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
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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
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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
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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 to be managed by NACO (and SACS, as appropriate). The MSM and TG Strategy provides additional specific recommendations on how to scale up MSM and TG interventions, and what the implications are for existing MSM and TG networks, NGOs, and CBOs.
1 Baxter D. “Bangkok’s MSM HIV Explosion – Precursor for Asia’s Mega-cities?” HIV Australia . Vol.5(2) July 2006. 2 Various studies as reported in “MSM and HIV/AIDS risk in Asia: What is fueling the epidemic among MSM and how can it be stopped?” TREAT Asia Special Report (August 2006) p10. 2007 Final Version
2. Situation and Response Regarding MSM and Transgender Populations 2.1 Select epidemiologic and contextual data 3 • The estimation undertaken by the NACP III Working Group (2006): - 2.35 million MSM for India, with state wise break-up - 0.24 million male sex workers - No separate estimation for TGs. However, in NACO’s “HIV/AIDS epidemiological Surveillance and Estimation report for the year 2005,”4 HIV prevalence in the only site for “eunuchs” showed 43.9% HIV prevalence amongst a small sample. While this may not be representative, it is a very high and worrisome figure requiring attention. • Mapping and enumeration exercises were undertaken by various SACS and their TI partners in 2005. However, virtually all community member challenge these figures and the process by which they were derived (i.e., MSM & TG NGOs and CBOs by and large were not consulted). For example, it was estimated that in all of Uttar Pradesh there were only 688 MSM and 1,268 Hijras, while Andhra Pradesh was calculated to have 100,000 MSM. In Gujarat only a combined MSM and FSW figure was provided. • STI and HIV prevalence figures for MSM are incomplete, with almost no data for TGs. What is thought to be known is as follows (from SACS 2005, unless otherwise stated): - Orissa STI 16% ; West Bengal HIV 6.4% (2006; up from 0.54% in 2005); Manipur HIV 15%; Goa HIV 4.90%; Gujarat HIV 10.67%; Andhra Pradesh HIV 6.45%; Tamil Nadu HIV 6.20%; - In Maharashtra, HIV prevalence over time (by source of data) is: Humsafar Trust records: 13.80% (1998), 17% (1999) MDACS surveillance data: 23.94% (2000), 23.60% (2001), 16.80% (2002), 18.40% (2003), 9.60% (2004), 6% (2005) 1999 onwards, samples included both MSM and Hijras. This lead to higher figures. But when the two populations were separated 2004 onwards, prevalence among MSM decreased significantly. Prevalence among Hijras in 2005 was as high as 44% • 2002 National BSS (for MSM) showed: - 69% of the respondents knew at least two correct ways of HIV prevention - 83% were aware about the need for consistent condom use - But only 13% reported condom use with commercial sexual partner in month preceding the survey
2.2 Current response • Much HIV prevention and care work has been carried out by various arms of the Indian lesbian, gay, bisexual and transgender movement since the late 1980s and early 1990s. In a significant measure what NACP III is considering today, the movement has been demanding for a long time. • Recent national and international consultations in India have highlighted the need to address MSM and TG populations in order to reduce HIV spread. • Coverage has been limited and there is a clear need to address different segments of MSM and TG populations; there are mixed capacities of NGOs and CBOs, but recent experience in rapid scale up and capacity building (funded by DFID) demonstrates the feasibility of scaling up. • Annex 2 provides a district-wise breakdown of networks, NGOs, and CBOs providing targeted interventions (or other services) for MSM and transgender populations.
3 Main sources of information provided by government bodies, donors and NGOs / CBOs participating in NACO-UNAIDS-RCSHA-SAATHII consultations on MSM, TG People and HIV in India – held in June-July 2006; information provided by donors and CBOs subsequent to these consultations. Specific references are available with SAATHII. 4 http://www.nacoonline.org/fnlapil06rprt.pdf .
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• The legal battle is growing; there is a PIL against Section 377, IPC; the arrest of MSM in two instances in Lucknow is still being fought in court.
3. Goal and Objectives of the Strategic Plan
NACP III Goal : Halt and reverse the epidemic in India in the next 5 years.
Specific objective is to reduce new infections as estimated in year 1 of the programme by • Sixty percent (60%) in high prevalence states so as to obtain the reversal of the epidemic; and • Forty percent (40%) in the vulnerable states so as to stabilize the epidemic.
Other biologic objectives: • Reduction in prevalence of most common STIs (Syphilis, Gonococci, Chlamydia, HSV, Candida and Bacterial Vaginosis) by 30% of the baseline by Year 5.
3.1 Objectives of this Strategic Plan
The specific purpose of this MSM and TG Strategic Plan is: • To scale up the coverage and quality of HIV prevention, care, and treatment interventions for MSM and Transgender populations.
Other objectives of the MSM and TG Strategic Plan are: • Stabilize HIV prevalence (i.e., reduce new HIV infections and reduce AIDS deaths); • Reduce impact of HIV by setting up support systems for MSM, TG, and PLHA (for care and support, increased treatment access, support for human rights)
3.2 Management of this Strategic Plan
This is a broad national plan which includes detailed information regarding existing MSM and TG organisations in India. It is designed to be managed by NACO or some body acting on NACO’s behalf. However, some critical steps must be taken in order to move forward with implementing this plan:
• A person or persons responsible for implementing this strategy must be identified at NACO and/or at another institution to which NACO can give some authority (e.g. UNAIDS); • Those persons need to review this draft plan and fill in the gaps, especially related to any additional budget that may be required. • State level MSM and TG strategic Plans must also then be designed, to fit in with the State-level Project Implementation Plans (PIPs). It is only then that specific next steps at State, District, and local levels will be clear. • A Technical Resource Group (TRG) for MSM and TG issues needs to be constituted and funds provided to allow the group to work.
The MSM and TG communities have highlighted the following two scale up flow charts (for where there are and are not any Targeted Interventions) as a way forward. This “framework “should be considered when making State- and District-level intervention plans. Furthermore, Annex 1 provides detailed information of the scale-up capacity and general situation in some states and regions.
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In places where there are no Targeted Interventions:
CBOs present?
No Yes
Identify / register CBOs (existing networks, donors) Build capacity
Targeted Interventions
In places where there are Targeted Interventions.
Targeted Interventions run by…
NGOs CBOs
Coverage is… Build capacity to increase Adequate Inadequate coverage
Transfer to CBOs CBOs fill in gaps TIs (phased manner) - full coverage - good quality then
4. Core Values and Guiding Principles
NACP III “Guiding principles include the Three Ones, equity, legal, ethical and human rights, PLHA and civil society participation.”
In order to most effectively scale up MSM and TG interventions, the MSM and TG community representatives felt that certain values and principles should be followed by all persons and organizations involved in planning, managing, and implementing those interventions. The Core Values and Guiding Principles endorsed by the community, in support of the above stated NACP III Guiding Principles, include:
• All programs should be underpinned by demonstration of respect to people who are practicing alternate sexualities, by all agencies and its constituents who support programs; • Participatory decision making through including representatives from MSM and TG communities will enhance the scope of program development and achievement of goals and purposes; • In any environment, when resource investments are made, all local community groups should be consulted and consensus built, and investments made. This will ensure that external investment does not divide the community and challenge the very basis of our coming together; • Community ownership : reviews, assessments, monitoring and evaluation of programs implemented by community groups and community organizations in conjunction with NGOs or by themselves should include people from such communities as part of the
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team. As a part of a population that has the highest risk and vulnerability, building a response that makes the natural owners of risk become the natural owners of the response will bring the best among community members and community organizations; • Programmes should be built on evidence , and where clear evidence does not exist efforts should be supported to gather such evidence; • Good governance through unbiased and transparent systems; • A high degree of trust should be shared, unless there is reason to believe that such trust would be misplaced. Such a trust should bring out a belief that community and community organizations have the intrinsic capacity to make changes in their behaviour and environment; • Capacity building should be seen as an essential, not additional. Therefore, capacity investment should be high and yield in real time human resource capacity building among community members.
5. Specific Strategy Components 5.1 Prevention Strategies: Saturation of HRG coverage through TIs
NACP III Highlights: • The highest priority to be given to the saturation of the three high risk groups (HRG) - commercial sex workers (CSW), injectable drug users (IDU); and men having sex with men (MSM) - with a comprehensive package of preventive services. SACS will be expected to concentrate on this group before moving to cover other groups; • Need to reach out to the high risk groups who are in scattered numbers in rural areas;; • Targeted Interventions will continue to emphasize and focus on the five elements that are the core activities of a TI: (1) Behaviour change, (2) Access to STI services to be provided by the NGO itself or by arrangement with a public / private facility, (3) monitoring access and utilization of condoms, (4) Ownership building, and (5) An enabling environment; • District Based Planning for achieving saturated coverage, and undertaking district based exercises to classify population groups based on differential risk status and geographic mapping; • Linking HIV related care, support and treatment with the TI set of services; • Establish Technical Support Units at SACS; • Higher coverage of MSM and TG populations with TIs(50%, 80%, and 100% mentioned)
Numerous Networks, NGOs, and CBOs are implementing interventions for MSM and TG populations. However, while approximately two-thirds of all states have some intervention, most districts have no interventions, and in many of the other districts the intervention coverage is not sufficient, as far as can be estimated (See Annex 3). In eleven (about one- third of) States/Union Territories there are no organisations working with MSM or TG populations (See Annexes 1 and 2). The total population of the 11 states is 66,561,837 (2001 Census), approximately 6% of the Indian population. Clearly, wherever there is an accessible MSM and TG populations, interventions should be provided; the scope for scaling up is high.
NACP III makes a conscious move towards CBO ownership and management of targeted interventions. This is in line with the community’s values of community ownership, and therefore this should be supported strongly by all constituents, including NGOs who might see this move as detrimental to their own existence.
TIs include a component of “enabling environment, but one of the key activities – access to legal services – is not provided for. NACP III should include such funding in TIs.
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Time Objectives and activities Indicators 5 frame Year 5 1. TIs scaled up to cover MSM and TG 1.1 100% of MSM and 100% of MSW reached by Vision populations interventions (NACP – CMIS) – but expected to be 50% 1.2 Number of targeted interventions where CBOs are formed (NACP – Operational Research) Year 4 1.1 Prioritise establishing TIs in District .1.1 At least 70% of all District Headquarters have at least Headquarters 1 TI (review) Year 3 1.2 Ensure TIs are running in all urban 1.2.1 100% of urban centres have at least 1 TI centres 1.3 Ensure MSM AND TG activities are part of NACP III midterm review Year 1 1.4 Finishing mapping of existing TI 1.3.1 10% of MSM and 10% of MSW reached by coverage, including mapping of CBOs interventions (NACP - CMIS) and existing formal and informal 1.4.1 50% of urban centres have at least 1 TI (review) networks, and size estimations 1.4.2 All those listed in Annex 1 have started or supported at 1.5 Identify and agree new TIs to be least 1 TI started; prioritise starting TIs in urban centres 1.6 Identify and agree which CBOs and networks to be scaled up Year 5 2. Quality of all TI components (BCC, STI 2.1.1 X% of male sex workers reporting use of condoms Vision services, condom promotion, social with their most recent client (NACP - BSS) mobilisation, enabling environment) is 2.1.2 X% of men reporting use of condoms in the last higher than at baseline. time they had anal sex with a male partner (NACP - BSS) 2.1.3 X% of TIs implementing quality interventions (as defined by standard service quality assessment tool) (NACP – special study) 2.1.4 Proportion of high risk groups and bridge populations reached through BCC activities during the reporting period (NACP – CMIS) 2.1.5 Services are MSM AND TG-friendly (special studies) Year 2-3 2.1 Conduct quality assessments. • All assessments and reviews conducted by end of year 3. 2.2 Conduct SACS/NGO/ CBO management assessments 2.3 Ensure MSM AND TG activities are part of NACP III midterm review Year 1 2.4 Work with NACO and SACS to get 2.4.1 Budget for accessing legal services accommodated money for legal services (e.g. for within TI budget. retaining lawyer’s services) included in TI budgets. 2.5 Establish minimum standards, and related monitoring tools, for interventions.
5.2 IEC, Social Mobilisation, and Mainstreaming
NACP III Highlights:
• NACP-III will focus on five key areas: risk reduction, vulnerability reduction, stigma reduction, impact mitigation and demand generation for services; • Audiences need to be segmented (e.g., different kinds of MSM), designing communications (messages, methods) that fit different audiences’ needs; • Strategic Communications Action Framework that integrates communication, community mobilisation, and advocacy to be developed
5 Throughout this document, indicators in black bold are those found in NACP III already. Those in light red are new indicators specific to MSM and TG populations. Means of verification for these need to be worked out.
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5.2.1 Communication Outcomes
NACP III lists around 30 different communication outcomes it seeks, such as “Increased acceptance of the dialogue and discussion on sex and sexuality in public domain” and “More openness about sexual issues in the media”, which potentially are beneficial to MSM and TG populations. There is a need to get MSM and TG gender and sexuality issues positively broadcast, especially on television. This could be linked with sensitising staff and policy makers at Doordarshan and perhaps even the BBC WST staff who work with Doordarshan. However, there are no MSM- or TG-specific outcomes sought. The Strategic Communications Action Framework should address this issue.
