1. AT GLANCE

2. Framework
HIV / AIDS and Global Health Agenda (Millennium Development Goals)
World AIDS Day
Current Epidemiological Status of HIV/AIDS
Response to the HIV Epidemic in India – NATIONAL AIDS CONTROL PROGRAMME (NACP)

3. Story of Kausar
Kausar 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.
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.

4. Story of Kausar……….. cont.
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.
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.
Kausar has also become a strong and vocal advocate for the rights of HIV/AIDS infected patients, especially women.
World AIDS Day on 1 December brings together people from around the world to raise awareness about HIV/AIDS and demonstrate international solidarity in the face of the pandemic. The day is an opportunity for public and private partners to spread awareness about the status of the pandemic and encourage progress in HIV/AIDS prevention, treatment and care in high prevalence countries and around the world. Between , World AIDS Days will have the theme of "Getting to zero: zero new HIV infections. Zero discrimination. Zero AIDS related deaths". The World AIDS Campaign focus on "Zero AIDS related deaths" signifies a push towards greater access to treatment for all.

5. HIV / AIDS and Global Health Agenda

6. HIV / AIDS and MDGs GOAL 6 Target 6 a 6.1
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 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

7. "Getting to zero: zero new HIV infections. Zero discrimination
"Getting to zero: zero new HIV infections. Zero discrimination. Zero AIDS related deaths”
World AIDS Day on 1 December brings together people from around the world to raise awareness about HIV/AIDS and demonstrate international solidarity in the face of the pandemic. The day is an opportunity for public and private partners to spread awareness about the status of the pandemic and encourage progress in HIV/AIDS prevention, treatment and care in high prevalence countries and around the world.
Between , World AIDS Days will have the theme of "Getting to zero: zero new HIV infections. Zero discrimination. Zero AIDS related deaths". The World AIDS Campaign focus on "Zero AIDS related deaths" signifies a push towards greater access to treatment for all; a call for governments to act now.

8. Current Epidemiological Status of HIV/AIDS

9. Global summary .

10. Key features of HIV epidemic globally
25 countries, since 2001, have reduced new infections by > 50%
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.
In the past two years there has been a 60% increase in the number of people accessing life-saving treatment.
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.
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.
57% of HIV-positive pregnant women received treatment to prevent HIV transmission to their child in 2011
At the end of 2011, an estimated 8 million people people were receiving antiretroviral therapy for HIV or AIDS in low- and middle-income countries, up from 6.6 million people in 2010 and up from just in 2003.
However, 7 million people eligible for HIV treatment still do not have access. 72% of children living with HIV who are eligible for treatment do not have access.

11. Number of people living with HIV in the world (Millions), 1990-2011
More people than ever are living with HIV due to fewer AIDS-related deaths and the continued large number of new infections.
In 2011, an estimated 34.2 million were living with HIV, up 17 per cent from This persistent increase reflects the continued large number of new infections along with a significant expansion of access to life-saving antiretroviral therapy, especially in more recent years.
Sub-Saharan Africa is the region most affected, with nearly 1 in every 20 adults living with HIV. Sub-Saharan Africa accounts for 69% of all people living with HIV.
HIV incidence and prevalence is substantially lower in Asia than in some other regions. But the absolute size of the Asia population means it has the second largest number of people living with HIV.
Source: The Millennium Development Goals Report 2012

12. Adult HIV prevalence (%)

13. AIDS Deaths
Globally there were more than half a million fewer deaths in 2011 than in 2005.
The number of AIDS-related deaths declined by nearly one-third in sub-Saharan Africa between 2005 and 2011.
The Caribbean experienced declines in AIDS-related deaths of 48% between 2005 and 2011 and Oceania 41%.
However two regions experienced significant increases in AIDS-related deaths; Eastern Europe and Central Asia (21%) and the Middle East and North Africa (17%).

14. New HIV infections
100
69.2
10.4
2.9
3.2
3.5
5.0
0.7
1.2
2.7
0.2
However progress is uneven. Since 2001, the number of people newly infected in the Middle East and North Africa increased by more than 35%. In Eastern Europe and Central Asia, there has also been an increase in new HIV infections in recent years.

15. Indian scenario

16. Key features of HIV epidemic in India
Estimated 3 million PLHA in India - third largest number of people living with HIV/AIDS (PLHA)
HIV epidemic in India is heterogenous and concentrated in nature
Spread in all states and union territories
Across all age groups

17. Estimated Adult HIV Prevalence
The adult HIV prevalence at national level has continued its steady decline from 0.41% in 2000 through 0.36% in 2006 to 0.31%
in 2009.
All the six high prevalence states show declining trend. However, the low prevalence states of Assam, Chandigarh, Orissa,
Kerala, Jharkhand, Uttarakhand, Jammu & Kashmir, Arunachal Pradesh and Meghalaya show rising trends in the last four years.
The adult HIV prevalence was 0.26% among women and 0.38% among men in 2008, and 0.25% among women and 0.36% among men in 2009.
Source: Technical Report on HIV Estimations, 2010, NACO & NIMS.

18. HIV prevalence across states
States with High prevalence
Manipur (1.40%),
Andhra Pradesh (0.90%),
Mizoram (0.81%),
Nagaland (0.78%),
Karnataka (0.63%) and
Maharashtra (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 ( %.)
All other states/UTs have lower levels of HIV.

19. Declining trends of Adult HIV Prevalence in High Prevalence States & Mizoram
Source: Technical Report on HIV Estimations, 2010, NACO & NIMS.

20. Rising Trends of Adult HIV Prevalence in Low Prevalence States
While this trend is evident in most states, some low prevalence states have shown a slight increase in the number of new infections over the past two years; this underscores the need for the programme to focus more on these states with low prevalence, but high vulnerability.
Source: Technical Report on HIV Estimations, 2010, NACO & NIMS.

