SUMMARY

This activity is a continuing collaboration between US Pacific Command (PACOM)/ Center for Excellence

(COE) and the Indian Armed Forces Medical Service (AFMS) to support prevention intervention through

abstinence and be faithful messages for military personnel, particularly new recruits and those in high HIV

prevalence postings. Promotion of abstinence or mutual faithfulness will be emphasized in the IEC

materials as a critical and effective means to reduce risk of HIV transmission. With FY08 funds, increased

production and distribution of IEC materials will allow the extension of AFMS' HIV/AIDS education campaign

to reach new recruits. To reach the entire military community, the AFMS plans to extend prevention

education with the focus on AB to the children enrolled in schools operated by the Ministry of Defense and

the Army Welfare Education Society. Since many Indian Armed Forces spouses are teachers in the defense

school system, the AFMS can draw from this pool for the school program. This new activity within the

Prevention A/B category will allow the AFMS to develop and initiate HIV prevention education that reaches

at least 400 defense school students.

BACKGROUND

The U.S. Department of Defense (DOD) in collaboration with the US Pacific Command/ Center of

Excellence (PACOM/COE ) has supported the Indian Armed Forces Medical Services (AFMS) since 2004

in building their capacity to provide HIV/AIDS prevention, care and treatment services to military personnel,

and their families, with a geographical focus that covers the capital city New Delhi; Shillong, in the North

East where there is a generalized epidemic; and in Mumbai and Pune in the high prevalence State of

Maharashtra. The Indian Armed Forces inducts 80,000 new recruits annually. As with many militaries

worldwide, the Indian Armed Forces personnel are an at-risk population since soldiers are generally young,

mobile, separated from their families, and exposed to commercial sex workers. Prevention education has

been extended to military spouses so that they can be peer leaders for other spouses in FY 06. In addition

to the new recruits, the AFMS views military posted with families, especially those with adolescent children

and youth, as an at-risk, yet highly reachable population through the defense school system. In FY07,

prevention activities included production of IEC materials emphasizing abstinence and faithfulness which

were distributed to the military IEC nodes. The AB messages include those that address male norms and

behavior of this young and sexually active group.

ACTIVITIES AND EXPECTED RESULTS

ACTIVITY 1: Production and Distribution of IEC Materials

Materials emphasizing AB messages are expected to reach over 40,000 soldiers. The Armed Forces

Military Services (AFMS) centers have trained peer leaders and counselors who facilitate the dissemination

of the IEC materials in conjunction with counseling and discussion of life skills, including dealing with peer

pressure, safer sex techniques and the importance of abstinence and/or fidelity.

ACTIVITY 2: Strengthening the HIV Prevention Program for Secondary School Children in Ministry of

Defense Schools

The AFMS will fund an initial implementation of a school-based HIV prevention education program in a few

of the secondary schools operated by the Ministry of Defense. This technical assistance will include

curriculum development, to adapt materials to the military school curriculum, training of teachers,

development of a peer education program and a transition plan to hand this model over to the school

administration over a specific time period. The Ministry of Defense's HIV/AIDS school program is expected

to reach over 400 school children.

SUMMARY

This activity focuses on supporting the Indian Armed Forces Medical Service (AFMS) HIV/AIDS prevention

activities. This is a continuing collaboration between US Pacific Command (PACOM)/Center for Excellence

(COE) and AFMS to support prevention interventions for the members of the uniformed services and their

spouses. Peer education activities will extend beyond improved knowledge or awareness of HIV to promote

condom use and facilitate distribution of condoms at military facilities and units. The capacity building

through a planned peer education curriculum includes providing individuals with motivation and skills to

adopt safer sex behaviors in the context of youth, high mobility, family separation and easy access to

commercial sex.

BACKGROUND

The Department of Defense (DOD) in collaboration with the US Pacific Command/Center of Excellence

(PACOM/COE ) has supported the Indian Armed Forces Medical Services (AFMS) since 2004 in building

their capacity to provide HIV/AIDS prevention, care and treatment services to military personnel, and their

families, with a geographical focus that covers the capital city New Delhi; Shillong, in the North East where

there is a generalized epidemic; and in Mumbai and Pune in the high prevalence State of Maharashtra. As

with many militaries worldwide, the Indian Armed Forces personnel are an at-risk population since soldiers

are generally young, mobile, separated from their families, and exposed to commercial sex workers. With a

troop strength of nearly 1.3 million, troop turnover, and annual recruitment of 80,000 new recruits and their

accompanying family dependents, new to the military community, it is critical for the AFMS to develop a

sustained cadre of peer leaders for new recruits and their families. The AFMS supports prevention

programs that facilitate appropriate, correct, and consistent condom use to promote HIV prevention. The

prevention program supports capacity building of personnel to strengthen condom use and as well as

facilitate procurement processes especially to military facilities and units in the high prevalence areas to

augment the other AFMS prevention activities.

