Targeted Intervention Project on HIV/AIDS The prevention of HIV infections in high risk groups is a major thrust of SEWA’s Health Programme. Targeted Intervention Programme of SEWA supported by Assam State AIDS Control Society is one of the most effective means of controlling the spread of HIV in the community. Targeted Intervention Project has been implementing amongst persons most vulnerable to HIV/AIDS, such as female sex workers (FSWs), men who have sex with men (MSM). 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.Much of the HIV transmission in India occurs within groups or networks of individuals who have higher levels of risk due to a higher number of sexual partners or the sharing of injection drug equipment. SEWA targets two core high risk groups (HRGs) of individuals who are most at risk under core composite Targeted Intervention • Female sex workers (FSWs) • High risk men who have sex with men (MSM), and transgenders (TGs) The HIV transmission dynamics in India are such that unless effective targeted HIV prevention saturates the most at risk HRGs of FSWs, MSM/TGs and IDUs ( Injected Drug Users ), the epidemic will not be controlled. But the positive implication of this is that if HIV prevention is successful in these HRGs, the epidemic will be substantially curtailed. Intervention package for High Risk Groups under Targeted Intervention Project Targeted interventions for HRGs offer a “package” of services, This package of services varies for each major HRG, but broadly follows the components outlined below. Outreach and Communication Peerled, NGO supported outreach and behaviour change communication. a. Differentiated outreach based on risk and typology b. Interpersonal behaviour change communication (IPC) Services Promotion of condoms, linkages to STI (sexually transmitted infection) services and health services with a strong referral and followup system. a. Promotion/distribution of free condoms and other commodities (e.g. lubricants for MSM, needles/ syringes for IDUs) b. Provision of basic STI and health services (including abscess management and oral substitution therapy for IDUs and also oral/anal STI services for MSM/TGs) c. Linkages to other health services (e.g. for TB) and Integrated counselling and testing centres d. Provision of safe spaces (drop in centres or DICs) (ICTC) Creating an Enabling Environment a. Advocacy with key stakeholders/power structures b. Crisis management systems c. Legal/rights education Community Mobilisation Building community ownership of the TI’s objectives (“community” refers here to the HRGs: FSWs, high risk MSM and IDUs). a. Collectivisation b. Creation of a space for community events c. Building capacity of FSW, MSM and IDU groups to assume ownership of the programme Since the year 2005, the Targeted Intervention Project SEWA has accorded priority to preventing and controlling HIV among populations at greater risk, which include inter alia sex workers. Targeted interventions (i.e. provision of risk reduction measures such as information, condoms, treatment for STIs) for high risk groups (FSWs and MSM.) will remain the mainstay of the response under NACP ( National AIDS Control Programme).SEWA has recognises that stigma and marginalisation experienced by high risk groups amplify risks and limit their ability to protect themselves and others. Therefore, SEWA aims to empower highrisk groups to enable improved negotiation and health seeking. Creation of an enabling environment and community mobilisation are the key programmatic strategies to address such vulnerability. SEWA notes that structural determinants such as poverty, gender inequality and lack of viable opportunities compel many persons, particularly girls and young women, into commercial sex. Further, many are forced or fraudulently brought into sex work. SEWA cannot and will not support any activity which encourage the compelling of persons into sex work. SEWA affirm the principle of voluntary entry and exit from sex work. SEWA, in partnership with other stake holders seek to address fundamental conditions that contribute to involuntary entry into for sex work. Simultaneously, at project sites, targeted interventions will help institute community mechanisms to prevent involuntary sex work. For persons in sex work, the project is promoting health and occupational safety by promoting use of condoms, providing access to STI and other treatment and encouraging voluntary HIV counseling and testing. SEWA is implementing the targeted interventions for sex workers and MSM to proactively assist persons opting out of sex work through collaborative arrangements with different stakeholders. At the same time, SEWA will not interfere with the rights of those choosing to remain in sex work. Targeted interventions will promote active involvement of sex workers in all aspects of project development, implementation and evaluation.