21. Annual New HIV Infections
New HIV infections has declined by more than 50% over the past decade from 2.7 lakh in 2000 to 1.2 lakh in Analysis of epidemic projections revealed that the number of new annual HIV infections has declined by around 56% during the last decade ( ).

22. State wise distribution of New HIV infections
Of these, six high prevalence states account for only 39%, while the states of Orissa, Bihar, West Bengal, Uttar Pradesh, Rajasthan, Madhya Pradesh and Gujarat together account for 41% of new infections.

23. Concentrated Epidemic
HIV epidemic in India is to a large extent confined among the High Risk Groups, i.e., Female Sex Workers, Injecting Drug Users, Men who have Sex with Men and Transgenders. The
prevalence of HIV/AIDS is about 20 times higher in these groups as compared to that among the general population.
Source: HIV Sentinel Surveillance, taken from Annual Report,
Department of AIDS Control, MOHFW

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

25. Routes of HIV Transmission, India
Unprotected sex (87.4% heterosexual and 1.3% homosexual) is the major route of HIV transmission, followed by transmission from Parent to Child which is 5.4% and use of infected blood and blood products is 1.0%. While Injecting Drug Use is the predominant route of transmission in northeastern states, it accounts for 1.7% of HIV infections nationally.
Source: NACO CMIS

26. AIDS Deaths
The trend of annual AIDS deaths is showing a steady decline since the roll out of free ART programme in India in 2004.
It is estimated that about 1.72 lakh people died of AIDS related causes in 2009 in India.

27. District
Categorization
India
A = 156 B = 39 C= 296 D= 118

28. Epidemic scenario India Maharashtra % Adult HIV Prevalence (%) 0.31
0.19
61.29
No. of PLHA
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

29. Maharashtra

30. Response to the HIV Epidemic in India – NATIONAL AIDS CONTROL PROGRAMME (NACP)

31. Milestones in HIV/AIDS control in India
Year
Events
1986
First AIDS case in India
Medium Term Plan
National AIDS Control Programme (NACP-I)
National AIDS Control Board (NACB)
National AIDS Control Organisation (NACO)
Nov 1999
National AIDS Control Programme (NACP-II)
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.
In 1986 after detecting 1st case AIDS Task Force under the Indian Council of Medical Research and a National AIDS Committee headed by the Secretary, Ministry of Health & Family Welfare was formed. A Medium Term Plan ( ) was launched
in four States - Tamil Nadu, Maharashtra, West Bengal and Manipur, and four metropolitan cities - Chennai, Kolkata, Mumbai and Delhi to combat HIV/AIDS.
NACP I - had the objective to slow down the spread of HIV infections so as to reduce morbidity, mortality and impact of AIDS
in the country.
NACP II - the focus shifted from raising awareness to changing behaviour, decentralization of programme implementation to the state level and greater involvement of NGOs
NACP III - Overtime, the focus has shifted from raising awareness to behaviour change, from a national response to a more decentralized response up to the district level and to increasing involvement of NGOs and networks of PLHA. Prevention and Care, Support & Treatment (CST) form the two key pillars of all the AIDS control efforts in India.

32. Model of HIV treatment service

33. 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 10
Link ART centres -
685
Community Care centres
122
350
253
ART plus centres 20
Pediatric COE 7
In order to facilitate the delivery of ART services nearer to the benefi ciaries, it was decided to set up Link ART Centres located mainly at ICTC in the district
/ sub-district level hospitals nearer to the patient’s residence and linked to a Nodal ART centre within accessible distance.
It has been observed that
patients need to travel long distance to access
the second line treatment. This has resulted in
low uptake of second line ART and also caused
inconvenience to patients. In view of these, it was
decided to expand the number of centres that
provide second line ART. Accordingly, some good
functioning ART centres were upgraded and
labelled as ‘ART Plus Centres’.

34. Target Achievements by NACO for 2010-11 and 2011-12
Indicator
Target
Achievement
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 **up to December 2011

35. Target Achievements by NACO for 2010-11 and 2011-12
Indicator
Target
Achievement
Achievement*
New Targeted Interventions
established
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 crore
pieces
44.72 crore pieces
34.9 crore
42.9 crore pieces
Targeted Interventions are preventive interventions focused at High Risk Groups and Bridge populations in a defined geographic area. The TI Projects are peer-led interventions implemented through NGOs/Community Based Organisations (CBOs). These projects are mentored, monitored and supported by the State AIDS Control Societies (SACS).
The Link Worker Scheme (LWS) is a rural outreach programme established during NACP-III to reach out to rural HRGs, their partners and other vulnerable groups and to link them with HIV/AIDS services. In addition, the Scheme will also cover young people. It is being implemented in identified priority districts of the country. The objective of the Scheme is to “Reach out to HRGs and vulnerable men and women in rural areas with information, knowledge, skills on STI/ HIV prevention and risk reduction.”
*up to January **up to December 2011

36. Social protection for people living with HIV
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.
“I thought that as long as I kept quiet about my illness, it would not affect my family or income,” he said.
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.

37. Social protection for people living with HIV
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.
Babu’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
By the end of 2011, 35 state social protection schemes had started providing food, transport, housing and pensions for people living with HIV.
Close to 150,000 people living with HIV are now accessing such schemes

38. References
Department of AIDS Control. Ministry of Health & Family Welfare. GOI. Annual Report
Millennium Development Goals. India country report. Central Statistical Organization, Ministry of Statistics and Programme Implementation, Government of India
Millennium Development Goals. Global report
State Fact Sheets. National AIDS Control Program III. March 2012
NATIONAL AIDS CONTROL PROGRAMME : Response to the HIV Epidemic in India.

39. THANK YOU