1. Maharashtra State Branch
Indian Red Cross Society
Response to the HIV/AIDS pandemic in Maharashtra
Mrs. Homai N. Modi
Hon. Secretary
Maharashtra State Branch

2. OPD Block

3. HIV/AIDS: Present Indian Scenario
About 2.5 to 3 million adults infected with HIV in India
38% are women
57% are in rural areas
Six high HIV prevalence states in South and North Eastern regions including Maharashtra
Facilitator’s Notes:
In 2007, million adults infected with HIV in India. Source:
38% are women
57% of these are in the rural areas
Source: Joint United Nations Programme on HIV/AIDS (UNAIDS), 2006 Report on global AIDS epidemic.
This map shows the six high prevalence states: Maharashtra, Andhra Pradesh, Tamil Nadu, Karnataka, Manipur, and Nagaland.
Meaning of High, Medium and Low risk states:
High Prevalence (red on the map): When > 5% amongst high risk groups and > 1% amongst antenatal cases
Medium Prevalence (orange): When > 5% amongst high risk groups and < 1% amongst antenatal cases
Low Prevalence (yellow): When < 5% amongst high risk groups and < 1% amongst antenatal cases
There are 111 high prevalence districts in India.
There are regional differences in modes of transmission:
Heterosexual routes is the most common in Tamil Nadu, Karnataka, Andhra Pradesh, and Maharashtra.
Through sharing needles of injection drug users in Nagaland and Manipur.
Source: National AIDS Control Organisation Sentinel Surveillance.
Ask participants which groups are considered high risk groups/populations?
Answer:
Commercial Sex Workers (CSWs)
Men who have Sex with Men (MSM)
IDU (Injection Drug Users)
Trafficked women
Graphic Source: National AIDS Control Organisation. Annual Report (up to July 2004). Page 18
Share the facts given in the slide.
2005 estimate is 5.7 million PLWHA (adults and children) in India.
First HIV case in India was seen in 1986 in Tamil Nadu.
First full blown case of AIDS was in Mumbai (1987).
HIV infection has been reported in all States.
HIV prevalence tends to be higher in the industrialised peninsular states.
High prevalence states are defined as those where the prevalence is > 5% in high risk groups and > 1% in pregnant women.
The six states with the highest prevalence are: Maharashtra, Andhra Pradesh, Tamil Nadu, Karnataka, Manipur and Nagaland.
There are regional differences in modes of transmission. Heterosexual routes are the commonest in all high risk States except for Nagaland and Manipur, where the commonest mode of transmission is through sharing needles of injection drug users.
In Tamil Nadu, an HIV prevalence of 50% has been found among some sex workers.
Ask participants how many patients are testing positive for HIV every month at their local site, if known? Has this changed over time?
Figure Source: NACO Annual Report, 2003

4. HIV/AIDS Scenario in Maharashtra
Maharashtra is one of the first and worst hit states in the country.
Major labour force for the financial capital of India Mumbai, comes from the rural parts of the state.
This labour force is exposed to Red light areas and also to HIV as they are living alone away from their families.
National Highway connecting important cities like Mumbai, Pune, Mangalore, Bangalore and Chennai passes through various districts in Maharashtra with major halts in smaller towns.
Large number of female sex workers along the highway catering to truck drivers.

5. HIV Trends in Maharashtra
Trainer’s Notes:
The data here is from Tamil Nadu. The trainer may ask the participants from other states to share the data from their states for the benefit of others in the training.
Source: website:
Reader’s Notes:
This slide shows sentinel surveillance data from Tamil Nadu, it shows reduction in antenatal surveillance rate from 1 (1998) to 0.75 (2003). This indirectly infers reduction of prevalence in the general population.
NACO

6. HIV Trends in Maharashtra
NACO

7. HIV Trends in Maharashtra
NACO

8. History of Bel Air Founded by Dr Billimoria in 1912 as a TB Sanatorium
Handed over to Red Cross Society in 1964
250 bedded hospital with 150 staff including 24 doctors and 60 nurses.
Well equipped Pathological Laboratory, CD4 Count Machine, Operation Theatre with Laparoscopy, X-ray-USG Machines, ECG, ICU, 24 hours Emergency, etc.
It also has a Naturopathy and Ayurveda Centre.

9. 1994 Bel-Air started getting HIV patients from 1994.
Bel-Air admitted HIV patients and did their best to treat them at a time when the country had no experience.
There was no support from the Government.
ART was not available.
Free food and treatment made available.

10. 1994 - 2000 The Society was resistant.
Families abandoned their patients.
Bodies were not claimed.
Even cremation was difficult.
Bel-Air staff were forced to wash the municipal crematorium after cremation of the HIV positive bodies.
High levels of stigma and discrimination

11.
Bel-Air started sending doctors to various HIV/AIDS international workshops and trainings to places like Bangkok, Europe etc. since no expertise was available in the country.
Nurses, counselors and other staff were also trained.

12. Endorsements 2002
Penguin publishes Positive Lives by Kalpana Jain, with a few stories
on the lives and experiences of HIV positive patients at
Bel-Air.

