Transcript Day1Session3-TI for IDUs

Targeted Interventions for IDUs
– an overview
Background
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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
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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
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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)
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Characteristics of HRGs
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Involved in behaviours which make them prone
for HIV infection
Behaviour practices are not legal
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Stigma & discrimination of the HRGs
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HRGs are targeted by police officials
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
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HIV among HRGs
HIV Sentinel Surveillance, NACO, 2007
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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%)
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HIV prevention among HRGs – Approaches
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Reluctance among HRGs to access mainstream
services (e.g. general hospitals,) due to stigma
and discrimination
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Services specifically for HRGs to be provided –
Targeted Intervention (TI)
Principles of TI:
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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.
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HIV prevention among HRGs – Approaches
Principles of TI…contd
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effectively use the language and culture of the
people being targeted.
acknowledge that barriers to accessing healthcare 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
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HIV prevention among HRGs – Approaches
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HRGs do not come out and actively seek
treatment/services, in-spite a TI
approach,
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stigma and discrimination
Fear of police officials
HRGs have to be actively sought out in
the community where they are
- OUTREACH
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Outreach – providing services to the
HRGs at their doorstep i.e. where they
are likely to be in the community
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HIV prevention among HRGs – Approaches
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Two ways of providing outreach services
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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
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HIV prevention among HRGs – Approaches
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Advantages of using peer educators for
providing services:
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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
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National AIDS Control Programme III
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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:
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Prevention of new infections
Care, support and treatment
Strengthening capacities
Building strategic information management
system
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National AIDS Control Programme III
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Enhanced focus on preventive efforts
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2/3rd of budges on prevention
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Major boost to TI programme
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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
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IDU Targeted Intervention
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Approach: Harm Reduction
Services:
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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
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IDU Targeted Intervention…
Services contd…
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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
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IDU Targeted Intervention…
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Service provision – two pronged strategy
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Mobile based services: through an outreach
team
Outreach workers (from IDU/non IDU
background) and Peer educators (current/exIDUs)
 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
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IDU Targeted Intervention…
Service provision…contd
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Static based services: through Drop-inCentre (DIC)
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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
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Screening – STI, abscess and other general
medical conditions, and treatment as required
Abscess management – including dressing
and cleaning
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IDU Targeted Intervention…
Service provision, Activities…contd
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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
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IDU Targeted Intervention…
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A programme manager for overall
management
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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
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