OPERATIONAL GUIDELINES FOR Implementing Targeted Interventions among Hijras and Transgender People in India Guidelines for CBOs/NGOs and SACS/TSU OPERATIONAL GUIDELINES FOR Implementing Targeted Interventions among Hijras and Transgender People in India Guidelines for CBOs/NGOs and SACS/TSU Date: 2015 © January 2014 to September 2014 National AIDS Control Organisation Ministry of Health and Family Welfare Government of India Maps are taken from OPG for Core Groups (FSW) NACP-III, TG and Hijra interventions need to develop TG and Hijra people specific maps based on TG and Hijra people’s needs Design and printing: New Concept Information Systems Pvt. Ltd. email: [email protected] Hkkjr ljdkj LokLF; ,oa ifjokj dY;k.k foHkkx LokLF; ,oa ifjokj dY;k.k ea=ky; Government of India Department of Health and Family Welfare Ministry of Health and Family Welfare yo oekZ lfpo Dated: 15th September, 2014 LOV VERMA Secretary Foreword The National AIDS Control Programme Phase IV (NACP IV) of India aims to accelerate the reversal of the epidemic and to further integrate the response by reaching out to the hard-to-reach population groups at high risk with targeted interventions through innovative approaches. One such group which has been recognised as a High Risk Group (HRG) and difficult to reach is Transgender and Hijras. It has been estimated that the HIV prevalence rate in India amongst the transgender community at some places is as high as 18%. Keeping in view the aim of reversal of HIV epidemic in India, it is of utmost importance that the Programme should make intensive efforts to control the spread of HIV infection within this groups on a priority basis. NACP IV has prioritised TG and Hijras (Trans-women) for HIV preventive interventions scale-up so as to reach all high risk TG/Hijra population. In this endeavour, Operational Guidelines for TG/ Hijra will help in building capacity of community led interventions. These Guidelines have been prepared after extensive consultation with experts and community members. The guidelines are beyond ‘business as usual’ having been developed from a bottom up approach with technical and community inputs which have been compiled and refined over a period of two years. Guidelines are designed for use by national public health officials and managers of HIV/AIDS and STI programmes, Non-Government Organisations (NGOs) including community and civil society organisations and health workers. As India is poised for upscaling TG and Hijra interventions, these guidelines will help in promoting excellence in TI programme interventions. Since these guidelines are first of its kind, I hope that the international community will also find it beneficial for implementing TG/ Hijra interventions. (Lov Verma) dejk ua 156] ,&Lda/k] fuekZ.k Hkou] ubZ fnYyh&110011 Operational Guidelines for Implementing Targeted Interventions among Hijras and Transgender People in India iii Acknowledgment The National AIDS Control Organisation in partnership with UNDP has prepared these Operational Guidelines after a series of consultations with technical and community resource persons, representatives of civil society, Government, core groups, donors and other stakeholders. The guidelines describe the operational details of how model targeted interventions for TG and Hijras can be operationalised. The guidelines also provide detailed information on issues related to programme management, services required in terms of human resources, infrastructure, linkages and monitoring and evaluation indicators for each programme area. This draft was written by Dr. Venkatesan Chakrapani, Shankar Silmula, and Ernest Noronha at UNDP and finalised by Manilal Pavitram, and Mridu Markan of the Department of AIDS Control TI division. I take this opportunity to acknowledge the contribution made by the resource persons, the TI Team of NACO, the DFID technical assistance support team(TAST) project, and the technical team at UNDP in preparing these guidelines. We hope that these guidelines will help State AIDS Control Societies, potential partners (NGOs, CBOs, and networks), programme managers and other staff working in TI projects and TSUs to implement and manage TI projects more effectively. Dr Neeraj Dhingra Deputy Director General – Targeted Interventions National AIDS Control Organisation iv Abbreviations and Acronyms AIDS Acquired Immuno-Deficiency Syndrome ART Antiretroviral Therapy ARV Antiretroviral BCC Behaviour Change Communication BSS Behavioural Surveillance Survey CBO Community Based Organisation DAPCU District AIDS Prevention and Control Unit FSW Female Sex Worker GIPA Greater Involvement of People Living with HIV/AIDS HCP Health Care Provider HIV Human Immuno-deficiency Virus HRG High Risk Group ICTC Integrated Counselling and Testing Centre IEC Information, Education and Communication LL Lower Level MSM Men who have Sex with Men NACO National AIDS Control Organisation OI Opportunistic Infections ORW Outreach Worker NACP National AIDS Control Programme NGO Non-governmental Organisation PE Point Estimate Operational Guidelines for Implementing Targeted Interventions among Hijras and Transgender People in India v PLHIV People Living with HIV PO Programme Officer PPTCT Prevention of Parent to Child Transmission RNTCP Revised National TB Control Programme SACS State AIDS Control Society SAEP School AIDS Education Programme SBC Strategic Behaviour change Communication STI Sexually Transmitted Infection TO Technical Officer STRCs State Training and Resource Centres TG-H Transgender – Hijra TI (STI/HIV) Targeted Intervention TSU Technical Support Unit UL Upper level Contents Foreword iii Acknowledgment iv Abbreviations and Acronyms v Introduction and Background 1 1. Purpose and Target Audience of the Guidelines 3 2. Background 5 Operationalising Targeted Interventions for Hijras and other Transgender People: Guidelines for CBOs/NGOs 13 1. Introduction 15 2. Phase 1 of Intervention: Start-Up 16 3. Phase 2 of Intervention: From Peer Educator Recruitment to Scale-Up 21 Operationalising Targeted Interventions for Hijra and Transgender populations: Guidelines for SACS and TSU 49 1. Mapping and Size Estimation 51 2. Criteria for TI Allocation, TI Unit Size, and Geographic Distribution of TIs 55 3. Recruitment, Capacity Building and Programme Management 56 4. Programme Management 65 Glossary 70 Operational Guidelines for Implementing Targeted Interventions among Hijras and Transgender People in India vii Annexure 1: Site Assessment 73 1. Exercises for Site Assessment 75 2. Capacity Standards for Participatory Site Assessment with HRGs 81 Annexure 2: Tool 83 Section I - Overview of Outreach Planning for Peer Educators 85 Section II - Outreach Planning Processes 87 Section III - Tools for Monitoring Project Outreach Planning 126 Annexure 3: Peer Educator Training 131 Section I - Sex and Sexuality 133 Section II - Understanding Sexual and Reproductive Health 138 Section III - STIs and the Role of PEs in STI Management 142 Section IV - HIV and AIDS 148 Section V - Identifying Risk and Vulnerability Factors 151 Section VI - Negotiation Skills 153 Section VII - Condom Promotion 156 Section VIII - Self-Esteem 159 viii