The main objectives of NACP I were to:
- Strengthen the management capacity for HIV control
- Build surveillance and clinical management capacity.
- Promote public awareness of HIV/AIDS and community support.
- Improve blood safety and
- Control the spread of sexually transmitted diseases.
An effective IDU intervention based on harm reduction strategy, module was developed. Condom use in targeted risk groups increased from less than 10 percent to a range of 50-90 percent. Awareness about prevention of HIV infection reached a range of 54-78 percent. Screening of donated blood became almost universal by the end of the project and the State law had banned professional blood donations. Under the project, 9 STD clinics were strengthened with improved effectiveness and quality of STD management. The syndromic approach for STD treatment was developed.
One of the most significant achievements was the adoption of a State policy on HIV/AIDS in 1996. *Till date Manipur is the first and the only state in India to have a clear cut and bold policy based on Harm Reduction.
The NACP II in Manipur was launched from 1999 with main focus on Injecting Drug Users (IDU) prevention interventions. Its primary goal was to reduce prevalence rate amongst IDUs and their sexual partners and also to bring a sustained change of behaviour amongst them. It had also aimed to keep HIV prevalence below 3% of the adult population in the state by raising awareness levels among 90% of youth and people in the reproductive age group and achieving 90% condom use among high risks groups.
Operationally, the project interventions would seek to achieve the following by the end of the project:
- To keep HIV prevalence rate below 3% in Manipur
- To reduce blood borne transmission of HIV to less than 1%
- To attain awareness level of not less than 90% among the youth and others in the reproductive age group
- To achieve condom use of not less than 90% among high risk categories like Commercial Sex Workers
While there has been a systematic improvement in the response, there are areas that still require greater attention and stronger focus. The lessons that have emerged from the implementation of NACP-II include the following:
- Complexities of the epidemic and its exact dimensions are yet to be understood especially in the State of Manipur.
- Frequent changes of Project Directors (PDs) of State AIDS Control Societies (SACS) and other senior programme managers at the state level weakened the thrust and focus of interventions. In some highly vulnerable States, PDs were either saddled with additional non-HIV responsibilities or given SACS charge as additional responsibility. A large number of functional positions in the SACS remained vacant. These factors contributed to an uneven implementation of the programme. It is necessary to have policy safeguard against this trend.
- Decentralisation and devolution of decision-making powers to the SACS was a right step, but without commensurate capacity development and technical support, it did not produce desired results.
- Focused attention on the HRGs through TIs proved to be an effective strategy for preventing the spread of infection. However, this was not appreciated and implemented in all states, partly due to attitudes towards high risk behaviours and partly due to weak systems for partnership with civil society. Consequently saturation of coverage of HRGs is yet to be accomplished.
- Condom promotion and procurement registered an improvement in 2005 but remained below the targets, emphasizing the need for more aggressive Social Marketing.
- Since the situation of the high risk populations keep changing and there are several environmental issues involved as well as the social responses in the proximity of the communities, a situation assessment can help in developing strategies that are appropriate. Though prevention programs have been in place among such populations through the NACP II, there are gaps in both coverage, quality of services and supply of commodities including tools for harm reduction. This analysis will assist in understanding “what are the efforts that are required to augment the response and minimize the response gaps”.
Manipur’s epidemic is still at an early stage and this presents a good opportunity to prevent infection rates from rising. With comprehensive intervention, it is possible to reduce the number of HIV+ people by 60% who will otherwise become infected in the next five years.
A team comprising of SACS officials and representatives of NGOs, GIPA Alliance, MNP+ along with an expert team from NACO made an indept discussion during December, 2005 and March, 2006 and finalised the preparation of PIP, NACP – III.
Goal and objectives
The goal of the state in NACP III is to halt and reverse the epidemic in Manipur over the next 5 years by integrating programs for prevention and care, support & treatment. To achieve this goal, the state will pursue four main objectives:
1) Prevention of new infections in high-risk groups and general population through:
a) Saturation of coverage of high-risk groups (80%) with targeted interventions (TIs)
b) Scaled up interventions in the general population.
2) Increasing the proportion of people living with HIV/AIDS who receive care, support and treatment.
3) Strengthening the infrastructure, systems and human resources in prevention and treatment programs at the district and state levels.
4) Strengthening a state-wide strategic information management system
The specific objective is to reduce sixty percent of new infection in the first year of the programme
The goal, objectives and strategies of NACP-III will be informed by the following guiding principles:
- The unifying credo of Three Ones, i.e., one Agreed Action Framework, one National HIV/AIDS Coordinating Authority and one Agreed National M&E System.
- Equity as monitored by relevant indicators in both prevention and impact mitigation strategies i.e. percentage of people accessing services disaggregated by age and gender.
- Respect for the rights of the PLHA, as it contributes most positively to prevention and control efforts. NACP-III would evolve mechanisms to be put in place at all levels to address issues related to human rights and ethics. Particular focus would be on the fundamental rights of PLHA and their active involvement as important partners in prevention, care, support and treatment initiatives.
- Civil society representation and participation in planning and implementation of NACP-III would receive priority since it is essential for promoting social ownership and community involvement.
- Creation of an enabling environment wherein those infected and affected by HIV could lead a life of dignity. This will be the corner-stone of all interventions. Stigma and discrimination associated with HIV/AIDS, which continues to pose a big challenge to policy planners and programme implementers in prevention, care and treatment efforts will be aggressively addressed.
- Having regard to the spirit behind “universal access”, NACP-III will scale up efforts and activities for providing HIV prevention, care, support, and treatment services.
- For making the implementation mechanism more responsive, proactive and dynamic, the HRD strategy of NACO and SACS will be based on qualification, competence, commitment and continuity.
- Strategic and programme interventions will be evidence-based and result-oriented with scope for innovations and flexibility. Priority will be accorded to specific local contexts.
Priorities and Thrust Areas of Manipur in NACP-III
NACP-III seeks to learn from the lessons of the previous two phases of programme implementation and build on the strengths thereof. Its priorities and thrust areas have been drawn up accordingly and include the following:
- Considering that more than 99% of the population in the country is free from infection, NACP-III will place the highest priority on preventive efforts while, at the same time, seeking to integrate prevention with care, support and treatment.
- Sub-populations that have the highest risk of exposure to HIV will receive the highest priority for intervention. These would include sex workers, men who have sex with men, and injecting drug users. Of lower priority will be those groups which have high levels of exposure to HIV infection such as long distance truckers, prisoners, migrants (including refugees) and street children.
- Those in the general population who have greater need for accessing prevention services such as treatment of STIs, voluntary counselling and testing and condoms will be next in the line of priority.
- NACP-III will ensure that all persons who need treatment would have access to prophylaxis and management of opportunistic infections. Persons who need access to ART will also be assured first line ARV drugs.
- Prevention needs of children will be addressed through universal provision of PPTCT services. Children who are infected will be assured access to paediatric ART.
- NACP-III will also make efforts to address the needs of persons infected and affected by HIV, especially children. This will be done through the sectors and agencies involved in child protection and welfare. Impact of HIV on others will also be mitigated through other welfare agencies providing nutritional support, opportunities for income generation and other welfare services.
- NACP-III will invest in community care centres to provide psycho-social support, outreach services, referrals and palliative care.
- Socio-economic determinants that make a person vulnerable also increase the risk of exposure to HIV. NACP-III will work with other agencies involved in vulnerability reduction such as women’s groups, youth groups, trade unions etc. to integrate HIV prevention into their activities.