Role of NGOs

Targetted Interventions
Non - Governmental Organisation Activities
Priority Targeted Intervention for Groups at High Risk.
The objective of Targeted Intervention Programme is to reduce the rate of transmission among the most vulnerable and marginalized population. One of the ways of controlling the disease from further spread is to carry out direct intervention programmes among these groups through multi-pronged strategies, beginning from behaviour change communication, counselling, providing health care support, treatment for STD, and creating an enabling environment that will facilitate behaviour change. Targeted Intervention is one of the most important components of the National AIDS Control Programme – Phase II.

Collaboration with NGOs since 1999.
In National AIDS Control Programme, Phase I 1992 to 1999 emphasis was given on awareness campaigns and environment building activities in the state. But in National AIDS Control Programme, Phase II 1999 to 2004 the focus has been shifted from awareness to change in behaviour through intervention, particularly for groups at high risk of contacting HIV/AIDS

Initiative of Maharashtra State AIDS Control Society
Status of Targeted Intervention Project since 1999

In 1999-2000 Maharashtra State AIDS Control Society took a lead and initiated 17 intervention activities. Out of which, 8 NGOs were working with long distance transport workers i.e. truckers intervention projects on highways in Pune, Nashik, Dhule, Raigad, Nagpur districts. While 9 were working with sex workers in Thane, Sangli, Pune, Kolhapur, Satara districts.

During the year 2000-2001, Maharashtra State AIDS Control Society funded 22 Targetted Intervention projects in the State out of which 11 were working with long distance transport workers in Pune, Nashik, Dhule, Raigad, Nagpur, Thane, Jalgaon districts, 8 were working on Commercial sex workers in Thane, Pune, Kolhapur, Satara, Nagpur districts and 1 with street girls in Pune district and 1 with Men having Sex with Men in 5 districts of Maharashtra and 1 with IVDU in Thane district.

In the year 2001-2002 Maharashtra State AIDS Control Society funded 24 intervention projects in the State out of which 13 NGOs were working with long distance transport workers in Thane, Pune, Wardha, Nagpur, Sindhudurg, Dhule, Solapur, Nashik districts, 4 were working with sex workers in Thane, Kolhapur, Nagpur districts, 4 with Migrant Labour in Thane, Nashik, Kolhapur, Raigad district. 1 with IDVU in Thane and 1 with Street children in Pune district, while 1 with men having sex with men in 5 districts of Maharashtra.

In the year 2002-2003 Maharashtra State AIDS Control Society supported 22 targetted intervention projects in the Sate out of which 11 NGOs were working with long distance transport workers in Nashik, Pune, Dhule, Thane, Sindhudurg, Wardha, Solapur districts. 6 were working with sex workers in Thane, Kolhapur, Latur, Parbhani, Nagpur districts, while 5 were working with Migrant Labour in Thane, Nashik, Raigad, Chandrapur and Kolhapur districts.

In the year 2003-2004, Maharashtra State AIDS Control Society is funding 12 new T.I. projects in Maharashtra alongwith the existing 21. We have thus reached the number of 33 interventions being implemented in 18 districts of Maharashtra. In addition to this we plan to scale up the existing projects as well as increase the number to 50.

Statement showing high risk districts, Map of ongoing Targetted Intervention Projects & Medico Social Information of Population with high risk behaviour, they are as given on the next page :-

Advertisement for inviting applications from NGOs – to scale up the existing activity

In the year 2001-2002 advertisement was released in newspapers. In response to the advertisement the society received total 216 proposals (Sex Workers 34, Truck Drivers 78, Migrant Workers 24, Street Children 2, IEC (Mixed) 77, Men Having Sex with Men 1. After scrutiny and as per guidelines of NACO and World Bank 12 targeted intervention projects were launched in 2003.

In order to scale up the activity the advertisement was again released in the newspapers on 8th May 2003 which resulted in tremendous response and we received 439 proposals. (Sex Workers 70, Men having sex with men – 0, Truck Drivers – 189, Migrant Workers – 41, Auto Rickshaw – 10, Jail Inmates – 34) from all over Maharashtra. The initial scrutiny has been completed. We have shortlisted 35 NGO proposals. A short orientation workshop on proposal development is planned in February 2004. After completion of JAT visit the selected proposals will be put up in the Executive Committee of Maharashtra State AIDS Control Society for approval.

Capacity building of NGOs
Since 1999 Maharashtra State AIDS Control Society has organised various training programmes and workshops for NGOs in collaboration with USAID/FHI/DFID/AVERT, Maharashtra. These workshops focused on issues like counselling, communication and need assessment, project monitoring and implementation strategy, T.I. proposal development, HIV/TB co-infection. Till December 2003 total 449 NGO representatives have been trained.

AVERT – MAHARASHTRA – Support
14 NGO staff were trained on basic facts of STD/HIV/AIDS, Sex and sexuality, 4 NGO representatives were sponsored for 4th West Bengal sexual health conference held in Kolkata, 2 NGOs representatives are trained as master trainers in sex and sexuality issues through stepping stones approach by Action-aid India supported by Avert Society – Mumbai.

Exposure visits for NGO representatives with MSACS officers
Under UNDP Programme exposure visits to Goa and Andhra Pradesh SACS were arranged. 3 NGOs for each visit were selected and the exposure visit was given in various Targeted Interventions and innovative projects in the states.

