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Strengthen migrants' HIV intervention

Dr Ashok K Agarwal, Dec 01, 2016, DHNS:
India has been implementing a comprehensive National AIDS Control Programme (NACP) since 1992. More than 60% of the programme resour-ces are allocated to HIV prevention activities. India has been praised the worldover for its success in HIV/AIDS programme; the annual new HIV infections reduced by 69% from 2,74,000 in 2000 to 86,000 in 2015.

Buoyed by similar success in a number of countries, the WHO and UNAIDS have devis-ed a fast track strategy for ensu-ring that HIV/AIDS ceases to be a public health threat by 2030.

To achieve this, UNAIDS has proposed 90-90-90 targets to be achieved by 2020. This me-ans, 90% of the estimated people living with HIV/AIDS (PLHIV) are tested and know their test result; 90% of the persons who know their HIV positive result, are put on antiretroviral therapy (ART); and 90% of them have reduced HIV viral load (meaning the infection within their body is under control).

The Indian HIV/AIDS prevention programme is delivered through 1,700 Targeted Intervention (TI) projects, 19,000 Integrated Counseling and Testing Centres (ICTC) and 520 ART. The TIs are implemented by NGOs and reach out to the six HIV high risk groups (female sex workers (FSW), men who have sex with men (MSM), transgender, injection drug users (IDU), migrants and truckers.

The Integrated Biological and Behavioural Survey (IBBS), 2015 reported the highest (9.9%) HIV prevalence among IDUs followed by 4.3% among MSM and 2.2% among FSW. About 64% of HIV is estimated to be in AP, Telangana, Maharashtra, Karnataka, Gujarat, Bihar and UP; and HIV is rising in Assam, Delhi, Jharkhand, Chandigarh, Punjab, Tripura and Uttarakhand. These 14 states in particular need more attention.

Higher risk
Among the HRGs, migrant population (72 lakh) is the largest. Some migrants are also MSM and IDUs, they are at a higher risk because of dual vulnerability. The NACP stresses reaching out to high risk and high vulnerable migrants. The HIV prevalence among migrants is 0.99% compared to the national adult (15-49 years) prevalence of 0.26%. The USAID/ PHFI PIPPSE project has been working under the guidance of NACO since 2012; and technical support to the migration intervention has been a key activity.

The PIPPSE has closely experienced the migration and HIV dynamics particularly through two migration corridor interventions across Ganjam (source/native district in Odisha) and Surat (destination/ workplace district in Gujarat) and across five districts of Uttar Pradesh – (source) Allahabad, Azamgarh, Gorakhpur, Jaunpur and Maharajganj, and Thane (destination district in Maharashtra).

The PIPPSE along with NACO has developed the Migrant Service Delivery System (MSDS) (www.msds.org.in). This tool helps track migrants across source and destination places to provide HIV prevention, care, support and treatment services.

At destination, there is an existing mechanism of reaching the migrants through the classical TIs implemented by NGOs. At source sites, returnee mig-rants and their families are rea-ched through health camps conducted during the migrant retu-
rning periods. There are repo-rts; in source migrant districts, positivity of HIV infection in sp-ouses of male migrants is higher when compared to other females. Thane is the only district with an estimated migrant population of 3.8 lakh out of a total HRG population of 4.6 lakh.

The HIV testing is a challenge in migrants, PIPPSE under guidance of NACO and SACS conducted community based testing (CBT) as a pilot through one of the migrant TIs (during Sept 2015 to Sept 2016, the TI facilitated HIV testing of 4622 migrants; out of which 97% tests were conducted through CBT camps at location and time, convenient to migrants).

In order to provide tailor-made services to the migrants’ community across source destination continuum (corridor), with confidentiality of the HIV positive migrants and their spouses; it is imperative to develop a comprehensive source intervention strategy.

The strategy could include reaching the migrants and their families through Accredited Social Health Activist (ASHAs) and Community Health Volunteers in urban areas. Migrant intervention will be an important contributor in achieving the 90-90-90 targets for eliminating HIV/AIDS public health threat.
(The writer is Chief of Party, PIPPSE, Public Health Foundation of India)

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