National response to hiv
Published on: Mar 3, 2016
Transcripts - National response to hiv
Dr. Y. D. Badgaiyan
Prof. & Head
Deptt. of Community Medicine,
The estimated number of people living with
HIV in India is 2,390,000, with an estimated
adult HIV prevalence of 0.31% in 2009.
Available evidence on HIV epidemic in India
shows a stable trend at a national level.
HIV/AIDS is concentrated among high-risk
group populations and is heterogeneous in
The primary drivers of HIV epidemic in India
are unprotected paid sex, unprotected sex
between men and injecting drug use.
Heterosexual route of transmission accounts
for 87% of the HIV cases detected.
Over the years, the HIV/AIDS epidemic has
moved from urban to rural India and from
high-risk to general population, largely
National AIDS Control Programme (NACP)
aims to contain the spread of HIV in India by
building all-encompassing response reaching
out to diverse populations.
The overall goal of NACP is to halt and
reverse the epidemic by prevention, care and
support and treatment.
This will be achieved through a four-pronged
1. Prevention of infections through saturation
of coverage of high-risk groups with targeted
interventions (TIs) and scaled up
interventions in the general population.
2. Provision of greater care, support and
treatment to larger number of people living
with HIV/AIDS (PLHA).
3.Strengthening the infrastructure, systems
and human resources in prevention, care,
support and treatment programs at district,
state and national levels and
4. Strengthening the nationwide Strategic
Information Management System (SIMS).
To meet the above objectives, various
interventions were initiated with clearly
- technical and operational guidelines and
- monitoring indicators.
The National AIDS Control Organisation
(NACO) under Ministry of Health and Family
Welfare is the overall body for framing policy,
guidelines and strategies for program
It also releases funds to various states and
reviews the progress under various
components of the program.
State AIDS Control Societies (SACS) have been
constituted throughout the country with the
responsibility of program implementation.
In high HIV prevalent districts, District AIDS
Prevention Control Unit (DAPCU) has been set
up for direct supervision at the ground level.
1. Targeted interventions.
2. Management of STI.
3. Condom promotion.
4. Blood safety.
5. Integrated counseling and testing services.
6. Care, support and treatment.
7. Information, education, communication and
8. Strategic information management system.
HIV epidemic in India is mainly concentrated
in high-risk population like
- female sex workers (FSW),
- men having sex with men (MSM),
- injecting drug users (IDU) and
- clients of sex workers.
Given their special vulnerabilities, prevention
strategies include five elements-
- behaviour change,
- treatment for sexually transmitted infections
- monitoring access to and utilization of
- ownership building and
- creating an enabling environment.
Prevention strategy includes peer led
interventions by Non-Governmental
Organizations (NGOs)/Community Based
Organizations (CBOs), both in the rural and urban
These are networked and linked to general
healthcare facilities to ensure that HRG s' access
them without stigma or discrimination; they are
also linked to Community Care Centers (CCC),
Counseling and Testing Centers and anti-
retroviral treatment (ART) centers.
TIs are aimed to effect behavior change for
having protected sex through awareness
rising among the high-risk groups and
clients of sex workers or bridge
populations, particularly single male migrants
and long distance truckers.
STI and Reproductive Tract Infections (RTI)
are key determinants of HIV transmission.
An estimated 6% of adult population suffers
from STI/RTI annually, accounting for about
30 million episodes per year.
Presence of STI increases the risk of
acquisition and transmission of HIV infection
five to ten times.
Control of STI provides a window of
opportunity for prevention of new HIV
infection and is the most cost-effective
means for preventing HIV transmission.
Provision of standardized package of STI/RTI
services through syndromic case
management by public health facilities and
preferred private practitioners is the
cornerstone of the program.
Condom promotion strategy aims to integrate
the use for family planning as well as
prevention of HIV and STI using various
channels of supply, i.e. free, through social
marketing and commercial outlets.
In addition, various innovative approaches
have been introduced including Condom
Vending Machines (CVMs) at strategic
sites, female condoms particularly for FSW
and special condoms for MSM population.
