6.Sikkim State Aids Control Programme

6.SIKKIM STATE AIDS CONTROL PROGRAMME Introduction: Demographically, the second largest country in the world, India has also the second largest number of people living with HIV/AIDS. National Health Policy (2002) and India vision 2020 commit the country to fight all communicable and preventable diseases with increasing life expectancy. Contemporary public health scenario in India reflect two dominant trends (i) an epidemiological transition towards greater incidence of non communicable/life style diseases, and (ii) the growing challenge of communicable and preventable diseases being accentuated by HIV/AIDS. The Millennium Development Goals (MDGs) commit all countries to reverse the spread of HIV/AIDS by 2015. As a signatory nation, India stands committed to achieve this goal through its National AIDS Control Programme (NACP). In 1992 the GOI launched the first National AIDS Control Programme (NACP-I) and was implemented during 1992-1999 with an objective to slow down the spread of HIV infections so as to reduce morbidity and mortality and impact of AIDS in the country. Under the directives from National AIDS control organization (NACO), the Department of Health and Family Welfare established AIDS Cell in the year 1991-92 with the guidelines and strategies laid down by NACO. In April, 1999 the programme entered into phase II and during the same time Sikkim State AIDS Control Society was also constituted with a Governing body (Apex body) under the chairmanship of the Chief Secretary with various Departmental Secretaries as members and Project Director as the member secretary. Further, an Executive Committee under the Chairmanship of Secretary, Health & FW department to implement the programme as per the guidelines & NACO was also constituted. In 2007 NACP phase III with a goal to halt and reverse the epidemic. National AIDS Control Programme Phase-III (NACP III)

Goals and objectives of NACP-III (2007-2011)

The vital goal of NACP-III is to halt and reverse the epidemic in India during the next five years, by integrating programmes for prevention, care, support and treatment. This can be achieved through four-pronged strategies: i) Prevent infections through saturation of coverage of high-risk groups with targeted interventions (TIs) and scale up interventions in the general population. ii) Provide greater care, support and treatment to larger number of PLHA. iii) Strengthen the infrastructure, systems and human resources in prevention, care, support and treatment programmes at district, state and national level. iv) Strengthen the nationwide Strategic Information Management System.

The specific objective is to reduce the rate of incidence by 60 per cent in the first year of the programme in high prevalence states to obtain the reversal of the epidemic, and by 40 percent in the vulnerable states to stabilize the epidemic.

Present Scenario of HIV/AIDS in Sikkim Information from AIDS case reporting indicates that sex is the main route of transmission in Sikkim (87%) followed by injecting drug use (7%). (A) Year wise detection of HIV Cases as of 01/05/2012 Year Male Female Surveillance Total Male Female 1995 2 0 0 0 2 1996 0 0 0 0 0 1997 1 0 0 0 1 1998 3 1 0 0 4 1999 5 0 0 0 5 2000 1 0 0 0 1 2001 2 0 0 4 6 2002 3 1 0 1 5 2003 3 1 0 1 5 2004 5 0 0 0 5 2005 9 2 2 1 14 2006 9 4 1 1 15 2007 12 7 0 0 19 2008 26 15 2 1 44 2009 16 13 4 6 39 2010 24 11 0 0 35 2011 19 15 0 0 34 2012 3 3 0 0 6 Total 143 73 9 15 240

(B) Age wise breakup of HIV Cases. Sl.No. AGE MALE FEMALE TOTAL 1. Below 10 4 3 7 2. 11-19 3 3 6 3. 20-29 48 51 99 4. 30-39 60 22 82 5. 40-49 26 6 32 6. 50-59 8 2 10 7. 60 Above 3 1 4 Total 152 88 240 (C) Modes of transmission of HIV Cases SEXUAL IDU PPTCT BLOOD & NOT TOTAL (Vertical BLOOD SPECIFIE Transmission) PRODUCTS D 206 16 6 6 6 240

(D) District Wise HIV Distribution District Male Female Total East 97 67 164 West 5 2 7 North 3 1 4 South 18 9 27 Others 29 9 38 Total 152 88 240

