Prevention of HIV and STI infection is one of the important components of National AIDS and STD Control Programme (NACP). The NACP Phase V (2021-26) aims to reduce annual new HIV infections thereby envisaging that people who are at risk of acquiring HIV infection use comprehensive prevention and access quality STI /RTI services (NACO, 2022). Aligning with the above, various prevention strategies are initiated by National AIDS Control Organisation (NACO) to provide prevention services primarily among the High-Risk Groups and other vulnerable population who are at risk of acquiring HIV/STI infections. The high-risk groups (HRG) include Female Sex Workers (FSW), Men who have Sex with Men (MSM), Hijra/Transgender persons (H/TG), People Who Inject Drugs (PWID) and the Prison Population. Migrants and Transport workers are considered as bridge population staying between the HRGS and general population and covered under various projects and initiatives. Prevention services are provided to the above population primarily through projects like Targeted Intervention (TI) and Link Worker Schemes (LWS) and activities in Prison and Other Closed Settings (P& OCS) and through Sampoorna Surakhsha Strategy (SSS). TI and LWS are implemented in partnership with Non- Governmental Organisations (NGOs) and Community Based Organisations (CBOs) contracted through State AIDS Control Societies (SACS) under the Social Contracting Mechanism of NACP. In order to provide comprehensive prevention, new approaches and strategies are adopted to reach the unreached population, efforts are made to reach the last-mile with a package of prevention, support and linkage services through a peer-led and outreach-based service delivery model in the programme. The TI projects are aimed at reaching out to HRGs and Bridge populations in urban or semi urban areas. Similarly, the rural HRGs and vulnerable populations are covered through LWS. In addition, NACP has laid emphasis to reach the inmates in Prison and other closed setting (P& OCS) with HIV and other health related services. Focus is given to reach out to the spouses and partners of HRGs and sub-groups of high-risk population who are active on the virtual platforms. It also involves expanding and intensifying the coverage of HRGs and Bridge Population, OST among injecting drug users and coverage of 'at-risk' HIV negative through comprehensive prevention packages to keep them negative through Sampoorna Suraksha Strategy (SSS). Community System Strengthening (CSS) acts as enablers to the overall prevention strategies to augment and achieve the goal of ending the AIDS epidemic by 2030. The prevention initiatives and projects are scaled up and are designed based on the evidences generated from the Mapping and Population Size Estimation (PMPSE), programme data, field intelligence, community feedbacks, HIV Sentinel Surveillance (HSS) and the inputs from the Technical Resource Groups through a consultative process (ICTC, STD clinics).

Major prevention interventions for HIV/STI services under NACP.

Targetted Intervention Projects (TI)

TI Projects are implemented through Non-Governmental Organizations (NGOs) and Community-Based Organizations (CBOs), contracted by respective State AIDS Control Societies (SACS) under the Social Contracting Mechanism of NACP. The selection of target groups and strategic locations for TI interventions are decided based on the programmatic mapping and population size estimates and field intelligence. Every TI project comprises of a Project Manager, Counsellor, M& E cum Account Officer, Outreach Workers, and Peer Educators based on the number of HRGs allotted, etc. Peer educators are engaged from within the community to strengthen the outreach and service delivery arms of the TI projects. Drop in Centres (DIC) are established under the TI projects to provide communities a safe space, offer clinical services, counselling, commodity provisions (Condoms, N/S, lubes etc.), conduct other social and behavior change communication and capacity building activities and referral services. TI outreach team prepare micro plans for providing services and update the plan periodically to optimize their outreach services. Monthly meetings are conducted at TI level to see the overall progress, gaps and prepare the next month activity plan. State wise list of TIs as on Dec 2024.

Opioid Substitution Therapy (OST)

Opioid Substitution Therapy (OST) is a vital harm reduction strategy designed to address the health risks associated with injecting drug use, particularly among People Who Inject Drugs (PWIDs). These individuals face significant dangers, such as the transmission of HIV, Hepatitis B, and Hepatitis C, often due to sharing of needles and syringes. The vulnerabilities of PWIDs are further heightened by various socio-economic and psychological factors, making them more susceptible to these health risks. To mitigate these dangers, OST is implemented as part of a comprehensive harm reduction approach under the National AIDS and STD Control Programme (NACP). OST involves administering long-acting opioid agonist medications sublingually, which helps to stabilize users by reducing cravings and withdrawal symptoms, ultimately aiding in the cessation of drug injection. This therapy is a cornerstone in reducing the transmission of HIV and other blood-borne infections among PWIDs. OST is primarily delivered through a "Directly Observed Treatment" model in clinic-based OST Centres, overseen by a Medical Officer. For stable clients, take-home doses are also provided. The therapy is offered through three distinct models: The Collaborative Model at public health facilities, the NGO-Based Model at Targeted Intervention NGOs, and the Satellite Model in prisons and other closed settings. In addition to OST, counseling and support services are essential components of this strategy, addressing the underlying psychological and socio-economic issues that contribute to drug use. By ensuring access to comprehensive healthcare for PWIDs and their families, OST supports both immediate health needs and long-term recovery, making it a critical tool against drug-related harms. State wise list of OST as on Dec 2024.

Interventions in Prison and Other Closed Settings (P&OCS)

NACO's prison intervention program is designed to address the heightened risk of HIV transmission in prisons and other closed settings (OCS) due to overcrowding, risky behaviors and limited access to healthcare. The program provides comprehensive HIV prevention, treatment, and care services tailored to the needs of the inmates. Key services include HIV screening and counseling, Antiretroviral Therapy (ART) provision, health education on HIV and related infections, and the distribution of condoms. Additionally, referrals are made for continued care post-release. The program also treats other diseases such as tuberculosis, sexually transmitted infections (STIs), and Hepatitis B and C, ensuring a holistic approach to inmate health and reducing the burden of communicable diseases within these high-risk environments.