ACTIVITIES AND EXPECTED RESULTS

ACTIVITY 1: Build Capacity of the AFMS through a Peer Education Program

The AFMS will be supported to conduct two Peer Leader workshops through a cascading Training of

Trainers (TOT) approach. Prospective peer leaders are identified and selected from various military units

across the project locations. A total of 160 peer leaders will be trained to promote HIV/AIDS prevention

through other behavior change beyond abstinence and/or being faithful. This learning will ‘cascade' down

through the peer leaders to reach at least 8,000 new recruits and other soldiers, as well as family members

stationed at the unit. Military spouses will be reached through the military wives' welfare associations and

through the medical services provided at the various command hospital units.

The modules and IEC materials for peer education training will conform to the national training guidelines

and be adapted from current USG-supported programs. The curriculum for the peer education workshops in

FY07 was developed with support from PEPFAR. Training and educational materials include behavior

change tools that address gender through discussing male norms and behaviors that lead to risk for HIV

infections. This includes addressing gender stereotypes in the military setting and complementary use of

administrative discourses for zero-tolerance towards gender-based violence within units.

ACTIVITY 2: Facilitate Condom Procurement for the AFMS HIV Prevention Program

The HIV prevention program will include a condom procurement component to support 30 facilities and/or

military units to receive condoms for distribution. The condom component will also include distribution at

medical health facilities where STI treatment is provided.

SUMMARY

The focus of this activity is to develop the human resource capacity of the Indian Armed Forces Medical

Services (AFMS) to provide a high quality of health care to HIV-positive soldiers. This is a continuing

collaboration between the US Pacific Command (PACOM)/Center for Excellence (COE) and the AFMS to

develop the human capacity to address aspects of care and treatment at military medical facilities and

among family members supporting HIV-positive soldiers. The overall objective is to improve the quality of

health care provided to HIV patients in clinics and in homes. FY08 funds will support palliative care training

workshops for military medical personnel that include the nurses and paramedical workforce.

BACKGROUND

The Department of Defense (DOD) in collaboration with the US Pacific Command/Center of Excellence

(PACOM/COE ) has supported the Indian Armed Forces Medical Services (AFMS) since 2004 in building

their capacity to provide HIV/AIDS prevention, care and treatment services to military personnel, and their

families, with a geographical focus that covers the capital city New Delhi; Shillong, in the North East where

there is a generalized epidemic; and in Mumbai and Pune in the high prevalence State of Maharashtra. The

Indian Armed Forces inducts 80,000 new recruits annually. As with many militaries worldwide, the Indian

Armed Forces personnel are an at-risk population since soldiers are generally young, mobile, separated

from their families, and exposed to commercial sex workers. With troop strength of nearly 1.3 million, troop

turnover, and annual recruitment of 80,000 new recruits and their accompanying family dependents, new to

the military community, it is critical for the AFMS to develop a sustained response for HIV prevention, care

and treatment. With FY07 funds and technical support from PACOM/COE, the AFMS developed and

executed a three-day workshop focusing on palliative care. The workshop focused on various aspects of

care and treatment, including medical adherence, post diagnosis counseling and psychological support. In

addition to military healthcare providers, family members play a role in support of PLHA and were able to

benefit from this workshop as well.

ACTIVITIES AND EXPECTED RESULTS

ACTIVITY 1: Capacity Building in Management of Palliative Care for HIV-Positive Soldiers

The AFMS will be supported to conduct a demonstration workshop on palliative care for medical care

givers. Funds will support technical support and travel as required to bring in at least 45 healthcare

providers from the various military units with health care facilities currently offering ARV services and

opportunistic infection (OI) treatment facilities. The curriculum for the training will be based on a similar

workshop conducted with FY06 funds and will be augmented with skills building, IEC and job aids from

other USG-supported programs like CDC, APAC and Avert programs which conduct such programs on a

regular basis.

Care givers in families of HIV+ soldiers are also being considered as a potential target for associated

trainings, which will be less clinical and offer more home-based palliative care guidelines. These

participants will be selected based on existing experiences and needs. In addition, technical assistance for

conducting a training needs assessment to identify the specific needs for members of families and care

givers will be planned.

SUMMARY

This is a continuation of the program activities from the previous year. The DOD/PACOM/COE partnership

will focuses on developing the human resource capacity of the Armed Forces Medical Services (AFMS) in

HIV/AIDS counseling and testing (CT). The program will also facilitate procurement of rapid test kits to be

utilized in eight military facilities across the geographical locations to augment the counseling activities. The

focus will be on building the long-term capacity of the AFMS in providing its own funds to support a cadre of

trained counselors through workshops, refresher trainings and exposure visits, as under the third National

AIDS Control Plan there is no funding from the National AIDS Control Organization (NACO) for supporting

civilian counselors in AFMS services.