(E) Modes of transmission of HIV/AIDS Cases detected during HSS YEAR STD ANC IDU FSW TOTAL 2001 1 3 0 0 4 2002 0 1 0 0 1 2003 0 1 0 0 1 2004 0 0 0 0 0 2005 1 1 1 0 3 2006 0 1 1 0 2 2007 0 0 0 0 0 2008 0 1 2 3 2009 4 1 4 1 10 2010 0 0 0 0 0 TOTAL 6 9 8 1 24

(F) TOTAL CASES REGISTERED AT ART CENTRE. STATUS MALE FEMALE TOTAL PRE ART 32 13 45 ART 34 31 65 TRANSFERRED OUT 16 4 20 LOST TO FOLLOW UP 4 0 4 DEAD 24 16 40 TOTAL 110 64 174  Number of cases registered through HSS is: 9 male + 15 female = 24  Cases not registered at ART centre due to non availability of proper registration system before 2005= 34

On ART PHLA on OI’s Sl No OI Male Female 1 D.O.T 2 1 2 Septrum DS 11 1 3 Fluconzole 150 1 0 4 Candid Mouth Paint 1 0 5 Total 15 2

(H) AGE WISE BREAK UP OF Total CASES REGISTERED AT ART CENTRE Sl. No. AGE MALE FEMALE TOTAL 1. < 10 4 2 6 2. 11-19 2 0 2 3. 20-29 24 30 54 4. 30-39 53 23 76 5. 40-49 19 6 25 6. 50-59 6 2 8 7. >60 2 1 3 Total 110 64 174

(I) TRANSFERRED IN AIDS CASES

MALE FEMALE TOTAL 10 5 15

(J) TOTAL AIDS CASES MALE FEMALE TOTAL 38 20 58

(K) Total AIDS Cases AGE Break-up Age Male Female Total 1-10 yrs 1 0 1 11-20 yrs 1 0 1 21-30 yrs 9 8 17 31-40 yrs 18 11 29 41-50 yrs 6 0 6 51-60 yrs 3 0 3 60 yrs and above 0 1 1 Total 38 20 58

STATE INFRASTRUCTURE LIST OF HIV/AIDS COUNSELLING AND TESTING CENTRES, STD CLINICS AND BLOOD BANKS

HOSPITALS ICTC PPTCT ICTC STD BLOOD (GENERAL) (ANC) (MOBILE) CLINIC BANKS STNM HOSPITAL, GANGTOK 1 1 1 1 1

CRH, MANIPAL 1 1 - 1 1

DISTRICT HOSPITAL, SINGTAM 1 1 - 1 -

DISTRICT HOSPITAL, MANGAN 1 1 - 1 -

DISTRICT HOSPITAL, 1 1 - 1 - GYALSHING DISTRICT HOSPITAL, NAMCHI 1 1 - 1 1

TOTAL 6 6 1 6 3

CARE SUPPORT AND TREATMENT (CST)

ART CENTRE SSACS BUILDING STNM COMPLEX, Ph:03592 205752

COMMUNITY CARE CENTRE DEVELOPMENT AREA, GANGTOK, Ph: 03592 202874

(I) Targeted Intervention Programme (TI)

Sikkim is one of the important tourist destinations. During the year 2009 total number of 6, 15, 628 domestic tourists visited the state followed by 17,730 foreign tourists, similarly during 2010 total no. of 7, 00, 011 domestic and the 20,757 no. of foreign tourists visited the state. Targeted interventions are aimed at offering prevention and care services to high risk populations (Female Sex Workers- FSW, Male Having Sex with Male- MSM and Injecting Drug Users- IDUs) within communities by providing them with the information, means and skills they need to minimize HIV transmission and improving their access to care, support and treatment services. It is estimated that more than 90% of HIV transmission in India is related to unprotected sexual intercourse or sharing of Injecting equipment between an infected and an uninfected individuals. Not everyone in the population has the same risk of acquiring or transmitting HIV. Much of the HIV transmission in India occurs within groups or network of individuals who have higher levels of risk due to a higher number of sexual partners or the sharing of injection drug equipment. These programmes also improve sexual and reproductive health (SRH) among these populations and improve general health by helping them reduce the harm associated with behaviour such as sex work and injecting drug use.

