Targeted interventions

Targeted Intervention (TI) is one of the main components under NACP III. The Program is designed to reduce the rate of HIV transmission among the Core Group viz. Female Sex Workers (FSWs), Men having Sex with Men (MSMs) and Injecting Drug Users (IDUs) & Bridge populations like migrants and truckers. The TI programme is being implemented through the Community Based Organizations (CBO) and Non Governmental Organizations (NGO).
Targeted interventions in JKSACS are a resource-effective way to implement HIV prevention and care programmes in settings with low-level and concentrated HIV epidemics in the state. They are also a cost-effective method of reaching people who are most at risk in more generalized epidemics. Targeted interventions are aimed at offering prevention and care services to high risk populations ( Female Sex Workers- FSW, Male having Sex with Male- MSM and Injecting Drug Users- IDUs) within communities by providing them with the information, means and skills they need to minimize HIV transmission and improving their access to care, support and treatment services. These programmes also improve sexual and reproductive health (SRH) among these populations and improve general health by helping them reduce the harm associated with behaviour such as sex work and injecting drug use.
Implementing targeted interventions in J&K state does not negate the need for broader interventions in the community. In many settings, it optimizes the use of resources by focusing on the environments and populations in which the risk of HIV infection is the greatest.
Targeted interventions in J&K
• are for people within the community who are most at risk of HIV and STI infection.
• are targeted to behaviour and practices not the identity
• involve them and their issues within the broader frame work of interventions
• are adapted to be culturally and socially appropriate to the target audience.
• Focus on limited resources and where they can be used to the best benefit.
• Acknowledge that barriers to accessing health-care services exist for some populations within communities.
• Acknowledge that people who are at risk of HIV infection are often marginalized from the broader community, stigmatized and discriminated against.
Components of Targeted Interventions:
1. Behaviour Change Communication
This component involves understanding and assessment of individual and group practices/behaviour, which can pose risk to HIV infection. Development of context specific strategies/activities to address the risk of infection through peer counseling, counseling through counselors, creating enabling environment to reinforce safe practices. Under NACP-III, the Peers, Outreach workers lead the activities under this component through one to one sessions and group sessions among the community. There are also group, issue specific Information Education and Communication (IEC) materials are developed to further augment behaviour change.
2. Access to STI services.
This component is aimed at improving the access to STI services as STI (both symptomatic and asymptomatic) pose greater risk for HIV infection and which is high among the High Risk Groups (HRGs).
3. Provision of commodities to ensure safe practices
TI programme ensure safe practices by providing choices and options of easy accessibility, availability and acceptability. The commodities (only male lubricated latex condoms) supplied through peers, out reach workers and social marketing. The social marketing is supported through two channels: Direct budget provision under TI and through appointment of social marketing agencies.
• For FSW TIs: there are provision of Male lubricated latex condom and Female condoms (only in some pilot interventions) through free distribution and social marketing outlets.
• For MSM TIs: there are provision of Male lubricated latex condoms and lubricant sachets through free distribution.
• For IDU TIs: there is provision of Needle, Syringe and OST drugs through free distribution.
• For Migrant and Truckers TIs: the provision will be through social marketing mode. Besides Condom Vending Machines and Free pick up condom boxes are placed at strategic locations to ensure uptake by clients at their convenience.
4. Enabling Environment through structural intervention :
This component of enabling environment was introduced in NACP-II focusing creation of an environment facilitating the access to information, services and commodities by the high risk groups. It is essential to note that these HRGs are considered marginalized section of the society super imposed with stigma and discrimination. Also it is desirable that an effective enabling environment creates a reinforcing atmosphere for sustenance of safe practices and behaviour reducing their vulnerability. Hence, under NACP-III, JKSACS envisage identification of power structures and their influence on the access and control over resources for sustaining safe behaviour and practices. There are provision for building the capacity of HRGs to advocate for themselves in creating enabling environment as well as control of requisite resources to address the issues of stigma and discrimination.
5. Community Organising and Ownership Building
JKSACS envisage that engaging NGOs/CBOs in programme management through developing their capacity and ownership will lead to steering of community agenda through themselves only. Presently the TIs have been able to provide services through peers representing the community, where community playing a passive role.
Hence, JKSACS envisage to mobilize the at-risk communities to play proactive role in implementation as NGO/CBOs, while the NGOs will continue to play the role as capacity builders and support agents, thereby putting the prevention responsibility on those who are themselves at risk.
6. Linkages to Care and Support Programme
JKSACS has experienced that lack of mechanism to strengthen linkage care and support programme (ICTC, ART, Community Care Centre, RNTCP Programme,) has affected access to these essential services meant to reduce vulnerability. JKSACS under NACP-III has envisaged to build the capacity of the Project Managers counselors, ORWS & Peer leaders.
Role of NGOs under TI Division JKSACS

