HIV/AIDS

 

After making its name supporting the National Leprosy Elimination Programme in poorly-served or hard-to-reach districts of AP and Orissa, LEPRA first entered the HIV/AIDS field in 1995, with a pilot project to improve treatment-seeking behaviour for sexually-transmitted infections (STIs) among truckers and reduce the prevalence of HIV.  The project introduced many innovative ideas, highlighting the importance of peer education, and improved awareness of sexual health and safe sex practices among the target group. Gradually, ownership was handed over to peer educators and halt point organising committees at the various halt points, and the project finished in 1997.
LEPRA started to become involved in HIV work on a large scale from 2002, at the request of the Andhra Pradesh State AIDS Control Society (APSACS).  From one project in 2002, two more started in 2003 and others in 2005.  In 2005 LEPRA also began HIV/AIDS projects in Madhya Pradesh (MP) and Orissa, in the former case at the request of MP State AIDS Control Society.

LEPRA has brought to the field of HIV its expertise drawn from years of experience of working with leprosy.  Both diseases present problems of stigma for those affected by it (even greater in the case of HIV), and fear of contagion among the population.  Also, like those living with HIV, leprosy-affected persons often need not just medical but also psychological, social and economic rehabilitation.  LEPRA's long history of working with and through communities to counter stigma and provide education about disease, and its experience in providing livelihood options, educational support and social re-integration to leprosy-affected persons, have made it well-placed to provide the same services to people living with HIV (PLHIVs).
Additionally, LEPRA’s extensive web of projects, often in remote areas, give it an admirable reach, especially in some tribal areas, where its close relations with tribes developed over decades of leprosy work make it trusted, and able to deliver similar interventions for HIV. 

LEPRA currently has a broad portfolio of projects on HIV/AIDS, providing interventions right across NACP-III’s strategic priority areas, from TIs with HRGs through extensive prevention work with the general population, to the provision of care and support for PLHIVs and technical assistance to build the capacity of other implementing organisations.  In a number of areas it has introduced innovative new methods, while in others its projects have been rated among the best in the country. 
The bulk of LEPRA's HIV-related work is focused on AP, the state with the highest recorded incidence in India according to the 2007 sentinel survey, at 21% of the total cases nationwide.  Its Orissa operations include the high-prevalence districts of Angul and Ganjam.

 

In tune with NACP-III's priority focus on TIs for HRGs, LEPRA currently operates five such projects, three in high-prevalence districts in Orissa, one in Bihar, and one covering specific mandals across five districts of AP.  Avahan project, spread across Nizamabad, Ranga Reddy, Medak, Adilabad and Hyderabad districts of AP, supports both FSWs and MSMs.  It reaches out to and empowers the at-risk communities.  As well as disseminating information on safer sex practices and managing STIs and referring HRGs for HIV testing, it engages in advocacy and networking, establishing rapport with local police officers.  4,138 FSWs and 902 MSMs are currently working with the project.

LEPRA's project for IDUs in Bhubaneswar was identified in 2008 as one of the best TIs in the country for IDUs because of its success in mobilising local communities against drug addiction.  In 2009 it covered 340 people under its needle-syringe exchange programme.  101 focus-group discussions reached out to 1,537 beneficiaries, and 143 police officers were among those sensitised.
In Koraput district of Orissa, LEPRA operates two TIs, including one addressing a new type of at-risk group whose importance was flagged-up by NACP-III:  at-risk and vulnerable adolescents.  In 2010, across the two projects, 3,964 community awareness meetings were held, sensitising 19,326 members of the at-risk populations.  158,090 condoms were distributed (free or through social marketing), and 1,672 people motivated to go for HIV testing.
The TI in Bhagalpur, Bihar, currently has 156 IDUs registered with it.  These are referred for HIV and STI testing, and for treatment of STIs and abscess management.  The project maintains a needle and syringe exchange programme for IDUs, and distributes condoms.

LEPRA extends its operations in the following areas:

• The General Population – Integrated Counselling and Testing Centre
• Collaboration with APSACs and the Society for the Elimination of Rural Poverty (SERP).
• Community Care Centres (CCCs)
• Supporting People living with HIV (PLHIV)
• The CHAHA project, TB and Malaria to address an identified gap in the NACP
• The Positive Prevention Toolkit (PPTK)
• Prevention of Parent to Child Transmission
• HIV-TB co-infection
• Capacity Building

Future Directions
In its HIV-related work over the coming years, LEPRA will

• Continue to focus on quality interventions to prevent HIV among HRGs and bridge populations (including migrants and at-risk adolescents), using public-private partnerships where possible;
• Seek partnerships with state AIDS control societies and with NACO to implement ARTCs and link ARTCs;
• Align itself with NACP Phase IV, complementing it with additional services where appropriate; and
• Provide technical support and capacity-building, particularly for the National Rural Health Mission as it increasingly plays a greater role in NACP.

LEPRA will also conduct both applied and clinical research related to HIV, including through its Blue Peter Public Health & Research Centre.  This will include studies on;

  1. Early biomarkers for TB among HIV patients;

  2. Drug resistance among HIV and STI clients;

  3. The molecular epidemiology of HIV clients;

  4. The epidemiology of HIV among tribal populations;

  5. Incidence of STIs among HIV-positive patients; and

  6. The management of common OIs among HIV patients.