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Technical support facilities: Helping to build an efficient and sustainable AIDS response. UNAIDS TSF 5 years report, 2011.
Geneva, Switzerland, UNAIDS, 2011 Oct.  p. (UNAIDS / JC2167E)This report highlights the role that the Technical Support Facilities (TSF) have played in Africa and Asia to strengthen countries capacities to fund, plan, manage and coordinate effective, larger scale HIV programs. Established by UNAIDS in 2005, the TSFs have provided support to over 70 countries through 50,000 days of technical assistance and capacity development.
Decentralising HIV M&E in Africa. Country experiences and implementation options in building and sustaining sub-national HIV M&E systems, in the context of local government reforms and decentralised HIV responses.
Washington, D.C., World Bank, Global HIV / AIDS Program, 2007 Aug. 10 p. (HIV / AIDS M&E -- Getting Results)In operationalising the 3rd of the Three Ones - One HIV M&E system, a growing number of countries in Africa are opting to decentralise their national HIV monitoring and evaluation (M&E) systems. This decentralization is primarily driven by other decentralisation processes happening within government, and by the fact that the HIV response itself is changing towards less centralized intervention and increased community ownership. Decentralisation of national HIV M&E systems is an arduous and resource intensive process, but experience has shown that it is essential to decentralise M&E functions as HIV services are rolled out. This note summarizes the experience of countries that are decentralizing their national HIV M&E systems and describes how it can be done. It defines decentralization, discusses the rationale and benefits of decentralizing the HIV response, and key factors to take into account when doing so. Decentralizing the HIV M&E system is linked to decentralizing the HIV response. The note describes how each of the 12 components of a HIV M&E system can be decentralized, with country examples. (author's)
Geneva, Switzerland, UNAIDS, 2007.  p. (UNAIDS/07.07E; JC1274E)These Practical Guidelines for Intensifying HIV Prevention: Towards Universal Access are designed to provide policy makers and planners with practical guidance to tailor their national HIV prevention response so that they respond to the epidemic dynamics and social context of the country and populations who remain most vulnerable to and at risk of HIV infection. They have been developed in consultation with the UNAIDS cosponsors, international collaborating partners, government, civil society leaders and other experts. They build on Intensifying HIV Prevention: UNAIDS Policy Position Paper and the UNAIDS Action Plan on Intensifying HIV Prevention. In 2006, governments committed themselves to scaling up HIV prevention and treatment responses to ensure universal access by 2010. While in the past five years treatment access has expanded rapidly, the number of new HIV infections has not decreased - estimated at 4.3 (3.6-6.6) million in 2006 - with many people unable to access prevention services to prevent HIV infection. These Guidelines recognize that to sustain the advances in antiretroviral treatment and to ensure true universal access requires that prevention services be scaled up simultaneously with treatment. (excerpt)
London, England, ActionAid International, . 27 p. (P1625/01/04)UNAIDS estimated that in Africa in 2003, more than 2.3 million people died from AIDS, 3 million were newly infected and a total of 12 million children were orphaned. Antiretroviral drugs are reaching a mere 50,000 of those with AIDS in developing countries. The HIV/AIDS pandemic is clearly a human and developmental disaster. This paper looks at the response to the HIV/AIDS crisis by the World Bank as a key member of the international donor/lending community, a leader in the international health community, and as Africa's principal development partner. In its seminal document, Intensifying Action Against HIV/AIDS, the World Bank acknowledges both its special leadership role in fighting HIV/AIDS and the need that it be held accountable for its stewardship. (excerpt)
UNAIDS and WHO Consultation on Progress in Prevention and Care in the Context of the "3 By 5 Initiative" and the Perspective of Universal Access in the Western Pacific Region, 12-16 December 2005, Manila, Philippines. Report.
