Policy of Targeted Intervention in Kerala. Is it hitting the target?

[Guest guest]

Dear FORUM

Targeted Intervention (TI) policy in Kerala need to be debated- based on

evidence.

I Am working in HIV/AIDS field in Kerala for some years. The State AIDS Society

(SACS) has adopted a Tamilnad version of TI here with many dilutions and in

different names, but it is my genuine doubt that why TI program in kerala?

Data says that in Kerala only 3 to 5 % of the Sex workers or MSMs were reported

to HIV+ve and majority of them are now practicing safe sex where as Maharstra or

Tamilnad 40 to 60% of the Sex workers were HIV+Ve (UNDP Report) and TI is an

important program in that context.

In kerala 95% of the HIV infections were from out side Kerala or had exposure to

infection from other state(Migrants). In that sense person had " outside

exposure " (Migrants) are more prone to HIV and they should be target group of

Targeted intervention.

More over the major objective of Targeted Intervention in kerala is to Reduce

the high risk of high risk groups and their behavior change.

Prevention of HIV/AIDS is not the primary aim of Targeted Intervention so that

HIV is fast spreading in to general public and still most of the SACS activities

are targeted to " high-risk group " .

If some body find my doubt is reasonable please commend

Thanking you

JOY CYRIAC

Poonjar Development Society

Poonjar, Kerala

E-mail: <joycyriac2000@...>

[Guest guest]

Dear Moderator,

It was interesting to read Mr.Cyriac’s comment on Targeted Intervention (TI)s in

Kerala.

Kerala has an early epidemic with less than 5% HIV prevalence in any high risk

group. In such a situation, the best policy is to adopt TIs to attempt to limit

the epidemic from spreading to the general population.

Kerala has nearly completed geographical coverage of the state, with TI

projects, 63 in all. All risk groups in a particular region such as FSWs, MSM

and prisoners are addressed by the same TI project, the so called composite

approach to TIs, which was pioneered here, because of the small size of the risk

groups. The mean HIV prevalence among FSWs in 2003 was 2.5%, that among MSM 1.2%

and that among IDUs are probably on the same scale from preliminary data.

In Kerala, HIV certainly is not fast spreading to the general public, since the

HIV prevalence among pregnant women in 2003 is 0.25% and it is not statistically

significantly raised over the 1998 level. What has been shown by NACO in other

states in India, is that the epidemic does not spread to a great extent among

the general population, until the HIV prevalence among the high risk groups,

esp. STD population increases above 5%.

So, the best way to prevent a generalized epidemic in Kerala, remains TIs among

high risk behaviour groups coupled with awareness programs for the public. This

stand has been endorsed by UNAIDS by it 2002 Global Update, ‘where interventions

for general and marginalized populations have taken place together—as in

Kerala—they have helped keep HIV prevalence low’.

It may be very useful to have programs to reduce risk among people leaving the

state for work in other places. But, actually targeting returnees may not be

useful, since their exposure to risk is over. Returnees have not been shown to

fuel the epidemic, except in the limited context of passing on the infection to

their spouses and children.

Dr.M.Prasanna Kumar

E-mail: <mpkumar@...>