A WHO report released has said that about 4.8 million people were living with HIV in Asia in 2010 and nearly half (49%) of them are in India. Seven Asian countries report an estimated 100,000 or more people living with HIV in 2009, collectively accounting for more than 90 per cent of people with HIV in the region. India tops the list followed by China. Although the prevalence of HIV has declined, India is home to the second largest population of people living with HIV. In 2010, only 23 per cent of pregnant women were tested for HIV and only 18% of PLHIV are on ART.
Though programmes across India have managed to contain the spread of HIV, the problem remains serious. India needs to stem the spread of AIDS disease rapidly. Its debilitating effects cut across the socio-economic strata of the Indian society. There is an urgent need to convergence of resources for HIV and SRH programmes to promote non discriminatory practices and for cost effectiveness. FPA India through a rapid assessment study identified gaps at the policy, systems and services delivery levels on SRH-HIV linkages in India.
Through a number of funding grants, FPA India was able to expand and increase information and services related to HIV in almost all locations. Awareness on HIV transmission and prevention, testing, treatment, care and support and services near their place of residence. Various branches conducted programmes to identify the areas of discrimination for PLHIV and their family members. Health check up was initiated nearby and continuum of care was provided including nutritional support.
Integrated services were provided at 40 clinics. VCTC has been established in 34 clinics across the country. A number of clients who avail SRH services also avail HIV-related services at the same clinic. Also those clients who are HIV positive among SRH services without facing stigma and discrimination.
Co-opting PLHIV in Branch Executive Committee
Thirty Branch Executive Committees and two Project Liaison Committees have co-opted one HIV positive person to provide guidance in the HIV programme of FPA India. Chennai, Nagaland, Mumbai and Kolkata Branches have established partnership with 21 NGOs and eight PLHIV networks of which eight MoUs have been established with NGOs and five with PLHIV networks. Besides this, eight Branches also signed a written MoU with local PLHIV network. This partnership helps the Branches to provide referral services to PLHIV for HIV related care and support services and in return they get referrals from these Networks and NGOs for SRH services.
Addressing Stigma and Positive Prevention among PLHIV and Key Population
A two year project was implemented at Kolkata, Mumbai, Nagaland and Chennai Branches in 2010 to promote sexual and reproductive health of People Living with HIV and Key Population groups and to empower PLHIV to access information and services to lead a healthy life. Refresher training programmes were conducted for staff and peer educators on positive prevention aspects. Regular recreational activities, expert talks and health sessions were conducted for PLHIV and KPs in the Drop in Centre and outreach area. Support group meetings were conducted in the outreach and Branch office/DIC. Follow up counseling sessions were conducted for the family members to help PLHIV maintain good health and adhere to ART treatment. Special counseling sessions was provided to discordant couples to maintain good health. PLHIV networks were strengthened and community volunteers were identified and trained in positive prevention aspects. Income generating skills were enhanced on jewellery and envelop making out of which 72 were PLHIV. Meetings for police personnel including officers on positive prevention were conducted. Bank officials were also sensitized to the needs of PLHIV and to consider giving small financial assistance to them to start small business.
People Living with HIV Stigma Index
People Living with HIV Stigma Index was launched in Tamil Nadu. A Project Advisory Committee was formed consisting of members from Tamil Nadu, AIDS Control Society, PLHIV networks, key population groups and other key stakeholders from Chennai to guide the Consultant and to provide support to carry out the study. People living with HIV often face stigma and discrimination and know what their rights are and how they can change things for the better. This index aims to collect information on their experiences on stigma, discrimination and their rights that will help in advocacy.
Rapid Assessment of Sexual and Reproductive Health and HIV Linkages in India
Linkages between SRH and HIV policies, programme and service delivery levels were reviewed and recommendations made to the government to implement a strong SRH-HIV integrated program. The assessment adapted the "Rapid Assessment Tool (RAT) for Sexual and Reproductive Health and HIV Linkages" developed by IPPF, UNFPA, WHO, UNAIDS, GNP+, ICW and Young Positives modified it according to the socio-cultural context of the country. The findings of the study were disseminated to the Assessment Team Members including NACO and MOHFW at New Delhi. At the state level, it was shared with the stakeholders at Mumbai, Lucknow, Kolkata and Bangalore.
