Targeted Intervention Suraksha programme.

Targeted Intervention (TI) is one of the main components under NACP IV. Kerala has rich experience in Targeted Intervention Program as the program started way back in 1996 and managed by different management units with the help of experienced technical professionals.The Program is designed to reduce the rate of HIV transmission among the Core Group viz. Female Sex Workers (FSWs), Men having Sex with Men (MSMs) and Injecting Drug Users (IDUs), Transgender & Bridge populations like Interstate Migrants and Long Distance Truckers. The TI programme was being implemented initially through Non-Governmental Organizations (NGOs)& Local Self Government (LSG), but an impact of the empowerment of the primary Stakeholder communities, lately, many of these projects have been entrusted for implementation through Community Based Organizations (CBOs). Some of these organizations have been implementing the project for more than 10 years.
Kerala TI programme is branded as “SURAKSHA”. The Malayalam word Suraksha means “Safety”. The Suraksha programme is being implemented through the Community Based Organisations (CBO), Non-Governmental Organisations, and Local Self Governments (LSG).

 

Objectives of Suraksha

Targeted Intervention (TI) focuses on Sexual Minorities who practice risky behaviour, to prevent and control the spread of HIV/AIDS among them and preventing the spread of HIV/AIDS through high risk groups to bridge population and general community. The Suraksha Projects are aimed at behavioural modification among target communities, from unsafe sexual practices and injecting practices.

 

Packages and Components of Suraksha

1. Outreach and Communication
   

• Peer-led, NGO supported outreach and behaviour change communication. (BCC)
• Differentiated outreach based on risk and typology.
• Interpersonal behaviour change communication (IPC).
• Large group format activities (eg. street theatre, games, etc..)

 

2. Services
   

• Promotion/distribution of free condoms and other commodities (e.g. lubricants for MSM, needles/syringes for IDUs.
• Linkages to Sexually Transmitted Infection (STI) services, TB, Anti-Retrieval Therapy (ART), Integrated Counselling and testing Centres (ICTC) and other health services with a strong referral and follow-up system.
• Provision of basic STI and health services (including abscess management and oral substitution therapy for IDUs and also oral/anal STI services for MSM/TGs).
• Provision of safe spaces (drop-in-centres or DICs).

 

3. Creating an Enabling Environment

• Advocacy with key stakeholders/power structures.
• Crisis management systems.
• Legal/rights education.
• Linkages with other programmes and entitlements.

 

4. Community Mobilization
   

• Building community ownership of the TIs objectives (“Community” refers here to the HRGs: FSWs, MSMs, IDUs, Migrants and Truckers).
• Collectivization
• Creation of a space for community events.
• Buildilng capacity with NGOs/CBOs/LSG to assume ownership of the programme.

 

Details of Suraksha Projects

National AIDS Control Programme -Phase IV envisages focusing on the coverage of core (FSW, MSM and IDU) and bridge (Migrants and truckers) population through targeted intervention (TI) programmes. Efficient NGOs, LSGs and CBOs are required for successful program implementation and KSACS is having a unique mix of partner agencies for TI program implementation. The co-operation of the wider society is also imperative for the effective implementation of the Targeted Intervention projects to halt and reverse the epidemic among core risk population.Regular onsite hand holding and mentoring support in all aspects of program implementation are needed for the project staffs so as to ensure quality services to the key population. Hence, Kerala SACS has formed a unique mix of partners for implementing Targeted Intervention.
As on November 2020, There are 61 Targeted Intervention (TI) projects,10 OST centers and 1 satellite OST center functional in the State which include 20 projects addressing Female Sex Workers (FSW), 13 for Men having Sex with Men (MSM), 5 Injecting Drug Users’ (IDU) projects, 6 Transgender (TG) projects, 15 Migrant Projects and 2 Trucker Interventions. These TIs in Kerala are being implemented by different types of entities such as, community based organisations (CBO), Non-governmental Organisations (NGO), government organisations and local bodies. Each TI project has a Project Manager with Social Work Post Graduation, Counsellor, Monitoring cum accounts officer, Outreach workers to coordinate field activities and Peer leaders (volunteers).