Component of TIs under NACP-III 1. Behaviour Change Communication. 2. Access to STI services. 3. Provision of commodities to ensure safe practices / Condom demonstration. 4. Enabling Environment through structural intervention. 5. Linkages to Care and Support Programme. 6. Community Mobilization. 7. Recruitment of NGOs/ CBOs for TI Programme. 8. Technical Support and Capacity Building Activities. 9. Monitoring and Evaluation Framework. Sikkim State AIDS Control Society has been implementing Targeted Intervention (TI) Projects from the year 2000 onwards. Six T.I. projects were implemented during the year 2011-12,4 IDUs and 2 FSWs Physical Target & Achievements for the year 2011-12. (Table-1) Sl. Target Group Target Group Implementing Area of Operation No NGOs

1. Commercial Sex 400 Voluntary Health Singtam & Gangtok. Workers Association of Sikkim 2. Commercial Sex 350 Drishti Namchi, Jorethang & Worker Gyalshing.

3. Injecting Drug 350 Hope Centre Jorethang Users (IDUs) 4. Injecting Drug 200 Hope Centre Namchi Users (IDUs) 5. Injecting Drug 550 Sikkim Gangtok & Ranipool, Users (IDUs) Rehabilitation & Detoxification Society

(II) INTEGRATED COUNSELING AND TESTING CENTRE : - The State has 13 Integrated Counseling and Testing Centers [ICTC] ,6 for ANC and 6 for GENERAL clients and 1 MOBILE ICTC. The 13 ICTCs are located within the District Hospitals, State Referral Hospital [STNM] and at SMIMS [CRH, Manipal]. All the staffs deputed at the ICTCs and PPTCTs comprising of Counselors and Lab technicians are trained and well versed in their work and are provided refresher training in regular intervals. To reach the far flung areas a Mobile ICTC van has been deputed which is utilized to spread awareness amongst the rural folks. A hired taxi is used by mobile ICTC which visits Primary Health Centers on Anti Natal Care days, Central Jail, SSB camps, SAP camps etc. 24X7 PHCs/F-ICTCs These PHCs are facility integrated ICTCs where HIV counseling and testing facilities are made available. The identified ANM/Nurse are trained on HIV counselling at Nursing College, Shillong, Meghalaya and the Lab Technicians are trained in Sikkim by State Resource person. Till date 17 PHCs are functional as F-ICTC.

Client Type Testing Target Achievement Achievement (%)

General Clients 20000 17920 90

ANC 12000 8356 70 Testing Targets and Achievements 2011-2012

Total no. of clients testing sero-positive (after 3 Number of clients tested for HIV specified tests) ICTC Clients ICTC Clients Name of ICTC Clients (excluding ICTC Clients (excluding Total ICTC -Pregnant Total ICTC Testing Pregnant -Pregnant women Pregnant women centre women) women) ICTC (VCCTC)STNM HOSPITAL, 3195 0 3195 12 0 12 ICTC(PPTCT),CENTRA L REFERRAL HOSPITAL 485 1467 1952 1 0 1 ICTC(PPTCT),SINGTA M 754 1036 1790 0 0 0 ICTC(PPTCT)GYNAE DEPARTMENT,STNM HOSPITAL 1644 2428 4072 5 1 6 ICTC(VCCTC),CENTR AL REFERRAL HOSPITAL 1507 0 1507 4 0 4 ICTC(VCCTC),SINGTA M 1662 0 1662 2 0 2 MOBILE ICTC 2165 73 2238 2 0 2 ICTC(PPTCT),MANG AN 406 765 1171 0 0 0 ICTC(VCCTC),MANG AN 796 0 796 0 0 0 ICTC(PPTCT),NAMCH I 625 1598 2223 1 2 3 ICTC(VCCTC),NAMC HI 3422 90 3512 2 0 2 ICTC(PPTCT),GYALSH ING 572 840 1412 0 0 0 ICTC(VCCTC),GYALS HING 687 0 687 0 0 0

