PEPFAR/India - Prevention
Preventing new infections represents the only long-term, sustainable way to turn the tide against HIV/AIDS. PEPFAR-India focuses in the following areas of prevention:
Prevention of Mother to Child Transmission (PMTCT) - The most important challenges for PMTCT in India are to improve the identification, testing and follow-up of infected pregnant women and their infants. To address the challenge, USG programs aim to increase demand, uptake and utilization of the services provided through support from the Global Fund, to mobilize the public sector with public-private partnerships, and to directly support a few model programs.
Sexual Prevention: Most-At-Risk Populations (MARPs) - Certain behaviors put people at greater risk of HIV infection: high rates of unprotected sexual partnerships; unprotected vaginal and anal sex with multiple partners; and injecting drugs with shared equipment. According to this, the following four groups have been identified as populations most at risk:
- Persons engaged in prostitution;
- Clients of persons engaged in prostitution;
- Injecting drug users (IDUs); and
- Men who have sex with men (MSM)
Other vulnerable populations include: mobile populations such as migrant workers, truck drivers, and members of the military and uniformed services (e.g. police). These populations can also be known as 'bridge populations' meaning they link most-at-risk populations to the general population. PEPFAR-India targets these high-risk populations with the following activities: purchase and promotion of condoms; STI management; messages/programs to strengthen perception of risk and to reduce risk for persons engaged in high-risk behaviors.
The USG has contributed to the development of the third National AIDS Control Program's (NACP-III) NGO and CBO operational -guidelines for MARP interventions. USG partners are also the technical leads for several prevention working groups, and are engaged in providing technical assistance to six State AIDS Control Societies for scale-up and quality enhancement of prevention programs. The Link Worker Scheme which involves a dedicated cadre of workers at the community and district level is another USG model that has now been adopted for scale-up across 33 states by the National AIDS Control Program for saturation of coverage of MARPs that are located in semi-urban and rural areas.
Sexual Prevention: General Population and Youth - HIV transmission in the general population often occurs through their sexual partners, who have infected sexual partner(s) in the most-at-risk populations. USG works to raise the general population's awareness of HIV. The USG supported Link Worker Scheme also covers the general population including unmarried youth and couples married at an early age in rural areas with activities related to life skills education and the promotion of the delay of sexual activity or abstinence, fidelity, and partner reduction.
Positive Prevention -Counselors play a critical role in linking people living with HIV/AIDS (PLHA) to services and provide significant emotional support. Current counseling programs focus on prevention and testing of HIV.
The globally accepted goals of Positive Prevention are to: prevent HIV transmission to partners; protect the HIV-infected patient from new strains of HIV and other STIs; and to prevent mother-to child transmission of HIV. Additionally, Positive Prevention has scientifically been shown to be both efficient and effective at preventing secondary infections. Changes in risk behavior of HIV positive persons are likely to have a larger effect on the spread of HIV than commensurate changes in risk behavior of HIV negative persons. USG has developed a follow-up Counseling Toolkit on PLHAs. In 2009, Peer Treatment Counselors across the state of Tamil Nadu will be trained on the purpose and effective usage of the Toolkit.