Blood Safety program under NACP-III aims to
ensure provision of safe and quality blood to
the far-flung remote areas of the country in
the shortest possible time through a well-
coordinated National Blood Transfusion
This is sought to be achieved by the
- Strengthening infrastructural facilities and
establishing blood storage centers in the
primary health care system for availability of
blood in far-flung remote areas;
- Ensuring that regular (repeat) voluntary non-
remunerated blood donors constitute the
main source of blood supply through phased
increase in donor recruitment and retention;
- Vigorously promoting appropriate use of blood,
blood components and blood products among
- Developing long-term policy for capacity
building to achieve efficient and self-sufficient
blood transfusion services;
- Mandatory testing of each unit of blood for HIV,
Hepatitis B and C, Syphilis and Malaria and
- Voluntary blood donation for which camps are
organized with the help of various organizations.
Counseling and HIV testing services are being
provided through 5223 Integrated
Counselling and Testing Centres (ICTC)
mainly located in government hospitals.
These services are also being expanded in
PHC/CHC in the rural areas, private sector
facilities and mobile clinics.
The main functions of an ICTC include HIV
diagnostic tests, counseling and promoting
behavioral change and referral for care and
The ICTC services are accessed by voluntary
clients (who visit the ICTC on their
own), provider initiated client testing
including patients with signs/symptoms of
HIV infection, patients with STI/RTI/TB and
pregnant women visiting antenatal clinics.
The care, support and treatment needs of HIV
positive people vary with the stage of the
The HIV infected person remains
asymptomatic for 6-8 years.
As immunity falls over time, the person
becomes susceptible to various Opportunistic
At this stage, medical treatment and
psychosocial support are needed.
ART and prompt diagnosis and treatment of
OIs improve the survival and quality of life.
Care support and treatment services are
provided through various facilities closely
linked with each other, with a defined referral
system as illustrated in Table 1.
Selected ART centers are upgraded as Centers
of Excellence (CoE) for tertiary care, training
and operational research.
Information, Education and Communication
(IEC) cuts across all program components.
There has been a strategic shift in IEC
strategy , with the focus moving on to
behavior change communication from just
NACO has undertaken extensive campaigns
to raise awareness and strengthen health
seeking and safe preventive behavior among
people toward HIV.
Thematic campaigns are designed and
undertaken using mass media, mid media,
outdoor and interpersonal communication
Some innovative interventions initiated for
mass awareness include Red Ribbon
Express during 2007-2008 and 2009-2010
and multimedia campaigns in Nagaland,
Manipur and Mizoram during 2009-2010.
The key interventions targeting the youth are
Adolescence Education Programme (AEP) and
Red Ribbon Clubs.
Efforts are being made to mainstream
HIV/AIDS with other sectors, notably with the
departments of women and child
development, rural development, labor, tribal
development, railways, armed forces, etc for
a multisectoral response.
India's response to HIV epidemic is governed by the
strategic information derived from HIV Sentinel
Surveillance, routine program monitoring data,
operational research and evaluation studies.
A nationwide web-enabled Strategic Information
Management System (SIMS) has been set up to
empower program management at various levels with
the information required for planning, management
and monitoring purposes.
This system also helps in evidence-based policy
formulation and program planning.
Beginning NACP-III, NACO has positioned
itself as the promoter and coordinator of
research on HIV/AIDS through
partnership, networking and capacity building
of institutions within the country.
The objective is to identify knowledge gaps
that are critical for effective program
There is evidence that HIV epidemic is
stabilizing in the country, particularly in
However, there is also indication of emerging
hot-spots in the northern states of the
country, which require focus and attention.
National response to HIV/AIDS during the first
three years of the NACP-III has been
commendable in terms of infrastructure and
system development, coverage of targeted
population and monitoring systems.
However, there are still challenges to achieve the
goal of the reversal of the epidemic.
Key areas which require special attention are TIs
for MSM, IDU and migrants and services to HIV
positive pregnant women and infants.