III) STI / RTI CONTROL PROGRAMME 1 NTRODUCTION

The STI/RTI Services are being provided in the state by SACS in collaboration with RCH Programme –II of the NRHM. The main focus of the RCH-NACP collaborative activities would be to provide quality STI/RTI service delivery to the general population up to grass root level. Level of STI/RTI Service delivery: There are 6 NACO designated STI clinics in the state. The STI clinics of central Referral Hospital, Sikkim Manipal institute of Medical Sciences was approved during the financial year 2009 – 2010. The preferred private provider model of service delivery to FSWs was introduced during 2009-2010. But somehow this could not be operationalzed because majority of the FSW population in Sikkim are flying sex worker which is affecting the regular contact and coverage for providing the services. However, the NGOs implementing FSW projects have set up clinic in the DICs where the government doctors visit regularly. Sometimes the girls are also referred to practicing government doctor or to nearest hospital.

TARGET AND ACCOMPLISHMENTS Status of physical target & achievements (2010-2011) Type of the Target 2010-11 Achievement till 31.03.11 Percentage Centres

Designated 2301 1562 68% STI/RTI clinics TI STI clinics 2128 286 13% TOTAL 4429 1848 42%

Activities undertaken during the year 2011-12: 1. Status of human resource: The STI Control Program is being managed by JD (STD) SACS in collaboration with Officers of HCHS & FW Dept. at state and district level. Technical support for training and supportive supervisory visit is provided by Consultants / Specialist doctors from STNM Hospital, Gangtok. All 6 STD Counsellor are trained and are in position. Lab Technicians of general laboratory in the referral hospital / Govt District Hospital are also trained. The Clinics Incharge are either a Gynaecologist / Dermatologist / Microbiologist and Dist. Medical Superintendent who are trained in STI/RTI Control programme under NACP. 2. Status of reporting All six STI/RTI Designated Clinics are regularly reporting to SACS. The counsellors personally bring the monthly reports and submit it to Joint Director (STD) SACS. The reports are submitted to M&E Section only after verification. Similarly, TI NGOs are reporting on STI/RTI Services in CMIS formats regularly. 3. Status of RTI/STI services delivery for HRGs in TI NGOS: The rationale for focusing on control of STI/RTI in HRGs is similar to the rationale for focusing HIV control in HRGs population through TI intervention. The prevalence of STI/RTI is much higher in this population and effective control of STI/RTI in HRGs community is likely to have a greater effect on control of STI/RTI in the general population. The opportunity of regular clinic contact with the HRGs is important to reinforce the preventive communication and counselling. The ultimate goal of STI/RTI control programme is to provide the STI/RTI Services to HRG community without any stigma and discrimination in all the service centres. There are 6 NACO designated STI clinics in the state. The STI clinics of central Referral Hospital, Sikkim Manipal institute of Medical Sciences was approved during the financial year 2009 – 2010. The preferred private provider model of service delivery to FSWs was introduced during 2009-2010. But somehow this could not be operationalzed because majority of the FSW population in Sikkim are flying sex worker which is affecting the regular contact and coverage for providing the services. However, the NGOs implementing FSW projects have set up clinic in the DICs where the government doctors visit regularly. Sometimes the girls are also referred to practicing government doctor or to nearest hospital. One more DIC for FSW project was started in Gyalshing, west Sikkim during 2011-12. Though the numbers of FSWs is around 50 only, SACS decided to provide Services to this group in coordination with concerned NGOs, Drishti and health Care providers of Govt. Dist. Hospital, Gyalshing. There is only one FSW who is positive and she is registered in ART Centre. Both the four TI programme for IDUs have established static clinics. There are only 2 private providers under TI & rest are from Govt. Health Institutions. Inspite of all these efforts, the FSW population in Sikkim prefer to avail STI/RTI Services from the DICs. The Govt. Doctors from the STNM Hospital & District Hospital visit the DICs in coordination with the concerned NGOs. No private doctors are willing to provide the services to FSWs with existing honorarium (Rs. 50). Therefore it is proposed to establish static clinics for FSW projects as below:- 1. Voluntary Health Association of Sikkim a) Deorali b) b) Singtam 2. Drishti a) Jorethang\ b) Namchi 4. Status of state and district level convergence with NRHM (with specific reference to availability of STI/RTI drug kits, training of CHC and PHC staff and data consolidation, involvement of SACS in inclusion of STI/RTI plan in state RCH II PIP) A state level convergence meeting of SACS with NRHM Officials was held on 12.10.2010 to discuss the various programmes to be implemented by SACS & NRHM. The STI /RTI cases are being managed by the GDMOs, Gynaecologists & Dermatologist. The colour coded STI/RTI drugs kits have been provided to all designated STI/RTI clinics by SACS. SACS has been conducting training on syndromic cases management for STI/RTI cases to the Medical Officer, Staff Nurse and Lab. Technicians of District Hospital and Primary Health Centres since 2009 in co-ordination with NEHM. Modular training based on new modules supplied by NACO has been introduced and the STI/RTI Control Programme is being implemented in a formal manner. NRHM is in the process of procuring equipments / instruments and furniture for all 4 DSRCs. Training plan has also been discussed with JD (RCH) NRHM. Funds have been released to Districts to role out the training programme. The STI/RTI drug kits are not provided in the DSRCS located in District Hospital Singtam, District Hospital Mangan & District Hospital Gyalshing through NRHM. RPR test kits are also not supplied by NRHM during 2011-12. 5. Training (Provide dates of training with number and type of personnel trained) a) Two days training to Deliver STI/RTI Services for Counsellors of designated STI/RTI Clinics and TI Clinics was held on 19th July 2011. The total no. of trainees were 14. b) Two days refresher Training of Nurses on STI/RTI Services and Care Support & Treatment was held on 6th -7th Dec 2011. The training was attended by Nurses from STNM Hospital, CRH Manipal, Tadong and all 4 District Hospitals. The total no. of participants were 27. The Induction training of new doctors (3) of Dermatology Dept. CRH, SMIMS will be done in February 2012. c) One day refresher training of Laboratory Technician of ICTCs, PPTCTs & general laboratory was conducted on 04.02.2012. The total participants were 13.

