New Delhi: A special train starts from New Delhi on 1 December on a mission—to criss-cross the country raising awareness about HIV/AIDS. The Red Ribbon Express, a joint project of the ministries of health and information and broadcasting and the railways, is being re-launched after a successful run in 2007-08. It’s one of several HIV prevention strategies in India, the primary aim being targeted intervention, or TI.
Such interventions were first initiated for high-risk groups by the Indian government in 1999 with the launch of the second National AIDS Control Programme, or NACP II, to prevent HIV transmission among the general population. Over the next eight years, its coverage of high-risk groups went from 300 to 764. As per the latest figures of the National AIDS Control Organisation (Naco), India has 1,247 targeted intervention projects covering female sex workers, drug users, gays, transgenders and truckers.
Gathering steam: The Red Ribbon Express in New Delhi on 1 December 2007. The train starts again on Tuesday on a cross-country tour. Arvind Yadav / HT
Recently, Naco entered into a memorandum of understanding with Avahan, the Bill and Melinda Gates Foundation’s India initiative for HIV/AIDS. The pact was a reaffirmation of its commitment to HIV as well as the beginning of the transition of Avahan’s projects to Naco and other partners.
Avahan began work in India in 2003 with a commitment of $200 million (Rs930 crore now). This was later increased to $258 million and then to $338 million. The foundation had three primary goals, one being to catalyse others to take over and replicate its model.
But when the time came for the Indian government to take over the projects, officials realized Avahan’s costing was different and the scale of the foundation’s programmes was greater than its own projects. “We asked them to hand over (the projects) in a systematic fashion. It meant a lot of negotiations and we realized that many components of their TI projects would have to be dropped,” said K. Sujatha Rao, secretary, ministry of health and family welfare, and a former director general of Naco.
The success of Avahan’s projects could not be ignored. The organization brought a fresh approach to projects, focusing on the management design in targeted interventions, scaling up projects and taking responsibility and accountability for them for six years.
“We’re pleased that every month, Avahan-supported organizations reach hundreds of thousands of people with condoms, risk-reduction counselling, HIV testing and other prevention services. And early signs are encouraging,” said Ashok Alexander, director of Avahan.
Avahan, however, did not enter India with a strategy in place. Alexander admits it was an ambitious programme and the organization had no clear plan. Avahan, along with its partners, eventually evolved a structure in which high-risk people are themselves the main implementors. “Now, they are the driving ‘salesforce’ of the programme, also leading the monitoring of the programme (and) doing risk reduction counselling,” explained Alexander.
The programme did face criticism for the high cost of its projects and the high salaries it paid its staff. “The average cost per beneficiary per year among Avahan-supported programmes is $45. This is well below the UNAIDS guidelines of $90-100 per beneficiary for high-risk groups,” Alexander admitted.
Government officials said criticism wasn’t warranted. “Avahan has a different costing and they have a right to salaries. Yes, when we take over, we cannot give the same salaries. And they seem to have made an indent in certain areas, but it’s not something you can bring down in two days. They are as good or bad as us,” says Rao.
A senior Naco official closely involved in the intervention programmes said salaries in projects taken over from Avahan would have to be brought down. Naco also has to bring the intervention projects in line with its guidelines, which could take up to six months.
To assist the government and other partners in transitioning nearly 170 projects, Avahan, along with the government, decided to take a phased approach. Between April and September, Naco took over 10% of Avahan’s female sex worker programmes. Over the next three years, until the completion of NACP III, Avahan will hand over 30% of its programmes each year.
The government launched NACP III in 2007 with an aim to halt and reverse the spread of HIV/AIDS in India over the next five years. “We have worked closely with Naco to develop a sustainable plan to gradually transfer key aspects of Avahan’s work in a series of stages, starting in 2009 and ending in 2012,” said Alexander.
On evaluating the intervention projects, Naco officials found many of these needed hand-holding.
“We have now decided that for every 10 TIs, we will post one programme officer who will help in the implementation of the projects...72 people have been trained already, and some 300 TIs have been looked after in the last two months,” said the Naco official mentioned earlier.