AT

GLANCE

Framework

0HIV / AIDS and Global Health Agenda (Millennium

Development Goals)

0World AIDS Day 2011-15

0Current Epidemiological Status of HIV/AIDS

0Response to the HIV Epidemic in India – NATIONAL

AIDS CONTROL PROGRAMME (NACP)

Story of Kausar0Kausar Khan, a mother of three, contracted

HIV/AIDS from her husband who then abandoned her. The hospital that she visited did not provide her with proper care. Weak and feeble, she went into acute depression and began to lose hope in life.

0 She then came in contact with a NGO. Kausar was counseled and treated in the drop-in center and was also facilitated a CD4 test. Kausar had no money for the necessary medical treatment so she was referred to the appropriate antiretroviral treatment center at a local government hospital.

Story of Kausar……….. cont.

0 Due to prompt treatment, her CD4 count went up and her health began to improve. The NGO also provided her training in embroidery and Kausar began to earn 2000 rupees per month.

0 Today, Kausar is living with her children. After receiving training in peer education and home-based care services for HIV/AIDS patients, she now works with the same NGO making home visits and providing encouragement and care to people living with HIV/AIDS.

0 Kausar has also become a strong and vocal advocate for the rights of HIV/AIDS infected patients, especially women.

HIV / AIDS and Global Health Agenda

HIV / AIDS and MDGs

GOAL 6 COMBAT HIV/AIDS, MALARIA AND OTHER DISEASES

Target 6 a Halt and begin to reverse the spread of HIV/AIDS

6.1 HIV prevalence among population aged 15 24 years‐

6.2 Condom use at last high risk sex

6.3 Percentage of Population aged 15 24 years with ‐comprehensive correct knowledge of HIV/AIDS

6.4 Ratio of school attendance of orphans to school attendance of non-orphans aged 10-14 years

Target 6 b Achieve, by 2010, universal access to treatment for HIV/AIDS for all those who need it

6.5 Proportion of population with advanced HIV infection with access to antiretroviral drugs

"Getting to zero: zero new HIV infections. Zero discrimination. Zero AIDS related deaths”

Current Epidemiological Status of HIV/AIDS

Global summary

Key features of HIV epidemic globally

0 25 countries, since 2001, have reduced new infections by > 50%0 Half of all reductions in new HIV infections in the last two years have

been among newborn children. In 2011, new infections in children were 43% lower than in 2003, and 24% lower than 2009.

0 In the past two years there has been a 60% increase in the number of people accessing life-saving treatment.

0 The number of people dying of AIDS- related causes fell to 1.7 million in 2011, a decline of 24% since the peak in 2005.

0 In sub-Saharan Africa, annual new infections in 2011 reached 1.7 million people, including 300,000  children. This is 21 percent lower than the 1997 peak and 15 percent lower than in 2001.

0 57% of HIV-positive pregnant women received treatment to prevent HIV transmission to their child in 2011

Number of people living with HIV in the world (Millions), 1990-2011

Source: The Millennium Development Goals Report 2012

Adult HIV prevalence (%)

Sub-Saharan Africa

Middle East and North Africa

South and South-East Asia

East Asia

Central and South America

Caribbean

Eastern Europe and Central Asia

Western and Central Europe

North America

Oceania

Total

0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5

5

0.3

0.5

0.8

0.5

0.2

0.1

1

0.2

0.3

0.8

AIDS Deaths

130000072.1

%

24000

1.3%

260000

14.4%

36000

2.0%

58000

3.2%

12000

0.7%

760004.2%

85000.5%

260001.4%

14000.1%

Sub-Saharan Africa Middle East and North Africa

South and South-East Asia East AsiaCentral and South America CaribbeanEastern Europe and Cen-tral Asia

Western and Central Europe

North America Oceania

Sub-Saharan A

frica

Middle East

and North

Afri

ca

South and South

-East

Asia

East Asia

Central a

nd South A

meric

a

Caribbean

Eastern

Europe and Centra

l Asia

Weste

rn and Centra

l Euro

pe

North A

meric

a

Oceania

Total0

500,000

1,000,000

1,500,000

2,000,000

2,500,000

3,000,000

1800000

75000270000

82000 92000 17000130000 31000 70000 4500

2600000

New HIV infections

69.2

2.910.4

3.2 3.5 0.7 5.0 1.2 2.7 0.2

100

INDIAN SCENARIO

Key features of HIV epidemic in India

0Estimated 3 million PLHA in India - third largest number of people living with HIV/AIDS (PLHA)

0HIV epidemic in India is heterogenous and concentrated in nature

0Spread in all states and union territories0Across all age groups

Estimated Adult HIV Prevalence

Source: Technical Report on HIV Estimations, 2010, NACO & NIMS.

HIV prevalence across states

HIV prevalence States

States with High prevalence Manipur (1.40%),Andhra Pradesh (0.90%), Mizoram (0.81%), Nagaland (0.78%), Karnataka (0.63%) andMaharashtra (0.55%).

States with prevalence higher then national average (0.31%)

Goa, Chandigarh, Gujarat, Punjab and Tamil Nadu

States with prevalence at par with national average 0.31% (0.25% – 0.39%)

Delhi, Odisha, West Bengal, Chhattisgarh and Puducherry (0.28- 0.30%.)

All other states/UTs have lower levels of HIV.

Declining trends of Adult HIV Prevalence in HighPrevalence States & Mizoram

Source: Technical Report on HIV Estimations, 2010, NACO & NIMS.