Manila, Philippines. WHO, Regional Office for the Western Pacific, .  p. ((WP)HSI/ICP/HSI/3.5/001; Report Series No. RS/2005/GE/45(PHL))The WHO Western Pacific Regional Office, in collaboration with the Joint United Programme on HIV/AIDS (UNAIDS), organized the four-day UNAIDS and WHO Consultation on Progress in Prevention and Care in the Context of the "3 by 5" Initiative and the Perspective of Universal Access in the Western Pacific Region with the general objective that, by the end of the consultation, the participants would have: (1) reviewed progress made on prevention and care scale-up in the context of the "3 by 5" Initiative; (2) shared experiences among countries on the current performance of monitoring and evaluation systems related to HIV/AIDS care, treatment and support: (3) identified ways to strengthen the integration of HIV/AIDS prevention and care: and (4) defined the conditions and terms of reference of a partners technical working group on HIV/AIDS prevention and care scale-up in the Western Pacific Region. (excerpt)
London, England, Overseas Development Institute, 2006 Aug.  p. (ODI Briefing Paper No. 9)Without greater mutual accountability among all stakeholders, lack of harmonisation will continue to cost lives. The international community reiterated its commitment to Universal Access to HIV/AIDS prevention, treatment, care and support at the UN High Level Meeting on HIV/AIDS in May-June 2006. But without hastening the application of the 'Three Ones' principles to guide the national AIDS response, we face a collective failure to realise the Universal Access commitment. The 'Three Ones' principles address the prevailing dysfunctions in coordinating national HIV/AIDS responses. These dysfunctions often include weak national plans as well as the proliferation of strategies, coordination arrangements, financial management systems, monitoring and evaluation criteria and procedures, and aid modalities established by donors. The national AIDS response has too often been characterised by confusion, duplication, gaps, distorted priorities, high transaction costs, poor value-for-money and lower than optimal results. (excerpt)
Rational Pharmaceutical Management Plus. WHO Biregional Workshop on Monitoring, Training and Planning (MTP) for Improving Rational Use of Medicines, Yogyakarta, Indonesia, December 14-16, 2005: trip report.
Arlington, Virginia, Management Sciences for Health [MSH], Rational Pharmaceutical Management Plus, 2006 Jan 23. 53 p. (USAID Development Experience Clearinghouse DocID / Order No: PD-ACH-511; USAID Cooperative Agreement No. HRN-A-00-00-00016-00)The workshop on Monitoring, Training and Planning (MTP) for Improving Rational Use of Medicines was convened jointly by two World Health Organization (WHO) regional offices -- for the Western Pacific (WPRO) and South East Asia (SEARO). Recognizing that the problem-focused strategy of MTP has been field-tested in several countries and shown to have significant impact in reducing the overuse and misuse of antibiotics and injections, the second International Conference on Improving Use of Medicines held in Chaing Mai, Thailand from March 30 to April 2, 2004 recommended that the MTP strategy be scaled up and replicated in other countries. Ineffective and often harmful prescribing and use of medicines remains widespread in many countries in the Western Pacific and South-East Asia, and WHO is collaborating with Australian Government Overseas Aid Program (AusAID) to train participants from countries in the two regions to implement MTP. (excerpt)
Geneva, Switzerland, UNAIDS, 2005 Feb. 79 p. (UNAIDS/05.28E)This report summarizes UNAIDS' assistance to countries in 2004 and 2005. Drawn from the reports of UNAIDS' Country Coordinators from over 75 countries, the report is divided into five chapters. Basic information on UNAIDS and how it operates, especially at country-level. How UNAIDS is contributing to implementation of the "Three Ones" principles. The many ways in which UNAIDS has assisted countries in strengthening their responses to AIDS. How UNAIDS is working to enhance the United Nations system's capacity to assist countries in responding to AIDS. How UNAIDS plans to meet key challenges for the future. (excerpt)
Implementation of the Declaration of Commitment on HIV / AIDS; core indicators. United Nations General Assembly Special Session on HIV / AIDS.