5.2.2 MSM and TG-sensitive BCC/IEC materials
Most IEC and BCC materials are MSM and TG “neutral”. Some materials have been developed specifically for MSM and TG populations, but these are not widely available. Those that are available focus mostly on prevention, and more is required with care, support, and treatment messages for MSM and TG. Furthermore, while this is clearly pushing the envelope of social acceptability, there is a need to introduce more messages around anal sex – with either male or female partners – as a high risk activity.
Time Objectives and activities Indicators frame Year 5 1. IEC and BCC materials used in India include both ‘MSM & Vision TG-friendly” and “MSM & TG-centric” materials Year 1-5 1.1 Conduct lube demand generation activities 1.1.1 TBD Year 3 1.2 Ensure MSM AND TG activities are part of NACP III 1.2.1 TBD midterm review Year 1-3 1.3 General IEC materials mentioning male to male sex and 1.3.1 Materials are distributed related HIV prevention issues (“MSM and TG -friendly”) are developed and distributed. 1.4 BCC/IEC materials for MSM and TG populations, 1.4.1 Materials are available to all MSM especially regarding anal and oral sex, are developed, and TG projects by end of Year 3 used, and available to all NGOs/CBOs working with MSM and TG populations (“MSM and TG-centric”) Year 1-2 1.5 Develop materials that include messages about care 1.5.1 Materials are available to all MSM and support services for MSM and TG: availability, cost, and TG projects by end of year 2 nature of services, etc. Year 1 1.6 Develop a repository/catalogue of MSM and TG-friendly 1.6.1 Materials collected and “housed” by BCC/IEC materials end of year 1 Year 5 2. Sex, sexuality, and gender issues are discussed more vision openly in mass media, especially television. Year 1-5 2.1 Partner with media to provide sexuality and gender 2.1.1 Training evaluations show broader trainings to BBCWST (as needed) and Doordarshan staff understanding of sexuality/gender and policy makers (might use Naz India and other issues; ways to broaden sexuality/ models) gender discussions developed.
5.3 Programme Strategies: Prevention
NACP III Highlights:
• Focus on providing a package of services across the continuum of prevention, care, support, and treatment (includes “lubricants and appropriate (‘ extra thick & extra lubricated’) condoms” for MSM); • India’s 611 districts will be divided into 4 epidemiologic categories: A = High prevalence, B = Concentrated Epidemic, C = Increased presence of vulnerable populations, D = low prevalence and low/unknown vulnerability. The package of services will be different for each category; • Convergence with National Rural Health Mission (NRHM), RCH, RNTCP, others; • Female condoms, thicker condoms with additional lubricants, condoms lubricated with
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benzocaine and pleasure enhancing variants will be introduced and promoted in various sub- populations; • Operations research for introducing female condoms and special condoms for groups like MSM will be done through NGOs and SMOs. This research will help evolve scalable programming approaches based on price sensitivity and acceptance studies.
5.3.1 STD and TB services
The main concerns for the MSM and TG communities are that current STI services provided under NACP II are not sensitive to the needs of MSM and TG. Specifically, anal and oral STIs are not part of the regular protocols, practices, or training of clinicians. Furthermore, it is difficult for MSM and TGs to communicate with (i.e. “notify”) their female partners (who often are unaware of their male partner’s MSM or TG behaviours) in case they might have an STI. All of the above would be facilitated by MSM and TG CBOs being able to offer their own STI clinics (as part of a full TI package).
Building links with the Revised National TB Control Programme (RNTCP) and its Directly Observed Therapy, Short course (DOTS) providers, including sensitizing them to MSM and TG issues, is also an important step.
Time Objectives and activities Indicators frame Year 5 1. STI services are good quality and MSM and 1.1 80% of MSM with STI symptoms seeking Vision TG friendly/sensitive services from qualified medical providers. (NACP-BSS) 1.2 Percentage/List of STI clinics for high risk groups reporting stock out of essential STI drugs (NACP-CMIS) Year 3 1.1 STI (and perhaps general medical) services 1.1.1 TBD are provided through CBOs, maintaining referrals to non-CBO clinics also 1.2 Ensure MSM and TG activities are part of NACP III midterm review Year 1-2 1.3 Revised STI, syndromic management 1.3.1 Quality of STI services improved protocols to include anal and oral STIs 1.3.2 Relevant NACO guidelines include anal and • Get copies of TCIF and FHI guidelines and oral STI diagnosis and treatment training manuals 1.4 Conduct a mapping of MSM and TG-friendly 1.4.1 Mappings completed in each districts by end STI clinics (in each State) at District hospital, of year 2 NGO, CBO levels • Where are budgets (not) being released? 1.5 Establish minimum standards for services (similar to Avahan clinical standards) 1.6 Build links with RNTCP and DOTS providers. Year 5 2. Male and female partners of MSM and TG are Vision in good sexual health Year 1-5 2.1 Develop relationship and referral systems 2.2.1 X% of partner referrals- refers to any with clinics (probably non-CBO clinics) who (male or female) sexual partners of STI can provide services to female and male patients attending clinics (NACP – CMIS) partners of MSM and TGs. 2.2 Sensitize these (non-CBO) clinics to MSM and TG issues.
5.3.2 Condom and lubricant supply
Arguably the most important prevention intervention for MSM and TGs is the consistent and correct use of condoms with each anal sex act, preferably accompanied by the use of an appropriate lubricant (e.g., water-based). There is a definite need to emphasise correct use, as this often gets left out of the interpersonal communication activities. Furthermore, there is
12 2007 Final Version a clear need to further emphasise barriers to condom acceptability and use, for example, increasing one’s risk perception around anal sex with either male or female partners (this would be assisted by more open communication around anal sex behaviours and less around sexual identity – see section 5.2 on IEC).
Lubricants broadly are not available in the market in most places. There are currently some attempts to fill this market gap through the local production and distribution of lubricants targeted, initially, for MSM and TGs. Ensuring availability of high quality lubricant is as important as ensuring high quality condoms, and NACO should consider public funding for lubricants just as it does for condoms. Alongside this, lube demand generation activities will be required.
NACP III talks of needing thicker condoms for MSM. However, this was not needed. Rather, the community wishes to focus on condom normalisation through provision of different types of condoms (working with commercial sector for this), addressing condom quality concerns as needed, and emphasising the “pleasure aspects” of condom use.
Time Objectives and activities Indicators frame Year 5 1. Every condom to be supported by lube (currently vision estimated at a minimum of 120 million sachets per year). Year 1-5 1.1 Conduct lube demand generation activities (also 1.1.1 TBD included in section 5.2 IEC above). Year 3 1.2 Ensure MSM and TG activities are part of NACP III midterm review. Year 1-2 1.3 Scale-up lube production (NFI) 1.3.1 Short- to medium-term • Finalize business plan sustainability plans in place • Hold discussions with HLL, Social marketing organisations, private sources 1.4 Work with NACO, MoHFW to increase GOI funding/ 1.4.1 – 1.5.1 Discussions here; lube guaranteed purchase of lube (similar to its purchase of funding increased condoms from HLL). 1.5 Hold discussions with NACO to increase TI budget for lubes. Year 5 2. Numerous condom varieties (dotted, flavoured, ribbed, 2.1.1 Number of commercial vision etc.) are available in the market. condoms (fully priced) sold (NACP – retail audit) 6 2.1.2 Number of condoms distributed by social marketing programs (NACP – NIFHW) Year 3 2.1 Ensure MSM-TG activities are part of NACP III midterm review. Year 1-5 2.2 Hold discussions with commercial and social marketing 2.2.1 Firms agree to increase firms to increase condom varieties in the market. Note that condom varieties (review) social marketing to be planned and phased selectively.
5.4 Care and Support
NACP III Highlights: The Care and support plan includes-
• Linking care and support activity to prevention; • Improved access to opportunistic infections and continuum of care; • Increasing the number of PLHA on anti-retroviral drugs therapy; • Care, support and treatment of children infected and affected by HIV; • Psycho-social, livelihood and nutritional support to PLHA.
6 NACP III says it needs to further define commercial condoms, and this should include various varieties as mentioned above.
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Current care and support programmes need strengthening to make them more available to, and sensitive of, MSM and TG populations. NACP III has provision for mapping and formative studies to provide evidence for care and support programmes, and it is important that MSM and TG issues get included in those plans.
Time Objectives and activities Indicators frame Year 5 1. MSM and TG who need services get 1.1 No & % of persons receiving pre and post Vision access to them, especially through CBO test counseling by age and gender, HRG managed care and support member (NACP – CMIS) programmes. 1.2 No. of persons who got tested at VCTC by age, gender, and HRG member (NACP – CMIS) 1.3 No. of persons who return for test report at VCTC- by age, gender, HRG member, and by HIV status (NACP – CMIS) 1.4 No. and % of persons who test positive by age, gender, and HRG member (NACP – CMIS) Year 1-5 1.1 Community Health Workers (MSM and 1.1.1 X% of CHW are providing support by year 3, TG CBO workers) are providing care year 5 and support 1.2.1 All high prevalence districts have MSM or TG 1.2 HIV+ MSM and TG counsellors PLHA as counsellors by end of year 5 providing services (in VCT/ICTC, etc.) 1.2.2 Linkages and referral systems functional Year 3 1.3 Ensure MSM-TG activities are part of 1.3.1 TBD NACP III midterm review Year 1-2 1.4 Develop and disseminate protocol for 1.4.1 Protocol and mapping completed. TG care and support services 1.5 1.4 Identify/map and then tell people 1.5.1 Persons surveyed report knowing what and about MSM and TG-friendly care and where MSM-TG-friendly services exist. support services in each state Year 1 1.6 Develop and disseminate TI 1.6.1 Completed (by UP SACS) and disseminated to implementation guidelines for MSM all districts, SACS, municipalities, and and TG continuum of care donors
5.5 Treatment: Anti-retroviral therapy
NACP III Highlights:
• Under NACP-III, first line ART drugs will be provided to all those who need; • All public health facilities will ensure that ART is provided to (a) PLHAs referred from targeted interventions (b) sero-positive women particularly those who have participated in the PPTCT programme (c) infected children and (d) those below poverty line; • Many non-governmental organizations, particularly non-profit charitable institutions have been providing excellent care, support and treatment services to PLHA… subject to strict quality parameters, they will be identified and covered under NACP-III for supply of free drugs, capacity building and linkages; • 250 ART centres across the country will have to be set up; • The 250 CD4 machines in India are adequate and NACP-III envisages developing and contracting out private providers to provide this service through public-private partnership.
The most important objectives here are to ensure that any HIV positive MSM and TG gets the needed treatment and related support. Related to this, these persons should be treatment literate so as to maximise the chances of successful treatment. In order to ensure these objectives are reached, current barriers to treatment access by MSM and TGs need to be identified and addressed, and sustained mechanisms for expanding treatment literacy are needed.
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Time Objectives and activities Indicators frame Year 5 1. MSM and TG who need sustained (for life) OI treatment, 1.1 Number of HRG PLHA in TIs vision ART (1 st , 2 nd , and 3 rd line), diagnostics, and nutritional who receive ARV treatment support get them without discrimination. (NACP – CMIS ART Centres) 1.2 OI, ART, diagnostics available and accessible Year 3 1.1 Ensure MSM-TG activities are part of NACP III midterm review Year 1-2 1.2 Ensure that MSM and TG issues are included in all 1.2.1 Guidelines adjusted to NACO guidelines and protocol include MSM-TG issues by end 1.3 Develop positive MSM and TG speakers guidelines and of year 2. training 1.3.1 Guidelines developed and distributed by end of Year 1 Year 1-5 1.4 Document incidents of denial of care, support and 1.3.1 Denial of care reports treatment to MSM-TG PLHIV – clearly indicating where published annually. in the entire system discrimination occurs Year 5 2. MSM and TG are “treatment literate” (fully informed about vision treatments, side effects, adherence, etc.) Year 3 2.1 Ensure MSM-TG activities are part of NACP III midterm review. Year 1-5 2.2 Adapt Engender Health and PSI treatment adherence 2.2.1 Guidelines distributed to all guidelines for MSM and TG and distribute. NGOS/CBOs 2.3 Build partnership with INP+ regarding treatment access 2.3.1 Discussions and meetings programme. help regularly 2.4 Increase MSM-TG profile and presence in INP+. 2.4.1 INP+ hires openly MSM-TG staff
5.6 Human Resource Development: Building Capacities - Training
NACP III Highlights:
• The aim is to build capacity of: programme managers at the national, state and district levels in leadership and strategic management; health professionals and health care providers at all levels of care and health care organizations, CBOs and NGOs in technical and communication skills; grass-roots level workers and functionaries of various government departments in technical, communications and counseling skills; • NACO considers the need for changing current training paradigm from knowledge and competence building to organizational transformation; • A Training Coordination Unit will be established at NACO.
The broadest vision – beyond five years and beyond only the scope of NACP – is that MSM and TG will have skills for strong livelihoods, and that there will be livelihood and other development programmes to support this vision. More immediately, the critical need is for medical staff in both public and private sectors to be friendlier towards, and sensitive to the specific needs of, MSM and TG populations. This is not small objective. It will require sustained technical and training support to public/private agencies, NGOs, CBOs, and PLHA networks, as well as increased ownership of civil society (e.g. NGOs, CBOs).