Future Plans
Exposure visits to state of Gujrat and West Bengal is planned in current financial year.

Evaluation Process of Targeted Interventions
The Targeted Intervention Projects implemented by NGOs were evaluated by International Institute of Population Sciences, Mumbai. In March 2002, 10 targeted intervention projects and in the year March 2003, 9 targeted intervention projects were evaluated. NGO with satisfactory performance were continued, while those whose performance was below par were discontinued by Maharashtra State AIDS Control Society.

Since 1999, Maharashtra State AIDS Control Society has discontinued total 9 projects whose performance was not satisfactory.

Mapping of the High Risk Groups
We have already completed HRG Mapping Study in 22 districts of the state. This study was conducted by Black Stone Market Facts India under technical and financial support from AVERT Society in association with Maharashtra State AIDS Control Society and Mumbai District AIDS Control Society. First Study Facilitation Group / State Steering Committee meeting was held on 9th and 10th July, 2003 to share the objectives, scope and coverage of the mapping study. The data collection formats were also discussed with the group. Second SFG/SSC meeting was held on 10th September, 2003 to discuss the preliminary information on target groups sites mapped in each study district. The proposed analysis and chapterisation. Plan for the report was also discussed. Third SFG/SSC meeting to share the findings of mapping study is due.

NACO organised a review meeting on 9th January, 2004, in which the findings of the study were presented. Based on the comments the report will be further modified. The financial report will be submitted to NACO on 16th February, 2004.

The following HRGs were studied:

Core Group

	Female Sex Workers (Brothel based and non-brothel based)
	Men who have sex with men. (MSM)
	Transgenders / Eunuchs
	Injecting Drug Users (IDUs)
	Truckers

Other Groups

	Migrant Labourers
	Street Children

Future Plans
The remaining 12 districts of Maharashtra will be covered during 2004-05. The district wise needs assessment of HRG map will also be undertaken in the state.

Lessons Learnt
As per plans developed by NACO, the NGOs play a pivotal role in the prevention of spread of HIV/AIDS. Their role is significant in advocating against stigma and discrimination of the people living with HIV/AIDS. The traditional strategy of enlisting NGOs’ support for Government programme has been limited to areas other than health. This has reflected in NGOs of good track record not indulging in HIV/AIDS related work.

Many NGOs applying for funds for SACS are

	Either novices who have no past experience
	NGOs who are seeking to build their institutions rather than the commitment to HIV/AIDS related work
	Many NGOs are in fact real ladders or career ladders for individuals who have started the NGO and then they are managed and controlled by family members.
	Many NGOs apply pressure on SACS officials by casually referring names of politicians.

This results in waste of large amount of time and energy. The criteria for NGO selection should be five years of registration instead of three years so as to assess the experience and capacity built over 5 years.

One of the strategies to minimize the negative impact of the above is that NACO/SACS should evolve the programme design strategies in the field and not on tabletop. For this it is necessary to involve atleast the key members of outreach communities in programme planning, execution and evaluation.

The success of peer-based intervention with sex workers is an example of this possibility.

Condom Promotion
Free supply and targetted social marketing
Unprotected multipartner sex is the main cause of HIV transmission. In India more than 80% HIV infected persons get infection through unprotected sexual contact. HIV transmission can be prevented by condom promotion. Condom is the best mean to protect STDs and HIV/AIDS. Maharashtra State AIDS Control Society has made a lot of efforts to create public awareness by conducting various activities. Through these activities the commercial sex workers and their clients have been convinced about the importance of the use of condom. The efforts are also being made to use condom not only for the sake of family planning but also to prevent RTI, STDs and HIV/AIDS.
Condom Promotion Programme is promoted by Maharashtra State AIDS Control Society through two channels.

Under Free Distribution Scheme
Initially Condom Promotion Programme was under Family Welfare Programme of the state. Now Maharashtra State AIDS Control Society is also running Condom Promotion Programme though District Health Offices, Municipal Corporations and Civil Hospitals.

Social Marketing Scheme
The purpose was to create awareness about the use of condom. Maharashtra State AIDS Control Society introduced social marketing scheme for Condom Promotion and distributed the Deluxe Nirodh through an NGO, DKT (India). The social marketing of condom is successfully done through the same NGO throughout the state including the District and Taluka level since November 2000. The said organisation is also supplying condoms to the beneficiaries under the targeted intervention project in the state. Presently DKT (I) is not procuring any Condom for social marking from Maharashtra State AIDS Control Society. (Letter Dated April 3rd , 2003.)

Distribution of Condom
Keeping in mind this importance, the distribution strategy of condom has been already planned. According to this strategy the free distribution of condom has been made under the Family Welfare Programme. By the end of March 2004, 2,71,32,968 condoms were distributed under the Family Planning, AIDS, STD Control Programme and 36000 condoms were distributed under social marketing scheme for the year 2003-2004.

Requirement of Condom for the year 2004-2005

Funds
NACO has sanctioned Rs. 75.00 lacs for Procurement of Condoms for the year 2002-2003. Out of that Rs. 64 lacs has been utilized for the purchase of 50 lacs pieces of condoms.