Geneva, Switzerland, UNAIDS, 2005 Jul.  p.Expenditures: 1. Amount of national funds disbursed by governments in low- and middle-income countries. Policy Development and Implementation Status: 2. National Composite Policy Index: Areas covered: prevention, care and support, human rights, civil society involvement, and monitoring and evaluation Target groups: people living with HIV, women, youth, orphans, and most-at-risk populations. National Programmes: 3. Percentage of schools with teachers who have been trained in life-skills-based HIV education and who taught it during the last academic year. 4. Percentage of large enterprises/companies which have HIV/AIDS workplace policies and programmes. 5. Percentage of women and men with sexually transmitted infections at health care facilities who are appropriately diagnosed, treated and counseled. 6. Percentage of HIV-positive pregnant women receiving a complete course of antiretroviral prophylaxis to reduce the risk of mother-to-child transmission. (excerpt)
Geneva, Switzerland, UNAIDS, Country and Regional Support Department, CRIS Unit, 2003 Mar. 42 p.Improved information and informed analysis are critical for the development of expanded national responses to HIV/AIDS. Some countries have developed HIV/AIDS surveillance systems and countries are increasingly collecting information on resources allocated for HIV/AIDS programmes and projects. Responding to the needs at the national and global levels for improved information and analysis, UNAIDS has embarked on an ambitious plan to establish an information system to support national AIDS responses. This document describes the historical development of the Country Response Information System (CRIS), and the related activities scheduled by UNAIDS in 2002 and 2003. It describes the philosophy of the proposed CRIS development for policy-makers and potential CRIS users. This philosophy stems from ongoing efforts to follow a modular approach to establishing a country-level information system. The system will be housed in National AIDS Councils (or equivalents), will contain national and subnational indicators, as well as programmatic information and key data pertinent to each national response. CRIS will provide partners in the global response to HIV/AIDS with a user-friendly system consisting of an indicator database, a project/resource-tracking database, a research inventory database and other important information. In particular, the indicator database, as the first component of the system to be operational, provides countries with a tool for reporting on national follow-up to the UNGASS Declaration of Commitment on HIV/AIDS. (excerpt)
Implementation of the Declaration of Commitment on HIV / AIDS: core indicators. United Nations General Assembly Special Session on HIV / AIDS.
Geneva, Switzerland, UNAIDS, 2002 Aug.  p.Global commitment and action: 1. Amount of funds spent by international donors on HIV/ AIDS in developing countries and countries in transition; 2. Amount of public funds available for research and development of vaccines and microbicides; 3. Percentage of transnational companies that are present in developing countries and that have HIV/AIDS workplace policies and programmes; 4. Percentage of international organizations that have HIV/AIDS workplace policies and programmes; 5. Assessment of HIV/AIDS advocacy efforts. (excerpt)
The added value of a CD4 count to identify patients eligible for highly active antiretroviral therapy among HIV-positive adults in Cambodia.
Journal of Acquired Immune Deficiency Syndromes. 2006 Jul; 42(3):322-324.In a retrospective study of 648 persons with HIV infection in Cambodia, we determined the sensitivity, specificity, and accuracy of the 2003 World Health Organization (WHO) criteria to start antiretroviral treatment based on clinical criteria alone or based on a combination of clinical symptoms and the total lymphocyte count. As a reference test, we used the 2003 WHO criteria, including the CD4 count. The 2003 WHO clinical criteria had a sensitivity of 96%, a specificity of 57%, and an accuracy of 89% to identify patients who need highly active antiretroviral therapy (HAART). In our clinic, with a predominance of patients with advanced disease, the 2003 WHO clinical criteria alone was a good predictor of those needing HAART. A total lymphocyte count as an extra criterion did not improve the accuracy. Nine percent of patients were wrongly identified to be in need of HAART. Among them, almost 50% had a CD4 count of more than 500 cells/KL, and 73% had weight loss of more than 10% as a stage-defining condition. Our data suggest that, in settings with limited access to CD4 count testing, it might be useful to target this test to patients in WHO stage 3 whose staging is based on weight loss alone, to avoid unnecessary treatment. (author's)
Interim WHO clinical staging of HIV / AIDS and HIV / AIDS case definitions for surveillance. African region.
Geneva, Switzerland, WHO, 2005.  p. (WHO/HIV/2005.02)With a view to facilitating the scale-up of access to antiretroviral therapy (ART) in the African Region the present document outlines recent revisions made by WHO to the clinical staging of HIV/AIDS and to case definitions for HIV/AIDS disease surveillance. These interim guidelines are based on an international drafting meeting held in Saas Fee in June 2004 and on recommendations made by experts from African countries at a meeting held in Nairobi in December of the same year. The revisions to the clinical staging target professionals ranging from senior consultants in teaching and referral hospitals to surveillance officers and first-level health care providers, all of whom have important roles in caring for people living with HIV and AIDS (PLWHA), including children. It is proposed that countries review, adapt and repackage the guidelines as appropriate for specific tasks at different levels of health service delivery. It is hoped that national HIV/ AIDS programmes in African countries will thus be assisted to develop, revise or strengthen their ART guidelines, patient monitoring and surveillance efforts. The interim clinical staging and revised definitions for surveillance are currently being reviewed in the other WHO regions and will be finalized at a global meeting to be held in September 2005. (excerpt)
Summary and recommendations from the UNAIDS Resource Tracking and Priority Setting Meeting, Washington D.C., USA, 20-21 March 2003.
