Strengthening the response to HIV: virtual learning from Aastha, India

Dr Sanjeev Singh Gaikwad

The Context: Aastha Project

• HIV prevention among male, female and transgender SWs in Mumbai and Thane from 2004 -2012

• Large metropolitan area with many single male migrants• SWs ever reached: 80,000 SWs• Rapid scale up and innovations make it a model within

BMGF Avahan• Special recognition by BMGF at International AIDS

Conference, Toronto, 2006

Aastha Project – cont’d• Aastha Innovations and lessons have been incorporated in the

Indian National Guidelines for Targeted Interventions (2007)• Identified as learning site by NACO and FHI 360 Globally• Winner of FHI 360 Program Excellence Award in 2009• Aastha has lead to FHI360 being requested by BMGF for

transferring learning's to African countries.

Large number of SWs: about 50,000 with > 1 new partner per dayExtreme heterogeneity among SWsHigh churn rate of SWs

Benchmark results…..• Avg. monthly STI screening coverage ranges between 31 - 45

% ( Currently 8-10k SWs)• 99% of all New SWs screened for STI • 85% of SWs Screened for Syphilis at least once and 69 %

screened every 6 months• About 85.2% of SWs have undergone C&T at least once and

50.2% access C&T every 6 months on an average

HIV Prevention approaches

Community Engagement

and Ownership

Poverty;

Lack of support

structures

Decreased social status;

Decreased autonomy

Entry into SW

Violence

Vulnerability to HIV

Social ostracism

Access to services

Sex Work

HIV

Behavioral

Biomechanical

Biological

Aastha: The focus on Quality….ACQUA (Aastha Continuous Quality Approach) Principle

Innovations of Aastha• Branding with niche

marketing• Microplanning; Peer

Educators as Managers for sites; individual tracking

• Aastha Minimum Package• Community based

monitoring of key indicators• Demand generation

mechanisms• Aastha condom• Rapid response system• Counseling and Testing

under PPP• SW specific CoC package• Aastha Enterprises• Vivek• FP-HIV Integration

Impact of ACQUA

• Monthly STI screening of SWs has been scaled up to 36% SWs (10,000 SWs/month) with quarterly STI screening at 93%

• Six monthly uptake of VCT is 50%

• Crisis response coverage is 99% with an average response time of 24 minutes and decreased police arrests

• Uptake of prevention messaging and condoms is nearly 100%

• Decrease in STI incidence from 37% to 3%

Brothel Based

44.7650.2

28.1

38

25.218.6

17.1

13.7

0

10

20

30

40

50

60

2004 2005 2007 2010Brothel Based(Mumbai) Brothel Based (Thane)

Brothel Based

Trend of HIV prevalence among SWs in Mumbai & Thane

Virtual Learning on Aastha….

• Tools, manuals and monographs from Aastha are available at the FHI360 website

• India HIV Portal is being developed as a repository for learning resources.

• Virtual training sessions through webinars: links will be sent to interested persons

• Fixed time theme specific group chats and webinars• Training of trainers on manuals and tools through virtual

classrooms• Bridge project (Africa-India-Asia Learning Network) supported by

the Gates Foundation to provide virtual learning from Aastha and other Avahan and India projects.

Virtual learning….

• 45 abstracts presented as poster presentations during international conferences

• 20 abstracts presented as oral presentations during international conferences

• Learnings have disseminated to Gujarat SACS, Goa SACS, MPSACS, Uttarakhand SACS, UPSACS, other Avahan Partners like HLFPPT, Pathfinder

• Disseminated learnings to 17 countries (Pakistan, Vietnam, Bangladesh, Papua New Guinea, Kenya, Nepal, Indonesia, Laos, Cambodia, Australia, Tanzania, Egypt, Ivory coast, Ghana, Ethiopia)

• 15 publications including training manuals, SOPs, Monographs published and disseminated across the country and the globe.

Thank You