NGOs play a pivotal role in the prevention of HIV/AIDS as they work closely with people who engage in high-risk behaviour. JKSACS has funded 17 NGOs, to enhance awareness and achieve behaviour change. The aim of NGO collaboration is to educate the vulnerable groups engaging in high risk behaviour and to promote safe sex. JKSACS encourages area and population-specific intervention programmes by grassroots-level NGOs and supports these 17 NGOs in order to create awareness, provide proper counselling, promote safe sex, care and treatment-seeking for HIV/AIDS cases. As part of its policy of transparency, JKSACS places advertisement in newspapers inviting NGO proposals. The selection of NGOs involves three stages:

1. Scrutiny of the proposal by the NGO Advisor and the Technical Advisory Committee.
2. A pre-sanction field inspection by the JAT team Officers.
3. Approval by the Executive Committee.
All proposals from NGOs are appraised by the NGO Advisor (Asstt. Director TI) and the TAC. Proposals recommended by the TAC are inspected by JAT team, who make field visits to verify the working of the NGO, their capability and the community's perception of the NGO. After field inspection, the proposals along with the field inspection reports are presented to the TAC team, than submitted to Executive Committee of JKSACS for final approval. Based on approval by the Committee, funds are disbursed to the NGOs in installments after signing the necessary agreement. JKSACS periodically inspects the NGOs to monitor the progress made. All NGOs are required to present a progress report to JKSACS. All intervention programmes are aimed at promoting safe behaviour by providing vulnerable and marginalized groups with access to condoms, counselling and STD treatment services. The groups identified for intervention programmes are truck drivers, IDU’s, commercial sex workers, migrant labour( industrial workers, slum dwellers ) and MSMs.

JKSACS has developed working relationships with NGOs to ensure that the HIV/AIDS situation is properly and adequately addressed in the appropriate manner. This gave the NGOs confidence and built bridges between the NGOs and JKSACS.To establish a rapport with NGOs, JKSACS has appointed an Asstt. Director TI, (NGO Advisor) who is easily accessible to the NGOs and provides them with information, advice and promotes participation. JKSACS also conducts training programmes on preparation and management of a TI projects, apart from workshops and seminars for these 17 TI projects (NGOs).The continuous efforts in improving awareness levels and regular advocacy have created an environment for HRG population to come out in the open to disclose their HRG status and unite to form an organization to promote their cause

Following table depicts the distribution of Targeted Intervention as per the district:

S.No	Target Community	Name of the district	No. of Projects in the  district
1	Female Sex Workers	Kathua Anantnag Baramulla	01 01 01
2	Men having Sex with Men	Srinagar	01
3	Injecting Drug Users	Jammu Srinagar Baramulla Rajouri	01 01 01 01
4	Core composite	Jammu Doda Rajouri Kulgam	01 01 01 01
5	Truckers	Jammu Srinagar	01 01
6	Migrant Labourer	Jammu Srinagar Leh	01 01 01
	Total		17

Targeted Intervention Projects working under JKSACS:

Name of the TI	District	Typology	Contract Period
Family Planning Assoiciation of India (FPA)	Srinagar	IDU	April 15 to March 17)
Peoples Social & Cultural Society (PSCS)	Srinagar	MSM	April 15 to March 17)
Kashmir institute of Education & Solar technology	Anantnag	FSW	April 15 to March 17)
Koshish	Srinagar	TRUCKER	April 15 to March 17)
Kashmir institute of Education & Solar technology (Core composte TI )	Kulgam	CORE COMPOSITE	April 15 to March 17)
Peoples Social & Cultural Society (PSCS)	Baramulla	IDU	April 15 to March 17)
J&K Peoples Welfare Instiute & Research Centre.	Baramulla	FSW	April 15 to March 17)
Aabru women's welfare society	Srinagar	ML	April 2014 to March 2016)
Rural Development and You	Leh	ML	April 2014 to March 2016)
Himalaya Seva Sang (Core composte TI )	Jammu	CORE COMPOSITE	April 15 to March 17)
Regional Education Society	Kathua	FSW	April 15 to March 17)
JKSPYM	Jammu	IDU	April 15 to March 17)
Voice	Jammu	TRUCKER	April 2014 to March 2016)
Society for development and training centre (Core composte TI )	Doda	CORE COMPOSITE	April 15 to March 17)
Himalaya Seva Sang (Core composte TI )	Udhampur	CORE COMPOSITE	April 2014 to March 2016)
Helping Hand A- Society	Jammu	ML	April 2014 to March 2016)
National development foundation (NDF)	Rajouri	IDU	April 15 to March 17)