Linkages between SRH and HIV policies, programme and service delivery levels were reviewed and recommendations made to the government to implement a strong SRH-HIV integrated program. The assessment adapted the "Rapid Assessment Tool (RAT) for Sexual and Reproductive Health and HIV Linkages" developed by IPPF, UNFPA, WHO, UNAIDS, GNP+, ICW and Young Positives modified it according to the socio-cultural context of the country.
FPA India's various branches have implemented targeted intervention projects. The Mumbai Branch implemented two targeted Intervention projects in Bhiwandi. The aim of the project is to reduce the incidence of transmission of STI/HIV/AIDS among migrant loom workers and enhance awareness on STI/HIV and encourage safer sex practices among migrants. The main objective of this project is behavioral change, condom promotion, STI care and treatment. Single migrant workers were reached out to media outlets. Thirty safe spaces were identified where planned counseling sessions and health checkup was conducted. Peer Educators were identified and were given symptomatic treatment. STI management was provided to clients and were tested for HIV. The Panchkula Branch conducted BCC activities for MSM and Transgender people. The Mohali Branch strengthened STI treatment and safe sex practices progarmmes. Another targeted Intervention project was implemented by Mumbai Branch to expand the mapping and enumeration of the sex workers, bar girls, floating street and home based female sex workers. Bar workers were identified and strategic-based communication activities were initiated. The Suraksha Project implemented by Trivandrum Branch organized regular sensitization programme for the IDUs and HIV Positive IDUs under continuum of care services the clients were referred to centers for ICTC, VDRL and ART.
Positive Prevention Guide in Hindi
The Health and Family Welfare Minister of Bhopal, Shri Narottam Mishra, released the Hindi version of the Positive Prevention Guide developed in English by FPA India and Indian Network of PLHIV (INP+) and translated into Hindi by RTC Bhopal. Speaking on the occasion. the Health Minister stressed on the need of bringing those who are suffering from HIV/AIDS to the mainstream of society for effective control of the disease with the help of government bodies and NGOs. Mr. Ashwini Kumar Rai, Project Director of MPSACS, presented the first copy of the book to the representative of Madhya Pradesh Network of Positive People. The programme was organized in collaboration with Madhya Pradesh State AIDS Control Society (MPSACS).
Community Care Centre
The Madurai and Dindigul Branches have been supported by the Tamil Nadu State AIDS Control Society to run Community Care Centre (CCC). These centres are located in the Reproductive Health Clinic of the branches and provide integrated services to PLHIV. Seven meetings and 218 members participated in the support group meetings for children infected and affected by HIV and their care takers
Health Fair at Eastern Railway
The Kolkatta Branch in coordination with Eastern Railway organized a Health Fair. The Fair was inaugurated by Dr. S. S. Rathor, Chief Medical Director of Eastern Railway. IEC material was distributed. The Eastern Railways expressed their desire to collaborate with the Branch to educate the R P F and general staff in different selected places on STI and HIV.