Item / Type	NGO	CBO	LSG/Govt.	Total
FSW	12	7	1	20
MSM	5	7	1	13
IDU	5	-	-	5
TG	5	1	-	6
MIGRANT	13	-	2	15
TRUCKER	2	-	-	2
OST	3	-	8	11
Total	45	15	12	72

Details of District wise Targeted Intervention (TI) Projects and OST Centers 

No	District	Typology							Implementing Agency			Total No. of TIs
		FSW	MSM	IDU	TG	Trucker	Migrant	OST	NGO	CBO	LSG/ Govt.
1	Trivandrum	2	1	1	1	0	1	2	7	0	1	8
2	Kollam	2	1	0	1	0	1	0	3	2	0	5
3	Alappuzha	1	1	0	0	0	1	2	3	0	2	5
4	Pathanamthita	1	1	0	0	0	1	0	1	2	0	3
5	Kottayam	2	1	0	1	0	1	0	3	2	0	5
6	Idukki	2	0	0	0	0	1	0	3	0	0	3
7	Ernakulam	2	1	2	0	1	2	3	6	3	2	11
8	Thrissur	1	1	0	1	0	1	0	2	1	1	4
9	Palakkad	1	1	0	0	1	1	0	4	0	0	4
10	Kozhikkode	2	1	2	0	0	1	3	5	2	2	9
11	Malappuram	1	2	0	1	0	1	1	2	1	3	6
12	Wayanad	1	0	0	0	0	1	0	2	0	0	2
13	Kannur	1	1	0	1	0	1	0	1	2	1	4
14	Kasaragod	1	1	0	0	0	1	0	3	0	0	3
State Total		20	13	5	6	2	15	11	45	15	12	72

KSACS has been addressing the high risk population since the second phase of National AIDS Control Program. First HIV case in Kerala was reported in 1987 and since then the Government of Kerala has been taking rigorous steps for the prevention and control of this infection in partnership with different civil society organisations. Kerala has initiated lot of innovative approaches and strategies in HIV program.Targeted intervention projects in Kerala mainly focusing on the poor and marginalized people in the high risk group who practice sexual behavior, to prevent and control the spread of HIV/AIDS among them and preventing the spread of HIV/AIDS through high risk groups to bridge population and general community. . However, there are evidences of using virtual space for soliciting clients. It is also noted that people belong to the non-marginalized category are also indulging in high risk practices.

The TI projects conduct activities to overcome social stigma this is not an easy task. To make the society aware of HIV/AIDS which has developed into a social problem more than a mere state of illness; convincing the society of its responsibility to control HIV/AIDS and promote sexual health instead of pushing the responsibility to the Government and voluntary organisations. Moreover, the society has to realize that the future responsibility of tackling the problem and implementation of sexual health programmes and its sustainability rest with the society and social systems.

In Kerala to a great extent many of the activities have succeeded in effectively implementing AIDS prevention programme by creating models or best practices, which could sustain the efforts/interventions even after the successful withdrawal of the projects. The contributory factor to this is the involvement of the NGOs, LSG, CBOs and the stakeholders to internalize the program and make sincere effort for its implementation. The success is indicated by the fact that there is a cardinal shift in environment, i.e., from that of resistance, apathy and indifference to that of sharing and owning up program responsibility. Many new national strategic models in TI were developed based on the learning and experience from Kerala TIs. A lot of efforts were taken for creating evidence based planning during NACP IV. The notable strategic interventions during NACP IV are Revalidation of HRG to actual numbers and Saturation of HRG coverage in the physical sites, eliciting low risk groups for Zero-budget coverage and prioritizing risk of HRG for program concentration and cost effective budgeting, strengthening Opioid Substitution Therapy (OST) program in Govt. Health OST Centers and NGO OST Centers, distinctive scaling ups for Transgender, expanding operations of Employer Led Migrant interventions (ELM), streamlining of ‘TI Management Tool (TMT)’ for service tracking and spotting default core services of HRG, etc. have been added value to the Targeted Intervention Program in the State.

The state continues to show low prevalence but highly vulnerable in the HIV epidemiological map of India due to typical geographical proximity to high prevalent southern states and high mobility pattern of Keralites. Besides improved health seeking behavior and high literacy, the state of Kerala had been proactive since the mid 90’s to take up targeted intervention program through non-governmental organizations across the high risk groups. This had resulted in frequent site validations, mere total saturation, quality interventions and innovative models like NHM convergence, Labour Department convergence, JillaPanchyat Led TI Interventions, etc. among high risk groups in the state. As an impact of the empowerment of the primary Stakeholder communities, Community Based Organizations (CBOs) were entrusted to implement these projects.