention of spread of HIV/AIDS. Their role is significant in advocating against stigma and discrimination of the people living with HIV/AIDS. The traditional strategy of enlisting NGOs support for Government 5 / 7

6 programme has been limited to areas other than health. This has reflected in NGOs of good track record not indulging in HIV/AIDS related work. Condom Promotion Many NGOs applying for funds for SACS are - Either novices who have no past experience. - NGOs who are seeking to build their institutions rather than the commitment to HIV/AIDS related work. - Many NGOs are in fact real ladders or career ladders for individuals who have started the NGO and then they are managed and controlled by family members. - Many NGOs apply pressure on SACS officials by casually referring names of politicians. This results in waste of large amount of time and energy. The criteria for NGO selection should be five years of registration instead of three years so as to assess the experience and capacity built over 5 years. One of the strategies to minimize the negative impact of the above is that NACO/SACS should evolve the programme design strategies in the field and not on tabletop. For this it is necessary to involve atleast the key members of outreach communities in programme planning, execution and evaluation. The success of peer based intervention with sex workers is an example of this possibility. Condom Promotion Free supply and targetted social marketing Unprotected multipartner sex is the main cause of HIV transmission. In India more than 80% HIV infected persons get infection through unprotected sexual contact. HIV transmission can be prevented by condom promotion. Condom is the best mean to protect STDs and HIV/AIDS. Maharashtra State AIDS Control Society has made a lot of efforts to create public awareness by conducting various activities. Through these activities the commercial sex workers and their clients have been convinced about the importance of the use of condom. The efforts are also being made to use condom not only for the sake of family planning but also to prevent RTI, STDs and HIV/AIDS. Condom Promotion Programme is promoted by Maharashtra State AIDS Control Society through two channels. Under Free Distribution Scheme Initially Condom Promotion Programme was under Family Welfare Programme of the state. 6 / 7

7 Now Maharashtra State AIDS Control Society is also running Condom Promotion Programme though District Health Offices, Municipal Corporations and Civil Hospitals. Social Marketing Scheme The purpose was to create awareness about the use of condom. Maharashtra State AIDS Control Society introduced social marketing scheme for Condom Promotion and distributed the Deluxe Nirodh through an NGO, DKT (India). The social marketing of condom is successfully done through the same NGO throughout the state including the District and Taluka level since November The said organisation is also supplying condoms to the beneficiaries under the targeted intervention project in the state. Presently DKT (I) is not procuring any Condom for social marking from Maharashtra State AIDS Control Society. (Letter Dated April 3rd, 2003). Distribution of Condom Keeping in mind this importance, the distribution strategy of condom has been already planned. According to this strategy the free distribution of condom has been made under the Family Welfare Programme. By the end of March 2004, 2,71,32,968 condoms were distributed under the Family Planning, AIDS, STD Control Programme and condoms were distributed under social marketing scheme for the year Requirement of Condom for the year Under Free 3,60,64,000 Supply Scheme 2. Under Social Marketing Scheme 50,00,000 Funds NACO has sanctioned Rs lacs for Procurement of Condoms for the year Out of that Rs. 64 lacs has been utilized for the purchase of 50 lacs pieces of condoms. 7 / 7