World AIDS Day
World AIDS Day (WAD) was observed on December 1. 2011. The new theme 'Getting to Zero' will be on until 2015 with a vision of achieving "Zero new HIV infections, Zero discrimination, Zero AIDS-related deaths." Various events were organized by FPA India branches. The Ahmedabad Branch in collaboration with Ahmedabad NP+ organized an advocacy programme for PLHIVs, youth and NGO representatives. The Agra and Chennai Branches organized interactive meeting and quiz competition for students. The Bijapur Branch in co-ordination with the District Health and Family Welfare Office held a rally and also conducted orientation programme on stigma and discrimination for SHG leaders and members. The Barwani Project organised a confluence for Accredited Social Health Activist (ASHA). The Belgaum Branch organised a district- level rally consisting of students from various schools and volunteers. The Bellary Branch in co-ordination with District Health and FW department and Bellary District AIDS prevention society conducted a mass meeting and a street play on care and support. The Bhubaneswar and Jaipur Branches arranged awareness programmes in slum areas where basic information on HIV/AIDS was imparted. The Bangalore Branch in collaboration with Bangalore Medical Services Trust (BMST) and Bharat Heavy Electronics Limited (BHEL) conducted a series of programmes for adolescents, women groups and PLHIVs. The Dindigul Branch in coordination with Society of Obstetrics and Gynecology and Nursing College organised awareness meeting for students. The Dharwad, Nilgiris, Panchkula and Yamunanagar Branches observed the day by arranging income generating training programme for PLHIV and offered practical tips for successful entrepreneurship. The Gwalior Branch invited PLHIV attached to Adarsh Siksha Samiti and were given training to improve their knowledge and skill by providing information on treatment facilities, opportunistic diseases and nutrition. The Trivandrum Branch conducted a yoga programme for their beneficiaries. The youth volunteers in Kalchini and Indore Branches held a motor cycle rally. The Madurai Branch along with the District Legal Service Authority and North Kanara Branch Lions Club organised rallies with college students. The Mysore and Solapur Branches in collaboration with the Rotary Club and Inner Wheel Club held a rally as well. In Mysore, the MSW students presented a street play on AIDS awareness among the public.
A Red Ribbon awareness Campaign was organized by the Mumbai and Bhopal Branches. The Mumbai Branch also organised a signature and T-Shirt painting campaign followed by exhibition on HIV/AIDS and HIV awareness rally presenting street play.
The Aastha Project
Funded by FHI 360, as part of the Bill & Melinda Gates Foundation's India AIDS Initiative, FPA India has been implementing Aastha Project in partnership with eight grass-roots NGOs to reduce the spread of HIV/STIs amongst sex workers and their regular partners in the Mumbai and Thane districts of Maharashtra. In the final year of second phase, the Project is consolidating its gains while moving on to refining project strategies for Care & Treatment (C&T) amongst SWs, building on the trust developed by the project amongst the SWs community over the last seven years.
Rise in awareness is one of the important indicators that shows the achievement of Aastha goals on field. Out of 12,884 active SWs 9402 (73%) have taken one of the Aastha services. 7636 (59%) Key Population were reached through one to one SBC sessions to motivate them for clinical services, repeated testing, and condom usage. Focused HIT approach led to dramatic results. The number of people tested rose and over 6000 tests were conducted. About 278 of those tested have been linked to the care and support services that they needed, including support for positive prevention. Adding family planning services to programs focused on HIV and other sexually transmitted infections has made the program more attractive to the SWs.
CBOs Capacitation and Aastha Parivaar
The focus was to strengthen the CBOs and provide support to Aastha Parivaar in building capacity of all 13 CBOs. New strategies are being implemented to strengthen the CBOs and bring visibility to CBO and Aastha Parivaar. For this financial year, an agreement has been signed between Aastha Parivaar and 13 CBOs. To strengthen the CBOs two special positions were added to the CBOs along with the CDO. Monitoring tool was prepared (Key deliverables) for tracking the progress of activities to be implemented at the CBO level. All the CBOs increased their Corpus funds. Preparing the Implementing Partners for transition to NACO (MSACS/MDACS) has been the focus in 2011. The Aastha Parivaar was supported by FPA India to increase its visibility and to give opportunities to the sex worker community to be mainstreamed. A refresher training was conducted for Aastha project nurses wherein the roles and responsibilities of nurses were discussed, especially in view of transition of Aastha NGOs to NACO. An orientation workshop was conducted on the NACO reporting format for Project Coordinators, MIS officers and Counselors followed by ORWs, PEs training in each IPs.
Consolidating community-based efforts
There are 415 Aastha gats with 6,883 members, 116 Aastha Gats are acting as condom depots. In 2011, Aastha gats organized 186 health camps. The gats also took 324 SBC sessions in the gat meetings and provided 1244 Aastha Tatkal Seva. Being a role model for the KPs, 96 Gat leaders and 487 Gat members did HIV testing.