As NACP III mentions, the inability to discuss sexuality and gender issues in the broader society is a key barrier to success. It is ever more important, then, to get medical personnel to make such discussions “normal”. There is a need to clarify further what it meant by “sexuality and gender issues”. Current training curricula exist (e.g., with Naz India) and these should be expanded upon and widely disseminated.
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Time Objectives and activities Indicators frame Year 5 1. Medical staff are MSM and TG friendly, sensitive vision Year 3 1.1 Conduct a review to assess the extent of inclusion of 1.1.1 Review completed by end of MSM and TG issues in the curricula outlined below. Year 3 1.2 Ensure MSM-TG activities are part of NACP III midterm 1.1.2 Medical curricula include review. sexuality and gender issues Year 1-2 1.3 Advocate with IMA, SCRT, medical colleges and all those 1.3 and 1.4 All doctors and who define medical and paramedical curricula (MoHFW) paramedics posted in government to include MSM-TG issues in curricula. This should hospitals, especially STD include gender and sexuality training as part of other departments, received sensitisation STD training curricula. on MSM and TG issues. 1.4 Discuss with responsible parties (Union and State Ministries of Human Resource Development, University Grants Commission, NCERT, SCERTs, Indian Medical Council, Indian Psychiatric Association) about including MSM-TG issues in medical and paramedical continuous education and other in-service training modules. Year 5 2. CBOs have sustained capacity (systems, training, etc) to vision manage and implement their own interventions in all States. Year 3-5 2.1 CBOs act as resources for newer CBOs, SACS, others. 2.1.1 TBD Year 3 2.2 Ensure MSM-TG activities are part of NACP III midterm review. Year 1-5 2.3 Include MSM and TGs in any planned trainings and 2.3.1 MSM-TG members included in orientations, especially for medical and para-medical staff all relevant trainings by end of Year (by TRG with Networks). 5. 2.4 CBO and network capacity building needs identified and 2.3.2 NACO, SACS, DAPCUs, non- capacity building plan implemented (BCC/IPC, STD MSM-TG NGOs/ CBOs are MSM- services/referrals, establishing DICs, advocacy, data TG sensitive, friendly collection and use, mapping skills, administration topics) Year 1 2.5 Training topics, skills sets, and core competencies 2.4.1 TBD related to MSM and TG are defined/clarified for: • Identification of quality leadership • Programme management • Technical issues 2.6 MSM and TG representatives are trained (by TSUs) with 2.5.1 TBD follow up and mentoring 2.7 Review training materials and adapt, as needed, to make 2.6.1 TBD MSM-TG sensitive. 2.8 If needed, share training materials with SACS, TSU. 2.7.1 TBD
5.7 Enabling Environment
NACP III Highlights:
• Review and reform structural constraints, legal procedures and policies that impede interventions aimed at marginalised populations; • Affirmative action is needed to reduce stigma and discrimination associated with the infected and affected persons and their access to prevention and quality treatment, care, insurance and legal services; • Review existing national guidelines for GIPA with a view to engage marginalised and affected groups; • Work in partnership with PLHA networks and other stakeholders towards creating an enabling environment through addressing issues of stigma, discrimination, legal and ethical concerns; • Need to amend the following laws: NDPS Act, ITPA, and Section 377 of IPC.
Creating a more accepting social, political, and legal environment for MSM and TG populations arguably remains the most pressing need for effectively scaling up interventions.
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The draft HIV Bill spearheaded by the Lawyers Collective is an important step in assuring social justice.
5.7.1 IPC Sections 377 and 292
Amendment of Section 377 of the Indian Penal Code is one of the most important legal reforms related to MSM and TG populations. NACO has, for the first time ever, publicly supported this reform. NACP III has listed such reform as a key indicator of success in creating a more enabling environment for successful HIV interventions.
Though not specific to MSM or TG populations, Section 292 is, in many ways, a more immediate hurdle as it penalizes obscenity. Many of the current IEC and BCC materials, not to mention newer materials required, could be penalised.
5.7.2 MSM and TG Advocacy Strategies
While there is movement at the national level towards creating a more enabling environment, clearly much work remains both there and especially at the State level. The most important aspect of an enabling environment – acknowledging there are MSM and TG populations across all states and districts in India, and providing interventions/services accordingly – does not exist in a number of States and districts. So while there are other common advocacy objectives with other high risk groups, there is clearly a need for MSM- and TG- focused advocacy activities, to be captured in national and state advocacy strategies.
Already some work on network-level advocacy strategies is happening, and this could be a model for other networks and perhaps state/national-level strategies.
Time Objectives and activities Indicators frame Year 5 1. Social acceptance of MSM and TG is increased, leading to a vision reduction in stigma, discrimination, and human rights abuses. Year 3 1.1 Ensure MSM-TG activities are part of NACP III midterm review Year 1-5 1.2 Hire advocacy officers at SACS and within NGOs/CBOs 1.2.1 Money in NACP II budget used Year 1-2 1.3 List of organisations providing legal services developed and 1.3.1 All related NGOs and CBOs given to all SACS and NGOs/CBOs receive list by end of Year 2. 1.4 State-level policy and advocacy units developed 1.4.1 At least 20% of States have units functioning. Year 1 1.5 Develop MSM and TG Advocacy strategies at National and 1.5.1 Percentage increase in State levels: outline key objectives, communication channels media coverage on HIV/AIDS (media), messages, audiences and influencers (police, issues (sexuality/legal issues). medical/health institutions, human rights commission, (NACP – Press and TV audits) lawyers and judges, etc.). Should include risk management strategies. 1.6 Liaise with other groups engaged in advocacy around Section 292 to outline areas for possible MSM and TG inputs.
5.8 Programme Management
NACP III Highlights:
• NACO will continue to work on the decentralized model; taking a more interventionist role in states that fail to deliver; • The National Council on AIDS will be under the chairmanship of the Prime Minister and composed of 31 participating ministries and civil society representatives ;
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• NACO will constitute Technical Advisory Groups on thematic areas (e.g., Targeted Interventions, Research) for guiding and assuring technical oversight; • Due to the special vulnerabilities of North Eastern States, a sub-office of NACO (embedded in the governance structure of NRHM) will be set up; • HIV/AIDS programmes (as well as RNTCP and RCH) will be coordinated with the NRHM; SACS may remain separate, but the new District AIDS Prevention and Control Units (DAPCUs) will be located within the District Health Societies; • All States will be requested to constitute a State Council on AIDS headed by the Chief Minister with the Minister, Health as Vice Chairperson. The SCA will have representatives from government and civil society , and will set policy guidelines, review the State’s performance; • The SACS Governing Body will have representatives of key government departments, civil society (elected by the state level civil society forum), trade and industry, private health sector, and PLHA Networks; • Every SACS will have the option to obtain external technical support through a Technical Support Unit; • The base unit of civil society partnership will be the district, through the District Forum; any civil society organisation can be a member of the Forum; the Forum will develop collaborative district implementation plans and review progress. • The State Level Forum will consist of representatives of the District Forums, not exceeding two per district, while the National forum will have representatives from the state level fora. Where any of constituencies is not represented at the national or state level forum, NACO or SACS will nominate a representative from that constituency. • There will be a Steering Committee of Development Partners; • NACO will outsource numerous services where there is a comparative advantage.
5.8.1 Governance arrangements
Accountability, especially of government programmes and services, is a pressing objective of the NACP III governance arrangement. MSM and TG representation in governing bodies is currently inadequate. The community feel that their presence and voice in key decision- making bodies is critical to assuring accountability and sufficient scale and quality of MSM and TG interventions. There should be “nothing for us without us”.
5.8.2 Partnerships and Alliances
There are numerous networks, and alliances in the MSM and TG communities. Scaling up interventions will require an unprecedented collaboration and partnership between these groups in order to achieve the necessary scale and quality of interventions and services. A national platform of MSM and TG networks, organisations, and interested individuals is needed. This would be a community representation body that, among other activities, could assist in the oversight of this Strategic Plan, keeping a community watch on, and close involvement in, its implementation.
There is, however, agreement that there should be a separate MSM–TG Technical Resource Group to ensure quality of interventions as well as high level accountability for those interventions.
Two more important partnerships are needed. Firstly, academic institutions should be engaged so that broad-based curricula on MSM-TG issues in various schools (e.g. social work) are implemented. Another possibility is to get schools to place students/interns in MSM-TG organisations. Secondly, mental health institutions should move towards revising their stand on homosexuality and transgender issues.
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Time Objectives and activities Indicators frame Year 5 1. “Nothing for us without us” vision Year 3 1.1 MSM and TG community representatives 1.1.1 Number of SACS, DACS and NGOs who are involved in donor and government have members of HRGs on their decision NACP III programme and project making bodies (NACP – Special Studies) management activities and decisions that 1.1.2 Each SACS Governing Council/Executive affect MSM and TG communities. Committee (Project Steering Committee, 1.2 Donor resources are distributed optimally to Advisory Committee) has meaningful (vote, ensure scaled coverage and quality of voice, power) MSM and TG representation interventions 1.2.1 MSM and TG representative participate in 1.3 Ensure MSM-TG activities are part of NACP III Joint Reviews NACP III midterm review Year 1-2 1.4 Get NACO to ask for Governing Council 1.4.1 Governing Council minutes submitted to minutes NACO at least once a year. 1.5 Review community representatives and ensure they are trained 1.5.1 Review and training mechanisms established and implementation begun. Year 1 1.6 MSM-TG TRG established 1.6.1 TRGs are effective, fair, competent, and • Agree membership, objectives, functional workload, remuneration, etc 1.6.2 TRG activities funded (by NACO or donor) 1.7 Conduct an MSM-TG “audit” of all the 1.7.1 Audit conducted by end of Year 1 SACS to hold SACS accountable 1.8 Develop a mechanism to identify MSM and 1.8.1 Mechanism established by end of Year 1 TG representation in national strategic events 1.9 Establish a national MSM and TG platform. Year 5 2. MSM and TG issues are “normalized” across vision India and in key social institutions Year 3 2.1 Ensure MSM-TG activities are part of NACP III midterm review Year 1-5 2.3 Work with academic institutions to add 2.2.1 Curricula are adapted by end of year 3 MSM-TG issues to curricula and increase 2.2.2 At least 5 academic institutions begin internships with MSM-TG organisations internships placements by end of year 3 2.4 Work with mental health institutions to leaders to increase normalisation of MSM 2.3.1 Mental health institutions adapt policies and TGs. and guidelines accordingly by end of year 5
5.9 Strategic Information Management
NACP III Highlights:
• Size estimation for MSM: 2,352,13; for Male Sex Workers (MSW): 235,213; • Only 18 out of 704 HIV sentinel surveillance sites are for MSM; • According to sentinel surveillance, prevalence among MSM is 8.74% across India; • Strategic Information Management includes monitoring, Computerised Management Information System (CMIS), Computerised Financial Management System, (CPFMS), evaluation, serologic (sentinel) and behavioural surveillance, and research; • CMIS will be reformed for better decentralised management at district level and overall monitoring at all levels; • All intervention programmes will include evaluation plans; • Strategic Information Management Units (SIMUs) will be established at national, state, and district levels; • Research outcomes include enhanced knowledge and evidence base, up-scaled HIV research across multi-disciplinary themes, improved research quality, better research capabilities and expanded partnerships.
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5.9.1 Indicators and benchmarks
NACP III outlines a number of monitoring and evaluation instruments. The Community has reviewed the three main instruments: the quarterly Dashboard (21 indicators), the Annual Core Indicators (23 indicators), and the Key Programme Indicators (130 indicators). It was found that:
• The Dashboard has three indicators that relate directly to MSM and TG populations; six indicators relate only indirectly to MSM-TGs. The remaining twelve indicators are only vaguely applicable. See Annex 4 for details. • The Annual Core Indicators has four indicators relating directly to MSM and organisations running MSM or TG interventions; five indicators relate only indirectly to MSM (nothing related to TGs), and the remaining fourteen are only vaguely applicable, it at all. See Annex 5 for details. • Out of the 130+ key programme indicators, more than twenty-five relate closely to MSM interventions and the organisations that run them. However, there is no indicator related specifically to transgender populations, so this segmentation will have to be monitored carefully in other ways. Also, while there are numerous indicators related to condoms and their use, there is no indicator for lubricant availability, access, or use.
There is concern that benchmarks for achievement are not identified. However, the community recognises that many of these can be filled in once appropriate baseline data are gathered. Another concern is the problem of getting policy makers and programme implementers to use the data once collected, but this is not specific to MSM and TG populations.
5.9.2 Research
Research (Operational, formative, evaluative)
Two of the biggest concerns of the MSM and TG community are (1) the (“high risk”?) MSM size estimation promulgated in NACP III, and (2) the MSM-TG mapping exercises previously conducted. The assumptions behind the size estimation are felt to be wrong, producing a very low number. The methods used for the mapping exercises were felt to be weak, which fed into the poor size estimations.
