1. TI for IDUs

2. 1.8 1.9 4.3 5.6 84.6 Sexual IDUBlood Perinatal Unidentified Routes of HIV Transmission SENTINEL SURVEILLANCE 2006 HIV infection in India is mostly through sexual route. Just 2 out of 100 HIV positive people are IDU. Why bother with IDU programmes when the ratio is less compared to sexual route?

3. HIV Prevalence – Various Groups 7 out of 100 IDUs are infected with HIV. This is the average for the country. However, high rate of HIV (>5%) among IDU in many sites/ cities (SS 2006) ensures a high chance of spread of HIV from IDU to IDU as well as the general community

4. Substance Users IDUs RISK RINGS HIV Wives and girlfriends of clients Husbands and boyfriends of FSWs Clients of FSWs Wives and girlfriends of Substance users Female Sex Workers IDU & HIV IDU HIV among IDUs can spread to general population through sexual partners/routes. Hence, the need for intervention among IDUs.

5. IDU Intervention in NACP III Estimates: 190,000 IDU in the country Objective: prevent transmission of HIV Approach: harm reduction (incorporated in the National Policy) Service delivery 1.Targeted Intervention 2.Delivery by NGOs 3.Provision of services at doorstep of IDU Service recipients: IDU and sexual partners

6. Harm Reduction Services Outreach Activity Direct service deliveryLinkageservices Opioid Substitution Therapy (OST) Linkages Services Tier3 2Tier 1 There would be 3 tiers of harm reduction services offered to IDU through TI. Tier 1 & 2 would be offered directly; 3 rd would be provided through linkage/referral:

7. Tier 1: Outreach Activity  Delivered through ORW and PE  Services Needle Syringe Exchange Programmes (NSEP) Condoms - free distribution and social marketing Primary health care, STI and abscess management Behaviour Change Communication (BCC)

8. Tier 2: Opioid Substitution Treatment Delivery by NACO accredited agencies Substitution agents: Buprenorphine, Methadone Initiated by a trained physician and administration through trained personnel Psychosocial services Follow-up by ORW/PE Provision/link to Tier 1 Services Strict record maintenance

9. Tier 3: Linkage Services Linkages 1. ICTC (voluntary informed consent) 2. ART, DOTS, RCH 3. Waste management agencies Accompanied referrals by ORW/ PE Established referral networks with medical, legal and welfare schemes Linkage with detoxification and rehabilitation centres

10. Enabling Environment ‘To create a milieu where IDU are able to access services freely without interference’ Advocacy with law enforcement agencies Regular advocacy with community leaders Periodic advocacy with health workers Raising public awareness including Advocacy for General Population