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Scaling up MSM-TG Interventions for NACP III 2007

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Scaling up MSM-TG Interventions for NACP III 2007 Evidence to Action: Strategic Plan for Scaling Up Interventions for MSM and Transgender Populations in India (for consideration as part of the NACP III Strategy and Implementation Plan) 2007/08 – 2011/12 31 March 2007 2007 Final Version Table of Contents Abbreviations............................................................................................................................. 3 1. Introduction and Background............................................................................................ 5 2. Situation and Response Regarding MSM and Transgender Populations ....................... 6 2.1 Select epidemiologic and contextual data ................................................................ 6 2.2 Current response....................................................................................................... 6 3. Goal and Objectives of the Strategic Plan........................................................................ 7 3.1 Objectives of this Strategic Plan ............................................................................... 7 3.2 Management of this Strategic Plan........................................................................... 7 4. Core Values and Guiding Principles................................................................................. 8 5. Specific Strategy Components.......................................................................................... 9 5.1 Prevention Strategies: Saturation of HRG coverage through TIs ............................ 9 5.2 IEC, Social Mobilisation, and Mainstreaming ......................................................... 10 5.2.1 Communication Outcomes .............................................................................. 11 5.2.2 MSM and TG-sensitive BCC/IEC materials .................................................... 11 5.3 Programme Strategies: Prevention......................................................................... 11 5.3.1 STD and TB services ...................................................................................... 12 5.3.2 Condom and lubricant supply ......................................................................... 12 5.4 Care and Support.................................................................................................... 13 5.5 Treatment: Anti-retroviral therapy ........................................................................... 14 5.6 Human Resource Development: Building Capacities - Training............................ 15 5.7 Enabling Environment............................................................................................. 16 5.7.1 IPC Sections 377 and 292 .............................................................................. 17 5.7.2 MSM and TG Advocacy Strategies ................................................................. 17 5.8 Programme Management ....................................................................................... 17 5.8.1 Governance arrangements ............................................................................. 18 5.8.2 Partnerships and Alliances ............................................................................. 18 5.9 Strategic Information Management......................................................................... 19 5.9.1 Indicators and benchmarks ............................................................................. 20 5.9.2 Research ......................................................................................................... 20 5.10 Procurement plan.................................................................................................... 22 5.11 Financial requirements............................................................................................ 22 5.12 Programme Outcomes and Targets ....................................................................... 23 6. MSM-Transgender Strategy Implementation Plan ......................................................... 24 Annex 1: Specific details on scale up for some regions and states .................................. 29 Annex 2: District-wise distribution of MSM and TG Targeted Interventions...................... 30 Annex 3: Dashboard for NACP-III (Highlighting MSM and TG)......................................... 52 Annex 4: Proposed Annual Core Indicators for NACP-III (Highlighting MSM and TG)..... 53 Annex 5: Participants in Strategy Development................................................................. 55 2 2007 Final Version Abbreviations AIDS Acquired Immune Deficiency Syndrome ART Anti-retroviral Therapy ARV Anti-retroviral BBC WST British Broadcasting Corporation World Service Trust BCC Behaviour Change Communication BMGF Bill and Melinda Gates Foundation CBO Community Based Organisation CCM Country Coordinating Mechanism CMIS Computerised Management Information System CPFMS Computerised Financial Management System CSW Commercial Sex Worker DAPCU District AIDS Prevention and Control Unit DIC Drop-In-Centre DFID Department for International Development DKT A Social Marketing Company EU European Union FCRA Foreign Contribution Regulation Act FSW Female Sex Worker GFATM Global Fund to fight AIDS, Tuberculosis, and Malaria GIPA Greater Involvement of People Living with HIV/AIDS GOI Government of India HBC Home Based Care HIV Human Immuno-deficiency Virus HRG High Risk Group ICTC Integrated Counselling and Testing Centre IEC Information, Education and Communication IPC Inter-Personal Communication, Indian Penal Code M&E Monitoring and Evaluation MIS Management Information System MSM Men (males) Who Have Sex with Men (males) MSW Male Sex Workers NACO National AIDS Control Organisation NACP National AIDS Control Programme NDPS Narcotic Drugs and Psychotropic Substances (Act) NE North Eastern States of India NFHS National Family Health Survey NGO Non-Governmental Organisation NRHM National Rural Health Mission OI Opportunistic Infection ORW Outreach Worker PE Peer Educator PIP Project/Programme Implementation Plan PLWHA People Living with HIV/AIDS PSI Population Services International PSA Public Service Announcement RCH Reproductive and Child Health Programme RNTCP Revised National Tuberculosis Control Programme SAATHII Solidarity and Action Against The HIV Infection in India S&D Stigma and Discrimination SIMU Strategic Information Management Unit STD Sexually Transmitted Disease STI Sexually Transmitted Infections SW Sex Worker TA Technical Assistance TAG Technical Advisory Group 3 2007 Final Version TG Target Group, Transgender THAA Tamil Nadu Aravanigal Association TOT Training of Trainers TRG Technical Resource Group UNAIDS United Nations Programme on HIV/AIDS VCT Voluntary Counselling and Testing WHO World Health Organisation 4 1. Introduction and Background In recent years across Asia, and within India, there has been increasing acknowledgement that Men who have Sex with Men (MSM) and Transgendered (TG) persons who engage in unprotected sex with multiple, concurrent partners are important drivers of HIV spread. In summary: • Across the region, HIV transmission among MSM and TG populations has recently been highlighted. In Bangkok, HIV prevalence in 2003 among “Thai to Thai” MSM (not including those who have sex with foreigners) was a surprisingly high 17%, and this jumped dramatically to over 28% in a follow-up survey in 2005.1 In India, HIV prevalence among MSM have reached as high as 6.8% in Tamil Nadu, 16% in Andhra Pradesh, and 16.8% in Maharashtra 2. • NACP III preparation exercises reconfirmed the importance of focusing efforts on prevention amongst high risk groups (HRGs). While much work has been done in India with female sex workers, it was recognized that the national programme had not given enough attention to injection drug users, “MSM”. In addition to this, NACP III - for the first time - recognizes that “MSM” is not a homogeneous population. The programme especially acknowledges the unique HIV prevention, care, and treatment needs of transgendered (TG) persons. • In the summer of 2006, regional meetings were held across India with MSM and TG groups to discuss the HIV prevention and care needs of those populations. This information let to a series of recommendations for India that fed into the “Risks and Responsibilities (“R&R”) Consultation” that was held in September 2006 with participants from all over Asia and the Pacific Rim. • During the fall of 2006, and building upon the R&R Consultation, further inputs from the MSM and TG community of India were gathered in order to develop the first draft of this “Strategic Plan for scaling up Interventions for MSM and Transgender Populations” (henceforth referred to as “the MSM and TG Strategy”). This information was collected by members of the India Network for Sexual Minorities and partners of Naz Foundation International. The compiled inputs were collated in a first document draft, which was then disseminated to known MSM and TG NGOs and CBOs for feedback and further input. In December 2006, an MSM and TG Leadership consultation was held in Bangalore in order to finalize the strategies, get community endorsement, and hold discussions with representatives of NACO. • This MSM and TG Strategy is designed to form a part of the NACP III Strategy and Implementation Plan. As such, the MSM and TG Strategy is structured in the same way; incorporates the same broad objectives, adding the necessary MSM and TG focus; follows similar broad implementation, monitoring, and evaluation mechanisms; and is designed
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