Need Assessment Report: HIV Services for Drug Abusers in North India

This report presents a comprehensive need assessment for HIV services in North India, specifically targeting drug abusers. It begins with an executive summary, followed by an introduction that highlights the global impact of HIV and the increasing problem of drug abuse in India, particularly in the North. The discussion section provides background information on HIV prevalence and transmission, including relevant statistics and figures. It reviews two existing need assessment plans and then details various assessment tools suitable for the target population, such as short questionnaires, face-to-face interviews, and telephonic interviews. The report also includes a drafted survey and an inventory of key HIV services, such as counseling, mobile testing, and community outreach. The conclusion summarizes the findings and emphasizes the importance of tailored services to address the needs of drug abusers. References and appendices with additional data are also included.

Running head: NEED ASSESSMENT FOR HIV SERVICES IN NORTH INDIA
Need assessment for HIV services in North India
Name of the Student
Name of the University
Author Note

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Executive summary
HIV is a major health concern and leading cause of death in the world. The infection occurs
through sexual acts, sharing of syringes and from mother to fetus. This report aims to formulate a
need assessment plan to treat HIV among drug abusers in North India. This target population has
been chosen because drug abuse is widely prevalent among the people in that region and
accounts for a large number of HIV infections.

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Table of Contents
A. Introduction................................................................................................................3
B. Discussion..................................................................................................................3
i. Background................................................................................................................3
ii. Review of two need assessment plans...................................................................6
iii. Need assessment tools for target population........................................................11
iv. Drafting of survey................................................................................................13
v. Inventory of key services.....................................................................................19
C. Conclusion...............................................................................................................20
References..........................................................................................................................21
APPENDIX A....................................................................................................................24
APPENDIX B....................................................................................................................26

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A. Introduction
AIDS or acquired immunodeficiency syndrome is a series of devastating infections
that are caused by the HIV or the human immunodeficiency virus. It is a retrovirus, which
attacks and kills the white blood cells, which are essential to the body's immune system. In
the 21st century, still no cure has been formulated for this devastating and frightening disease
present in the world. AIDS and HIV continue to affect million lives around the world. The
principal modes of transmission are through perinatal transmission, sexual contact or blood
transfusion. The brutal circle of drug abuse has engulfed India. The number of addicts is
increasing every day. Drug abuse started off among the high-income group youth. Presently,
it has crossed social boundaries and permeated to every section of the society (Hser et al.
2016). The target population selected for this study is drug abusers from North India.
B. Discussion
i. Background
According to the World Health Organization, HIV has claimed more than 35 million lives
till date. Globally, 1.0 million people died from HIV and its related factors in 2016. At the end of
last year, there were 36.7 million HIV patients and 1.8 million newly infected patients. 43%
children and 54% adult with HIV currently receive antiretroviral therapy (ART). Statistics state
that the WHO African Region is most affected, with 25.6 million AIDS patients (Shisana et al.
2014). It accounts for two thirds of new global HIV infections. Around 25.5 million people
living with HIV live in sub-Saharan African regions. Majority of them (an estimated 19 million)
live in south and east Africa. 40% of all HIV patients are not aware of being infected.

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Figure 1- Prevalence of HIV among adults by WHO
Source- (Who.int, 2017)
Between 2000 and 2016, the rates of HIV infections reduced by 39%. HIV related deaths
lowered by one third of the population and 13.1 million people were saved due to ART. The
different HIV programs formulated by health organizations and governments helped in this
achievement. According to the UNAIDS gap report 2016, the prevalence of HIV epidemic is
third largest in India (Naco.gov.in, 2017). When compared to other middle-income countries,
this value looks small. However, owing to India's large population, the value amounts to 2.1
million HIV patients. Recently, there has been a 32% decline in new HIV cases (86,000 in 2015),

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and a 54% decline in AIDS-related deaths between 2007 and 2015. As per the India HIV
Estimation 2015 report, HIV prevalence in adults (15–49 years) was approximately 0.26% in
2015 (Naco.gov.in, 2017)). There was 0.22% prevalence among females and 0.30% among
males.
India has recently witnessed a massive increase in drug hauls over the past five years
according to data released by various reports. India acts like a prime target for illegal drug
consumption according to the World Drug Report. Recent data suggest that more than 10.7
million people are drug users in the country. The demographics are represented by the WHO
reports (as shown in Figure 3). Drug menace is a matter of concern in North India. The 2015
Punjab Opioid Dependence Survey found 230,000 drug users in the state (Pal et al. 2015). It was
conducted between February and April. This amount equates to around 836 drug addicts per
100,000 people. Key populations who are at an increased risk of HIV include homosexual men,
drug addicts, prisoners, sex workers and their consumers, and transgender people. These
statistics show that there is a need of HIV assessment in the northern part of the country.