Based on experience of organisations working with MSM and TG populations, the following formative research topics, already highlighted in NACP III, require close quality control and review of protocols. It is strongly recommended that MSM and TG populations be closely involved in the development and implementation of these studies:
• Establish a valid baseline to measure coverage : towards this end, (high risk) MSM, MSW, and TG mapping exercises and population size estimations should be conducted (using a sound methodology such as that developed through Avahan which involves knowledgeable community members). The specific definition for size estimation might be “the number of MSM who access selected public sex venues in that city over a particular time-period”. • Data confidentiality : MSM and TG mapping exercises must place special emphasis on confidentiality issues, of both people and sensitive information (such as cruising/sex sites), especially given the highly stigmatised social and legal environment. Guidelines should be developed and followed to ensure confidentiality is maintained. • Service coverage gaps for MSM and TG populations (e.g., BCC/IPC, condom accessibility, STI treatment, VCTC, care and support, ART) need to be identified;
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• The HIV sentinel surveillance system should allow for better tracking of the epidemic among MSM and TG. Currently only 18 out of 704 sentinel surveillance sites are for MSM; it is not clear how NACPIII can reach its stated intention of improved surveillance if this number remains so low.
In addition to the general research topics identified in the NACP III Strategic Plan, The following topics are priorities for MSM and TG populations:
• Lubricant Social Marketing • Qualitative studies on enablers and barriers to condom use among MSM and TG populations (negotiating condom use, risk perception, etc).
Other areas of research suggested include:
• Prevalence of HIV, anal and oral STIs (and the inclusion of these in the STI sentinel surveillance system) • Health care providers’ attitudes to MSM and TG • Mental health and coping mechanisms of MSM and TG • Partner relationships and violence, and its effect on partner notification • Barriers and enablers of treatment seeking behaviours, safer sexual behaviours
Furthermore, the following research has been conducted in limited areas. Research protocols exist, and such research might be conducted in other areas in India:
• Violence against, and human rights violations of, MSM and TGs and the affect on HIV risk. • STI prevalence amongst MSM and TG populations • Social and sexual networks amongst MSM and TG populations.
Time Objectives and activities Indicators frame Year 5 1. The evidence-base for MSM and TG interventions is valid 1. Feedback on data provided to vision and used for programme planning, and the capacity to NGOs and CBOs gather appropriate evidence-base is built. Year 3 1.1 Knowledge management systems highlighting MSM-TG 1.1.1 NACO website created for services, organisations, etc. developed online sharing and disseminating • Option 1: make MSM-TG issues part of a national research data and reports (NACP clearinghouse – Review) • Options 2: create an MSM-TG-specific clearinghouse. 1.1.2 Number and proportion of 1.2 Ensure MSM-TG activities are part of NACP III midterm partners sharing information with review SACS (NACP – CMIS) Year 1-3 1.3 MSM and TG population size estimates need to be 1.3.1 No. of district level risk validated and, where necessary, revised. This should assessment studies: From 0 in include participation of community members. Where 2005 to 606 in 2011 (NACP – feasible, estimates should be disaggregated by level of CMIS) risk behaviours. 1.3.2 Percentage of districts 1.4 Valid baselines (size estimations, services) conducted which have updated HRG for TIs in each district. mapping data (NACP – CMIS) 1.5 Announce and disburse research grants 1.4.1 Completed in all states by end of Year 3. Year 1 1.6 Hold discussions with NACO, UNAIDS, and Avahan 1.5.1 Discussions held by end of about knowledge management plans Year 1. 1.7 HIV Surveillance sites to be reviewed to include appropriate MSM & TG sites 1.8 Finalize national research agenda in consultation with MSM & TG groups 1.9 Allocate funding for conducting research among MSM & TG populations in the ‘national HIV research fund’
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5.10 Procurement plan
The procurement plan for NACP III lists both male and female condoms but does not include procurement of lubricants. This is a major gap for MSM and TG populations, who will work to convince NACO to put lubricants into the plan as soon as possible.
5.11 Financial requirements
It is expected that much of this plan is or can be covered under the current NACP III Budget. However, some new services and goods need to be added. At the time of writing these additions had not been costed, but include the following:
Financial support to key MSM and TG networks to provide capacity building support to existing and new NGOs and CBOs conducting HIV prevention and care activities for MSM and TG populations. Such networks include, but are not limited to (in alphabetical order) Amma, Challenge/SIIAP, Federation for Male Social and Sexual Health Programme, INFOSEM, MANAS Bangla, Naz Foundation International, Nipasha, Nirmaan, Pasam, SAATHII, Suraksha, and Udaan. Inclusion of legal services in Targeted Interventions Government procurement of lubricant
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5.12 Programme Outcomes and Targets
The following table is taken from the NACP III Strategy and Implementation Plan. Most of the original table has been deleted leaving only those targets related (directly or indirectly) to MSM and transgendered populations.
Program Program Targets Description of targets for NACP III estimates (units) Year-end Targets 2005 2006 2007 2008 2009 2010 2011
1-A Prevention Package in High Risk Population 2 Number of MSM reached by intervention per year 2.352 million 1.15 million 7 0.12 0.46 069 0.92 1.15 1.15 1.15 4 Number of TI for CSW, MSM, IDUs 2100 691 700 1300 1800 2100 2100 2100 Condom Promotion 13 Number of condom distributed 3500million/Year 1050 1400 1750 2450 2800 3150 100 14 Number condoms distributed by social marketing programs 2000million /Year 600 600 700 800 900 1000 1200
Number of sex acts by HRG in which condoms are used 1200 million /Year 600 660 720 840 960 1080 1080
Number of SM condoms utilized in TI 1000 million /Year 100 300 500 700 800 900 1000 15 Number of Commercial condoms 500 million/Year 150 275 300 325 350 350 350 16 Number of free condoms 1000million/Year 500 450 400 350 300 280 280 Improving STI management 17 Number of adults with STI symptoms accessing syndromic management 108 million 32.4 37.8 43.2 48.6 54 59.4 64.8 18 Number of STI accessing laboratory services 2 million 0.1 0.6. 0.8 1.0 1.4 1.6 2.0 Voluntary Counselling and testing 19 Number of vulnerable population and clients of sex workers accessing VCT services 7 million/year 0.4 0.8 3 4 6 6.5 7 II Care, Support and Treatment 28 0.33 million OI Number of OI episodes treated in public sector episodes 0.329 0.325 0.321 0.316 0.310 0.306 0.303 30 Number of PLHA provided ART in the program under public sector 0.3 million 0.035 0.100 0.150 0.200 0.250 0.300 0.300 Number of research projects completed at the national/regional level 15 per year 5 10 15 15 15 15
7 2.3 million MSM > 5 partners- HRG Estimation by expert group. The program will cover 50%
6. MSM-Transgender Strategy Implementation Plan The following is a summary of the activities listed above across all the components of the plan. It broadly covers the nation, and a similar plan is required for each state, with related prioritisation. Some state- and region-specific priorities for scale up have already been provided by the communities, and these are found at the end of the table.
Objectives and activities Person/Organisation Responsible Yr 1 Yr 2 Yr 3 Yr 4 Yr 5 Managing the Strategic Plan 1. A person or persons responsible for implementing this strategy must be identified at NACO to identify X NACO and/or at another institution to which NACO can give some authority (e.g. UNAIDS) 2. Those persons need to review this draft plan and fill in the gaps, especially related to MSM & TG Focal persons/organisation X any additional budget that may be required 3. A Technical Resource Group (TRG) for MSM and TG issues needs to be constituted NACO to constitute, donors to fund X and funds provided to allow the group to work 4. State level MSM and TG strategic Plans must also then be designed, to fit in with the SACS with assistance from X State-level Project Implementation Plans (PIPs). It is only then that specific next steps at State, District, and local levels will be clear 5. Monitoring and assess/evaluate implementation NACO, SACS, MSM & TG Focal X X X X X persons/organisation, MSM&TG NGOs and CBOs Prevention Strategies: HRG saturation 1. TIs scaled up to cover MSM and TG populations SACS/PSUs with assistance from TRG and local MSM and TG networks, CBOs 1.1 Prioritise establishing TIs in District Headquarters X X X X 1.2 Ensure TIs are running in all urban centres X X X 1.3 Ensure MSM-TG activities are part of NACP III midterm review NACO, SACS X 1.4 Finishing mapping of TI coverage SACS/PSU with direct involvement of X 1.5 Prioritise establishing TIs in urban centres MSM and TG NGOs, CBOs 1.6 Identify and agree which CBOs and networks to be scaled up 2. Quality of all TI components (BCC, STI services, condom promotion, social mobilisation, enabling environment) is higher than at baseline. 2.1 Conduct quality assessments. 2.1-2.2 Contracted by NACO or SACS, X X 2.2 Conduct SACS/NGO/ CBO management assessments conducted by third party; 2.3 Ensure MSM-TG activities are part of NACP III midterm review 2.3 NACO, SACS 2.4 Work with NACO and SACS to get money for legal services included in TI budgets. TRG, local MSM & TG networks, CBOs X IEC, Social Mobilisation, and Mainstreaming 1. IEC and BCC materials used in India include both ‘MSM & TG-friendly” and “MSM & TG-centric” materials 1.1 Conduct lube demand generation activities NGOs, CBOs X X X X X 1.2 Ensure MSM-TG activities are part of NACP III midterm review NACO, SACS X 2007 Final Version
1.3 General IEC materials mentioning male to male sex and related HIV prevention SACS/PSU, MSM & TG NGOs/CBOs X X X issues (“MSM & TG-friendly”) are developed and distributed. 1.4 BCC/IEC materials for MSM and TG populations, especially regarding anal and oral sex, are developed, used, and available to all NGOs/CBOs working with MSM and TG populations (“MSM & TG-centric”) 1.5 Develop materials that include messages about care and support services for MSM SACS/PSU, MSM & TG NGOs/CBOs X X and TG: availability, cost, nature of services, etc. 1.6 Develop a repository/catalogue of MSM-TG-friendly BCC/IEC materials X 2. Sex, sexuality, and gender issues are discussed more openly in mass media, SACS/PSU, media houses especially television. 2.1 Provide sexuality and gender trainings to BBCWST (as needed) and Doordarshan NACO can arrange, MSM & TG X X X X X staff and policy makers (might use Naz India and other models) NGOs/CBOs conduct Programme strategies: Prevention 1. STI services are good quality and MSM friendly/sensitive 1. SACS, TI Partners, Research Bodies (for M&E) 1.1 STI (and perhaps general medical) services are provided through CBOs 1.1 SACS, TI Partners X 1.2 Ensure MSM-TG activities are part of NACP III midterm review 1.2 NACO, Donors 1.3 Revised STI, syndromic management protocols to include anal and oral STIs 1.3 NACO, SACS, Indian Medical X X • Get copies of TCIF and FHI guidelines and training manuals Association 1.4 Conduct a mapping of MSM-TG-friendly STI clinics (in each State) at District 1.4 SACS, TI Partners hospital, NGO, CBO levels • Where are budgets (not) being released? 1.5 Establish minimum standards for services (similar to Avahan clinical standards) 1.6 Build links with RNTCP and DOTS providers. 2. Male and female partners of MSM and TG are in good sexual health NACO, SACS, NRHM, RCH Programme, TI Partners 2.1 Develop relationship and referral systems with clinics who can provide services to TI Partners X X X X X female partners Condom and lubricant supply 1. Every condom to be supported by lube (currently estimated at a minimum of 120 NACO, Donors, Condom Makers million sachets per year). 1.1 Conduct lube demand generation activities (also included in section 5.2 IEC above) TI Partners, TA Agencies X X X X X 1.2 Ensure MSM-TG activities are part of NACP III midterm review NACO, Donors X 1.3 Scale-up lube production (NFI) NFI, INFOSEM X X • Finalize business plan • Hold discussions with HLL, Social marketing organisations, private sources 1.4 Work with NACO, MoHFW to increase GOI funding/ guaranteed purchase of lube (similar to its purchase of condoms from HLL) 1.5 Hold discussions with NACO to increase TI budget for lubes 2. Numerous condom varieties (dotted, flavoured, ribbed, etc.) are available in the Condom Makers market. 2.1 Ensure MSM-TG activities are part of NACP III midterm review NACO, Donors X