BACKGROUND

The Department of Defense (DOD) in collaboration with the US Pacific Command/ Center of Excellence

(PACOM/COE ) has supported the Indian Armed Forces Medical Services (AFMS) since 2004 in building

their capacity to provide HIV/AIDS prevention, care and treatment services to military personnel, and their

families. The geographical focus covers the capital city New Delhi; Shillong, in the North East where there is

a generalized epidemic; and in Mumbai and Pune in the high prevalence State of Maharashtra. As with

many militaries worldwide, the Indian Armed Forces personnel are an at-risk population since soldiers are

generally young, mobile, separated from their families, and exposed to commercial sex workers. With a

troop strength of nearly 1.3 million, troop turnover, and annual recruitment of 80,000 new recruits and their

accompanying family dependents, new to the military community, it is critical for the AFMS to develop

sustained long term services for HIV prevention that are accessible to military personnel. With FY06 funds,

AFMS developed a three-day workshop on HIV/AIDS counseling and testing that helped the AFMS to build

human capacity on counseling and testing as per national guidelines. With FY07 funds, as a follow-up for

long term counseling activities, the AFMS supported an additional training session that included key military

officers attending the RTC Counseling Workshop in Bangkok.

ACTIVITIES AND EXPECTED RESULTS

ACTIVITY 1: Capacity Building of AFMS in Provision of Quality CT Services.

This activity will support a workshop in counseling and testing, using materials developed previously and

previously trained counselors as workshop trainers and facilitators. The AFMS needs to develop it own

cadre of military counselors. Many of the counselors working in the military clinics are currently contract

civilian counselors supported by NACO. However, NACO will no longer fund these civilian counselors. The

AFMS does not have funds to retain the civilian counselors and needs to develop it own cadre of military

HIV counselors. Through the AFMS-supported training, at least 45 counselors already serving the military

community will receive training in counseling and testing for HIV/AIDS . Expanding the number of military

HIV counselors will strengthen the military clinics and referral network and allow more military personnel to

know their HIV status. Supportive supervision for on-going monitoring and follow-up counseling of positive

persons will also be a key activity.

ACTIVITY 2: Facilitating Procurement of Rapid Test Kits

To augment the above counseling and testing activities and promote voluntary testing, at least eight military

facilities will receive test kits to encourage at-risk personnel to know their status. Technical assistance in the

form of standard operating procedures and protocols to build institutional capacity in providing high quality

testing services will be provided. Quality assurance models will also be introduced to maintain the standards

and assess the performance of the units using the kits.

SUMMARY

The US Pacific Command (PACOM)/Center for Excellence (COE) in collaboration with the Office of

Defense Cooperation (ODC) will continue to work closely with the Indian Armed Forces Medical Services

(AFMS) to improve and enhance the skills of healthcare providers, including doctors, to manage, care, treat,

and monitor HIV patients who are on antiretroviral treatment (ARV). Activities under this program area

focus on strengthening the human resource capacity of the AFMS and to ensure that the AFMS has the

critical medical supplies to provide HIV/AIDS treatment and care services.

BACKGROUND

The DOD/PACOM/ODC program has supported the Armed Forces Medical Services (AFMS) since 2004 to

build their capacity to provide HIV/AIDS prevention, care and treatment services. HIV/AIDS continues to be

a problem in the military, particularly in the North East, a region where there is generalized HIV/AID

epidemic. The AFMS program provides health services to the military throughout India, focused primarily at

New Delhi, Shillong, Pune and Mumbai.

ACTIVITIES AND EXPECTED RESULTS

ACTIVITY 1: HIV/AIDS Treatment and Care Workshop for Healthcare Providers

In FY07, the AFMS developed HIV care and treatment training programs, and organized two training

workshops. These four-day workshops focused on recent trends in prevention and treatment strategies for

HIV patients in the civilian and military sectors. Workshops program included sessions on "Antiretroviral

Therapy Case Studies", "Monitoring Antiretroviral Therapy: Practices and Problems", "Emerging Toxicity

Syndromes in HIV in HIV Infection", and "Recent Concepts in Drug Resistance and Strategies to Maximize

Drug Compliance". Building on these past workshops, with FY08 funds, AFMS plans to carry out similar

workshops for healthcare providers who did not attend the previous two workshops. At least 40 military

medical providers will be trained to deliver ART services.

ACTIVITY 2: Procurement of Disposable Medical Supplies for AFMS Medical Facilities

PACOM/COE, working with the ODC, will facilitate the procurement of disposable medical supplies,

including OI kits, CD4 kits, and Roche Amplicor to ensure healthcare providers will have critical medical

supplies for patient care and treatment. Once procured, medical supplies will be given to the AFMS to

distribute to military medical facilities. AFMS will report on the military medical facilities that benefit from the

supplies and on usage. Funds will also support technical support and travel as required. At least four

service outlets will provide ART.