TI for IDUs
Routes of HIV Transmission
Sexual
84.6
IDU
Blood
1.8
1.9
Perinatal
4.3
5.6
Unidentified
HIV infection in India is mostly through sexual route. Just 2 out of 100 HIV positive
people are IDU. Why bother with IDU programmes when the ratio is less compared to
sexual route?
SENTINEL SURVEILLANCE 2006
HIV Prevalence – Various Groups
7 out of 100 IDUs are infected with HIV. This is the average for the country. However, high
rate of HIV (>5%) among IDU in many sites/ cities (SS 2006) ensures a high chance of spread
of HIV from IDU to IDU as well as the general community
IDU & HIV
Wives and
girlfriends of
clients
Clients
of FSWs
Female Sex
Workers
Wives and girlfriends of
Substance users
IDU
IDUs
RISK RINGS
Husbands and
boyfriends of FSWs
HIV
Substance Users
HIV among IDUs can spread to general population through sexual partners/routes. Hence,
the need for intervention among IDUs.
IDU Intervention in NACP III
• Estimates: 190,000 IDU in the country
• Objective: prevent transmission of HIV
• Approach: harm reduction (incorporated in the
National Policy)
• Service delivery
1. Targeted Intervention
2. Delivery by NGOs
3. Provision of services at doorstep of IDU
• Service recipients: IDU and sexual partners
Harm Reduction Services
• There would be 3 tiers of harm reduction services offered to
IDU through TI. Tier 1 & 2 would be offered directly; 3rd would
be provided through linkage/referral:
Direct service delivery
Tier 1
Outreach
Activity
Tier 2
Opioid
Substitution
Therapy
(OST)
Linkage services
Tier 3
Linkages
Services
Tier 1: Outreach Activity
 Delivered through ORW and PE
 Services




Needle Syringe Exchange Programmes (NSEP)
Condoms - free distribution and social marketing
Primary health care, STI and abscess management
Behaviour Change Communication (BCC)
Tier 2: Opioid Substitution Treatment
 Delivery by NACO accredited agencies
 Substitution agents: Buprenorphine, Methadone
 Initiated by a trained physician and administration




through trained personnel
Psychosocial services
Follow-up by ORW/PE
Provision/link to Tier 1 Services
Strict record maintenance
Tier 3: Linkage Services

Linkages
1.
2.
3.



ICTC (voluntary informed consent)
ART, DOTS, RCH
Waste management agencies
Accompanied referrals by ORW/ PE
Established referral networks with medical, legal
and welfare schemes
Linkage with detoxification and rehabilitation
centres
Enabling Environment
‘To create a milieu where IDU are able to access
services freely without interference’




Advocacy with law enforcement agencies
Regular advocacy with community leaders
Periodic advocacy with health workers
Raising public awareness including Advocacy for
General Population