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2.2 Hold discussions with commercial and social marketing firms to increase condom NACO, SACS, TI Partners X X X X X varieties in the market Care and support 1. MSM and TG who need services get access to them, especially through CBO managed care and support programmes. 1.1 Community Health Workers (MSM and TG CBO workers) are providing care and X X X X X support 1.2 HIV+ MSM and TG counsellors providing services (in VCT/ICTC, etc.) 1.3 Ensure MSM-TG activities are part of NACP III midterm review NACO, SACS X 1.4 Develop and disseminate protocol for TG care and support services 1.4 TRG, INFOSEM, Nipasha X X 1.5 1.4 Identify/map and then tell people about MSM and TG-friendly care and support services in each state 1.5 UNAIDS and networks 1.6 Develop and disseminate TI implementation guidelines for MSM and TG continuum TRG, building on GSACS guidelines X of care Treatment: ART 1. MSM and TG who need sustained (for life) OI, ART (1 st , 2 nd , and 3 rd line), diagnostics, and nutritional support get them without discrimination. 1.1 Ensure MSM-TG activities are part of NACP III midterm review. NACO, SACS X 1.2 Ensure that MSM and TG issues are included in all NACO guidelines. 1.2 TRG, Networks, and Nipasha X X 1.3 Document incidents of denial of care, support and treatment to MSM-TG PLHIV – clearly indicating where in the entire system discrimination occurs. 1.4 Develop positive MSM-TG speakers guidelines and training. 1.4 Networks X X X X X 2. MSM and TG are “treatment literate” (fully informed about treatments, side effects, adherence, etc.). 2.1 Ensure MSM-TG activities are part of NACP III midterm review. NACO, SACS X 2.2 Adapt Engender Health and PSI treatment adherence guidelines for MSM and TG 2.2 TRG, Networks, and Nipasha X X X X X and distribute. 2.3 Build partnership with INP+ regarding treatment access programme. 2.4 Increase MSM-TG profile and presence in INP+. 2.4 Networks Human Resource Development: building capacities – training 1. Medical staff are MSM and TG friendly, sensitive 1.1 Conduct a review to assess the extent of inclusion of MSM and TG issues in the X curricula outlined below. 1.2 Ensure MSM-TG activities are part of NACP III midterm review 1.3 Advocate with IMA, SCRT, medical colleges and all those who define medical 1.3 NACO, Donors, UNAIDS, Clinton X X curricula (MoHFW) to include MSM-TG issues in curricula Foundation, Avahan 1.4 Discuss with responsible parties about including MSM-TG issues in continuous education and other in-service training modules 2. CBOs have sustained capacity (systems, training, etc) to manage and implement their own interventions in all States 2.1 CBOs act as resources for newer CBOs, SACS, others X X X 2.2 Ensure MSM-TG activities are part of NACP III midterm review NACO, SACS X
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2.3 Include MSM and TGs in any planned trainings and orientations TRG with Networks X X X X X 2.4 CBO and network capacity building needs identified and capacity building plan SACS/PSU, MSM & TG NGOs/CBOs X X X X X implemented (BCC/IPC, establishing DICs, STD services/referrals, advocacy, administration topics) 2.5 Training topics, skills sets, and core competencies related to MSM and TG are defined/clarified for: • Identification of quality leadership • Programme management • Technical issues 2.6 MSM and TG representatives are trained (by TSUs) with follow up and mentoring 2.6 PSUs 2.7 Review training materials and adapt, as needed, to make MSM-TG sensitive 2.7 TRG, with Networks X 2.8 If needed, share training materials with SACS, TSU 2.8 TRG, networks Enabling Environment 1. Social acceptance of MSM and TG is increased, leading to a reduction in human rights abuses. 1.1 Ensure MSM-TG activities are part of NACP III midterm review NACO, SACS X .2 Hire advocacy officers at SACS and within NGOs/CBOs X X X X X .3 List of organisations providing legal services developed and given to all SACS and X X NGOs/CBOs .4 State-level policy and advocacy units developed .5 Develop MSM and TG Advocacy strategies at National and State levels: outline key SACS/PSU, MSM & TG NGOs/CBOs X objectives, communication channels (media), messages, audiences and influencers (police, medical/health institutions, human rights commission, lawyers and judges, etc.) – Note: may emerge from the INFOSEM advocacy strategy being developed. Programme Management 1. “Nothing for us without us” 1.1 MSM and TG community representatives are involved in donor and government NACO, SACS/PSU, donors, MSM & TG X NACP III programme and project management activities and decisions that affect MSM NGOs/CBOs and TG communities. 1.2 Donor resources are distributed optimally to ensure scaled coverage and quality of interventions 1.3 Ensure MSM-TG activities are part of NACP III midterm review 1.4 Get NACO to ask for Governing Council minutes DFID/UNAIDS/ World Bank X X 1.5 Review community representatives and ensure they are trained 1.6 MSM-TG TRG established NACO, UNAIDS, other X • Agree membership, objectives, workload, remuneration, etc 1.7 Conduct an MSM-TG “audit” of all the SACS to hold SACS accountable 1.8 Develop a mechanism to identify MSM and TG representation in national strategic events 2. MSM and TG issues are “normalized” across India and in key social institutions 2.1 Ensure MSM-TG activities are part of NACP III midterm review NACO, SACS X 2.2 Work with academic institutions to add MSM-TG issues to curricula and increase SACS/PSU, MSM & TG NGOs/CBOs X X X X X
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internships with MSM-TG organisations 2.3 Work with mental health institution leaders to increase normalisation of MSM-TGs. Strategic Information Management 1. The evidence-base for MSM and TG interventions is valid and used for programme planning 1.1 Knowledge management systems highlighting MSM-TG services, organisations, etc. 1.1 TRG? X developed • Option 1: make MSM-TG issues part of a national clearinghouse • Options 2: create an MSM-TG-specific clearinghouse. 1.2 Ensure MSM-TG activities are part of NACP III midterm review 1.2 NACO, SACS 1.3 MSM and TG population size estimates need to be validated and, where necessary, 1.3 – 1.4 SACS/PSU, MSM & TG X X X revised. This should include participation of community members. Where feasible, NGOs/CBOs estimates should be disaggregated by level of risk behaviours. 1.4 Valid baselines (size estimations, services) conducted for TIs in each district. 1.5 Announce and disburse research grants 1.5 NACO or donors 1.6 Hold discussions with NACO, UNAIDS, and Avahan about knowledge management 1.6 MSM & TG NGOs/CBOs X plans 1.7 HIV Surveillance sites to be reviewed to include appropriate MSM & TG sites 1.7-1.9 NACO 1.8 Finalize national research agenda in consultation with MSM & TG groups 1.9 Allocate funding for conducting research among MSM & TG populations in the ‘national HIV research fund’
28
Annex 1: Specific details on scale up for some regions and states
State or region Who will begin interventions in Who will expand interventions What consultation process do we suggest What assistance can current CBOs, districts with no coverage? in districts with low coverage? for beginning and expanding interventions? NGOs, and networks provide for capacity building AP, Karnataka, Community consultation to be held with With funding, INFOSEM and NFI Kerala full representation to get consensus can provide capacity building decisions. workshops on sexuality/gender; set up process, financial management, accounting, inventory, M&E, audits, documentation. Other CBOs (to be identified) have the skills to provide technical and managerial assistance to new CBOs. Gujarat Most existing NGOS and CBOs. Most existing NGOS and Proactive collaboration with existing With funding, NFI and INFOSEM CBOs. NGOs and CBOs Expand networks of existing CBOs Goa N/A Humsafar Goa Same as Maharashtra (below) With funding, NFI and INFOSEM Maharashtra INFOSEM Network members and Jalgaon – Udaan Meetings with SACS and other donors With funding, NFI and INFOSEM Udaan. Priority districts with no Kolhapur – Samapathik Community representation in current CBOs or interventions Nagpur – Sarathi recruitment process include Ahmednagar, Aurngabad, Nashik – Samapathik and Community participation in size Chandrapur, Dhule, Jalna, Latur, Udaan estimation and sites assessment. Nanded, Raigad, Ratnagiri, and Pune – Samapathik, Solapur. Udaan, and Astitva. Kashmir SACS, Humsafar Kashmir. SACS, Humsafar Kashmir. Work with organisations already involved in With funding, NFI and INFOSEM process, share data. Uttar Pradesh SACS, NFI, Bharosa Trust (Year SACS, NFI, Bharosa Trust Consultation to include all groups working With funding, NFI and INFOSEM 2-3) (Year 4-5) in UP on MSM and TG issues, to share experiences, and develop helping relationships East and Second priority; based on First priority. Need state and/or regional consultation With funding, NFI and INFOSEM Northeast additional funding. to outline who, where, and what to scale up (to avoid overlap, territoriality) Donors need to conduct peer reviews of proposals for expansion/new interventions
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Annex 2: District-wise distribution of MSM and TG Targeted Interventions Colour coding State/UT A = High Prevalence B = Concentrated epidemic C = Highly vulnerable D = Vulnerable District A (163) = High Prevalence B (59) = Concentrated epidemic C (278) = Increased presence D (111) = Low prevalence, low/ of vulnerable populations unknown vulnerability
Organised by 5 Regions: South, Northeast, East, North, West: State/District Category Urban Population: MSM-TG size NACO Estimate Number of TIs/ Implementing What gaps? (A-D) Centre 2001 Estimation of TI need/ MSM Pop’n covered Organisation South
Andaman & Nicobar 356,152 NONE NEEDED 0/0 Islands: Vul (2 Districts) 1. Andaman D 0 2. Nicobar C 0 Andhra Pradesh 8: 76,210,007 12 Exclusive + 3+?/? Hi Prev (23 Districts) 25 Composite 3. Adilabad C 486 Shree Sai Mahila Mandali, Mapping, Quality STI Care, Swayam Shakthi Society, Condom & Lubes Supply, Alliance NGO Care & Support 4. Anantapur A 4,604 Alliance NGO, “ “ Sahacharudu Society 5. Chittoor A 1,264 Pass(Tirupathi), Sneha “ “ Sangam, CRLRSWA (Nagari, Srikalahasthi, Nindra) 6. Cuddapah A 572 Alliance NGO, Sneham “ “ Welfare Society(Produtur), Surakhsitha Sangam 7. East Godavari A Rajahmun 4872.62 1,825 1825+ Godavari Mata Welfare “ “ dry, Association (CBO- Kakinada Rajamundry), HLFPPT NGO, Kranthi Rekha Welfare society (CBO- Amalapuram), Aasha Kiranam Welfare Society(CBO-Kakinada) 8. Guntur A Guntur, 4405.52 2,670 2670+ HLFPPT NGO, Sneha “ “ Narsarao Sudha(CBO), Friends peta, Society(CBO) Tenali and
8 Size estimations for AP taken from Avahan and represent “high risk MSM”. There may be more under different definitions.
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State/District Category Urban Population: MSM-TG size NACO Estimate Number of TIs/ Implementing What gaps? (A-D) Centre 2001 Estimation of TI need/ MSM Pop’n covered Organisation Pidugurall a 9. Hyderabad A H’bad 85,000? MITHRUDU - TI/State Mapping, Quality STI Care, Network, ASHA Society- Care & Support MSM PLHA Network, Raksha Society- MSM PLHA Network, Suraksha Society - State CBO, AMMA - State CBO Associations, Saathi 10. Karimnagar A 1,020 Alliance NGO, Mapping, Quality STI Care, Shakthi Society Condom & Lubes Supply, Care & Support 11. Khammam A 890 Jeevan Kranthi Welfare “ “ Society 12. Krishna A Machilipa 4218.41 1,553 1,533+ HLFPPT NGO, SAATHI “ “ tnam (CBO-Vijaywada) 13. Kurnool A 2,677 Alliance NGO, Suraksha “ “ Society - Ind. CBO 14. Mahbubnagar C 1,500 Jeevan Jyothi Welfare “ “ Society CBO 15. Medak A 480 Alliance NGO, “ “ MITHRUDU(CBO), Saheli Samanvaya Sangam(CBO- Sangareddy), 16. Nalgonda A 1,640 Alliance NGO, “ “ Chaitanya Welfare Society (CBO) 17. Nellore A 10,000? Aikyatha Welfare “ “ Society(CBO), Duties(NGO), Spandana, 18. Nizamabd A 942 Alliance NGO, “ “ Anubandham Society 19. Prakasam A 10,000? Navjeevan Welfare Mapping, Quality STI Care, Society(CBO- Ongole), Condom & Lubes Supply, Aasha Prakasham, Care & Support, Technical Apthudu, Support for CBO Apthbandav, Development Friends(TG), Chaitanya 20. Rangareddy A 1,253 MITHRUDU(CBO), Mapping, Quality STI Care, ASHA Society- MSM PLHA Consistent Supply of Network, Condom & Lubes ,Care & Raksha Society- MSM Support PLHA Network,
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State/District Category Urban Population: MSM-TG size NACO Estimate Number of TIs/ Implementing What gaps? (A-D) Centre 2001 Estimation of TI need/ MSM Pop’n covered Organisation Suraksha Society 21. Srikakulam A Palasa, 2528.49 886 886+ HLFPPT NGO Mapping, Quality STI Care, Sklm Condom & Lubes Supply, Care & Support, CLI 22. Visakhapatnam A Vizag, 3789.82 1457+ HLFPPT NGO, Mapping, Quality STI Care, Anakapal Sahara Trust(CBO) Condom & Lubes Supply, 1,457 le and Care & Support Paderu 23. Vizianagaram A Vizianag 2245.1 947 947+ HLFPPT NGO “ “ aram and Parvathip uram 24. Warangal A 3,043 Deeparadhana, Alliance “ “ NGO 25. West Godavari A Eluru 3796.14 1,771 1,771 HLFPPT NGO Mapping, Quality STI Care, Condom & Lubes Supply,Care & Support, CLI Karnataka 9: Hi Prev 246 52,850,562 11,408 12 Exclusive + 1+?/ ? (27 Districts) 21 Composite 26. Bagalkot A - 1,652,232 - 1 Composite KHPT 27. Bangalore City A 6,523,110 1+?/6255+? Sangama, Swabhava 49 7049 Trust/Gelaya 28. Bangalore Rural A 9 1,877,416 182 1 Composite 1/1700? Suraksha 29. Belgaum A 20 4,207,246 158 Composite Birdu (?) 30. Bellary A 10 2,025,242 317 CBO+ Composite Sadh ana + Myrada 31. Bidar A 6 1,501,374 65 32. Bijapur A 6 1,808,863 96 CBO+ Composite Spoort hi + KHPT 33. Chamrajnagar A 4 964,275 268 CBO+ Composite Be laku + Myrada 34. Chickmagalur C 8 1,139,104 133 35. Chitradurga A 6 1,510,227 141 1 Composite Myra da 36. Davangere A 6 1,789,693 272 CBO+ Composite Che tana + Abhaya 37. Dharwad A 6 1,603,794 263 CBO+ Composite 2/1000?+? Snehajyohi + Suraksha 38. Gadag A 9 971,955 96 1 Composite Samraksha 39. Gulbarga A 12 3,124,858 165 1 Composite KHPT 40. Hassan A 8 1,721,319 136 CBO+ Composite Nazar + SVYM 41. Haveri A 7 1,437,860 76 1 Composite Samraksha 42. Kodagu A 3 545,322 50 43. Kolar A 12 2,523,406 432 1 Composite Myrada 44. Koppal A 4 1,193,496 119 1 Composite Samraksha 45. Mandya A 7 1,761,718 165 1 Composite KHPT/Gela ya
9 Size estimations for Karnataka taken from Avahan and represent “high risk MSM”. There may be more under different definitions.