6. Procurement (indicate status of consumables, infrastructure strengthening and computers) RCH- II NRHM has already issued supply orders for equipments, instruments and furniture for all designated STI/RTI Clinics of the State. 7. Supervision and Monitoring (indicate numbers of visits made to STI, TI and NRHM facilities) by SACS and TSU STI focal persons and STI mentors a. The Supportive Supervisory visit of all Designated STI/RTI Clinic and DICs/Clinics under T.I. Projects was conducted by the State Resource Team (Mentors) from 7.11.2011 to 23.11.2011. b. The Supportive Supervisory vist of the NRHM facilities conducted along with Joint Director, RCH & P.O NRHM during the last week of February The 2nd Supportive Supervisory of DSRC and TI Clinics IEC is a process of working with individuals, communities and societies to develop communication strategies to promote positive behaviours which are appropriate to their settings. Communication is a cross cutting and integral strategic intervention in all components of HIV/AIDS prevention, care, support and treatment programmes under the National AIDS Control Programme Phase III (NACP-III).The ultimate goal of IEC component is to create an enabling environment that encourages HIV related prevention, care and support activities, and to reduce stigma and discrimination at individual, family, community and institutional levels. As prevention is given more emphasis, especially in a low prevalence state like Sikkim, efforts were made in the reporting period to mainstream the issue of HIV/AIDS through advocacy, orientation and sensitization programmes with stakeholders. SACS initiated a number of activities during the reporting period with special focus on youth, women and rural population. The media used were electronic, print, mid media and Interpersonal Communication. With an aim to instigate behaviour change among this age and gender group, Sikkim SACS implemented the Mobile IEC Campaign and the Multi-Media Campaign 2010-11, that covered the entire State through innovative methods. Mass Media and Outdoor Media activities were carefully synchronised with the Campaigns to effectively reach out to the target group. Red Ribbon Clubs, NYKs, selected NGOs, FBOs, and Media were largely mobilised during the Multi-Media Campaign. The following section presents the budget allocation and expenditure followed by activities undertaken during the reporting period, a gap analysis and proposed activities for 2011-12.

