Details for Reform Option "Targeted interventions among high-risk group of HIV/AIDS, Tamil Nadu"
The spread of HIV/AIDS is associated with behaviour. Generating awareness and changing behaviour can therefore reduce its transmission. The first case of AIDS in India was detected in Tamil Nadu (TN) in 1986. As the number of infections grew, the AIDS Prevention and Control Project (APAC) was started in TN and Pondicherry in 1995 under a tripartite agreement between Voluntary Health Services (VHS), a charitable Non Governmental Organisation (NGO) in Chennai, United States Agency for International Development (USAID) and the Government of India through its National AIDS Control Organisation (NACO).
APAC has concentrated on high risk population groups for targeted interventions, including long distance truck drivers, female commercial sex workers, tourists, slum populations, factory workers, men having sex with men and migrant workers. A network of 72 carefully selected NGO partners delivers the intervention programmes in TN and Pondicherry.
The thematic areas for interventions are: Prevention Along The Highway (PATH), Women In Prostitution (WIP), Slum Intervention Programme (SIP), Tourist and Women In Prostitution (TWIP), Industrial Intervention Programme (IIP), Men having sex with men (MSM), Migrants Intervention Programme (MIP).
The APAC project is governed by a Project Management Committee (PMC), which is chaired by the Health Secretary of the Government of Tamil Nadu. Other members include representatives from NACO, Tamil Nadu State AIDS Control Society (SACS), Pondicherry SACS, USAID and VHS. This committee sets the policies and guidelines for APAC. Community needs assessment is carried out to establish which materials are required for behaviour change.
Strategies adopted are:
(i) Spreading culturally sensitive messages through peer education: Peer educators are voluntary members of the community who receive training from the NGO to deliver education on Sexually Transmitted Infections (STIs) and HIV/AIDS at a small cost.
(ii) Promoting condom use: APAC has collaborated with Hindustan Latex Limited (HLL) to supply condoms of improved quality to the areas of intervention. Social workers employed by the NGOs or APAC educate individuals on condom usage. They sensitise potential retailers through appropriately developed training programmes conducted by professional agencies. Retailers are encouraged to increase their stock, display and sell condoms through attractive schemes.
(iii) Street plays: Performances are conducted to convey messages on STIs and HIV/AIDS in overt and covert form. NGOs selected by APAC are provided training at the APAC supported Resources and Training centres in traditional media. A state level meeting for planning was convened to decide the content of the plays. It was followed by script writing on different topics to be covered surrounding the subject of HIV/AIDS. The theme, language, content, and background were carefully selected to produce maximum impact among the audience. Plays were standardised for uniformity. Professionals with specially designed costumes were engaged to participate in the plays. All NGOs funded by APAC are equipped with well-trained instructors who further train local volunteers to continue these activities. After the plays, NGO staff are available for discussion and follow up.
(iv) Promotion of quality services: The partner NGOs in their area of operation identify health care providers. They are sent for training to APAC Continued Education and Training Centres (CETC) for delivery of quality care for STIs and HIV/AIDS at the local level. They also provide field supervision and support to the partner NGOs. Social workers, counsellors and peer educators create awareness on STI symptoms and encourage patients to seek treatment from these qualified medical practitioners, thus establishing referral networks.
(v) Interpersonal communication (IPC): APAC employs both traditional and non-traditional media to communicate effectively to spread awareness and to remove the stigma attached to HIV/AIDS. IPC is conducted within each thematic intervention through trained counsellors, social workers and peer educators. Advertising agencies are employed to design and develop print and electronic media messages in line with APAC requirements. Outdoor activities such as mobile exhibitions or campaigns on bus or auto panels are also conducted regularly to address specific issues.
(vi) Behaviour Surveillance Surveys (BSS): Research complements the activities of APAC. BSSs have been conducted annually in TN and Pondicherry with the objective of discovering trends in the behaviour of high-risk populations, STI prevalence in the general population and high-risk groups and to understand better the needs of the community.
(vii) Creating a healthy environment for People Living with HIV/AIDS (PLHA), so that they and their families can lead normal lives.
The Efforts of APAC are monitored every year through Behavioural Surveillance Surveys (BSS). Some of the results among selected groups include:
Commercial Sex Workers-Female (CSW-F)
(i) Condom usage among CSW-F with clients has increased from 56% in 1996 to 85.9% in 2004.
(ii) Voluntary procurement of condoms has shown a steady increase to 87.4% in 2004 from 11% in 1996.
(iii) Risk perception among the CSW-F has increased from 42% at base line (1996) to 77% in 2004.
Truckers and Helpers
(iv) Involvement of truckers and helpers with a non-regular partner has declined to 33.7% in 2004 from 48% in 1996.
(v) Condom usage of truckers and helpers with paid partners has increased to 88.5% in 2004 from 55% in 1996.
Availability of condoms
(vi) Increase in condom distribution from 17,000 outlets in 1996 to 55,505 outlets in 2004
(vii) Increase in sale of condoms to 31 million pieces in 2004.
The work of APAC has been appreciated by NACO and is now recognised as a Training Resource Group for targeted intervention in the country. Based on the experiences from the first phase of the APAC project, additional funds were provided to APAC by USAID for the second phase of activities (2003-2007).
APAC was provided with a grant of $10 million (INR 439 million) during the first phase (1995-2002) and $15 million (INR 660 million) for the second phase (2003-2007).
21 districts of Tamil Nadu and Pondicherry are covered by a network of APAC partner NGOs since 1995.
It takes a year from the time of grant allocation to effectively deliver the various program components.
Focus on behavioural modification: Through a multi- pronged strategy, behaviour change in the high-risk groups is encouraged.
Focused designing of messages: Messages are designed and organised according to the need of the recipient.
Quality of services: Availability of services and treatment for STD and HIV/AIDS sufferers by qualified medical professionals, and availability of quality condoms for prevention of infection.
No disadvantages perceived.
Government Order and Legal Agreement between partners.
Who needs to be consulted
State Government, Donor agencies, National AIDS Control Society, State AIDS Control Society.
Sustainability of the activities has driven all the strategies of APAC, including:
(i) Selection of committed NGO partners who are already working in the field and have their own infrastructure and manpower.
(ii) Raising the capacity of NGOs to deliver messages more effectively to meet the programme needs.
(iii) Spreading awareness of STIs and HIV/AIDS through multiple channels and training of healthcare providers in the area to meet demand.
(iv) Collaboration with manufacturers to maintain constant supply of high quality condoms to retailers in intervention areas.
Chances of Replication
The APAC model can be successfully replicated with careful selection of NGOs, planned technical assistance, supportive onsite supervision and supportive referral services.
The APAC model is unique in the state because it was the first wholly private sector approach to address the problems of AIDS in Tamil Nadu. This model has set an important standard for productive partnership of the government with private sector institutions.
Dr. Anuradha Davey, Research Consultant, IRMS, September, 2005.