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State/District Category Urban Population: MSM-TG size NACO Estimate Number of TIs/ Implementing What gaps? (A-D) Centre 2001 Estimation of TI need/ MSM Pop’n covered Organisation 46. Mysore A 7 2,624,991 163 CBO Gelaya/KHPT 47. North Kannada A 11 1,353,299 107 48. Raichur A 6 1,648,212 86 1 Composite Samraksha 49. Shimoga C 9 1,639,595 233 1 Composite KHPT 50. South Kannada A 8 1,896,403 272 CBO+ Composite Aasare + Cardis 51. Tumkur A 9 2,579,516 219 CBO+ Composite Amarde ep + Cardis 52. Udupi A 4 1,109,494 145 CBO+ Composite Snehasangama guard +? Kerala: Hi Vul 31,841,374 7 Exclusive + 3 2+?/ ? (14 Districts) Composite 53. Alappuzha B 54. Ernakulam A 55. Idukki C 56. Kannur C 57. Kasargod C 58. Kollam C 59. Kottayam B 60. Kozhikode B FIRM 61. Malappuram C 62. Palakkad C 63. Pathanamthitta B 64. Thiruvananthapuram B FIRM 65. Thrissur B FIRM 66. Wayanad C Lakshwadeep: Vul 60,650 NONE NEEDED 0+?/ ? (1 District) 67. Lakshwadeep C 60,650 0 Pondicherry: Concent’d 974,345 No Exclusive + 0+?/ ? (4 Districts) 1 Composite 68. Karaikal D 1000? 1/? Sahodaran 69. Mahe B 70. Pondicherry (City) A 4000? 1/? Sahodaran 71. Yanam D Tamil Nadu 10 : Hi Prev 62,405,679 107,295? 10 Exclusive + 26+?/10,901? (30 Districts) 20 Composite 72. Chennai A 2+?/5000+? Sahodharan, SWAM, THAA, Acuagul, ICWO 73. Coimbatore A Yes NMCT: CBO+ Composite 1/2044+ Nesam (NFI), NMCT 1822; (TAI)
10 Size estimations for TAI (Avahan) represent “high risk MSM”. There may be more under different definitions. “Other” estimates come from the mapping exercise conducted by Indian Marketing Research Berew, funded by APAC (figures were provided by Federation for Male Social and Sexual Health Programme).
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State/District Category Urban Population: MSM-TG size NACO Estimate Number of TIs/ Implementing What gaps? (A-D) Centre 2001 Estimation of TI need/ MSM Pop’n covered Organisation Other: 13,600 74. Cuddalore A Yes 4200? CBO+ Composite 1/? Pasam 75. Dharmapuri A Yes RIDO: 130 CBO+ Composite 1/144 Anbalyam, RIDO (TAI) 76. Dindigul B Yes 6250 1/508 Namm (NFI) 77. Erode D Yes CARE: 827; 2/810+385+? MSMS (NFI), Erode Other: 6750 District Aravanigal Association; CARE (TAI) 78. Kanchipuram A Yes ARM: 3,588 1+?/1703 Hand, T AA, Suder Only ARM is funded. Foundation; ARM (TAI) 79. Kanyakumari A Nagerkovil 2750? 1/525 Kumari 80. Karur A Yes 2545? 1/? Wheel 81. Krishnagiri D Yes 3500? 1/900 Krishnagri Aas 82. Madurai A Yes ISM: 548; 1/1807+1095 Gokulum (NFI), ISM (TAI) Other: 14,250 83. Nagapattinam A Mayavaram Other: 3680 1/624 Kits&Kins (NFI) 84. Namakkal A Yes WORD: 177; 1/268 Nanban, WORD (TAI) Other:7800 85. Nilgiris D Yes Other: 7500 1/? Rainbow 86. Perambalur A Yes Other: 3500 1/? Sanghamam 87. Pudukkottai A Yes 3000? ? Udhayam Not funded 88. Ramanathapuram A Yes Other: 4400 ? Bright Not funded 89. Salem A Yes PDI: 1,123 1/900+1490 Vadamalar, PDI (TAI) Onlhy PDI is funded 90. Sivaganga C Yes Other: 3800 ? Saha Not funded 91. Thanjavur A Kumbakonam 4000? 1/928 Liaas (NFI) Lube 92. Theni A Yes Arogyaagam: 1+?/236+? Theni District Aravanigal Only Arogaayam is funded. 109 Association, Care, Arogaayam (TAI) 93. Thoothukudi C Yes 6000? 1/831 Love India (NFI ) Lube 94. Tiruchirappalli A Yes 11000? 1/942 Snegiytham (NFI) Lube, no funding for TG CBO 95. Tirunelveli A Yes 4500? 1/912 Saral (NFI) Lub e 96. Tiruvallur B Yes CHES: 2819 1/1336 PAA, CHES (TAI) Only CHES is funded. 97. Tiruvannamalai A Yes Other: 6750 1/? Aravani Welfare Not funded Association, Hope 98. Tiruvarur A Yes Other: 3750 1/ Gandhi Not fun ded 99. Vellore C Yes GLOW: 2002 1/1649 MAAS, GLOW (T AI) Only GLOW is funded. 100. Viluppuram D Other: 5000 ? VMMK (TNSACS-Supported) 101. Virudhunagar C Yes Other: 2400 1/? Priyam No t funded
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State/District Category Urban Population: MSM-TG size NACO Estimate Number of Tis/ Implementing What gaps? (A-D) Centre? 2001 estimation of TI needs/MSM Pop’n covered Organisation NORTHEAST
Arunachal Pradesh: 1,097,968 NONE NEEDED 0/0 Vulnerable(16 Districts) 102. Anjaw C 0 103. Changlang C 0 104. Dibang Valley D 0 105. East Kameng D 0 106. East Suiang C 0 107. Kurung Kumey D 0 108. Lohit C 0 109. Lower Dibang valley D 0 110. Lower Subansiri D 0 111. Papum Pare C 0 112. Tawang D 0 113. Tirap C 0 114. Upper Siang D 0 115. Upper Subansiri D 0 116. West Kameng C 0 117. West Siang C 0 Assam 26,655,528 6 Exclusive + 8 2+?/? (23 Districts) Composite 118. Barpeta C 119. Bongaigaon C 120. Cachas C 121. Carrang D 122. Dhemaji C 123. Dhubri C 124. Dibrugarh D 125. Goalpara C 126. Golaghat C 127. Hailakandi D 128. Jorhat C 129. Kamrup B 130. Karbi Anglong C 131. Karimganj D 132. Kokrajhar C 133. Lakhimpur C 134. Marigaon D 135. Nagaon D 136. Nalbari D
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State/District Category Urban Population: MSM-TG size NACO Estimate Number of Tis/ Implementing What gaps? (A-D) Centre? 2001 estimation of TI needs/MSM Pop’n covered Organisation 137. North Cachar Hills D 138. Sivasagar C 139. Sonitpur D 140. Tinsukia D Manipur 11 : Hi Prev 2,166,788 2,850? No exclusive + 2 3/1550+? 1 TI is BMGF, 1 TI is (9 districts) Composite SACS; 1 TI is unfunded 141. Bishnupur A Aasha 142. Chandel A 143. Churachandpur A 144. Imphal A Imphal 1000 Aasha / SASO, Maruploi FNDN 145. Moreh A 146. Senapati A 147. Tamenglong A 148. Thoubal C Aasha 149. Ukhrul D Meghalaya: Vulnerable 2,318,822 1 Exclusive + 1 0+?/ ? (7 Districts) Compsite 150. East Garo Hills C 0 151. East Khasi Hills C 0 152. Jaintia Hills C 0 153. Ri Bhoi C 0 154. South Garo Hills C 0 155. West Garo Hills C 0 156. West Khasi Hills C 0 Mizoram: Vulnerable 888,573 NONE NEEDED 0+?/ ? (8 Districts) 157. Aizawl A 0 158. Champhai A 0 159. Kolasib A 0 160. Lawngtlai C 0 161. Lunglei D 0 162. Mamit C 0 163. Saiha A 0 164. Serchhip A 0 Nagaland 12 : Hi Prev 1,990,036 No Exclusive + 1/? (11 Districts) 1 Composite 165. Dimapur A 300 Guardian Angel
11 Size estimations for Manipur taken from Avahan and represent “high risk MSM”. There may be more under different definitions. 12 Size estimations for Nagaland taken from Avahan and represent “high risk MSM”. There may be more under different definitions.
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State/District Category Urban Population: MSM-TG size NACO Estimate Number of Tis/ Implementing What gaps? (A-D) Centre? 2001 estimation of TI needs/MSM Pop’n covered Organisation 166. Kohima A 0 167. Kiphera A 168. Longleng A 169. Mokokchung A 0 170. Mon A 0 171. Peren A 172. Phek D 0 173. Tuensang A 0 174. Wokha C 0 175. Zunheboto A 0 Sikkim: Vulnerable 540,851 NONE NEEDED 0+?/ ? (4 Districts) 176. East Sikkim D 0 177. North Sikkim D 0 178. South Sikkim B 0 179. West Sikkim B 0 Tripura: Vulnerable 3,199,203 1 Exclusive + 1 0+?/ ? (4 Districts) Composite 180. Dhalai D 0 181. North Tripura B 0 182. South Tripura C 0 183. West Tripura C 0
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State/District Category Urban Population: MSM-TG size NACO Estimate Number of Tis/ Implementing What gaps? (A-D) Centre? 2001 estimation of TI needs/MSM Pop’n covered Organisation EAST
Bihar: HI Vul 82,998,509 19 Exclusive + 6 (SACS-5, (38 Districts) 29 Composite UNDP-1)/? 184. Araria C 185. Arval C 186. Aurangabad D 187. Banka C 188. Begusarai C 189. Bhagalpur D 190. Bhojpur C 191. Buxar D PLUS 192. Darbhanga C 193. East Champaran A 194. Gaya C 195. Gopalganj C PLUS 196. Jamui C 197. Jehanabad C 198. Kaimur (Bhabua) B 199. Katihar C 200. Khagaria A 201. Kishanganj A Pratham 202. Lakhisarai C 203. Madhepura C 204. Madhubani A 205. Munger C Maghad Gramin Seva Sangh 206. Muzaffarpur A Mzffrpr PLUS 207. Nalanda D 208. Nawada C 209. Patna B Patna PLUS, All India Dav Society, Pushpa Bharati Seva Samaj Rachna 210. Purnia A 211. Rohtas C 212. Saharsa C 213. Samastipur C PLUS 214. Saran C 215. Sheikhpura C 216. Sheohar C 217. Sitamarhi A
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State/District Category Urban Population: MSM-TG size NACO Estimate Number of Tis/ Implementing What gaps? (A-D) Centre? 2001 estimation of TI needs/MSM Pop’n covered Organisation 218. Siwan D PLUS 219. Supaul C 220. Vaishali C PLUS 221. West Champaran A Chhattisgarh: Hi Vul 20,833,803 5 Exclusive + 7 0+?/ ? (16 Districts) Composite 222. Bastar A 0 223. Bilaspur D 0 224. Dantewada C 0 225. Dhamtari C 0 226. Durg D 0 227. Janjgir-Champa D 0 228. Jashpur C 0 229. Kanker D 0 230. Kawardha C 0 231. Korba C 0 232. Korea D 0 233. Mahasamund A 0 234. Raigarh C 0 235. Raipur C 0 236. Rajnandgaon D 0 237. Surguja C 0 Jharkand: Hi Vul 26,945,829 6 Exclusive + 10 1 (SACS)/? (22 Districts) Composite 238. Bokaro C 0 239. Chatra C 0 240. Deoghar D 0 241. Dhanbad C 0 242. Dumka D 0 243. East Singhbhum D Jam 1 Tata Steel 244. Garhwa D 0 245. Giridih C 0 246. Godda C 0 247. Gumla D 0 248. Hazaribag D 0 249. Jamtara D 0 250. Koderma D 0 251. Latehar D 0 252. Lohardaga D 0 253. Pakur C 0 254. Palamu D 0 255. Ranchi C 0
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State/District Category Urban Population: MSM-TG size NACO Estimate Number of Tis/ Implementing What gaps? (A-D) Centre? 2001 estimation of TI needs/MSM Pop’n covered Organisation 256. Sahibganj D 0 257. Seraikela D 0 258. Simdega D 0 259. West Singhbhum C 0 Orissa: Hi Vul 36,804,660 1000-1200? 8 Exclusive + 14 8-10(SACS)+ (30 Districts) Composite 1(Oxfam)/230? 260. Angul C 261. Balangir C 262. Baleswar C 263. Bargarh D 264. Bhadrak C 100? Fellowship, Saraswati, Santiseva 265. Boudh C 266. Cuttack A 267. Deogarh C 268. Dhenkanal D 269. Gajapati D 270. Ganjam A 271. Jagatsinghapur C 272. Jajpur C 273. Jharsuguda D 274. Kalahandi C 230? 130? Bhawanis 275. Kandhamal D 276. Kendrapar C 277. Kendujhar C 278. Khordha B 279. Koraput C 280. Malkangiri C 281. Mayurbhanj C 282. Nabarangapur C 283. Nayagarh C 284. Nuapada C 285. Puri C 286. Rayagada C 287. Sambalpur A 288. Subarnapur C 289. Sundergarh C West Bengal: Hi Vul 80,176,197 15,000- 18 Exclusive + 1(SACS)+6/ (18 Districts) 20,000? 25 Composite 10,000? 290. Bankura C 0 Networking, needs ass’t
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State/District Category Urban Population: MSM-TG size NACO Estimate Number of Tis/ Implementing What gaps? (A-D) Centre? 2001 estimation of TI needs/MSM Pop’n covered Organisation 291. Bardhaman B Burdwan, Swapnil / MANAS Footnote 13 Durgapur, Asansol Bangla 292. Birbhum C 0 Needs assessment 293. Cooch Behar C Cooch Mitjyu / MANAS Needs assessment Behar Bangla 294. Darjeeling C Darj, Siliguri Mitjyu / MANAS Footnote Bangla 295. East Midnapore C Haldia 0 MANAS Bangla Needs assessment 296. Hooghly A Chandanna Amitie’ / MANAS Footnote gar, Bandel, Serampore Bangla 297. Howrah C Howrah Amitie’ / MANAS Footnote Bangla 298. Jalpaiguri B Jalpaiguri Mitjyu / MANAS Footnote Bangla 299. Kolkata A Kolkata Bandhan, Koshish, Footnote MANAS Bangla/ Pratyay, PLUS Kolkata, Kolkata Rishta 300. Malda C 0 Needs assessment 301. Murshidabad B Behrampu Swikriti / Sangram, Needs assessment r MANAS BAngla 302. Nadia C Ranaghat 0 MANAS Bangla Needs assessment 303. North 24 Parganas C Bongaon, Swikriti / Prantik / Footnote Barasat, Dumdum MANAS Bangla 304. North Dinajpur C 0 Networking, needs ass’t 305. Purulia C 0 Networking, needs ass’t 306. South 24 Parganas C Baruipur Astitva / MAN AS Footnote Bangla 307. South Dinajpur C 0 Networking, needs ass’t 308. West Midnapore B Midnapur, 0 MANAS Bangla Needs assessment Kharagpur
13 MOUs, vision, mission of network; policy finalisation; livelihood options; skilled staff; training (including leadership); skills building; GPs; advocacy.
