An estimated 2.4 million Indians are HIV positive, 83% of which are aged between 15-49 years (2009). India’s HIV epidemic is largely confined to a few industrialized states in the country’s south and west. Maharashtra is with its 420,000 affected people the second highest affected state, and accounts with the other southern states of Andra Pradesh (500,000), Karnataka (250,000), and Tamil Nadu (150,000) for 55% of India’s HIV infections.
The Indian HIV epidemic has not yet taken hold of its general population and is largely concentrated in a few high-risk groups, spreading first and foremost through unprotected sex between sex workers and their clients (such as migrants and long distance truck drivers), and through the use of contaminated injecting equipment when taking drugs. (Source: Worldbank, 2012)
HIV prevention in India:
- National Level: National Aids Control Organisation (NACO) – In Control of Aids programmes across the country
- State Level: Mahrashtra State Aids Control Society (MSACS) – funding agency
- Local Level: Programmes are being implemented through local NGOs ie. IIYW receives grants from MSACS
Main target groups for HIV/AIDS programmes:
- Female Sex Workers (FSW) – core target group
- Migrants
- Long-distance Truckers
- Intravenous Drug Users (IDU)
IIYW is the only organization in Nagpur offering HIV projects for 3 different high-risk target groups, namely FSWs, Migrants, and Truckers. IIYW’s 3 HIV projects are collaborating through monthly meetings in order to share ideas, as well as organizing a joint health camp every 6 months.
The IIYW’s FSW project targets specifically non-brothel-based female sex workers in non-city areas of the Nagpur district.
Rationale:
The highest HIV prevalence rates in India are found in Maharashtra, Andhra Pradesh and Karnataka in the South; and Manipur, Mizoram, Nagaland in the north-east. Heterosexual contact is the most common mode of HIV transmission in India, which is largely linked to sex work. About half the FSWs do not use condoms consistently with their clients, putting them at high risk of HIV infection. Non-brothel-based FSWs, who form the majority of sex workers in India, were at a significantly higher risk of HIV infection as compared to brothel-based FSWs.
IIYW’s FSW project works in 10 areas, namely: Koradi, Kamptee, Sawaner, Higna Market, Pardi NAKA, Kalmeshwar, Katol, Wadi, Pershiwani, Narkhead.
In these 10 districts IIYW runs 60 condom outlets. The FSW project works with 10 PPPs (Projects Private Practitioners) and every quarter year the beneficiaries are seen by a PPP for an internal examination and general check-up. A target of 20% FSW should be referred to government facilities. Every 6 months the beneficiaries are tested for HIV and syphilis. For this purpose an Integrated Counseling and Testing Centre (ICTC) technician will visit the beneficiaries’ working areas in order to take a blood sample. In case of a positive HIV test, the FSW will be referred to the ART (anti-retroviral therapy) scheme. If a beneficiary suffers from an STI she can come to the project for help at any time.
STI medicine, as well as female and male condoms, are provided free of charge.
Additionally, the project aims to make the FSW aware of government schemes and facilities for people living below the poverty line (BPL).
AIM and OBJECTIVES
Aim:
To halt & reverse the prevalence of HIV/AIDS among the Female Sex Worker (FSW) Population and provide quality services for their sexual health needs in Nagpur District
Objectives:
- To scale up prevention activities regarding STI, HIV and AIDS to saturate (85 to 90%) coverage of high-risk groups and vulnerable populations by initiating Behaviour Change Communication (BCC) activities and mobilizing the community in Kamptee, Koradi, Paradi, Hingana and Wadi, Kalmeshwar, Katol, Narkhed, Parshivani, Saoner Nagpur District/City.
- To saturate and increase utilization of Integrated Counselling and Testing Centres (ICTC), STI care, support and treatment services among FSWs in Kamptee, Koradi, Paradi, Hingna Wadi, Kalmeshwar, Katol, Narkhed, Parshivani, Saoner Nagpur District/City.
- To promote the effective usage of condoms and ensure availability and accessibility of the same among the FSWs population.
- To ensure the sustainability of the program in Kamptee, Koradi, Paradi, Hingna and Wadi, Kalmeshwar, Katol, Narkhed, Saoner, Parshivani Nagpur districts/city by building capacity of CBS, staff, various stakeholders and service providers.
- To develop, train and monitor groups of peer educators from the PTG and community.
- To create an enabling environment through Advocacy & Networking in the project area.
- To build capacity of staff, as well as various stakeholders and service providers in implementing strategies and sustaining the programmes.
- To conduct the mapping and enumeration of the Female Sex Worker (FSW) population in West Zone of Nagpur City.
ACHIEVEMENTS
Coverage
| |
2009-10 |
2010-11 |
2011-12 |
2012-213 |
2013-14 |
| Target |
1000 |
1500 |
1500 |
1500 |
1500 |
| Regular Contact |
NA |
730 |
1462 |
1617 |
1688 |
| Ever Reached |
1386 |
2183 |
2214 |
2275 |
2303 |
| Drop Out |
0 |
0 |
612 |
613 |
615 |
| Active Population |
1386 |
2183 |
1602 |
1662 |
1688 |
STI Management
| |
2010-11 |
2011-12 |
2012-13 |
Apr 2013- July 2014 |
| Clinical Attendance |
2543 |
3999 |
5737 |
2358 |
| RMC |
1611 |
3144 |
5330 |
5330 |
| STI Treated |
353 |
367 |
349 |
120 |
| Internal Examination |
179 |
367 |
3741 |
2276 |
| VDRL (Syphilis) |
808 |
1029 |
2348 |
941 |
HIV Testing
| |
2010-11 |
2011-12 |
2012-13 |
Apr 2013- July 2014 |
| Testing |
1638 |
2346 |
2757 |
1157 |
| No. of Positive |
1611 |
3144 |
5330 |
5330 |
| ART Linkages |
18 |
8 |
11 |
1 |
OUTCOMES
The project’s target group is involved in sexual activities and at high risk of HIV and STI infections; a hidden population which cannot be easily reached. Therefore, the project applies a peer strategy, where FSWs are trained in order to provide services to a group of their peers, covering the high risk key population (KP).
- We have successfully provided capacity building of the peer group.
- Now the peer group is educated about every service, and can provide information to key persons about safe sexual practices, health awareness, and STI treatments.
- Additionally, one of peer educator from Koradi is working in Micro Finance.
CHALLENGES
- The changing pickup spots of FSWs make it difficult to contact them.
- Opening bank account of peer educators – lack of documents
- Identifying & contacting FSWs is a very difficult task.
- FSWs do not open up easily and try to avoid speaking to the staff.
- The majority of FSWs are housewives, and hence do not readily agree to keep condoms with them.
- Arranging follow ups with FSW are very difficult.
FUTURE TARGETS
The FSW’s reached so far represent only the tip of the iceberg. Many more, particularly young FSW’s, remain hidden. Therefore, we continue to train our Peer Educators (PEs) and Out Reach Workers (ORWs), enabling them to reach all FSW’s and raise awareness about our services, the risks of HIV/AIDS, and promote safe sexual practices.
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