It is estimated that more than 90% of HIV transmission in India is related to unprotected sexual intercourse or sharing of injecting equipment between an infected and an uninfected individual. The most effective means of controlling the spread of the HIV epidemic in India is through the implementation of Targeted Interventions (TIs) amongst persons most vulnerable to HIV/AIDS, people belonging to High Risk Groups (HRGs) such as Female Sex Workers (FSWs), Men who have Sex with Men (MSM) and Transgenders (TGs) and Injecting Drug Users (IDUs). In addition, the Bridge Populations of truckers and migrants also require focused interventions as broader transmission of HIV occurs through these sexual partners of HRGs, who also have lower-risk sexual partners in the general population. They are known as 'Bridge Population', because they form a transmission bridge from the HRG to the general population.
Targeted Interventions (TIs) with specific strategies and deliverables have been designed to focus on five major components to reach the goals of controlling and reversing HIV/AIDS:
- Behaviour Change Communication (BCC)
- Treatment for Sexually Transmitted Infections (STI )
- Distribution of condoms and other risk reduction materials
- Ownership building
- Creating an enabling environment
- Needle syringe exchange programme
- Opioid Substitution Therapy (OST)
- Employer Led Model (ELM) of intervention amongst migrants
I. Target Groups:
A. Core 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).
Female Sex Workers (FSW)
For the purpose of Targeted Interventions (TIs), a Female Sex Worker (FSW) is an adult woman, who engages in consensual sex
Men who have Sex with Men (MSM)
MSM is used to denote all Men who have Sex with other Men as a matter of preference,regardless of their sexual identity or orientation and irrespective of whether they also have sex with women or not. MSMs are also highly vulnerable to HIV and a strategically important group for focusing HIV prevention programmes as some, though not all, MSM sub-populations do have high rates of partner change as well as high number of concurrent sexual partners; and those that often engage in anal sex with multiple partners.
Injecting Drug Users (IDUs)
HIV is highly transmissible through the sharing of needles and other injection equipment as a result of which, it can spread very rapidly amongst IDUs who may inject drugs, then fall back into non-injecting drug use (e.g. oral), or abstinence, and then return to injecting drug use. IDUs are another for which TIs are of critical importance as some IDUs are also sex workers and once HIV prevalence is high in the IDU population, it can expand quickly into the larger high risk sexual networks.
Transgender Groups (TG/ Hijra)
Hijras belong to a distinct socio-religious and cultural group, a ‘third gender’ (apart from male and female). They dress in feminine attire (cross-dress) and are organised under seven main gharanas (clans). For the purposes of TIs, hijras are covered under the term ‘trans-genders’ or TGs.
B. Bridge Populations: The broader transmission of HIV beyond high-risk groups (s, , and ) 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 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’.
Evidence shows long-distance truck drivers who spend months at a stretch on highways, being away from their family are move throughout the country, those who are at higher risk of HIV can form transmission “bridges” from areas of higher
In developing countries an increasing number of poor illiterate people, mostly single males, are moving from rural areas to work
. Tasks, Personnel and Structures:
NACP focusses on implementing TIs through NGOs and CBOs. The NACO has developed SACS’ recruit suitable NGOs, CBOs or networks following the processes laid out in
TSUs oversee the implementation of TIs in the respective States along with SACS and facilitate its execution along with partner organisations.
Core groups: Through the TIs under NACP , highrisk and , and receive a comprehensive package of preventiveservices, including treatment for , distribution of condoms and other risk reduction materials, needle syringe exchange programme, Opioid Substitution Therapy (OST) etc.
Bridge Populations: Interventions for Bridge Populations particularly focus on clients of sex workers who receive acombination of services including condom promotion, referrals to clinical services for STI management and Behaviour Change Communication (BCC). Specific strategies have been outlinedto approach two major populations within the bridge population: and . The HIV prevention program with truckers has 4 major strategies i.e. enhancing their knowledge on the issue and motivating them to adopt safe sexual practices, among long-distance truckers, through, increasing the involvement of CBO in the planning, management, and monitoring of the project program.
Intervention programmes amongst migrants target both transit and destination points using community-based intervention points at grass-root level, as well as behaviour change through massive awareness creation and increasing the accessibility of condoms at the community level. The Employer-led Model of interventions also helps in building capacity within government, corporate and private institutions, specifically focusing on migrant informal workers.