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State/District Category Urban Population: MSM-TG size NACO Estimate Number of Tis/ Implementing What gaps? (A-D) Centre? 2001 estimation of TI needs/MSM Pop’n covered Organisation NORTH
Chandigarh: Vul 900,635 No exclusive + 1 0+?/ ? (1 District) Composite 309. Chandigarh A 900,635 1000? Deepshikha Samiti/ Pahal Foundation Delhi: No Category 13,850,507 3 Exclusive + 10 3+?/ ? (9 Districts) Composite 310. Central Delhi B 3000? Naz India (NI), Bard Lube availability 311. East Delhi B 4500? NI, SaharaTG No TG CBO 312. New Delhi A 3000? NI 313. North Delhi B 2500? NI, Akansha 314. North East Delhi B 1500? Aradhya 315. North West Delhi C 2500? Aradhya, Love Lif e Society 316. South Delhi C 3000? NI 317. South West Delhi C 2000? Mitr 318. West Delhi C 2000? Mitr Haryana: Vulnerable 21,144,564 5 Exclusive + 6 0+?/ ? (20 Districts) Composite 319. Ambala C 0 320. Bhiwani C 0 321. Faridabad C 0 Pahal Foundation No TI started 322. Fatehabad C 0 323. Gurgaon C 0 Pahal Foundation No TI started 324. Hisar C 0 325. Jhajjar A 0 326. Jind C 0 327. Kaithal C 0 328. Karnal C 0 329. Kurukshetra C 0 330. Mahendragarh C 0 331. Mewat C 0 332. Panchkula C 1000? 0 Virat Foundation No TI started 333. Panipat C 0 334. Rewari C 0 335. Rohtak C 0 336. Sirsa C 0 337. Sonipat C 0 338. Yamunanagar C 0 Himachal Pradesh: 6,077,900 1 Exclusive + 2 0+?/ ? Hi Vul (12 Districts) Composite
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State/District Category Urban Population: MSM-TG size NACO Estimate Number of Tis/ Implementing What gaps? (A-D) Centre? 2001 estimation of TI needs/MSM Pop’n covered Organisation 339. Bilaspur D 0 340. Chamba C 0 341. Hamirpur D 0 342. Kangra D 0 343. Kinnaur C 0 344. Kullu C 0 345. Lahaul & Spiti D 0 346. Mandi C 0 347. Shimla C 0 348. Sirmaur D 0 349. Solan D 0 350. Una C 0 Jammu & Kashmir: 10,143,700 2 Exclusive + 4 0+?/ ? Vulnerable (15 Districts) Composite 351. Anantnag C 352. Baramulla D Generally very 353. Budgam D ? Humsafar Kashmir conservative s ociety. 354. Chilas (Gilgat) C 355. Doda B NGO/CBO registration is 356. Jammu C very time consuming. 357. Kargil C 358. Kathua D 359. Kupwara C 360. Leh D 361. Poonch D 362. Pulwama D 363. Rajauri C 364. Srinagar C ? Humsafar Kashmir 365. Udhampur D Punjab: Hi Vul 24,358,999 6 Exclusive + 8 0+?/ ? (17 Districts) Composite 366. Amritsar A 367. Bathinda C 368. Faridkot C 369. Fatehgarh Sahib C 370. Ferozepur C 371. Gurdaspur C 372. Hoshiarpur C 373. Jalandhar C 374. Kapurthala C 375. Ludhiana A 376. Mansa C
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State/District Category Urban Population: MSM-TG size NACO Estimate Number of Tis/ Implementing What gaps? (A-D) Centre? 2001 estimation of TI needs/MSM Pop’n covered Organisation 377. Moga C 378. Muktsar C 379. Nawanshahr C 380. Patiala C 1000? Pahal Foundation No TI sta rted 381. Rupnagar B 382. Sangrur C Rajasthan: Hi Vul 56,507,188 13 Exclusive + 0+?/ ? (32 Districts) 19 Composite 383. Ajmer A 1000? Pahal Foundation, Manthan 384. Alwar B 385. Banswara B 386. Baran D 387. Barmer B 388. Bharatpur C 389. Bhilwara C 390. Bikaner D 391. Bundi D 392. Chittorgarh D 393. Churu D 394. Dausa D 395. Dholpur C 396. Durgarpur D 397. Ganganagar A 398. Hanumangarh C 399. Jaipur B 1000? Pahal Foundation No TI star ted 400. Jaisalmer D 401. Jalor D 402. Jhalawar A 403. Jhunjhunu D 404. Jodhpur D 405. Karauli C 406. Kota D 407. Nagaur D 408. Pali D 409. Rajsamand C 410. Sawai Madhopur D 411. Sikar D 412. Sirohi B 413. Tonk B 414. Udaipur C Uttaranchal: Hi Vul 8,489,349 2 Exclusive + 3 0+?/ ?
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State/District Category Urban Population: MSM-TG size NACO Estimate Number of Tis/ Implementing What gaps? (A-D) Centre? 2001 estimation of TI needs/MSM Pop’n covered Organisation (13 Districts) Composite 415. Almora C 0 416. Bageshwar C 0 417. Chamoli C 0 418. Champawat C 0 419. Dehradun C 0 420. Haridwar C 0 421. Nainital C 0 422. Pauri Garhwal C 0 423. Pithoragarh C 0 424. Rudraprayag C 0 425. Tehri Garhwal C 0 426. Udham Singh Nagar C 0 427. Uttarkashi C 0 Uttar Pradesh: Hi Vul 166,197,921 26 Excl + 48 0+?/ ? (71 Districts) composite 428. Agra B Yes ?/1000? Nai Sebra Condom and lub e 429. Aligarh C Yes 430. Allahabad C Yes ?/1000? Vishvas Condom and lube 431. Ambedkar Nagar C 432. Auraiya D 433. Azamgarh C 434. Bagpat C 435. Bahraich C 436. Ballia C ?/1000? Nai Kiran Condom and lube 437. Balrampur A 438. Banda A 439. Barabanki C ?/1000? Mitr Condom and lube 440. Bareilly C 441. Basti C 442. Bijnor C 443. Budaun C 444. Bulandshahr C 445. Chandauli C 446. Chitrakoot C 447. Deoria C 448. Etah A 449. Etawah A 450. Faizabad C 451. Farrukhabad C 452. Fatehpur C
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State/District Category Urban Population: MSM-TG size NACO Estimate Number of Tis/ Implementing What gaps? (A-D) Centre? 2001 estimation of TI needs/MSM Pop’n covered Organisation 453. Firozabad C 454. Gautam Buddha C Nagar 455. Ghaziabad C ?/1000? Besara Lubes, condom, STI Tx 456. Ghazipur B 457. Gonda C 458. Gorakhpur C 459. Hamirpur C 460. Hardoi C ?/1000? Parevertah Lubes, condom, STI Tx 461. Hathras D 462. Jalaun C 463. Jaunpur C ?/1000? Ham Khayal Lubes, condom , STI Tx 464. Jhansi C 465. Jyotiba Phule Nagar C 466. Kannauj C 467. Kanpur Dehat C 468. Kanpur Nagar C ?/1000? Hasrat Lubes, condo m, STI Tx 469. Kaushambi C 470. Kheri C 471. Kushinagar C 472. Lalitpur C 473. Latehar A 474. Lucknow C ?/5000? Bharosa Lubes, condom, S TI Tx 475. Maharajganj C 476. Mahoba C 477. Mainpuri C 478. Mathura C 479. Mau C 480. Meerut C 481. Mirzapur C 482. Moradabad C 483. Muzaffarnagar C 484. Pilibhit C 485. Pratapgarh C 486. RaeBareli C 487. Rampur C 488. Saharanpur C 489. Sant Kabir Nagar C 490. Sant Ravidas Nagar C 491. Shahjahanpur C 492. Shravasti C
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State/District Category Urban Population: MSM-TG size NACO Estimate Number of Tis/ Implementing What gaps? (A-D) Centre? 2001 estimation of TI needs/MSM Pop’n covered Organisation 493. Siddharthnagar C 494. Sitapur C 495. Sonbhadra C 496. Sultanpur C 497. Unnao C 498. Varanasi C ?/1000? Asha Lubes, condom, STI Tx
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State/District Category Urban Population: MSM-TG size NACO Estimate Number of Tis/ Implementing What gaps? (A-D) Centre? 2001 estimation of TI needs/MSM Pop’n covered Organisation WEST
Dadra & Nagar Haveli: 220,490 NONE NEEDED 0+?/ ? Vul (1 District) 499. Dadra & Nagar Haveli C 220,490 0 Daman & Diu: Vul 158,204 NONE NEEDED 0+?/ ? (2 Districts) 500. Daman C 0 501. Diu B 0 Goa: Concentrated 1,347,668 No exclusive + 1 1+?/ ? (2 Districts) Composite 502. North Goa A 7000?/1000? 1/3000? Humsafar Goa? Needs upscaling in 503. South Goa A total Total Humsafar Goa? general Gujarat: Concentrated 50,671,017 12 Exclusive + 7 5+? (25 Districts) Composite 504. Ahmedabad B Yes 1 CBO 1+?/2800MSM? Chuval Gram Vikas + 200 TG? Trust 505. Amreli B Yes 506. Anand/Nadiyad B Yes 507. Banas Kantha A Yes 508. Bharuch B Yes 509. Bhavnagar B Yes CBO+ Composite Lakshya Trus t + NA study in progress Bhavnagar Bloodbank 510. Dahod B Yes 511. Gandhinagar B Yes 512. Jamnagar B Yes 1 CBO Lakshya Trust NA study in progress 513. Junagadh B Yes 514. Kachchh C Yes 515. Kheda B Yes 516. Mahesana A Yes 1 CBO 1/2000MSM+TG Chuval Gram Vikas ? Trust 517. Narmada B Yes 518. Navsari A Yes 519. Panch Mahals B Yes 520. Patan A Yes 521. Porbandar B Yes 522. Rajkot B Yes 1 CBO 1/4000MSM? Lakshya Trust 523. Sabar Kantha B Yes 524. Surat A Yes 1 CBO 1/5000MSM? Lakshya Trust 525. Surendranagar A Yes 526. The Dangs A Ahwa 527. Vadodara B Yes 1 CBO 1/7000MSM? Lakshya Trust
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State/District Category Urban Population: MSM-TG size NACO Estimate Number of Tis/ Implementing What gaps? (A-D) Centre? 2001 estimation of TI needs/MSM Pop’n covered Organisation 528. Valsad/Vapi A Yes Lakshya Trust NA study i n progress Madhya Pradesh: Hi Vul 60,348,023 14 Exclusive + 0+?/ ? (48 Districts) 23 Composite 529. Anuppur D 530. Ashoknagar D 531. Balaghat D 532. Barwani C 533. Betul C 534. Bhind C 535. Bhopal A 1000? Shringar 536. Burhanpur D 537. Chhatarpur D 538. Chhindwara C 539. Damoh D 540. Datia D 541. Dewas C 542. Dhar C 543. Dindori D 544. Guna D 545. Gwalior C 546. Harda C 547. Hoshangabad C 548. Indore A 1000? Shringar 549. Jabalpur A 550. Jhabua D 551. Katni C 552. Khandwa C 553. Khargone B 554. Mandla D 555. Mandsaur A 556. Morena C 557. Narsinghpur D 558. Neemuch B 559. Panna D 560. Raisen D 561. Rajgarh C 562. Ratlam C 1000? Shringar 563. Rewa B 564. Sagar C 565. Satna C 566. Sehore C
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State/District Category Urban Population: MSM-TG size NACO Estimate Number of Tis/ Implementing What gaps? (A-D) Centre? 2001 estimation of TI needs/MSM Pop’n covered Organisation 567. Seoni C 568. Shahdol C 569. Shajapur C 570. Sheopur D 571. Shivpuri C 572. Sidhi D 573. Tikamgarh D 574. Ujjain A 575. Umaria D 576. Vidisha D Maharashtra 14 : Hi Prev 96,878,627 16 Exclusive + 6+?/ ? (35 Districts) 39 Composite 577. Ahmednagar A 6 Towns 40,40,642 534 Samapathik est’n 1/534 Snehalaya Only Snehalaya TI (Pathfinder), Udan started Savli, Astitva/ Kalaga 578. Akola A 579. Amravati B Udaan/Humsafar 580. Aurangabad A 1000?/? 581. Beed A Beed and 21,61,250 791 1/791 Gramin Vikas Parli Mandal(Pathfinder) 582. Bhandara A 583. Buldhana B 584. Chandrapur A 1000?/? 585. Dhule A 586. Gadchiroli A 587. Gondia B 588. Hingoli A 589. Jalgaon A 4 Towns 36,82,690 594 1/594 Godavari Foundation (Pathfinder) collaborating with Udaan; Jaagruthi Trust 590. Jalna A 500?/? Udaan, Jagruti/Humsafar 591. Kolhapur A 2 Towns 35,23,162 596 1/596 MSPSS (Pathfinder)
592. Latur A Udgir 20,80,285 1/123 Grameen Vikas 123 Mandal(Pathfinder) 593. Mumbai A 65,000?/4500 4+?/ ? Astitva, Dai Welfare
14 Size estimations taken from Avahan and represent “high risk MSM”. (Source are Pathfinder PSA Estimation August 2006; Report of mapping and needs assessment of MSM in Pune by Humsafar & Samapathik June 2005.) There may be more under different definitions.