[Geneva, Switzerland], UNAIDS, 2003 Mar. 10 p.The key objectives of the meeting were: 1. To review current and future efforts on resource tracking by the practitioners; 2. To identify gaps; 3. To identify key (short/long term) priorities; 4. To develop a consensus on how to work together in the future with a discussion on the potential value of forming a Consortium. All of the presentations given during the course of the meeting are available on the UNAIDS website (www.unaids.org) and will not be discussed here. This report highlights the discussions on gaps, priorities, and recommends next steps. (excerpt)
Geneva, Switzerland, Joint United Nations Programme on HIV/AIDS [UNAIDS], 2002 Aug. 24 p. (UNAIDS/02.45E; WHO/HIV/2002.17)The purpose of the guidelines is to assist National AIDS Programmes (NAPs) and Ministries of Health in implementing second generation HIV surveillance systems through a logical and standardized process. More specifically, the guidelines are primarily addressed to programme managers, epidemiologists, social scientists and other experts working in or with national programmes on surveillance issues. The practical steps and recommendations place particular emphasis on the initial steps involved in the implementation of second generation surveillance systems. They include the following: assessment, consensus, plan and protocol development, implementation and, finally, monitoring and evaluation. (excerpt)
“Three Ones” key principles . “Coordination of National Responses to HIV / AIDS”. Guiding principles for national authorities and their partners.
Geneva, Switzerland, UNAIDS, 2004. 4 p.The HIV/AIDS pandemic is a genuine global emergency taking the lives of eight thousand people a day and threatening the lives of tens of millions more as the infection continues to spread around the world. New but still limited resources to respond to the needs of people living with HIV and AIDS and those at risk of infection will be utilized most efficiently if there is maximum coordination within the international community. To leverage resources and have the maximum impact on the global response to AIDS, all parties should strive to target their programmes on the priority needs of affected countries strive, seeking to avoid duplication of effort. (excerpt)
Geneva, Switzerland, UNAIDS, . 2 p.The AIDS epidemic is a complex global crisis, which continues to worsen. At the same time, the world is responding more effectively than ever before. National responses are broader and stronger, and have improved access to financial resources and commodities. We, bilateral and multilateral donor agencies meeting with national leaders combating the spread of AIDS, reaffirm our broad and sustained commitment to supporting national AIDS responses. We endorse the “Three Ones” or key principles for concerted AIDS action at country level, with a view toward achieving the most effective and efficient use of available resources and ensuring rapid action and result-based management. These principles – detailed in the conference papers – are: One agreed HIV/AIDS Action Framework that provides the basis for coordinating the work of all partners. One National AIDS Coordinating Authority, with a broad based multi-sectoral mandate. One agreed country level Monitoring and Evaluation System. (excerpt)
Geneva, Switzerland, UNAIDS, 2004 Jun.  p. (UNAIDS/04.35E)This progress report summarizes the achievements of CRD (Country and Regional Support Department) in 2003 and presents selected highlights in greater detail. The first section outlines the strategic framework for action, Directions for the Future, the status of its implementation, the associated capacity strengthening of UNAIDS at country level, and challenges for 2004 and the next biennium. Text boxes in this section highlight “UNAIDS corporate tools” employed to implement the strategic framework. The second section reviews CRD’s efforts to translate global initiatives into results at country level. UNAIDS is involved in numerous global initiatives, three, which required particular involvement of UNAIDS resources at country level, are highlighted here. The third section reviews regional progress towards implementing the strategic framework for action. The examples cited, whilst not being an exhaustive review of country work, illustrate how UNAIDS has worked as a catalyst for national AIDS response. This report concludes with a collection of two-page country situation and progress summaries from 70 of the 134 countries with the UN Theme Groups on HIV/AIDS. (excerpt)
