Background Introduction
It is estimated that more 90% of HIV Transmission in India is related to unprotected sexual intercourse.
Though, Haryana is a low prevalence state in STD/HIV/AIDS transmission but various studies and our past experience shows that there is a rapid increase in vulnerable population.
Rohtak district is situated in south eastern part of Haryana state and is bordered by Sonepat in North East, Jind District in North, Jhajjar in South, Hissar in the North West and Bhiwani in West. The district is situated on the National Highway 10 leading from Delhi to Hissar.
Rohtak being the center for higher education (due to presence of University and Medical College), a number of students come from other districts and are studying here. This also somehow promotes engaging more in sexual activities for pocket money and fulfilling daily requirements. 
Looking into these trends, HNYKS proposed to implement Targeted Intervention Project in the District. Haryana State AIDS Control Society gave the responsibility of carrying out intervention in Rohtak district to HNYKS. Earlier we were covering both MSM as well as FSW.but now we are working with 1000 FSW.

Brief about the project
Targeted Intervention in context of HIV/AIDS is a set of Activities and Approaches aimed at reducing the risk of HIV Infection among People who practice high-risk behavior. Therefore, Haryana Nav Yuvak Kala Sangam (HNYKS) was sanctioned a Project for TARGETED INTERVENTION PROJECT (TIP) FOR FSWs AT ROHTAK TOWN AND SURROUNDINGS. 

 

Mission and objective of the project

• To increase knowledge about STDs/HIV transmission & its relation to sexual practices using BC interventions among identified targeted population. 

• To promote health-seeking behavior by utilizing appropriate counseling techniques and providing STD treatment wherever required to patients and their regular sex partners in the target area. 

• To promote correct and consistent use of condom among target population groups by making condom accessible and provide support to retail outlets for social marketing of condoms. Accessibility would also include the communication support 

• To create enabling environment for sustainability of the project in the target area and to create an environment that doesn’t create obstacles in safer behaviour.

• To mobilize/empower the community so that they can advocate and articulate their own issues and respective solutions.

• To increase knowledge about risk reduction strategies.

• Explore safe and private spaces for HRGs to meet and work together.

Demographic profile of target population
HNYKS covers Rohtak City & surroundings with the population of following High Risk Group viz. 

Female Sex Workers (FSWs) -1000 
As per mapping study, the social background of target group reveals that maximum number of FSWs belongs to productive age. Educational standard varies from illiterate to highly qualified.More than 3/4th FSWs belong to Rohtak & nearby areas. Left over 1/4th hail from outside states/UT & other areas. 1/5th FSWs are housewives, 1/6th are students & half of the FSWs are married.

Strategies or methodology

The main approach of the project is through:

• Imparting complete knowledge and generating awareness on STDs/ HIV and AIDS to the target population (Primary Stakeholders) using IEC material in one to ones/ one to group, reinforcing BC using audiovisuals, lectures by experts, using little media etc.

• Advocacy for behaviour change among Secondary and External Stakeholders through Project Advisory committee Meetings.

• Conducting Baseline survey to know the knowledge Attitude & practice of the target audience. Acc. To the findings of the baseline study BCC Strategy was developed.

• Increasing availability and accessibility of condoms to 100% of the TPAs and consistent use among 80% of the target population.

• Increasing health-seeking behaviour among 100% of the TPAs and providing STD treatment using SCM among 500 of the Target population in the target area.

The methodology adopted for achieving these objectives rest on effective communication through the use of specialized interventionist tools like:

• Behaviour Change Communication [BCC] (Communication that dynamically changes according to the need of the community and supports change from High risk to low risk behaviour)

• Promoting sate behaviour through effective One to Ones and Focus Group Discussion/Group Discussions to promote safe sex and avoidance of multi-partner sex.

• Recruiting peers to promote BCC and helping sustainability of change.

• Adoption of communication strategy through the liberal use of IEC.

• Maintaining at least 20 condom outlets for condom distribution 

• Advocacy for treatment seeking behaviour for STDs and HIV/AIDS.

• Providing counseling services.

• Helping trial behaviour into sustainable changed behaviour.

Activities taken during the Year 2009
Establishing Resource Centre 

HNYKS opened its Resource cum Drop-in Center at:
Kachhi Garhi Mohalla, Rohtak, at a prime and highly accessible area of the target group and made functional throughout but now STI Clinic has been set up for better STI facility.

Training and Capacity Building
The success of any program mostly depends on the trained and capacitated staff. HNYKS considered this issue seriously and organized a number of training programs for capacity building of staff and peer educators regarding HIV/AIDS and issues related to S.T.D Care and Prevention. In the last 6 months, a number of trainings were organized, in which emphasis were given on the 

• Targeted Intervention Project- core group and non-core group 

• Needs Assessment, Mapping and Base line Study

• Technical issues like STI, HIV/AIDS their prevention, Stigma and curative aspects.

• Record keeping and monitoring

Besides organizational training & Orientations following trainings & Exposure visits were also attended by respective staff :

Designation	Duration	Training Topic & Organizer
Project Director	25-26 June.09	TI by HACS
Project Manager	25-26 June. 09 24-29 Aug. 09	TI by HACSTI by STRC
Counselor	25-26 June. 09 20-2 Aug 09	TI by HACS Master training for GFTAM at Jamia Milia Islamia
Doctor	25-26 June.09	SCM by HACS

Peer educators identified, selected then Orientation Training for Peer Educators & ORWs and New staff was organized at Office Premises on 3rd Aug 09. Participants were given light on HIV/AIDS Scenario/Problems in Haryana & India, Syndromic Case Management, Enabling Environment, Role of Peer Educator & ORW & their responsibilities, Condom Promotion, BCC through IEC etc the no. of .
Participants were 25.the training was quiet educative and all the doubts of peer-educators were cleared by the project-manager and the counselor.