Budget Allocation and Expenditure 2011-2012 Note:- The total budget outlay was Rs. 125.19 lakhs for the financial year 2011-2012. The total budget expended as on 31.03.11 is Rs.124.84 lakhs. The financial achievement for the reporting period is 100%.

PHYSICAL ACTIVITIES UNDERTAKEN DURING 2011-2012 A. MASS MEDIA i) Under Mass Media TV, against a stipulated target of 50 spots, 50 number of already existing video spots were telecast on the local private TV Channel during Special Events and specific Campaigns. Under long format programmes, 10 shows were produced and telecast in the local private TV Channel. Thus, the physical achievement under mass media TV was 100%. ii) In AIR, 30 episodes of Rural, Youth and Women Programmes and 10 jingles were produced and aired throughout the year. Topics covered include STI/RTI, ICTC, PPTCT, Condom, Youth & RRCs, CST, Positive Living, and Blood Donation. Physical achievement- 100%. iii) 60 numbers of Print Advertisements were released on local dailies during special events and Campaigns. Target achievement - 100%.

B. IEC MATERIAL PRINTING AND REPLICATION

Under this sub-head, development of following IEC materials (as per 2011-2012) was carried out: Development & Printing of Diary; Printing of booklet Shaping our Lives, Identity cards for RRC members, Posters on Condom, Stigma and Discrimination, ICTC, IDUs, Right of PLHA, Positive Living and BCC were printed, AEP Module in English & Nepali was printed and 4000 copies of Newsletter was printed. Thirty numbers of GI Programmes were outsourced to cover rural and semi-urban population. C. OUTDOOR AND MID-MEDIA Outdoor Media: a. 50 number of information boards (backlit & front lit) with messaging on condom were installed at the pillars of two taxi stands in Gangtok. b. 20 numbers of Permanent Hoardings were installed at strategic locations around the State. Mobile IEC Campaign: The Campaign started from June 2011. During the financial year 2011- 2012 only 3 districts were covered, South, East and West and a total of 200 performances were completed. The Campaign could not be continued due to major earthquake on 18th September 2011. Multi Media Campaign: The two year old Multi media campaign is yet another milestone engraved in the history of Sikkim. This campaign was tagged as the RED FEST and an array of participants from all corners of the State was registered who supported the cause. The campaign not just served the purpose of disseminating correct messages but also created a sense of responsibility amongst the youth. The campaign also intervened the school children and the drop out youths. A wide variety of activities as Drama, Dance, Song, Quiz competition, Painting competition, football etc. were carried out during the campaign. The Multi-Media Campaign addressed issues like usage of Condoms, access to service and treatment centres, stigma & discrimination, voluntary blood donation, positive living, and IDUs.

D. SPECIAL EVENTS

Out of 4 Special Events namely International Day against Drug Abuse, National Voluntary Blood Donation Day, World AIDS Day, and National Youth Day only 3 Events were commemorated at State and District Levels. National Voluntary Blood Donation Day which falls on 2nd October could not be commemorated due to the earthquake. E. HELPLINE

One number of existing helpline stationed at SSACS Office is functional. F. M&E AND DOCUMENTATION

Impact assessment of the Mid-media and Multi-media Campaign will be conducted in the financial year 2012-2013. G. HIRING OF COMMUNICATION AGENC

