Dr E M Sudarsana Natchiappan MP representing India
In UN Economic and Social Commission for Asia and the Pacific Highlevel Intergovernmental meeting in the Assessment of Progress against Connitments in the Political Decleration on HIV / AIDS and Milliniom Development Goal in Bangkok 6 -8 Feb 2012
Agenda Item No.4
Review of implementation of political declaration on HIV/AIDS and progress on MDG goal to ensure universal access to prevention care support and treatment
In order to control the spread of HIV/AIDS, the Government of India is implementing the National AIDS Control Programme (NACP) as a centrally sponsored scheme. Its policy framework is anchored in the National AIDS Prevention and Control Policy (2002). The focus, over the years, has moved from raising awareness to behavioral change, from a national response to a more decentralized response and to increasing involvement of NGOs and networks of People living with HIV/AIDS (PLHA). Phase-III (2007-2012) of NACP, currently being implemented, is evidence-based, with well structured policy, programmes and schemes with operational guidelines. Launched in July 2007, it has the goal to halt and reverse the epidemic in the country over the five-year period by scaling up prevention efforts among High Risk Groups (HRG) and general population, and integrating them with Care, Support & Treatment services.
Prevention and Care, Support & Treatment form the two key pillars of all the HIV/AIDS control efforts in India. These are being achieved by behaviour change communication for improved awareness, up-scaling targeted interventions among the high risk groups, expanding counseling and testing services, condom promotion, management of STI/RTI, support and treatment of HIV infected persons including the treatment of opportunistic infections, provision of anti-retroviral drugs and mainstreaming of HIV intervention strategies. Strategic Information Management and institutional strengthening activities provide support for implementing these core activities at national, state and district levels.
HIV epidemic in India is a dual epidemic driven by sexual and IDU routes of transmission, concentrated in nature with high HIV prevalence among high risk groups – Injecting Drug Users (IDUs) (9.19%), Men who have sex with men (MSM) (7.3%), Females Sex Workers (FSW) (4.94%) and Sexually Transmitted Infection clinic attendees (2.46%). Compared to this the prevalence among ANC clinic attendees (pregnant women- proxy for general population) is much lower (0.48%). Therefore, prevention through focused interventions amongst these groups is of extreme importance for controlling HIV epidemic.
The current estimates highlight an overall reduction in adult HIV prevalence from 0.41% in 2000 to 0.31% in 2009. The estimated number of new annual HIV infections has also declined by more than 50% over the past decade from 2.7 lakh new infections in 2000 to 1.2 lakh in 2009.
Ensuring prevention services to Most at Risk populations is the key strategy of the programme. The Most at risk populations includes Female Sex Workers (FSWs), Men who have Sex with Men (MSM) ,Transgenders (TGs), and Injecting Drug Users (IDUs) and in addition bridge population like Truckers, and Migrants implemented through NGO and CBOs .
Over 1600 TIs programme covered 80% of FSW population, 76% IDU and 69% MSM population.
These interventions provide package of services aiming at behaviour change, STI care and condom and safe needle practice.
NGOs and CBO are played a significant role in this complex intervention.
The programme has robust mechanism to ensure quality of services for ensuring national goal of prevention and control of HIV among these groups.
Counselling and testing services
In India, HIV counselling and testing facilities have been up scaled from 4037 in 2007 to 9993 in the year 2011 in order to ensure access of counselling and testing facilities to all at risk population.
This also include 1018 ICTCs under Public Private Partnership (PPP) model facilities in private hospitals and maternity homes to ensure counseling and testing facilities in the private sector
Every year about 17 million people access these services for knowing their HIV status.
The Prevention of Parent To Child Transmission (PPTCT) intervention is working towards the elimination of mother to child transmission.
PPTCT coverage has scaled up from 2.3 million in 2007 to 6.8 million in 2011. The plan for further scaling up in NACP IV is from 6.8 in 2011 to 14 million in 2017.
India is moving from single dose Nevirapine to the more efficacious regimen for prevention of mother to child transmission which will further reduce the transmission of HIV from mother to child.
The NACP has an integrated approach between counselling and testing facilities and STI/RTI services.
Care and support services
By providing these services, out of 2.4 million of estimated HIV infections in the country, 1.67 million has been registered for treatment and care services.
Of the 1.67 million people registered in ART, 475,000 are on ART through a network of 330 ART centres in the country. In view of the large size of the country with wide geographical area, a concept link ART centre was evolved to provide care and support near to beneficiaries. 678 such link ART centres are set up in the public health facilities in the country. In addition, 253 community care centres are linked up to ART centres for adherence counselling and follow p etc.
GOI had rolled out second line ART services through 17 centres to provide ART services to resistant patients.
Programme has provided high priority to paediatric HIV. Children less than 15 yrs account for 3.5 percent of the total number of people living with HIV/AIDS (PLHA) in India.
Nearly 95000 children are registered out of which 27597 are receiving free ART.
Since 2006 about 4 lakhs people were added to the pool PLHIV on ART and it has been planned that by 2017 number PLHIV on ART will be doubled.
By implementing these activities a significant progress has been made in MDG goals as follows
There is 50% reduction in new infections in last decade aiming at halting the epidemic and begins to reverse.
The prevalence of HIV infection among pregnant women in the 15- 24 has been declined from 0.86% in 2006 to 0.48% in 2009.
Condom use rate with non regular partners has increased from in 59.1% 2006 to 61.7% in 2009.
All the above achievements were possible because of the active support and participation of various stakeholders and involvement of various Ministries / departments in the government including Education, Home affairs, Women and Child, Social Justice and Empowerment, Rural development, Youth Affairs and Sports, Panchayati Raj, Roads and surface transport etc.
The programme is presently working out the priorities to enable to reach the goal in line with political declaration specifically ensuring the universal access to prevention, care support and treatment.