The Behavior Surveillance Survey (BSS), a periodical research exercise undertaken by APAC provides valuable insights with respect to changing trends in HIV risk behavior among the at risk populations over a period of time. APAC has been designing its programs and implementation strategies through inputs drawn from eleven waves of BSS in the urban localities of Tamil Nadu and six rounds in Pondicherry. The BSS findingsare critical in monitoring and evaluating the impact of intervention efforts, enabling the design of better plans to achieve better results. It also helps to understand the transmission dynamics of the intervention and sets the agenda for future research requirements.

In this context, the twelfth and seventh rounds of BSS for the year 2009 were conducted in Tamil Nadu and Pondicherry respectively. In the state of Tamil Nadu, the survey was carried out in the same towns as in previous BSS rounds namely Chennai, Coimbatore, Madurai, Theni, Salem, Vellore, Erode, Nagercoil, Dindigul, Palani, Trichy and Tuticorin. The survey covered Pondicherry and Karaikal districts in Pondicherry.

This year, apart from Tamil Nadu and Pondicherry, APAC has conducted the first wave of BSS in all the Intensive Intervention Districts (IIDs) of APAC - Kanchipuram, Villupuram, Trichy, Karur, Kanniyakumari, Tirunelveli and Tuticorin. Another distinct feature of this BSS is that PLHIV in the 7 IIDs were also included for the study apart from the regular 13 categories - FSWs, Truckers & helpers, Slum youth, Men & women factory workers, Men & women migrant workers, IDUs, MSM, Aravanis, Male patients attending STD clinics and College youth. The BSS findings were shared with all the stakeholders, media and consultants in the field of HIV through a Dissemination Seminar held at The Residency Towers in Chennai on 25/11/09.

Key Proceedings

Release of Monographs

• Release of Tamil Nadu urban BSS monograph by Health secretary, Government of Tamil Nadu and first copy received by the Project Director, TNSACS

• Release of APAC-IID BSS monograph by Honorary secretary, VHS and first copy received by the Project Director, APAC

• Release of Pondichery monograph by the Project Director, TNSACS and first copy received by Dr. Lakshmi Bai, Project Director of TAI.

Welcome Address

Dr. Bimal Charles, the Project Director of APAC welcomed the gathering and gave a brief introduction about the context and purpose of the BSS survey.

Inaugural address

Dr. E.S. Krishnamoorthy, the Honorary Secretary of VHS addressed the audience with a positive note on the gains of lessons learnt during the survey. The findings proved valuable in identifying the need to expand existing strategies and analysing the implications for future action. He emphasised that the third phase was the most dynamic phase of APAC and mentioned the 5 As

Key note address

Dr. S. Vijayakumar, Special Secretary & Project Director of TNSACS delivered the key note address. He pointed at the favourable political will in the state which was supportive to implementing comprehensive HIV programs that addressed every gap. The state was pioneering cost effective programs that were replicable models in similar contexts. Enhancing treatment seeking behavior was an important challenge that demanded considerable attention. It is crucial to translate learnings into action in order to achieve the target of ‘no new infection in 2012’.

Presidential address

Mr. V.K. Subburaj, the Health Secretary, Government of Tamil Nadu highlighted the magnitude of the efforts required to achieve zero prevalence. He welcomed the fact that the knowledge levels with respect to STI, HIV/AIDS awareness were high among the population groups surveyed in the BSS, but expressed concern about low levels of awareness about the same, among college students. His comments about major findings indicated the areas that require action

Mr. Rajendran, Program Manager - Research presented the major findings of the BSS conducted in urban Tamil Nadu, IIDs and Pondicherry. The highlights are summarised below.

Objective

To obtain repeated measures on specified indicators in Tamil Nadu and Pondicherry.

Samples

The total number of samples was 15100, 7200 and 1900 in the urban localities of Tamil Nadu, IIDs and Pondicherry respectively.

Methodology

Interviews, Data collection through questionnaires, In-depth interviews, Focus Group Discussions and Mystery client observations.

Key Findings

Implications

• Misconceptions are still prevalent among all the groups and intervention efforts needs to focus on this direction

• The importance of condom usage with regular partners needs to be given emphasis

• The categories comprising the general population (MYS, migrants and factory workers) have low exposures to intervention.

Objectives

• To assess knowledge level on transmission and prevention of HIV/AIDS and their adherence to safe sex practices

• To understand the extent of partner testing and disclosure status.

• To understand the level of stigma and discrimination in terms of self stigma and public attitude.

Samples

400 PLHIV from seven IIDs were recruited for the survey

Key Findings

Implications

• Knowledge on modes of HIV was nearly universal except for vertical transmissions which were correctly reported by 80% of the respondents. Knowledge without misconception among PLHIVs was also high.

• Condom usage practice is reportedly low among MSMs.

• About 17% of discordant couples from the core groups reported inconsistent condom usage with regular and non paying partners.

• Disclosure status is limited to partners and immediate family members (less than one third of the parents and siblings knew respondents’ status).

• Nearly one fourth of the MSM have not disclosed their positive status to regular partners.

• Three fourth of the PLHIV registered high level stigma scores. Among the general population, stigma is driven by sense of livelihood, security and fear of social acceptance.

• MSMs’ condom usage with regular partners and commercial partners is an area of concern. Similarly consistent condom use among discordant partners with all types of partners requires further emphasi

• Reduction of stigma that stems from factors such as job insecurity, social isolation and self blaming require attention.

The following queries/comments were raised by a few among the audience during the discussion hour. The corresponding discussions are also presented.

• A question on the common misconceptions that prevailed among the respondents had this clarification - fear of transmission through sharingtoilets and vessels, musquito bites. Some of them even believed that the smell of a person or other physical characteristics can indicate their HIV status.

• One among the audience commented that condom demonstration through several steps instils fear among prospective users about their ability to follow all the steps correctly. It was suggested to make it simple.

• Dr. Desikachari stressed on the need for a focused approach to comprehensively address the concerns of PLHA.

• Dr. Beena Thomas pointed out that the aspect of sexual violence and relevant indicators were missed out in the survey.

The Project Director of APAC provided some key inputs which set the pace for the future course of action

• Knowledge without misconceptions is a challenge.

• There is a need for effective communication strategies and the efforts must involve testing of messages with the community, better capacity building of HCPs and field workers.

• Reduced number of interventions has led to increased sex among truckers with paid partners, indicating the relevance of BSS in tracking these changes.

• Strengthening the FSW intervention will effect behavior change among other groups.

• Discordant couples reporting inconsistent condom usage is an area of concern.

• Counseling services need to be strengthened in order to effect reduced self stigm

The Project Director of TANSACS suggested that the triangulation studies and BSS data should be brought together to design an effective action plan. He pointed out that data on ART adherence indicates its strength which could be utilised to address gaps in positive prevention. The reason for low levels of HIV/AIDS among college students was stated as inadequate reach of relevant messages to new entrants in the sex trade

Concluding remark

• The pioneering efforts of APAC were showcased, inspiring a renewed sense of commitment among HIV/AIDS partners towards the cause.

• The dissemination set the direction not only for APAC but for all the stakeholders with respect to the future course of action.

• The strengths and gaps in the intervention efforts could be collectively identified thus enabling the design of corrective measures and better strategies.

• Valuable insights could be gained due to collective thinking by the eminent audience of field experts and consultants.