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Link Worker Scheme, Jaunpur

The key strategies of NACP-IV (part of NACSP) focuses on intensifying and consolidating prevention services with a focus on HRGs and vulnerable population as well as expanding IEC services for high risk groups with a focus on behavior change and demand generation and increasing access and promoting comprehensive care, support and treatment. These key strategies hold good in a way to consolidate the gains achieved during third phase as well as expand those learning to emerging pockets of epidemic. The HIV epidemic in India continues to be heterogenic, especially in terms of its geographical spread. As per the Technical Brief of HIV Sentinel Surveillance (HSS) 2012-13, the declining trend among ANC clients, considered as a proxy for general population, is consistent with Indi a's story of large scale implementation and high coverage during Third Phase of National AIDS Control Programme.

The HSS, 2012-13 also highlights that although the overall HIV prevalence continues to be low as 0.35%, there are about 80 sites which shows more than 1% prevalence and 12 sites with more than 2% prevalence.


Some of these sites are in the moderate and low prevalence States of Bihar, Chhattisgarh, Gujarat, Madhya Pradesh, Jharkhand, Odisha, Rajasthan, Uttar Pradesh and West Bengal. Similarly, HSS 2010-11 highlights that there is significant decline in prevalence among High Risk Groups (i.e. Female Sex Workers, Men who have Sex with Men) except in case of IDUs the prevalence remains consistent.

HSS 2010-11 highlights that some low prevalence State s in west, north and east India have demonstrated a stable to rising trend. This rising trend in moderate and low prevalence States is interpreted by the growing understanding for need of high intensity interventions, saturation of coverage of high risk groups especially in rural areas, improving access to testing and treatment services. During NACP-III, NACO had invested significant resources and garnered political leadership to bring in these State's capacity and strengthen response.

Although, during NACP-III, the coverage of FSW (81%), MSM (67%) and IDU (81%) through a total of around 1821 targeted interventions (TIs) for high risk groups and bridge population was achieved mainly in urban and peri-urban areas, the coverage of rural HRGs and vulnerable population remained comparatively challenged. During NACP-III, the coverage and understanding of rural sex-work dynamics, impact of migration related transmission dynamics has evolved through implementation of Link Workers Scheme in selected districts in India. During NACP-III by the end of March 2012, the Scheme covered about 1,60,000 HRG, 18,70,000 Vulnerable Population and 37,000 PLHIV. Nearly 59% HRGs have been tested at ICTC and 58% HRGs have been referred to STI services under this intervention. This has been done by establishing linkages with existing services. In order to create a sense of ownership in the community and involve the youth in fighting against HIV, 13,296 Red Ribbon Clubs and 21,170 Information Centres had been established at the village level by March, 2012

From these evidences it is clear that there is a need for comprehensive interventions focusing at community level to reach out rural HRGs and vulnerable population to achieve the accelerated response considering the emerging epidemic drivers in India especially that of rural ANC prevalence being higher than urban ANC prevalence in mode rate and low prevalence States (HSS, 2010-11), spouses of migrants having four times higher risk than non-migrants (Male out -migration: a factor for the spread of HIV infection among married men and women in rural India, PLOS One, September 06, 2012).

The following figure shows the importance of rural HRGs and vulnerable population in the context of HIV transmission dynamics:


The above diagram highlights the fact that until now, the focus on population at high risk and bridge population has resulted significant decline, but the emerging epidemic drivers due to selected groups among general population in rural areas also need to be targeted adequately and comprehensively maintain the responses achieved. This is possible once the interventions are designed and implemented in a community environment by the community volunteers as is being carried out under Link Workers Scheme.


  • The scheme aims at building a rural community model to address the complex needs of rural HIV prevention, care and support requirements in selected geographies.
  • The scheme aims at reaching out to rural population who are vulnerable and are at risk of HIV/AIDS in a non-stigmatised enabling environment.
  • The scheme aims at improving access to information materials, commodities (condoms, needles/syringes) through collaborating with nearest TI or government health facilities, testing and treatment services ensuring there is no duplication of services or resources
  • The scheme aims at improving linkage to other social and health benefits provided by other line departments in line with local norms, regulations suitable for vulnerable populations
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