13. 2003
Dr.Sr.Rosily, M.D. with eight years experience working with HIV/AIDS patients in Ghana, West Africa, joined Bel-Air.
Completed Fellowship in HIV medicine from Christian Medical College, Vellore.

14. Endorsements
The President of India Hon’ble Dr. A. P. J. Abdul Kalam visits Bel-Air.

15. Mrs. Homai N Modi, Hon. Secretary, Indian Red Cross Society, Maharashtra State Branch, receives the President

16. President at Bel-Air

17. UNAIDS proposes Bel-Air as a Public Private Partnership Model.
Endorsements 2003
UNAIDS proposes Bel-Air as a Public Private Partnership Model.

18. Patients admitted and treated at Bel-Air
Year
H.I.V. TB 8
417 52
546 57
411 64
332 89
202
260
423
305
522
389
577
560
605
653
699
905
1494
1125
1979
1751
1743
Total
6227
9950

19. HIV OPD Year No. of Patients 2002 323 2003 731 2004 1578 2005 3205
2006
6401
2007
8959
2008 till March
1841
Total
23038

20. Laparoscopic surgeries started in 2008.
Bel-Air started Orthopaedic, Gynaec and General Surgeries for HIV patients way back in 1998.
Laparoscopic surgeries started in 2008.

21. Ayurvedic Centre
Bel-Air has a full fledged Ayurvedic Centre which provides alternative medicines and yoga therapy to HIV patients also.

22. Endorsements
Director of Bel-Air nominated as member of the Country Coordinating Mechanism (CCM) of the UN Global Fund against AIDS, TB and Malaria(GFATM).

23. Endorsements 2007
The Director of Bel-Air nominated as the Chairperson of the Technical Resource Group (TRG) on Community Care Centres (CCCs) of National AIDS Control Organisation (NACO) Ministry of Health and Family Welfare, Government of India.

24. Endorsements 2007 A special Report on Bel-Air by
(National Public Radio) USA.
Website link:

25. Bel-Air College of Nursing 2006
The first nursing program in India with a focus on HIV/AIDS.
The first Nursing College in India with a collaboration with an American University.
Identified by Indian Nursing Council & NACO to train nurses in HIV.
118 students currently in three batches.

26. Bel-Air College of Nursing 2006
University of Illinois Collaboration for
- Faculty exchange
- Student Exchange
- Curriculum
- Joint research activities
- Participation in seminars and academic meetings
- Exchange of academic materials and other information.
- Special short term academic programs.
- Professional development programs.

27. 2006
Support from
Minu K. and Mehroo M. Patel Endowment Fund for Advancement of Nursing in India
Bel-Air Benefit Foundation, Chicago.
Ribbon Foundation, Chicago.

28. 2006 Bel-Air National Training Institute
Center for Disease Control (CDC), Atlanta and International Training and Education Center on HIV (I-TECH) Seattle, Washington, commits to provide technical support to Bel-Air.

29. 2007 Bel-Air National Training Institute
Global Fund Round VI
Bel-Air selected to train Community Care Center (CCC) nurses in the states of Maharashtra, Chatisgarh, West Bengal, Rajasthan, Madhya Pradesh, Orissa, Gujarat, Bihar and Uttar Pradesh.

30. 2008 Bel-Air National Training Institute
Indian Nursing Council identifies College of Nursing for training of nurses from all over India in HIV/AIDS.

31. 2008 Bel-Air National Training Institute
Indian Red Cross Society National Head Quarters selects Bel-Air for a Care and Support Program in Pune, Nashik and Kolhapur Districts with the help of German Red Cross.

32. Bel-Air a National Training Institute 2003 - 2008
Bel-Air has trained 804 doctors, 220 nurses, 41 health workers 57 counselors and 81 faith leaders in HIV/AIDS management.

33. Bel-Air - A Success Story
Successful in creating an environment free of stigma and discrimination in the hospital
Larger society accepting HIV without discrimination.
International schools in Panchgani send their students for treatment to Bel-Air.
Acceptance of positive patients by their family members.
Most patients recovering and going back to lead normal productive lives.

34. Bel-Air - A Success Story
Levels of stigma and discrimination have reduced drastically in the community.
Awareness on HIV prevention in the community has increased specially among the youth.
Students from Panchgani schools mingle with patients regularly.
Positive patients regain their confidence and dignity.
25 HIV positive co-opted as staff.
Unprecedented unique model in the country.

35. Future scope
Bel-Air is a potential training center for doctors, nurses and other health care providers from South and South East Asia in HIV/AIDS.

36. Contact Details
Mrs. Homai N. Modi Prof. Minu K Patel & Dr. Mehroo Patel
Hon. Secretary Bel-Air Benefit Foundation,
Indian Red Cross Society (312)   Fax:(312)
Maharashtra State Branch
Tel:
Fax:
yahoo . co . in
Father Tomy K. MCBS Dr. Manohar Jethani,
Director Ribbon Foundation, Chicago,
Bel-Air Hospital , Quincy Ct, Glendale HTS, IL –60179.
Mobile Tel:
Tel: – / Fax:
vsnl . com
Website:

37. THANK YOU