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Figure 2- Demographics of India related to HIV and drug abuse
Source- (Who.int, 2017)
ii. Review of two need assessment plans
Tools used- Needs assessment is the procedure of identification, analysis and
prioritization of the needs of a target population. These plans help in determining the capacity of
the target population in addressing the health issues. This part of the report will describe different
aspects of two such plans (Warren et al. 2014). The first is capacity building needs assessment,

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in the context of IDU interventions in India. The second plan is the need assessment report:
integrated HIV prevention in Forth Valley.
The IDU survey in India tried to understand capacity building needs and gaps of health
service providers like managers, monitors and implementers related to IDU HIV prevention
needs, throughout the country. This survey explored and documented the capacity of existing
systems and tools related to IDU. It focused on a thorough analysis or review of the capacity
tools, which already existed like training modules. The data was collected and analyzed by
conducting an email survey among IDU staff, officers and monitoring staff. Semi structured
questionnaires were developed and drafted for specific category during primary data collection.
Peer review analysis was followed for these questionnaires and they were finalized after
thorough discussion with stakeholders. This survey encompassed questions built on series of
essential themes that are associated with proper functioning of IDU. It included questions on
basic drug addiction knowledge and HIV, reduction in harm, conducting management strategies,
exchange of syringe, distribution of condoms and providing primary healthcare facilities. This
survey did not collect data from individuals but questioned a representative of organization who
was well acquainted with the functioning of IDU. All states were represented in the survey by
sending questionnaires to the health organizations in all geographical regions of the country. 106
IDU targeted interventions were sent these surveys and the basis of selection was based purely
on the prevalence of HIV in the different regions. The collected data was analyzed qualitatively
and statistically to formulate recommendations for prevention of HIV.
The second assessment plan was conducted by to collect information from healthcare
providers and service clients (patients) from different parts of the country, compare them and to
implement the results in a model that will lead to efficient HIV prevention in the area. The

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epidemiology of HIV was studied from previous reports and research articles, professionals were
consulted locally and in other areas. These professionals comprised of staff in government
organizations, local authorities and healthcare service providers of voluntary organizations.
Discussion with patients or client groups was carried out to identify their needs. The patients
primarily represented the African community and homosexual (owing to the prevalence of HIV
in them). A questionnaire was designed for the client groups which required information on the
sexuality, gender, age, ethnicity, presence of steady sex partner, homosexuality, venue of
meeting their partners and history of previous HIV tests. New findings were discussed with
professionals and the findings were circulated. This was done to ensure successful
implementation of the interventions.

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Key findings- Some of the major findings from the IDU need assessment plan conducted
in India are mentioned below (Appendix A):
Some of the key findings from the Forth Valley need assessment plan are mentioned
below (Appendix B):

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The findings from the two reports led to the development of several recommendations. It
was summarized that capacity building assessments need to be strengthened for better response
from clients. Several management issues like resource allocation, provision of more staff,
expertise and training experience in staff needed immediate attention. There should be regular
update of the training materials and the staff should be attracted towards training programs by
designing innovative mechanisms. Proper technical assistance must be provided to effectively
deliver and implement the services. Certain thematic areas like management of drug overdose,

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female IDU, abscess management and availability of training and resource material in local
languages needed more attention.
iii. Need assessment tools for target population
 Short questionnaires- It will reach large number of participants in a short time
with minimum cost incurred and minimum staff. It will mainly focus on substance
abuse respondents from the northern states of India. Participants from the age
group of 20-45 will be mainly spoken to (Bhana et al. 2015). These surveys will
collect information on the different drugs used by them, the predominance of use,
effects of these drugs on sexual acts and whether they use disposable needles or
share them with peers.
 Face to face interviews- Though, this tool is time consuming and tedious, it will
allow the interviewer to build a rapport with the participant. These interviews will
be carried out in rehabilitation or healthcare centers where drug addicts have
come for HIV diagnosis (Adebajo et al. 2014).
 Telephonic interview- These will provide better results compared to the previous
two tools. Respondents will not feel embarrassed to talk about their sexual
orientation, partners, prevalence of STDs and use of protection during such acts
(Béhanzin et al. 2013).
 Multistep surveys- The respondents will be presented with questionnaires on more
than one occasion. The data collected in first instance will be analyzed and they
will be further subjected to specific questions based on their responses to the first
survey until a consensus is reached. Questions will be based on their ethnicity,
religious views, first exposure to drugs, reason for addiction, knowledge on HIV

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and AIDS (Hagan et al. 2015). This tool can be analyzed in community forums
where people from the priority population of drug addicts can be invited. The
primary goal of these tools is to construct a health program, which if implemented
properly can prevent the prevalence of HIV among the drug addicts in North
India.

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A summary of the tools designed for drug addicts who have been diagnosed with HIV are
mentioned below in Table 1.
iv. Drafting of survey
A 6 question interview was drafted to study the behavior, associated risk factors and
response of drug addicts, diagnosed HIV positive from North India owing to the prevalence of
drug addiction in the region. This interview was pretested on a friend who role played. After
pretesting, certain questions were added to the survey with the aim of utilizing better responses
to improve HIV prevention services. The questions which had been added later on have been
highlighted.

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v. Inventory of key services
A major component of the study involved creating HIV services inventory. It intends to
gather specific information about the staff and services at HIV centers. Community workers can
play an important role in providing these services, which can prevent HIV in drug addicts in the
target population.
Types of service Their role
Counseling on drug abuse and HIV Address the risks and protective factors
common to all drug addicts who are vulnerable
to HIV infection.
Mobile HIV tests These facilities will offer diagnostic services
free of charge at major towns and cities.
HIV care and treatment Promote training on the harmful effects of the
infection.
Abstinence from drugs and sexual
engagement with many partners
These restraints will prevent the incidence of
infection.
Support groups Offer motivation on HIV care and drug
abstinence without the need extensive training.
Community education and outreach Involve door to door outreach, peer education,
condom distribution and community
acceptance.

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C. Conclusion
This need assessment study on HIV infection among two different populations provides
direct evidence on the services that need to be focused on while implementing the services in
North Indian population of drug addicts. The report elaborates the different tools that are utilized
in assessing the prevalence of HIV in a population. It can be concluded from the report that, HIV
has been inextricably linked to drug addiction since the beginning. Several key services need to
be followed for preventing the incidence of the disease among drug users in the target
population.

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References
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APPENDIX A

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APPENDIX B

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