The NACP- III was launched with the objective to halt and reverse the spread of the HIV/AIDS epidemic in India. The evidence that a large percent of the PLHIVs are in rural areas confirms the movement of the epidemic from urban centres to rural ones. This evidence demands a specially designed strategy that can help in reaching out to these significant numbers residing in rural areas and saturating their coverage.
Link Workers Scheme (LWS) the rural focus HIV prevention programme with the mandate to work in 163 high prevalent and highly vulnerable districts in India with the specific goal of reducing rural India’s vulnerability to HIV. The impact of HIV in rural areas is enormous due to stigma and discrimination surrounding HIV, resulting in poor access to health care, gender inequality and above all infections going undetected or treated by unqualified practitioners. The LWS “links” HRGs and vulnerable populations in rural areas, to HIV services.
Currently Link Worker Scheme is operational under domestic funds in 17 states. The scheme envisages identifying and training, this village level workforce of Supervisors, Link Workers and volunteers on issues of HIV/AIDS, gender, sexuality, STIs and above all on mobilizing difficult-to-reach, especially vulnerable sub populations including high risk individuals, youth and women. Linking these marginalized sub populations to the public health services for STI, ICTC, ART and then their follow up back to communities is one of the key areas that is expected to be addressed by theses Link Workers, generating volunteerism among the community for fighting HIV/AIDS and inculcating health values is another cornerstone of this strategy.
I. Target Groups:
The Link Worker Scheme intends to reach out to those at risk and vulnerable individuals or groups who are at present not able to access to HIV related information and services.
The target groups for the LWS are broadly classified into following groups:
a. High-risk groups (HRGs): Groups or networks of individuals who have a higher number of sexual partners or share injection equipment have higher levels of risk of contracting as well as spreading HIV infection to other population groups and are designated as High Risk Groups(HRG).There are three core HRGs — Female Sex Workers (FSWs), high risk Men who have Sex with Men and Transgenders (MSM and TGs), and Injecting Drug Users (IDUs).
b. Vulnerable groups: At-risk men, which include clients of sex workers;at-risk women who have casual multiple partners; partners/spouse of migrants /mobile men and women; partners / spouses of commercial drivers/ cleaners; partners/spouses of FSWs/MSMs/IDUs; women in women headed households; PLHIV; OVC; and youth population.
c. BridgePopulations: The broader transmission of HIV beyond high-risk groups (FSWs, MSM, Transgenders and IDUs) often occurs through their sexual partners, who also have lower-risk sexual partners in the “general” population. Bridge populations are formed of people, who, through close proximity to HRGs are at the risk of contracting HIV, particularly clients of sex workers. Truckers and migrant labourers form a major section of bridge populations. They are a critical group because of their ‘mobility with HIV’
II. Tasks, Personnel and Structures:
Link Worker Scheme envisages a new cadre of trained and motivated local personnel who are introduced at the village level as link workers. These trained volunteers are then expected to implement the following features of the scheme:
1. Identification of individuals/groups within the villages in need of information and services through detailed Situation Need Assessment (SNA).
2. Generation of demand and strengthening access to various HIV/AIDS related services by involving a team of highly motivated and trained representatives from the community – a male and a female Link Worker- for a cluster of villages.
3. Enhancing community participation, building a sense of ownership and stakes in it to enable the short-term, time-bound interventions that sustain beyond the programme.
In order to sustain the process of change in the communities, even after the project withdraws, the scheme visualises the link workers carrying out the following tasks:
• Serving as peer educators and create awareness about HIV in the village.
• Providing support in managing the information centres
• Providing linkages, referrals and follow up.
• Mobilizing communities to participate during events, or outreach camps.
• Ensuring that the change process gets support and acceptance from the community.
• Coordinating the day-to-day functioning of Red Ribbon Club
• Serving as condom depot holders
• Establishing rapport with local groups and get information about the possible HRGs
• Providing care and crisis support to the PLHIVs
Activities conducted under the LWS include:
• Community outreach to establish linkages with services:
Link Workers will reach out to those at risk and vulnerable individuals who are at present not able to access to HIV related information and services. The scheme will promote risk reduction and motivate community members to adopt behaviour change and will link them up with programmes and services.
The focus will be on advocating for availability of quality services and reduction of stigma and discrimination against HRG and PLHIV.
• Community mobilization:
Community members will be facilitated to develop ownership and sustain the scheme beyond the life of the programme. Formation of youth groups, Red Ribbon Clubs and involvement of volunteers will be encouraged to ensure that the efforts are sustained.