Geneva, Switzerland, UNAIDS, 2004 Jul.  p.In monitoring resource flows for HIV and AIDS, it has proven easier to collect information on donor governments, multilateral agencies, foundations and nongovernmental organizations (NGOs) than to obtain reliable budget information on domestic outlays for HIV and AIDS in affected countries. As a result, UNAIDS has focused significant efforts on strengthening the capacity of countries to monitor and track expenditures for HIV and AIDS. This report summarizes the latest information available on HIV-related spending in 26 countries. Seventeen of the countries are from the Latin America and Caribbean (LAC) region. Resource tracking in the LAC region, as well as in Thailand, Burkina Faso and Ghana has benefited from the leadership of the Regional AIDS Initiative for Latin America and the Caribbean (SIDALAC), which helped implement the National AIDS Account (NAA) approach. Beginning with pilot projects in three countries in 1997–1998, NAA has now been extended throughout the region, in large part due to the provision of extensive technical assistance by countries involved in the early pilot projects. NAA uses a matrix system that describes the level and flow of health expenditures on AIDS. The NAA model: a) identifies key actors in HIV and AIDS activities; b) uses existing data or makes estimates for specific services or goods purchased; c) analyses domestic (public and private) and international budgets; d) determines out-of-pocket expenditures; and e) assesses the financial dimensions of the country’s response to AIDS. (excerpt)
Geneva, Switzerland, UNAIDS, 2004 Jul.  p. (UNAIDS/04.39E)As the AIDS epidemic has spread, funding for sexually transmitted diseases (STDs) and HIV and AIDS activities has also increased sharply over the last few years. Based on the best available information, UNAIDS estimates that spending on AIDS in low and middle-income countries amounted to nearly US$ 4.7 billion in 2003 – a 20% increase over 2002 (US$ 3.9 billion) and an almost 15 fold increase over 1996 expenditures. Along with the spread of the epidemic, political commitment to reverse the spread of AIDS has grown stronger, triggering greater international action to mobilize critical financial resources. At the Millennium Summit in 2000, world leaders pledged to halt and begin to reverse the spread of AIDS by 2015. In 2001, the United Nations General Assembly Special Session on HIV/AIDS unanimously adopted the Declaration of Commitment on HIV/AIDS, which provides a comprehensive framework for achieving the HIV-related vision of the Millennium Development Goals. The Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) was launched in 2002 to increase resources to fight three of the world’s most devastating diseases. Resolving to address the challenges of financing for development, world leaders adopted the Monterrey Consensus in 2002, pledging to mobilize and increase the effective use of financial resources to achieve internationally agreed development goals. On World AIDS Day 2003 WHO and UNAIDS released a detailed plan to reach the 3 by 5 target of providing antiretroviral treatment to three million people living with AIDS in developing countries and those in transition by the end of 2005. This is a vital step towards the ultimate goal of providing universal access to AIDS treatment to all those who need it. In 2003, the United States government launched the United States President's ‘Emergency Plan for AIDS Relief’ (PEPFAR). Just this year, the Copenhagen Consensus stated that AIDS is the leading priority for the international community. As a result of increased advocacy and mobilization efforts, spending on AIDS activities increased from US$ 998 million in 2000, to US$ 3.9 billion in 2002. It is estimated that global spending from all sources will reach US$ 6.1 billion on AIDS activities in 2004. (excerpt)
AIDS. 2004; 18 Suppl 3:S49-S53.The widespread use of any antimicrobial agent, including antiretroviral agents, has the potential to select drug-resistant populations of microorganisms. HIV drug-resistant strains have been recognized as a serious threat to the efficacy of current antiretroviral treatments and could jeopardize efforts to increase access to treatment in countries most affected by the HIV epidemic. The WHO Global HIV Drug Resistance Surveillance Programme aims at enhancing and enabling the response to the threat of antiretroviral drug resistance by assessing the geographical and temporal trends in HIV drug resistance, increasing our understanding of the determinants of HIV drug resistance, and identifying ways to minimize its appearance, evolution and spread. Based on a global network of experts and collaborating institutions, the programme is developing and field-testing tools and guidelines for the regular monitoring of the level and spread of HIV resistance, particularly in treatment-naive patients. Although relevant progress has been made, several important challenges still exist to the implementation of this essential and innovative programme. (author's)
Working document on monitoring and evaluating of national ART programmes in the rapid scale-up to 3 by 5.