Link Workers Scheme (LWS)

The Link Worker Scheme (LWS) is designed to bring HIV prevention, care and support services to rural areas, addressing the needs of high-risk groups (HRGs) and vulnerable populations who are often underserved. This scheme specifically targets Female Sex Workers (FSWs), Men who have Sex with Men (MSM), People Who Inject Drugs (PWID), Hijra/ Transgender, People living with HIV (PLHIV) and vulnerable groups like migrants and truckers, Antenatal cases, Persons with Tuberculosis in rural settings. The primary objective is to bridge the gap in HIV services by providing these populations with access to screening, counseling, treatment and support. The scheme employs link workers from the community who are trained to conduct outreach, provide information and facilitate access to health services. These link workers play a critical role in identifying individuals at risk, conducting interpersonal communication, distributing condoms, and ensuring referrals to HIV screening and treatment centers. The scheme also involves community mobilization and capacity-building activities to strengthen the local response to HIV. By leveraging local resources and community networks, LWS ensures that rural populations receive comprehensive and continuous HIV related services, thus reducing the burden of the epidemic in these hard-to-reach areas. The LWS is implemented through NGOs/CBOs contracted through respective SACS under the social contracting mechanism.State wise list of Link Worker as on Dec 2024.

One Stop Centre (OSC)

One Stop Centres (OSC) is designed in a person centered approach to provide an integrated HIV prevention-care services in community settings while also addressing other health and well-being requirement through a referral mechanism. Primarily services are provided to the People Who Inject Drugs (PWID), Hijra/Transgender persons (H/TG) and Bridge population (Migrants, Transport Workers and Other Vulnerable Population) who otherwise do not access HIV prevention, screening and treatment due to high stigma, discrimination and lack of awareness. Under the Global Fund Grant 2021-24, this initiative was implemented by Plan India and YRG Care as PR and SR respectively.

Commodity Provisions under Prevention Strategy

Condoms: The provisioning of condoms is one of the important pillars of National AIDS and STD Control Program for prevention of further transmission of HIV, STI as well as other viral diseases like Hep B and C etc. Condoms are distributed through facilities like Targeted Interventions, Integrated Counselling and Testing Centres, Designated STI RTI Clinic, Anti-Retroviral Treatment Centres, Care and Support Centres and newer centres like Sampoorna Suraksha Kendra, One Stop Centres etc under NACP. Condoms are supplied through Ministry of Health and Family Welfare- Free Supply Scheme.

New Needle and Syringes for PWID: Targeted Interventions, under the NACP program, is one of the core strategies for HIV prevention among People Who Inject Drugs (PWID). Apart from providing clinical services that includes HIV & STI testing and treatment, regular medical check- up, abscess management, overdose prevention and management etc. the TIs are also designated centres for providing harm reduction services such as Needle Syringe Exchange Programme (NSEP) and Opioid Substitution Therapy (OST). The services under the TIs are executed through a peer based outreach as well as static premise based approach. i.e. Drop in Centres (DIC). NSEP program primarily involves education and distribution of new needle/syringes to PWIDs to reduce HIV infections through sharing of infected needles and the used needle syringes are collected in return to remove them from circulation and disposal as part of the bio-waste management. The PWIDs registered under the TIs are further encouraged to take up the OST treatment program .

STI services:
Sexually transmitted infections (STI) and reproductive tract infections (RTI) pose a significant challenge to sexual and reproductive health and well-being. Sexually transmitted infections can be defined as infections that spread primarily through sexual contact. These infections can also be transmitted from an infected mother to her infant (vertical transmission) during pregnancy and childbirth and through blood products and tissue transfer.
More than 30 microorganisms are associated with various STI and RTI. Along with significantly increasing the risk of acquisition and transmission of HIV, these infections are responsible for serious sexual and reproductive morbidity (including infertility), adverse pregnancy outcomes and various cancers.

The syndromic approach is considered as the backbone of STI and RTI services in India. Under NACP, STI color-coded kits are distributed as a part of syndromic case management approach to streamline and simplify the diagnosis and management of common STI and RTI.
The STI and RTI services at district level are provided through a network of DSRC (also branded as ‘Suraksha Clinic’) under National AIDS and STD Control Programme (NACP). These clinics are primarily located in district hospitals (DH) and medical colleges (MC). The services at district/sub-district level and below are provided at DH, sub-district hospitals (SDH), community health centres (CHCs), primary health centres (PHCs), and sub-centres (SCs) under National Health Mission (NHM).

DSRCs provide various STI and RTI services to general, high-risk and vulnerable populations and acts as a referral unit for cases referred from Targetted Interventions (TI)/ Link Worker Scheme (LWS)/ ART centres (ARTC) and other health facilities under NHM.
The STI and RTI services are included as essential services under Sampoorna Suraksha Strategy (SSS) to cater to the needs of ‘at-risk’ population (populations at significant risk of HIV and STI and are defined under Sampoorna Suraksha Strategy) and One Stop Centres (OSC). The LWS covers HRGs, bridge population and PLHIV, including their spouses and partners, and other vulnerable population in rural areas. The STI and RTI services under LWS are mainly provided through referrals and linkages to NACP/ NHM facilities.