Prevention is the mainstay of the strategic response to HIV/AIDS in Karnataka as 99 percent population of the state is uninfected. The HIV prevalence pattern in the remaining one percent population largely determines the prevention and control strategy for the epidemic in the state.
The HIV prevalence level in Karnataka shows disproportionately higher prevalence of the infection among certain population groups. An analysis of Annual Sentinel Surveillance data (2010-11) shows that female sex workers (FSWs) and men-who- have-sex-with-men (MSM) and Truckers have disproportionately higher prevalence of HIV infection. HIV prevalence (as per provisional data of HSS 2010-11) in the general population is 0.70 percent, its prevalence among FSWs is 5.1%, MSM is 5.4%, Truckers is 3.2% , Migrants is 0% and IDUs 0%, (Figure 1). In Karnataka, prevention and control of HIV/AIDS in HRGs will effectively control spread of HIV infections in general population. Thus, there is need of effective Targeted intervention programme for control of concentrated HIV epidemic in state.
Evidence also suggests that Karnataka’s HIV/AIDS epidemic is largely due to unsafe sex worker-client interactions. About 91 percent HIV cases in Karnataka is from unprotected sex. Perinatal transmission of the infection is 5 percent, whereas 0.34 percent HIV infection is due to transfusion of infected blood or blood products. Though HIV transmission through infected needles and syringe is only 0.24 percent of overall prevalence.
Epidemic in General Population
Through MSM and sex worker-client interactions the infection spreads to general population. As a majority of men with MSM behaviour are married and a majority of sex worker clients are males from general population, migrant labours and truck drivers, they pose the risk of infecting their spouses and unborn children.
Targeted Intervention for Prevention, Care and Treatment
For the overall reduction in the epidemic, Targeted Intervention (TIs) are aimed to effective behaviour change among the high risk groups and clients of sex workers or bridge populations through raising awareness. These interventions are aimed to saturate three high risk groups with information on prevention; address clients of sex workers with safe sex interventions, and build awareness among the spouses of truckers and migrant workers, women aged 15 to 49 and children affected by HIV or vulnerable population groups.
Apart from prevention of HIV infection, TIs facilitate prevention and treatment of sexually transmitted diseases as they increase the risk of HIV infection, and are linked to care, support and treatment services for HIV infected.
In 2003-04 mapping for HRGs in Karnataka was conducted for all the districts. The second time mapping for Female sex workers, men-who-have-sex-with-men was completed for KHPT districts during 2009-10. During this period managerial, technical and financial systems were also set up to develop and implement focussed strategies to reduce HIV prevalence among high risk groups.
Given the HRGs special vulnerabilities, prevention strategies include five elements — behaviour change, treatment for sexually transmitted infections (STI), monitoring access to and utilisation of condoms, ownership building and creating an enabling environment.
In fact impetus to enabling environment under NACP-III drives the prevention strategy. It encourages peer led interventions by community based organisations or NGOs both in the rural and urban areas and focuses on clients of sex workers, partners of MSM and IDUs. All TIs are rights based, they empower the communities. NGOs/CBOs engaged in TIs are networked and linked to general healthcare facilities to ensure that HRGs access them without stigma or discrimination; they are also linked to Community Care Centres, Counselling and Testing Centres and ART centres. The prevention strategies are thus linked to care and treatment, and empower the community against stigma and discrimination.
TIs for FSW
Targeted Intervention among female sex workers bring awareness about health implications of unsafe sex and HIV/AIDS issues. The TIs reduce sex workers vulnerability to STIs and HIV/AIDS through promotion of
Specific TIs for IDUs
Apart from Targeted Intervention for general population, the following specific interventions are provided to IDUs to reduce their vulnerability.
Specific TIs for MSM
Bridge Group TIs
Bridge populations comprise people, who, through close proximity to high risk groups are at the risk of contracting HIV. Quite often they are clients or partners of male and female sex workers. Truckers and migrant labours are major bridge populations. There are 12 migrant TIs in Karnataka.
4 Truckers TIs cover the major High in the state and provide services to approximately 60,000 truckers in a year.
They are a critical group because of their ‘mobility with HIV’. Their living and working conditions, sexually active age and separation from regular partners for extended periods of time predispose them to paid sex or sex with non-regular partners. Further, inadequate access to treatment for sexually transmitted infections aggravates the risk of contracting and transmitting the virus.
NACO has developed comprehensive Operational Guidelines on Targeted Intervention for Truckers and Migrants.
TIs to Reduce the Vulnerabilities of Bridge Population
The NACO interventions are aimed at controlling the spread of HIV and STI through information raising about their transmission and prevention. All interventions are aimed at promoting safe sex through use of condoms. They also facilitate easy access to condoms, treatment for STI, counselling and testing services.
How are Interventions reached to Truckers?
These interventions involve interaction with the target community about sexually transmitted infections, HIV/AIDS and safe sex. For better recall and understanding information, education and communication materials are used in such community interactions. Peer educational activities are also undertaken for effective outreach of the messages.
So far, all interventions were carried out by NGOs at locations where truck drivers halt for sufficient duration like along highway stretches, business activity areas, check posts or port areas. Under NACP-III, a larger gamut of organisations constituting National Highway Authority of India, social marketing organisations in the promotion of condoms, NGOs and truckers’ organisations at state and district level are involved in a concerted effort for better outreach of the interventions. The ultimate aim is to harness the trucking community, associations, brokers and others in driving these interventions.
Interventions aimed at Migrants
The interventions for migrants are focussed on 1.2 Lakhs of migrant in Karnataka. Temporary, short duration migrants are covered by the Migrant TIs. They are of special significance to the epidemic because of their frequent movement between source and destination areas. For reaching interventions to migrants, NGOs identify active volunteers from among them and train them in spreading preventive messages among their fellow workers. Factory owners, construction companies and other employers engaging the services of these migrants are also motivated to undertake preventive HIV education activities among them.