Geneva, Switzerland, WHO, . 20 p.Currently, five to six million people infected with HIV in the developing world need access to antiretroviral (ARV) therapy to survive. Only 400,000 have this access. The failure to deliver ARVs to the millions of people who need them is a global health emergency. To address this emergency, WHO is fully committed to achieving the "3 by 5" target - getting three million people on ARVs by the end of 2005. This is a means to achieving the treatment goal: universal access to ARVS for all who need them. WHO will lead the effort, with UNAIDS and other partners, using its skills and experience in coordinating global responses to diseases such as the effective and rapid control of SARS. The monitoring and evaluation (M&E) of the 3 by 5 initiative is a high priority. It will be crucial to know how countries are meeting the agreed goals and objectives and how local levels (districts, Regions or Provinces) are monitoring progress and identifying any problems they may encounter. The need for a substantial amount of country input and ownership of the process will require a refinement of the M&E strategy in close consultation with countries. However, key components of the M&E strategy can be developed now, with further refinements and developments to come later. This document is a work in progress. It represents the best effort to describe a coherent approach to the monitoring and evaluation of scaling up to the reach the goal of 3 by 5 that is possible at this time. This working document is best viewed as a step in a process that will include field testing, the gathering of additional experience, additional review, the validation of indicators presented and subsequently refinement. If inadequacies are found in this working document, they are mostly the result of incomplete information and experience on which to base decisions. That will be corrected as experience mounts. (excerpt)
Monitoring the Declaration of Commitment on HIV / AIDS. Guidelines on construction of core indicators. Revised.
Geneva, Switzerland, UNAIDS, 2002 Dec. 72 p. (UNAIDS/02.51E)The purpose of the current guidelines is to provide countries with technical guidance on the detailed specification of the indicators, on the information required and the basis of their construction, and on their interpretation. These guidelines aim to maximize the validity, internal consistency and comparability across countries and over time of the indicator estimates obtained, and to ensure consistency in the types of data and methods of calculation employed. (excerpt)
Geneva, Switzerland, Joint United Nations Programme on HIV / AIDS [UNAIDS], 2003 Mar. 28 p. (UNAIDS Best Practice Collection. Key Material; UNAIDS/03.16E)Until recently, relatively little attention had been paid to HIV/AIDS care and prevention in the context of a humanitarian response. Traditional priorities in emergencies included the provision of food, water, sanitation, shelter and basic health services. Because of the long incubation period of HIV, the disease was not considered an immediate threat to life and was therefore not thought of as a ‘relief issue’. Factors (such as poverty, social instability and powerlessness), typically associated with conflicts and the forced displacement of people, were already known to exacerbate HIV transmission. Until the catastrophic Rwandan refugee crisis of 1994, however, there was little appreciation of how very significant these factors were. Before that date, no major specific interventions for HIV infection or for other sexually transmitted infections (STIs) had been designed for refugees. This monograph documents the first large-scale AIDS and STI intervention programme to be implemented during a refugee crisis. It describes the operational aspects of the intervention, the observed impact and the effect this experience had on policies and practices in other refugee situations, among both international and nongovernmental organizations. It provides insights into the elements and approaches for STI services that will be useful for reproductive health programme managers from government and international organizations as well as nongovernmental organizations involved in relief operations. It will also be useful for district or regional health managers in identifying needed support systems for STI service delivery. (excerpt)
Chennai, India, Voluntary Health Services, AIDS Prevention and Control Project, . 43 p.In Tamil Nadu, India, there are no research studies undertaken to establish the prevalence of HIV among women in prostitution. However, the clinical data from various sources reveal that a significant proportion of them are infected with HIV. The situational assessment conducted by the nongovernmental organization (NGO) partners facilitated by AIDS and Prevention and Control (APAC) revealed various factors, which made women more prone to the infection. It was mainly due to the inconsistent usage of condoms; various myths and misconceptions; lower empowerment; lower social status and educational level. To this effect, the APAC project adopted the implementation of holistic, participatory gender specific and culture sensitive prevention programs among women in prostitution. It provides relevant information to risk population groups, promotion of quality condoms, enhancement of sexually transmitted disease and counseling services, and explorative research for increasing the effectiveness of the project. It is noted that APAC supports six NGOs in six towns in Tamil Nadu to implement the targeted intervention among women in prostitution.