NACO and NACP

Response of Govt to HIV National AIDS Control Programme (NACP) under Ministry of Health & Family Welfare in 1992 NACP I (1992 – 1999) NACP II (1999 – 2006) NACP III (2007 – 2012)

NACP I & II  NACP I The focus was to observe the trends of HIV infection, create safe blood banks and raise awareness in the general community  NACP II Initiation and Expansion of TIs (90 IDU TI – mostly in NE) Raising awareness on HIV Conducting regular surveys to understand behaviour

NACP III (2007 – 2012) Goal: To halt and reverse epidemic in India over next five years Objectives 1.Prevention of new infections 2.Care, support and treatment 3.Strengthening capacities 4.Building strategic information management systems

NACP III (2007 – 2012) Continued emphasis on prevention Significant up-scaling of activities (increased targets) TI with greater focused approach (sex workers, IDU and MSM interventions) Empowering and capacity building to manage TI

Targeted Interventions STI care Condom promotion Enabling environment Blood safety Integrated Counselling and Testing including PPTCT STI care IEC and social mobilisation Mainstreaming ART HIV-TB co- ordination Treatment of opportunistic infections Community care centres Post-Exposure Prophylaxis HIV Sentinel Surveillance Behavioural Surveillance Monitoring and Evaluation Operations research DAPCU Technical resource groups Enhanced HR at NACO, SACS and districts Enhanced training activities Prevention High risk populations Low risk populations Care & support Monitoring and Evaluation Institutional Strengthening Care, Support & Treatment Strategic Information Management Capacity Building NACP-III at a Glance

Summary: Priorities under NACP-III Saturate coverage of High Risk Groups Scale-up treatment services Decentralize to district and sub-district level Normalize use of condoms Focus on youth and adolescents

Targeted Interventions

Targeted Interventions Under NACP-III 1. More focused approach Core Groups FSWs IDUs MSM/Transgender Bridge Population Truckers Migrant Workers 2. Specific package of services for HRGs 3. Emphasis on CBO-led Interventions Components of Targeted Intervention Behaviour Change Communication Management of Sexually Transmitted Infections Condom Promotion Needle Syringe Exchange Programmes (NSEP) OST (directly or through referral) Enabling Environment Referrals & Linkages Community Mobilization

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

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

Components of TI Condom Promotion Management of STIs Community Mobilization Enabling Environment Referrals & Linkages Behaviour Change Communication HRGs Needle Syringe Exchange Programmes (NSEP) Opioid Substitution Therapy (OST)

Condom Promotion  Every person should have access to condoms when he/she needs it  Primary Strategy: Free supply of condoms to HRGs through TI NGOs/CBOs  Secondary Strategy: Promoting social marketing of condoms through Social Marketing Organizations

Needle Syringe Exchange Programmes (NSEP)  Involves supplying new, clean needles and syringes to IDUs, in exchange of old used needles and syringes, along with efficient waste disposal management  More readily associated with the harm reduction approach than any other type of intervention  Incorporate a variety of other preventive strategies such as outreach, risk reduction education, referrals to other health and social services, etc.

Opioid Substitution Therapy (OST) Involves substitution of injecting drugs with medically safe drug Associated with reduction in injecting behaviour and helps the IDU to wean off from drugs Used in combination with NSEP Provides maximum impact when used in combination with NSEP

Community Mobilization  Community members get to participate in collective decision-making  Formation of various committees like DIC Management Committee and Clinic Committee empowers the community  It creates community norms for service uptake and safer sex behaviour

Referrals & Linkages  Linkages to STI and health services with strong referral and follow-up  Promotion/distribution of commodities including free condoms, lubricants, needles/syringes  Linkages to other health services (e.g. for TB) and Integrated Counselling and Testing Centres (ICTCs)  Linkages for waste disposal with medical institutions and private agencies  Provision of safe spaces (DICs)

Management of STI  STI services: An opportunity for prevention education to the individual as well as to his/her partner  Planning for STI services done with the HRGs  Clinicians should have an attitude of respect towards the community  Availability of services should be as per the needs of the community  Accessibility of services at optimal locations (i.e. not too far from the major hotspots)

Enabling Environment  To enable HRGs to negotiate safer injecting and safer sex  Advocacy with policy makers, law enforcers and opinion leaders  Reduction of vulnerabilities through crisis response system  Treatment and legal literacy for IDUs  Also address broader socio-economic vulnerabilities include factors such as poverty and illiteracy

Behaviour Change Communication  It is vital to change the community’s behaviour to ensure that they practice safer injecting and safer sex  This involves creating awareness about the importance of using new needles/syringes, condoms, services available for STI and the importance of regular screening for related conditions  It also means creating a demand for these services  TIs need to encourage analytical thinking and problem- solving among HRGs so as to help them overcome their barriers to HIV/STI risk reduction