1. Targeted Interventions for IDUs – an overview

2. Targeted Intervention for IDUs - an Overview 2 Background  In Asia, 4.7 million people were infected with HIV (UNAIDS, 2009)  Half of the HIV infected people (2.31 million) in India  Prevalence among general population: 0.34% (NACO, 2008)  88% of HIV infection among people between 15 – 49 years age

3. Targeted Intervention for IDUs - an Overview 3  Sexual route predominant mode of transmission (>85%)  Injecting accounts for only 1.7% of all HIV transmission  HIV present in all the states of India  Spread of HIV not uniform Some states more affected Some population groups more affected and at higher risk as compared to others e.g. young, male High Risk Groups (HRGs) – Female Sex Workers, Men having Sex with Men, & Injecting Drug Users (IDUs)

4. Targeted Intervention for IDUs - an Overview 4 Characteristics of HRGs  Involved in behaviours which make them prone for HIV infection  Behaviour practices are not legal HRGs are targeted by police officials  Stigma & discrimination of the HRGs HRGs do not come out and seek risk reduction services.  HRGs are reluctant to seek services designed for the general population HRGs become vulnerable to contract HIV and remain hidden from the mainstream services

5. Targeted Intervention for IDUs - an Overview 5 HIV among HRGs  HIV prevalence among HRGs more as compared to general population  HIV rates differ among different HRGs; highest in MSM & IDU  Current data (2008) shows highest in IDU (>9%) HIV Sentinel Surveillance, NACO, 2007

6. Targeted Intervention for IDUs - an Overview 6 HIV prevention among HRGs – Approaches  Reluctance among HRGs to access mainstream services (e.g. general hospitals,) due to stigma and discrimination Services specifically for HRGs to be provided – Targeted Intervention (TI)  Principles of TI: are for people within the community who are most at risk of HIV infection. are adapted to be culturally and socially appropriate to the target audience. focus on limited resources and where they can be used to the best benefit.

7. Targeted Intervention for IDUs - an Overview 7 HIV prevention among HRGs – Approaches Principles of TI…contd effectively use the language and culture of the people being targeted. acknowledge that barriers to accessing health- care services exist for some populations within communities. acknowledge that people who are at risk of HIV infection are often marginalized from the broader community, stigmatized and discriminated against

8. Targeted Intervention for IDUs - an Overview 8 HIV prevention among HRGs – Approaches  HRGs do not come out and actively seek treatment/services, in-spite a TI approach, stigma and discrimination Fear of police officials  HRGs have to be actively sought out in the community where they are - OUTREACH  Outreach – providing services to the HRGs at their doorstep i.e. where they are likely to be in the community

9. Targeted Intervention for IDUs - an Overview 9 HIV prevention among HRGs – Approaches  Two ways of providing outreach services By members of the general community By members who are themselves part of the high risk community: ‘peer education’ approach  Peer education approach seen to be the better approach to reach out to HRGs

10. Targeted Intervention for IDUs - an Overview 10 HIV prevention among HRGs – Approaches  Advantages of using peer educators for providing services: Identification of the HRGs becomes easy The services provided are more acceptable as the HRGs  One of their own is providing services and advising on behaviour change. Easy trust and warmth from the HRG community,  Easy penetration into the network of the HRGs. Stigma and discrimination is minimal PEs – a role model for the HRGs  Emulate reduced risk behaviour

11. Targeted Intervention for IDUs - an Overview 11 National AIDS Control Programme III  NACO: nodal agency to deal with HIV prevention and care in India  NACP III phase: 2007 – 2012  Goal: Halt and reverse the HIV epidemic by the end of NACP III.  Objectives: Prevention of new infections Care, support and treatment Strengthening capacities Building strategic information management system

12. Targeted Intervention for IDUs - an Overview 12  Enhanced focus on preventive efforts  2/3 rd of budges on prevention  Major boost to TI programme Universal coverage for all HRGs 80% of all HRGs to be covered with HIV prevention activities to halt and reverse the epidemic  TIs run by NGOs contracted by State AIDS Control Societies (SACS), funded by NACO National AIDS Control Programme III

13. Targeted Intervention for IDUs - an Overview 13 IDU Targeted Intervention  Approach: Harm Reduction  Services: Behaviour change communication Risk reduction materials: Needle syringes, abscess prevention materials (spirit swabs, distilled water, etc.), and condoms STI – detection & treatment Treatment of general medical conditions, abscess management, etc. Counselling on drug related aspects

14. Targeted Intervention for IDUs - an Overview 14 Services contd… Opioid Substitution Treatment (OST), if the TI accredited for OST Referral to appropriate agencies for other services:  HIV related services: ICTC, ART, etc.  Drug relates services: detoxification, rehabilitation, OST  Others: night shelters, vocational training,  Facilitating formation of support groups, self help groups IDU Targeted Intervention…

15. Targeted Intervention for IDUs - an Overview 15 IDU Targeted Intervention…  Service provision – two pronged strategy Mobile based services: through an outreach team  Outreach workers (from IDU/non IDU background) and Peer educators (current/ex- IDUs)  Visit to ‘hotspots’ – areas of IDU congregation  Activities: Befriend IDU clients, Collect basic information about the IDU Providing risk reduction materials Basic behaviour change communication. Motivation to visit the DIC for receiving additional services

16. Targeted Intervention for IDUs - an Overview 16 Service provision…contd Static based services: through Drop-in- Centre (DIC)  Physical space established by NGO close to the hotspots  3 – 4 rooms: rest & recreation, counselling, doctor’s room, and dressing room  Staff: ANM/Counsellor, doctor, outreach worker  Activities  Screening – STI, abscess and other general medical conditions, and treatment as required  Abscess management – including dressing and cleaning IDU Targeted Intervention…

17. Targeted Intervention for IDUs - an Overview 17 Service provision, Activities…contd Counselling for risk reduction and other drug related issues Rest for IDUs Recreation by provision of recreational materials such as television, carom board, etc. Group discussions and facilitation of support group formation Provision of risk reduction materials, including Needle/syringe and condoms IDU Targeted Intervention…

18. Targeted Intervention for IDUs - an Overview 18  A programme manager for overall management Guiding the team for daily activities Planning the activities of the TI Monitoring & supervision of the project Advocacy with relevant stakeholders Building referral linkages and networking Regular reporting to relevant authorities IDU Targeted Intervention…