Programme Delivery

- OUT REACH AND COMMUNICATION 
To bring down the behavior change from high risk to low risk among target group through BCC, Gender Specific Communication Strategy was developed that resulted in development of effective BCC/IEC Material. .

Distribution of Leaflets/Handouts, posters & stickers were adopted as a regular phenomenon to spread the message. 

• Counseling is done by counselor appointed for the purpose. Target group 
  is motivated to adopt health seeking behavior, safe sex practice, proper usage of condoms, treatment-seeking attitude etc every individual referred for any kind of services is pre counseled by the counselor and after availing services a post counseling is also done. A total no of 736 FSW were counseled during the reporting period. 

• Inter Personal Communication (IPC) were made by PE/ORWs. Target Group was motivated for BCC, Health seeking behaviour, Condom Promotion etc. Few among them were referred for STD Treatment. A total no of 3084 IPC sessions were conducted during the reporting period. 

• One-Group Contacts were held in different high risk areas by our ORWs in which a group of 3-5 & 7-10 persons respectively were motivated to adopt Safe Sexual Practice & Health Seeking Behaviour with Demonstration of Proper Usage of Condom along with distribution of BCC Material & Condom A total no 62 group meetings were conducted with a total attendance 620. 

• Peer Education: The Peer Educators and outreach client from non-core group identified and from core group selected on their activeness, popularity among the target group and willingness to work on HIV/AIDS issues. They were oriented on the project and its related issues. These volunteers helped in identifying new target groups and holding discussions with them.

SERVICES- 

• In STI Services we have two types of streamline treatement to treat the patients.first is to provide them pre-counselling then send HRG for physical exam. To DIC and get t/t there. For presumptive t/t we are organizing Health Camps so that rest of the HRG will be covered. This Treatment was started through Referral Card System for six days a week. at Drop-in-centre.the no of STI patients attended the clinic were 570 FSW and121 MSM, among them 525 FSW and 105 MSM were treated successfully About 553 FSW and 113 MSM were referred to ICTC and 473FSW and 103 MSM were tested.86% Among those referred to the services were tested. 

• 7 Health camps were organized for Treatment in general and STD treatment in particular. Target group was motivated to adopt Safe Sexual Practice & Health Seeking Behaviour with Demonstration of Proper Usage of Condom along with distribution of BCC Material & Condom. During health camps we have covered 232 HRG .Those who had attended the camp were also given presumptive t/t. most of these patients were also referred to ICTC for HIV testing.

• Drop in center we have DIC at Kachhi Garhi Rohtak district. We are conducting 2 meetings every month at DIC and 2 at our office .Our targeted population is doing so many cultural activities in drop in center like songs, dance and drama related to HIV/AIDS..Around 6 program had already been done. Our main motto behind improving dic is to boost the HRG group ,and provide them better facilities in every aspect. 
  Our peereducators are also playing a leading role in motivating them to comeover the stigma and share their problems, with us. 

• Condom availability and accessibility were ensured through these depots. 

• During one to one interactions and group meetings/discussions condom demonstrations were done and doubts were cleared when raised. 

• We procured both kinds of condoms i.e. free and socially marketed from the Health Department and promoted those as per the need. During interactions, information regarding other condoms available in the market like dotted, flavoured, striped, and scented was also given to the target group who needed/requested. During last 6 months 50650 condoms were distributed.

• The HRG visiting GH Rohtak for ICTC are also given travelling allowance by the organization so that maximum no of testing can be done. 

- To create enabling environment.

• Volunteers/peer educators formed from the community to increase the level of knowledge about HIV/STD/AIDS

• 9 Advocacy workshop were organized during the last 6 months such as T.I.P. Member representatives of different NGO’s Govt. officials, ex-army persons and police personnel’s. A good representation of females were also observed during the workshop. Civil Surgeon, Rohtak has also contributed and shared his experiences. 

• Networking with Haryana State AIDS Control Society, District Health Officials, representatives of Truck Union, Labour Union and other NGO’s like Jan Shikshan Sansthan, Chaubisee Vikas Sangh working in the target area along with advocacy at micro and macro level. 

• Funds provided to meet the immediate needs of the targeted population group who needed/requested.

- To mobilize/empower the community 

• Community events/Important Days were organized/celebrated to influence Community Influencers to support PEs & ORWs supported by Lecture on HIV/AIDS, etc. IEC innovative. 

• Self Help Groups were also formulated from different target groups. They are in initial stages. No formal trainings for them have been conducted. These groups would share and advocate their issues in different forums. 

Senital Surveillance
Haryana AIDS Control Society gave the responsibility of carrying out surveillance in Rohtak district among FSWs. We had taken samples of 250 HRGs.

Monitoring & Evaluation

• Staff Meetings were regularized besides doing once in a month, meetings were organized on every Saturday to solve out all field problems and share the progress of the projects besides reviewing the process adopted by experience sharing.

• MIS format developed and record maintained accordingly.

• All relevant registers are maintained as per guided by the NACO guideline for implementation of CTIP.

• Community events were conducted through participatory resource appraisals ensuring around 80% community participation in project activities

• MIS Reports were regularly sent to HACS besides Half Yearly Report & Utilization Certificates.