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State/District Category Urban Population: MSM-TG size NACO Estimate Number of Tis/ Implementing What gaps? (A-D) Centre? 2001 estimation of TI needs/MSM Pop’n covered Organisation ? Society, Humsaaya, Humsafar Trust, Sakhi Char Chowghi, Udaan 594. Mumbai Suburban A 595. Nagpur A 1000?/? Sarathi Upscaling needed 596. Nanded A 1000?/1000? Sarthi est’n Udaan-Maya/Astitva 597. Nandurbar A 2 Towns 13,11,709 41 1/41 Astitva , Shriram Map/baseline in progress; Ahirrao Memorial Pathfinder project to be Trust (Pathfinder) started. 598. Nashik 3 Towns 49,93,796 172 1/172 Pravara M edical Trust (Pathfinder), Astitva- Paro 599. Osmanabad A Udan-Rakshak 600. Parbhani A 2 Towns 15,27,715 202 1/202 Socio- Economic Development Trust(Pathfinder) 601. Pune A 1 Town 72,32,555 3200 Humsafar & 2/3200 Samapathik; Udaan, Pathfinder project just Samapathik est’n and Samabhavna starting. (Pathfinder) 602. Raigad A 22,07,929 HUmraahi Trust; PSA Baseline Study to Pathfinder be conducted during April-May 2007 603. Ratnagiri A 604. Sangli A 1000?/? Mooknayak 605. Satara A 1000?/? Mooknayak 606. Sindhudurg B 607. Solapur A 608. Thane A 10,000?/5000 Jugnu Trust; Astitva Map/baseline in progress ? 609. Wardha A 610. Washim B 611. Yavatmal A 3 Towns 24,58,271 204 1/204 Gramee n Samasya Mukti Trust (Pathfinder)
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Annex 3: Dashboard for NACP-III (Highlighting MSM and TG)
• Those in bold relate directly to MSM and TG populations . • Those in normal text relate indirectly to MSM-TG. • Others are not applicable .
Indicator Target Annual Core Indicator 1. Number of TIs (by category) 2. Percentage of TIs reporting condom stock-out in last quarter 3. Number of ICTC clients tested and receiving result 2.2 4. Number of HIV+ pregnant women (mother and baby) receiving a complete course of ARV prophylaxis 2.4 5. Percentage of blood units provided by voluntary donors
6. Number of ART service centers 7. Number of eligible people with advanced HIV infection
receiving ART (disaggregated by sex and age) 2.5 8. Percentage of SACS with HRG representatives included in SACS decision-making bodies 9. Percentage of districts with at least one functioning PLHA network 2.3 10. Percentage of funds disbursed relative to targets
11. Percentage of SACS with approved financial and administrative delegation 12. Percentage of states where partnership forum met in the last quarter 13. Percentage of SACS’ NGO Adviser positions filled
14. Percentage of SACS with PDs in sole charge for more than one year 15. Percentage of states with at least 80% CMIS reporting 4.1 16. Percentage of states which submit their dashboards to NACO regularly 4.2 17. Percentage of due procurement contracts awarded during the original bid validity period 18. Percentage of ICTC centers with test kit stock-outs during quarter
19. Percentage of ART centers with ART stock-outs during quarter 20. Percentage of SACS where governing body met at least once during reporting quarter 21. Number of district units established, staffed and reporting, relative to targets
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Annex 4: Proposed Annual Core Indicators for NACP-III (Highlighting MSM and TG)
Those in bold relate directly to MSM and TG populations . Those in normal text relate indirectly to MSM-TG. Others are not applicable .
Objectives OVI MOV / Source Targets Dashboard Goal To halt and reverse the epidemic over the next 5 years Outcomes/Outputs 1. New infections in Behaviour Change high risk groups and 1.1 Percentage of female sex workers reporting consistent use of 1.1 – 1.6 IBBS/BSS vulnerable populations condoms with clients in the last 12 months increased from X to Baseline from 2006 prevented 80% National BSS HRG 1.2 Percentage of IDUs who have adopted behaviours that reduce survey. Mid-line transmission of HIV in the last 30 days from X to 80% BSS in 2009. End- 1.3 Percentage of men reporting use of condom the last time line BSS in 2011. they had anal sex with a male partner from X to 80% 1.4 Percentage of population aged 15-49 reporting condom use in last sex with non-regular partners (disaggregated by sex and age subgroup) 1.5 Percentage of men reporting they are clients of SW 1.6 Percentage of population aged 15-49 with accurate knowledge on HIV/AIDS (recall three modes of transmission, 2 modes of prevention and who reject major misconceptions about HIV transmission) increased from X to 100% disaggregated by gender and age Intervention Coverage 1.7– 1.9 CMIS, 1.7 – 1.9 1.7 Percentage of sex workers report being reached by TIs reports and special Linked to increases to 80% studies Dashboard 1 1.8 Percentage of IDUs reporting being reached by TIs increased from X to 80% 1.9 Percentage of MSM (high as defined by NACO) reporting being reached by TIs increased from X to 80% Intervention Planning 1.10 Percentage of districts which have done high risk 1.10 CMIS, mapping increased from 10% to 100%. Consultant reports
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Objectives OVI MOV / Source Targets Dashboard 2.Proportion of Services / Coverage persons living with 2.1 Number of ICTC (PPTCT / VCT) facilities increased from X to Y 2.1 CMIS HIV/AIDS receiving by 2011 care, support and 2.2 Number of ICTC clients tested and receiving result increased 2.2 CMIS 2.2 treatment increased. from X to Y by 2011 (disaggregated by sex and age) Dashboard 3 2.3 Percentage of districts with at least one functioning PLHA 2.3 CMIS, special 2.3 networks increased from X to Y% studies Dashboard 9 Treatment and Care 2.4 Percentage of HIV+ pregnant women (mother and baby) 2.4 CMIS, PPTCT 2.4 receiving a complete course of ARV prophylaxis increased records Dashboard 4 from X% to Y% by 2011. 2.5 Number of eligible people with advanced HIV infection 2.5 CMIS 2.5 receiving ART (disaggregated by sex and age) increased from Dashboard 7 X to Y by 2011 2.6 Number of affected and vulnerable children receiving care and 2.6 CMIS, support through programmes increased from X to Y by 2011. 3. Infrastructure, 3.1 Annual increases in budgets for HIV/AIDS in other ministries/ 3.1 SACS records, systems and human departments interviews with key resources in 3.2 Percentage of SACS which achieved at least 80% of planned staff prevention and expenditure targets treatment 3.3 Percentage of audit reports completed and forwarded within programmes at the time limits to NACO district, state and 3.4 Percentage of TIs run by CBOs national levels strengthened. 4. Strategic 4.1 Percentage of states with at least 80% CMIS reporting 4.1– 4.2 CMIS 4.1 Information Monitoring 4.2 Percentage of states which submit their dashboards to NACO 4.3 State PIPs, State Dashboard 16 and Evaluation within time limit BSS, HSS data, 4.2 Systems enhanced. 4.3 Percentage of states whose annual plans demonstrate programme reports, Dashboard 17 strategic and tactical changes in response to previous M&E interviews with key data stakeholders.
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Annex 5: Participants in Strategy Development
Participants in the November 2006 planning meeting in Lucknow:
Name Organisation Vivek Anand Humsafar Trust Tony Bondurant DFID Programme Management Office Aditya Bondyopadhyay Naz Foundation International Arif Jafar Naz Foundation International Ashok Row Kavi Humsafar Trust/UNAIDS Sonal Mehta DFID Programme Management Office Sylvester Merchant Lakshya Trust Vijay Nair Naz Foundation International Lok Prakash Naz Foundation International Andy Melendez Salgado Humsafar Trust Billy Stewart DFID
Participants in the December 2006 planning meeting in Bangalore:
Sr. No. Name Organization State 1. Ashok Row Kavi The Humsafar Trust Maharashtra 2. Vivek Raj Anand The Humsafar Trust Maharashtra 3. Arif Jafar NFI All India 4. Aditya Bondyopadhyay NFI All India 5. Pawan Dhall SAATHII - Kolkata All India 6. Lok Prakash NFI All India 7. Vijay Nair NFI AP, Karnataka 8. Sylvester Merchant Lakshya Trust Gujarat 9. Andy Salgado The Humsafar Trust All India 10. Sonal Mehta DFID All India 11. Tony Bondurant DFID All India 12. Gordon Mortimore DFID All India 13. Muthu Kumar Lotus TN 14. Rahul Singh Milan/Naz Delhi 15. Rex Watts Sangama Karnataka 16. Priya Babu Sudar Foundation TN 17. Laxmi Astitva Maharashtra 18. Ashabarthi THAA TN 19. Bindumadhav Khire Samapathik Maharashtra 20. G. Prashanth Mithrudu/ASHA AP 21. Dev Anand Gelaya Trust Karnataka 22. Ravi Prakash Jain Bharosa Trust UP 23. Dr. Athar Qureshi NFI TN 24. Safik Manjothi Udaan Maharashtra 25. Sekar SWAM TN 26. Jaya Kumar Snegytham TN 27. Agniva Lahiri PLUS Kolkata West Bengal 28. G. Krishna Suraksha Society- AP/ Raksha AP 29. Sanjib Chakrabarty MANAS Bangla West Bengal 30. Vinay Chandaran Swabhava Trust Karnataka 31. Akshay Khanna Independent researchers New Delhi 32. Shanti Vardhan HLFPPT - Nestam AP 33. Dr. Venkatesan Chakrapani The Humsafar Trust/INP+ All India 34. V. Sasidhar AP-PSU AP 35. Swapna Bhawanis Orissa 36. Bhim Singh Deepshikha Samiti UT of Chandigarh 37. Arshid Bashir Humsafar Kashmir Jammu & Kashmir 38. Pratek Talate Chuval Gram Vikas Trust Gujarat
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