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

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.

SUMMARY

The focus of this activity is laboratory infrastructure capacity building and support. This is a continuing

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

Armed Forces Medical Services (AFMS). The objective is to build and improve comprehensive HIV

laboratory capacity within the AFMS health care delivery system. With FY08 funds, support will be provided

to continue to expand the number of military laboratories with the capacity to support diagnostic and clinical

monitoring.

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 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 HIV prevention, care and treatment program which can be accessed by military personnel and

their families. As part of a comprehensive HIV/AIDS prevention program, the PACOM/COE has supported

the AFMS to improve its laboratory capacity to address the growing needs of the HIV/AIDS within the

military. The AFMS has dedicated medical services facilities and command hospitals which include

laboratories varying in capacity and quality across the country. PACOM/COE has provided limited support

to five military laboratories, including procuring equipment and supplies.

ACTIVITIES AND EXPECTED RESULTS

ACTIVITY 1: Building Infrastructure and Capacity of the AFMS for Provision of Quality Laboratory Services

PACOM/COE, working with the Office of Defense Cooperation (ODC), will facilitate the purchase of critical

HIV laboratory instruments and disposable supplies, including the reagents required for ensuring quality HIV

testing. At least four military laboratories will receive medical equipment and supplies, together with training

to conduct HIV tests and other advance tests like CD4 and PCR tests which will facilitate the diagnosis of

HIV. Key HIV medical instruments and lab disposable supplies, including reagents, will be procured and

given to the AFMS to distribute to select military medical facilities in the program locations. AFMS will

report on the military medical facilities that have benefited from the instruments and supplies and on the

utilization rates. Technical assistance will include supporting quality assurance and routine monitoring

including adherence to standard operating procedures. Funds will also support technical support and travel

as required.

SUMMARY

The focus of this activity is to promote the Indian Armed Forces Medical Service (AFMS) policy and

program development and leadership in HIV/AIDS by supporting the participation of key military medical

leaders at workshops and training programs. This is a continuing activity of the US Pacific Command

(PACOM)/Center for Excellence (COE) with AFMS. This activity also supports the commitment of the

AFMS to share their developing HIV/AIDS knowledge and experience within the region and among the

civilian community, to lead a regional level model in HIV/AIDS prevention, care and treatment programs.

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 HIV prevention, care and treatment program. In previous years, with PACOM/COE support and

coordination, AFMS has nominated military medical officers working on the HIV/AIDS prevention program

and conducting AIDS research to the Asia Pacific Military Medicine Conference (APMMC) and other

regional, international AIDS fora. Such participation in international conferences has led to interests from

regional militaries of Nepal and Indonesia, in learning more about the AFMS' HIV/AIDS program

experience; technical assistance for developing similar HIV/AIDS programs in their countries and;

participation in training workshops organized under the aegis of the AFMS.

ACTIVITIES AND EXPECTED RESULTS

ACTIVITY 1: Strengthen the AFMS Capacity to Develop a Regional Model for HIV/AIDS Programs in the

Military

The main activity will entail facilitation of continual military-military exchange on implementation and

management of HIV/AIDS programs in the military. With FY08 funds, at least five senior and mid-level

military medical officers will be supported to participate in international conferences, training programs, and

professional exchanges, enabling Indian military medical officers to engage in HIV/AIDS policy dialogues

with military and civilian communities and to promote documentation and sharing of experiences.

Participation in regional workshops and conferences will provide a foundation for the AFMS to serve as a

future regional leader and model in military HIV mitigation, treatment and care.

BACKGROUND

HIV/AIDS is a priority for the US Mission in India, with two Embassy-level committees addressing HIV/AIDS

issues. Under the leadership of the US Ambassador, the Deputy Chief of Mission (DCM) chairs the US

Mission's HIV/AIDS Coordination Committee. The committee promotes collaboration and coordination

among USG programs working in HIV, including USG Consulates, USAID, HHS/CDC, the Office of Defense

Cooperation and other offices of the Department of State. The Ambassador has delegated the leadership of

the President's Emergency Plan for AIDS Relief (PEPFAR) team in India to the DCM, who holds quarterly

meetings with the agency technical heads and the PEPFAR Coordinator to review policy and technical

issues.

The interagency PEPFAR team is comprised of agency technical heads, program managers and key

support staff from USAID, CDC, ODC, and a representative from the Department of State's Political Unit for

DOL. The Coordinator holds weekly DVC meetings for these staff, based in Delhi, Chennai, and Hyderabad,

to discuss programmatic, technical, and management issues. The team has recently set up State Technical

Working Groups, bringing together USG agency representatives to ensure a harmonized program in USG

focus states and unified communication with the State AIDS Control Societies (SACS) and the USG

Consuls General. Two Technical Working Groups (TWGs) on Prevention and on Treatment, Care and

Support, are being established; Scopes of Work, Operating Procedures for core and partner members and

identification of partner members will be finalized shortly. Day-to-day PEPFAR management is provided by

the PEPFAR Coordinator, and the Strategic Information (SI) Officer. A Program Management Assistant will

be appointed shortly.

ACTIVITY

Commodity procurement, overall program guidance and technical input is provided by the Center of

Excellence in Disaster Management and Humanitarian Assistance (COE), Hawaii, under a contract from the

US Pacific Area Command (PACOM). The DOD program is managed by a half-time program manager at

the COE, with in-country support and guidance from the ODC and technical support as needed from

PACOM's Surgeon's Office, COE's Senior Medical Advisor, and the Armed Forces Institute of Medical

Sciences.

The ODC staff in New Delhi, primarily the Deputy Chief and one FSN in New Delhi, handle liaison with the

Armed Forces Medical Services and facilitate commodity procurement and execution of other DOD

activities under the PEPFAR program. A new half-time FSN program management assistant for the New

Delhi office is now being recruited. PEPFAR funding also support office equipment, supplies and travel,

including ICASS costs.