SSACS used the services of SIBIN GROUP, an advertising firm based in Gangtok, for all the creative work. H. MAINSTREAMING & YOUTH PROGRAMME Following activities were under taken by Mainstreaming for 2011-12:  Training of Paramedical and nursing staff & students of STNM & Manipal Hospital: Avoiding workplace hazards and encouraging safe clinical practices has prompted this activity in FY 2011-12.  PRI: For percolation of HIV/AIDS messages among rural folk, SSACS proposes for TOTs/Sensitization for PRIs at village, block and Zilla levels. SACS will continue to piggy-ride on the in-house training sessions of the SIRD.  Department of Police: SSACS will reach out to different areas of the Police force through orientation, sensitization sessions, as well at TOTs.Sikkim Armed Police, ITBP, State and District Jail Authorities as well as inmates will be the target group.  Tourism Department and stakeholders: Workshops for tourism stakeholders will be organised consistently through the 1st and 2nd quarters.  Industry Department: Advocacy with Officials from Industry Department and Senior Managers of Industries, to discuss formation of Work Place Policy. Sensitization programmes for factory workers has also been proposed for.  Media: One day Advocacy with editors and senior journalists of leading media houses has been proposed for to encourage ethical reporting on issues pertaining to HIV/AIDS.  FBOs: Involvement of FBOs in several activities and most importantly the Multi-Media Campaign 2010-11, will be capitalised upon for sustained partnership.  Workshop for PLHAs: The one-day workshop with PLHA network aims to educate them about aspects related to HIV/AIDS, ART Adherence, Positive living and Rights. It also entails bridging the gap between the PLHAs and Civil Society and encouraging them to live a free life. Youth: Following activities were under taken by Youth Affairs for 2011-12:  Refresher training for Peer Educators and members of existing RRCs from all district of Sikkim.  Advocacy with Nodal person of OSY youth for formation of 23 new RRCs.  Sensitization of Principals/Head of Colleges, NYks having RRCs on HIV/AIDS, VBD and Life Skill Education.  Training of Lecturers on HIV/AIDS and VBD.  Three day Residential Capacity Building Workshop for Peer Educators of RRCs on HIV/AIDS, VBD,Life Skill Education ,Substance Abuse

I. DROP-IN-CENTRES

One number of existing DIC for PLHAs being managed by Sikkim Network of Positive People (SNP+). It has 84 members. (V) Care, Support and Treatment Introduction Sikkim is a low prevalence state. The number of HIV+ cases here are less compared to other states of India. However, the number of positive cases detected from ICTCs has been increasing over the years which necessitate the needs for continuous care, treatment and support service available in the state. The state has one ART Centre housed in the STNM Hospital Complex, Gangtok. Patients from different districts are registered followed up with clinical assessment and CD4 counting. Majority of the patients on ART are from the East district.

(VI) COMMUNITY CARE CENTRE People living with HIV (PLHIV) require a range of HIV services including care, treatment and support depending on the progression and stage of HIV infection. The progression of infection and consequent weakening of the immune system will result in the PLHIV being venerable to various opportunistic infection. The PLHIV will require care and treatment for opportunistic infection (OIs) and some of these illnesses may require in-patient care in a hospital or other centers that provide this facility. Under the National AIDS Control Programme (NACP) Phase – II, 122 community Care Centres (CCCs) were set up to provide treatment for minor OIs and provide psychosocial support through sustained counseling. CCCs were intended to function as a bridge between hospital and home care. Hence, CCCs were envisaged as stand-alone short-stay homes for PLHIV. These were not linked to other activities of the programme.

In Sikkim the CCC was inaugurated on 26th March 2010 by Honble Minister HC, HS & FW at Development Area, Gangtok with 10 beds and all the necessary infrastructural support.