Rising Trends of Adult HIV Prevalence inLow Prevalence States

Source: Technical Report on HIV Estimations, 2010, NACO & NIMS.

Annual New HIV Infections

2000 2001 2002 2003 2004 2005 2006 2007 2008 20090

0.5

1

1.5

2

2.5

3

No

. of n

ew in

fect

ions

in la

khs

State wise distribution of New HIV infections

AP20%

MH9%

OR9%BI

8%

KA8%WB

6%UP5%

RJ4%

MP4%

GU4%

Other23%

APMHORBIKAWBUPRJMPGUOther

Concentrated Epidemic

Source: HIV Sentinel Surveillance, 2008-09 taken from Annual Report, Department of AIDS Control, MOHFW 2011-12

Primary Drivers of HIV epidemic in India

0Sex work continues to act as the most important source of HIV infection in India due to the large size of clients who get infected from sex workers.

0 Along with High risk groups (FSW, MSM, IDU), Long-distance Truckers and Single Male Migrants are the key drivers of HIV epidemic in India

Heterosexual; 87.4

Homosexual; 1.3

Blood and blood

products; 1

Infected sy-ringes and

needles; 1.7Parent to Child; 5.4

Transgenders; 3.3

Routes of HIV Transmission, India

Source: NACO CMIS 2010-11

AIDS Deaths

DistrictCategorization

India

A = 156B = 39C= 296D= 118

Epidemic scenario

India Maharashtra %

Adult HIV Prevalence (%) 0.31 0.19 61.29

No. of PLHA 2395442 40,060 1.67

No. of CLHA 104450 871 0.83

No. of New Infections 120668 3968 3.29

No. of AIDS related deaths 172041 1649 0.96

Maharashtra

Response to the HIV Epidemic in India –

NATIONAL AIDS CONTROL PROGRAMME

(NACP)

Milestones in HIV/AIDS control in India

Year Events

1986 First AIDS case in India

1990-92 Medium Term Plan

1992-99 •National AIDS Control Programme (NACP-I)•National AIDS Control Board (NACB)•National AIDS Control Organisation (NACO)

Nov 1999 National AIDS Control Programme (NACP-II)

2007-12 National AIDS Control Programme (NACP-III)

20?? NACP IV An elaborate and extensive process has been initiated early last year to ensure that it feeds into the national 12th plan planning processes.

Model of HIV treatment service

Infrastructure for Care, Support &Treatment Services in NACP III

Facility for CST Baseline (March 2007)

Target (March 2012)

Achievement ( Jan 2012)

ART centres 107 250 342

COE 0 10 10

Link ART centres - - 685

Community Care centres

122 350 253

ART plus centres - - 20

Pediatric COE 0 7 7

Target Achievements by NACO for 2010-11 and 2011-12

Indicator 2010-11 2011-12

Target Achievement Target Achievement*

Clients tested for HIV 111.7 lakh 95.45 lakh 120 lakh 90.52 lakh

PLHIV on ART 4,04,815 4,07,361 4,50,000 4,86,173

Pregnant Women tested for HIV

86.49 lakh 66.38 lakh 90 lakh 70.87 lakh

HIV+ Pregnant Women & Babies on ARV

Prophylaxis

11,350 11,962 17,500 11,074

Opportunistic Infections treated

2.7 lakh 4.97 lakh 3.1 lakh 5,41 lakh

*up to January 2012 **up to December 2011

Target Achievements by NACO for 2010-11 and 2011-12

Indicator 2010-11 2011-12

Target Achievement Target Achievement*

New Targeted Interventionsestablished

140 188 170 208

HIV-TB Cross Referrals**

8.5 lakh 10.48 lakh 9.5 lakh 9.97 lakh

Districts covered under Link Worker Scheme

186 179 219 209

Condom distribution 22.46 crorepieces

44.72 crore pieces

34.9 crorepieces

42.9 crore pieces

*up to January 2012 **up to December 2011

Social protection for people living with HIV

0 Thirty-five year old Harihar Babu had a comfortable job as a taxi driver earning Rupees 10,000-12,000 every month. He travelled frequently, driving passengers all over his home state of Chhattisgarh in central India. But all this changed in 2007 when he and his wife tested HIV positive.

0 “I thought that as long as I kept quiet about my illness, it would not affect my family or income,” he said.

0 But the bouts of illness became longer and driving over long distances became impossible for him. In addition to dealing with the stigma of living with HIV, Babu saw his income decline by 50 percent.

Social protection for people living with HIV

0 In January 2011, Babu and his family received monthly food rations through a nationwide scheme that provides subsidized food to families living below the poverty line. He and his family found relief thanks to a special amendment approved by the Chhattisgarh government to include people living with HIV.

0Babu’s family can now buy rice, sugar and salt at nominal prices. This support has gone a long way in ensuring the family has enough nutrition in times of distress

References

0 Department of AIDS Control. Ministry of Health & Family Welfare. GOI. Annual Report 2011-12

0 Millennium Development Goals. India country report. Central Statistical Organization, Ministry of Statistics and Programme Implementation, Government of India. 2011.

0 Millennium Development Goals. Global report. 2012.

0 State Fact Sheets. National AIDS Control Program III. March 2012

0 NATIONAL AIDS CONTROL PROGRAMME : Response to the HIV Epidemic in India.

0 http://transition.usaid.gov/in/newsroom/success_stories/kausar.htm

0 http://www.worldaidsday.org/

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