VII) Blood Safety Programme Blood Transfusion Services constitute a crucial part of health care delivery system. Adequate and safe supply of blood and blood components is essential to enable a wide range of critical care procedures to be carried out in hospitals. Unfortunately, blood transfusion can be a cause of illness like transmission of dreaded viruses like HIV etc. While the vast majority of HIV infections in India are attributed to the sexual route of transmission, the transfusion of unsafe blood and blood products account for 2.07 percent of the HIV infections in the country in 2004- 2005. When viewed against the fact that in 1999 unsafe blood and blood products accounted for over 9 percent of AIDS cases, this drop to 2.07 percent is certainly encouraging. Access to safe blood is maintained by law, and is the primary responsibility of NACO. The specific objective of the blood safety programme is to ensure reduction in the transfusion associated with HIV transmission to 0.5 percent, while making available safe and quality blood within one hour of requirement in a health facility. Ensuring the widespread availability of safe and quality blood is a critical component of the National AIDS Prevention and Control Programme [NACP]. The state has 2 government blood banks namely Central Blood Bank at STNM Hospital, Gangtok and district level blood bank at Namchi District Hospital. These two blood banks are supported by NACO. The blood bank in Central Referral Hospital, Tadong under Sikkim Manipal Institute of Medical Sciences is a private blood bank. CBB, STNM Hospital is also identified as Regional Blood Transfusion centre (RBTC) to oversee the blood collection. All the blood banks in the state are licensed to supply whole human blood. Sikkim also has a State Reference Laboratory to conduct validation of the results of HIV positive and negative blood samples from various reporting unit (blood banks and ICTCs/PPTCS) on quarterly basis. Physical Targets & Achievements S.N Activity Target 11-12 Achievement

1. Total units of blood collection 2400* 3327 units** 2. Total voluntary blood collection 70% of the total collection 2613units 2. % of Voluntary Blood Donation - do - 78.5% 3. No. of Voluntary Blood Donation Camps 50 61 4. Voluntary Collection of units of blood at 31 units per camp 1679 VBD Camps *Naco supported Blood Bank target ** including

The following chart shows the comparative collection of blood units through voluntary donation since the beginning of NACP III

Reactivity in Blood The blood collected at camps and blood banks are screened for HIV, Hepatitis B, Hepatitis C, Syphilis and Malaria. These are mandatory testing detection of Transfusion Transmitted Infections. In 2010-11 the HIV reactivity and other infections is as follows:

1. % of HIV sero-reactivity: 0.2% 2. % of HBV sero-reactivity: 0.6% 3. % of HCV sero-reactivity: 0.1% 4. % of Malaria positivity: 0 5. % of VDRL positivity: 0.3%

Voluntary Blood Donation

Blood collected from voluntary (non-remunerated) blood donors from low risk population who give blood regularly are the foundation of a safe and adequate blood supply. To promote voluntary blood donation in the state motivational camps in schools, colleges and other institutions as well as training to the donor motivators from the Red Ribbon club, NYK and other NGOs etc. was conducted. To generate awareness among public 14th June World Blood Donors Day and 1st October as National Voluntary Blood Donation Day was observed this year in all the districts involving Red Ribbon club, NYKs, and NGOs. These events were observed by banner displays; rally; posters, quiz & essay competition; motivational camps; TV spots and live phone programme on 91.9 FM on VBD. External Quality Assessment Scheme (EQAS) In 1999 NACO initiated the External Quality Assessment Scheme (EQAS) for HIV testing for the Blood Banks and the laboratories which were involved with carrying out HIV testing. The objective of this scheme is to bring qualitative improvement in HIV testing in Blood banks and ICTC/PPTCT laboratories. Under this scheme all blood banks and ICTCs/PPTCs send all HIV positive and 20% of the negative samples from their laboratories to the State Reference Laboratory (SRL) which is presently located at SACS building under the supervision of Dr.Pema Pema Youden Bhutia, HOD Microbiology, Department of STNM Hospital, who is the Incharge of SRL. The samples send from these centres are again tested and reports validated at SRL and if any discordance in reporting then the same sample is again send to National Reference Laboratory for confirmation of the test. Monitoring and Supervision The blood banks in the State are supervised once or twice a month and on random basis as well as visit to voluntary blood donation camps are conducted to ensure improvement in the standards and quality in the blood transfusion service. Furthermore, a team consisting of representatives from State Blood Transfusion Council (SBTC), State Drug Controller and SACS conducts a supervisory visit to all the blood banks of the State including Central Referral Hospital, Tadong.